Journal of Affective Disorders Reports

BackgroundNon-suicidal self-injury (NSSI) represents a growing public health concern, particularly in adolescents. Emotion dysregulation is central to prevailing NSSI models, yet it remains unclear whether acceptance-based emotion regulation (ER) and its underlying neural processes are disrupted in naturalistic, dynamic contexts. MethodsPre-registered neuroimaging trial in recently diagnosed and treatment-naive adolescents with NSSI (n=25) and healthy controls (n=25) using an ER paradigm with dynamic video clips and concomitant functional magnetic resonance imaging. Behavioral, neural activity, and connectivity indices during emotion reactivity and acceptance-based regulation were compared between groups. ResultsAdolescents with NSSI experienced elevated negative feelings during neutral clips, reflecting heightened baseline negativity. In comparison to controls, they displayed reduced temporal and ventrolateral prefrontal engagement during emotional reactivity, but increased engagement of regions implicated in both emotion reactivity (right amygdala, insula) and ER (right dlPFC, dmPFC, vlPFC) when utilizing acceptance. Higher activation in the right dlPFC was positively associated with difficulties in accessing ER strategies in everyday life. Adolescents with NSSI showed reduced functional connectivity between the right amygdala and left dlPFC. ConclusionsAdolescents with NSSI exhibited a baseline negativity bias and altered neural engagement during both negative emotional reactivity and acceptance-based regulation, characterized by increased activation and reduced amygdala-dlPFC connectivity. These findings highlight atypical emotion processing in real-life contexts in individuals with NSSI. Targeting acceptance-based regulation and prefrontal-limbic circuitry may represent a promising intervention approach for adolescents with NSSI.

Background: Childhood adversity (CA) is recognized as a distal risk-factor for suicide attempts (SA) in individuals with psychiatric disorders. However, not all individuals with experiences of CA will engage in SA. Contributing to this relationship may be proximal factors such as impulsivity, inward anger and self-aggression. However, these factors are often conceptually blended and measured in different samples. We sought to clarify association among CA and personality factors in persons with SA. Methods: Participants from two studies comprised individuals with a diagnosed psychiatric disorder and history of SA (n= 139) and individuals with depressive disorder (clinical controls, CC; n= 24). We investigated self-reported levels of CA, impulsivity, inward anger, and self-aggression between the SA and CC (pcorr< .012). We tested the relationship among the factors using regression (pcorr<.017) and mediation model (indirect effects, p<.05) within the SA group. Sensitivity models were run controlling for age, gender, symptom severity, trait anger, and externally oriented aggression. Results: SA group had higher impulsivity (pcorr=.067) in a model controlled for age and gender. Other factors did not differ among groups. Within the SA group the analyses revealed positive association among CA and personality factors (pcorr<.06) in basic and model with age and gender, however the association was not specific for internally (self) oriented factors (coefficient comparison, p<.07). Parallel mediation model indicated that CA had indirect effect on self-aggression through impulsivity (p=.001) and to a lesser extent through inward anger (p=.066). Generally, models controlling for cognitive depression symptoms showed less prominent effects (pcorr>.1). Limitations: The study was cross-sectional and did not include behavioral tasks (state) measures of proximal factors. Conclusions: CA and personality factors showed similar severity levels among the SA and CC groups suggesting they may relate to broader psychopathologies, rather than specifically to SA. The association of CA with anger and aggression was unspecific to internally oriented factors indicating the need for more precise measuring instruments developed specifically for individuals with SA. Overall, the study highlights personality factors as being associated with risk in broader vulnerable populations.

Background Emotionally Unstable Personality Disorder (EUPD) is characterised by emotional dysregulation, unstable self-identity, interpersonal difficulties, dissociation, and a high prevalence of non-suicidal self-injury (NSSI). Mental imagery plays a role in emotion processing and autobiographical memory. Yet little is known about the relation between voluntary visual imagery and self-harm in EUPD. The study aimed to examine the imagery characteristics, including visual imagery vividness and synaesthetic-like experiences, and their association with NSSI in EUPD. Method Forty adults aged 18-45 years meeting ICD-10 Diagnostic Criteria for Research (ICD-10 DCR) for EUPD were recruited through purposive sampling. Visual imagery was assessed using the Vividness of Visual Imagery Questionnaire-2 (VVIQ-2). NSSI and its functions were assessed using the Inventory of Statements About Self-Injury (ISAS). Synaesthesia-like experiences were screened using a seven-item questionnaire developed for the study. Group comparisons were performed using independent-samples t-tests, and correlations were assessed using Pearson's correlation coefficient. Results Twenty-nine patients (72.5%) with EUPD had NSSI. Participants with NSSI had significantly higher mean VVIQ-2 scores than those without NSSI (118.48 +/- 24.81 vs. 93.36 +/- 35.66; p = 0.016; Cohen's d = 0.89). VVIQ-2 scores correlated positively with intrapersonal ISAS functions (r = 0.38, p = 0.015) but not interpersonal functions (r = 0.19, p = 0.22). Three participants (7.5%) demonstrated imagery scores compatible with probable hyperphantasia. Four participants reported synaesthesia-like experiences. Conclusions Greater visual imagery was associated with non-suicidal self-harm in patients with EUPD. Imagery vividness was predominantly associated with intrapersonal functions of non-suicidal self-harm, particularly affect regulation, rather than interpersonal motivations. These findings suggest that visual imagery may represent a previously under-recognized cognitive factor contributing to emotional dysregulation and self-injurious behaviour in EUPD. Assessment of imagery characteristics may have clinical relevance when designing psychotherapeutic interventions for EUPD.

IntroductionPneumonia is a common source of sepsis and carries significant morbidity and mortality. Prior research suggests patients with severe mental illness may receive disparate care and experience worse outcomes from infectious and cardiovascular conditions. Whether mental illness influences the radiographic presentation of pneumonia-related sepsis, which can guide antimicrobial selection and clinical decision making, remains poorly-understood. MethodsThis retrospective study examined chest imaging findings in 202 adult septic patients with respiratory source infection presenting to a large tertiary care emergency department between December 2017 and December 2019. Patients were stratified by the presence (n = 51, 25.2%) or absence (n = 151, 74.8%) of a comorbid mental illness, defined broadly to include neurocognitive, mood, personality, psychotic, and substance use disorders. Radiographic findings, including parenchymal abnormalities, pleural effusions, and laterality, were systematically abstracted from the medical record and compared between groups using Chi-squared testing. ResultsPatients with mental illness were more likely to have at least one radiographic finding (84% vs. 74%), though this difference did not reach statistical significance (p = 0.14). The average number of findings per patient was nearly identical between groups (3.14 vs. 3.12, p = 0.38), and no individual radiographic feature differed significantly between cohorts. DiscussionThese findings suggest that, contrary to our hypothesis, mental illness may not be associated with the radiographic appearance of pneumonia in septic patients. Larger, diagnosis-specific studies are needed to evaluate whether specific psychiatric subgroups exhibit distinct imaging patterns.

Background: Individuals diagnosed with depression during pregnancy are more likely to develop cardiovascular disease (CVD) later in life. However, it remains unclear whether subclinical depressive symptoms or symptom trajectories across time are associated with indicators of cardiovascular health (CVH). Therefore, the present study evaluated the relationship between longitudinal depressive symptom trajectories beginning in pregnancy and future CVH. Methods: This secondary analysis of the multisite prospective nuMoM2b-Heart Health Study and included participants with complete longitudinal data from early pregnancy to 2-7 years post-delivery. Participants self-reported depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) at 6-13 weeks gestation (early pregnancy), 22-29 weeks gestation (mid- to late-pregnancy), and 2-7 years post-delivery. Latent class mixture modeling was conducted to identify longitudinal patterns of depressive symptoms across early pregnancy, mid-late pregnancy, and extended postpartum follow-up. Structural equation modeling was used to test whether EPDS trajectories were associated with latent CVH, adjusted for length of follow-up interval, pre-pregnancy BMI, gravidity, adverse pregnancy outcomes, smoking history, age, education, income, and use of psychiatric medications. Results: A total of 3,934 participants (mean (M) {+/-} standard deviation (SD) age=27.6{+/-}5.6 years) met inclusion criteria with a mean follow-up interval of 3.2{+/-}0.9 years. A 4-class model, which provided the best fit to the EPDS data (mean posterior probability across classes=0.81), produced the following trajectories: (1) stable low (n=2412; 61.1%), (2) increasing severity (n=848; 21.5%), (3) decreasing severity (n=476; 12.1%), and (4) stable high (n=212; 5.4%). Compared to the stable low group, all groups exhibited significantly lower CVH (stable high: {beta}=0.06, p<0.01; decreasing severity: {beta}=0.05, p=0.02; increasing severity: {beta}=0.08 p<0.01). Pairwise comparisons among the three elevated-symptom groups revealed no significant differences in latent CVH (all ps >0.24). Discussion: The longitudinal course of depressive symptoms from pregnancy to 2-7 years post-delivery varied across individuals. Compared to those with consistently low depressive symptoms, individuals with higher severity symptoms at any point all exhibited lower CVH, regardless of the specific trajectory of symptoms. These findings support a life-course perspective in which depressive symptom patterns may represent an early indicator of cardiometabolic vulnerability.

Background: Emotion dysregulation is a core feature of bipolar disorder (BD), yet its behavioral expression during depressive episodes, and potential differences between its types, BD-I and BD-II, remain unclear. This study used automated facial-expression analysis during naturalistic affective film viewing to examine subtype-specific and context-dependent emotional responding in bipolar depression. Methods: The sample included 135 participants: 69 healthy controls and 66 patients with BD (BD-I, 23; BD-II, 43). Participants viewed nine emotionally evocative film clips spanning negative, positive, neutral, and socially threatening contexts, while their facial expressions were continuously recorded and quantified using computer vision-based facial-expression analysis. Results: Patients with BD-I showed a distinct, context-dependent facial-expression profile, characterized by greater negative responses across multiple contexts than other groups. Specifically, they showed increased sadness during sad, reward, and amusing clips, and elevated anger during sad and neutral clips. In socially threatening contexts, BD-I participants showed a multivalent pattern of elevated anger, fear, and joy, suggesting poorly coordinated or context-incongruent affective expression. In contrast, BD-II participants did not differ significantly from healthy controls on any emotion, despite depressive symptom severity comparable to BD-I participants. Conclusions: These findings suggest that facial-expression patterns in bipolar depression differ across subtypes. BD-I may be characterized by heightened negative reactivity and altered context-appropriate modulation of emotional expression, whereas BD-II may not show comparable alterations in overt facial output. Automated facial-expression analysis during naturalistic stimulation may provide a useful behavioral marker for characterizing subtype-specific affective disturbance in bipolar depression and related psychopathology.

Suicidal ideation in obsessive-compulsive disorder (OCD) is common and clinically significant, yet much of the existing literature conceptualizes suicide risk through the lens of comorbid depressive symptomatology. The present study examined whether other clinical features can identify clinically meaningful patterns associated with SI. Participants included 231 individuals with clinically significant OCD symptoms. SI was operationalized using Item 9 of the Beck Depression Inventory-II and binarized to reflect the presence or absence of suicidal thoughts. Depression severity scores were intentionally excluded from the predictive feature set, and three machine learning models (ElasticNet, Random Forest, and Explainable Boosting Machines) were evaluated using repeated nested cross-validation. All three algorithms showed comparable predictive performance. Given this overlap, the EBM was selected for interpretation due to its ability to model nonlinear relationships and interaction effects transparently. The model identified quality of life, obsessive-compulsive trait severity, somatic burden, and conscientiousness as prominent predictors of SI. Risk functions suggested nonlinear increases in estimated suicide risk at elevated levels of obsessive-compulsive traits and reduced quality of life. Additionally, interaction analyses indicated that severe obsessive-compulsive traits combined with elevated somatic burden were associated with higher estimated suicide risk than either factor alone. These findings suggest that interpretable machine learning can support clinically relevant phenotypic hypothesis generation. They also highlight somatic burden, functional impairment, obsessive-compulsive trait severity, and conscientiousness as potentially underappreciated targets for SI risk assessment in OCD, beyond the traditional focus on depressive comorbidity.

Background: Hydrogen sulfide (H2S) is an endogenous gasotransmitter synthesised in the central nervous system (CNS) primarily by cystathionine {beta}-synthase (CBS) and cystathionine {gamma}-lyase (CSE). Pre-clinical studies consistently implicates H2S deficiency in the pathophysiology of depression through disruption of synaptic plasticity, neuroinflammation, oxidative stress, and brain-derived neurotrophic factor (BDNF) signalling. Yet, we still lack direct clinical evidence quantifying circulating H2S in patients with Major Depressive Disorder (MDD), particularly from South Asian populations. In this study, we measured serum H2S levels in drug-naive patients with MDD and compared them with healthy controls at a tertiary care center in eastern India. We examined the associations between serum H2S and depression severity as assessed by the 17-item Hamilton Depression Rating Scale (HAM-D-17). This institution-based, cross-sectional analytical study was conducted at North Bengal Medical College and Hospital (NBMCH), West Bengal, India, over 12 months. Fifty drug-naive patients fulfilling DSM-5 criteria for MDD and fifty age- and sex-matched healthy controls were enrolled by consecutive sampling. We quantified serum H2S using the spectrophotometric methylene blue method and depression severity was assessed using HAM-D-17. Statistical analyses included independent-samples t-test, chi-square test, and linear regression. Serum H2S was markedly and significantly lower in MDD patients (0.068 {+/-} 0.044 {micro}mol/L) compared with healthy controls (0.524 {+/-} 0.272 {micro}mol/L; p < 0.001), representing an approximately 7.7-fold reduction. HAM-D-17 scores were significantly higher in MDD patients (28.94 {+/-} 12.78) than in controls (3.96 {+/-} 2.31; p < 0.001). Linear regression across the combined cohort revealed a significant negative association between serum H2S and HAM-D score (R{superscript 2} = 0.287; y = 24.64 - 26.84x; p < 0.001), indicating that higher serum H2S was associated with lower depression severity. Within the MDD group alone, the regression was weak (R{superscript 2} = 0.061), consistent with a floor effect. Within the control group alone, the regression was strong (R{superscript 2} = 0.772). No significant associations were found between serum H2S and any sociodemographic variable in either group. Drug-naive MDD patients exhibited substantially reduced serum H2S levels compared with healthy controls, and lower H2S was associated with greater depression severity. These findings provide direct clinical evidence from an Indian population supporting the H2S deficiency hypothesis of depression and suggest that the CBS/CSE-H2S axis may represent a novel biomarker and therapeutic target in MDD. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=106 SRC="FIGDIR/small/26352330v1_ufig1.gif" ALT="Figure 1"> View larger version (27K): org.highwire.dtl.DTLVardef@1ce64f6org.highwire.dtl.DTLVardef@1465ca2org.highwire.dtl.DTLVardef@6bba64org.highwire.dtl.DTLVardef@9a1411_HPS_FORMAT_FIGEXP M_FIG C_FIG

Purpose This study aimed to examine the association between screen time and depressive symptoms among Chinese college students, and to investigate the mediating roles of sleep quality and emotion regulation in this relationship. Furthermore, a serial mediation model was constructed to elucidate the underlying psychological mechanisms linking screen exposure to depression. Methods A stratified cluster sampling method was employed to recruit 10,999 college students for a cross-sectional questionnaire survey. Data were collected on screen time, sleep quality, emotion regulation ability, and depressive symptoms. Descriptive statistics, correlation analyses, and regression analyses were conducted using SPSS 26.0 A serial mediation model was tested using the PROCESS macro (Model 6), and bootstrapping procedures were applied to estimate the significance of indirect effects. Results Correlation analyses indicated that screen time was significantly positively associated with depressive symptoms (r = 0.16, p < 0.01) and sleep quality (r = 0.15, p < 0.01), and significantly negatively associated with emotion regulation (r = -0.13, p < 0.01). Sleep quality was positively correlated with depressive symptoms (r = 0.31, p < 0.01), whereas emotion regulation was negatively correlated with depressive symptoms (r = -0.42, p < 0.01). Regression analyses further showed that screen time significantly positively predicted depressive symptoms ({beta} = 0.712, p < 0.001), positively predicted sleep quality ({beta} = 0.217, p < 0.001), and negatively predicted emotion regulation ({beta} = -0.085, p < 0.001). In addition, both sleep quality ({beta} = 1.318, p < 0.001) and emotion regulation ({beta} = -0.424, p < 0.001) were significant predictors of depressive symptoms. Mediation analyses demonstrated that sleep quality significantly mediated the association between screen time and depressive symptoms (95% CI [0.239, 0.332]), as did emotion regulation (95% CI [0.269, 0.416]). Moreover, a significant serial mediation effect of sleep quality and emotion regulation was observed in the relationship between screen time and depressive symptoms (95% CI [0.082, 0.117]). Conclusion Screen time is significantly associated with depressive symptoms among college students, with sleep quality and emotion regulation serving as important mediating mechanisms. Extended screen exposure may be linked to higher levels of depressive symptoms by impairing sleep quality and weakening emotion regulation capacity.

Post-traumatic stress disorder (PTSD) is associated with high rates of comorbid personality disorders, which may contribute to PTSD severity. Among veterans with PTSD, obsessive compulsive personality disorder (OCPD) is common, with reported prevalence estimates ranging from 7-44%. Despite this, the relationship between OCPD traits and PTSD severity remains poorly understood. This retrospective, cross-sectional study examined associations between PTSD severity and OCPD traits in a naturalistic sample of 99 Veterans evaluated by a single clinician in a PTSD/Trauma Recovery Services clinic. PTSD symptoms were measured with the PTSD Checklist for DSM-V (PCL-5), and OCPD traits were measured with the Pathological Obsessive-Compulsive Personality Scale (POPS). Relationships between these two constructs were examined using Pearson correlations. Overall PTSD severity was significantly and positively correlated with total OCPD traits (r = 0.46, p < 0.001). Among OCPD domains, maladaptive perfectionism showed the strongest association with PTSD severity (r = 0.44, p <.001), followed by emotional overcontrol and reluctance to delegate (both r = .38, p < .01), rigidity (r = .35, p < .01), and difficulty with change (r = .28, p < .05). These findings suggest OCPD traits impact PTSD symptom burden in veterans, warranting further research and clinical attention.

Background Multimorbidity is increasingly prevalent, and associated with worse clinical and psychosocial burdens. Interoception, the brain's ability to sense and interpret internal bodily signals, may contribute to multimorbidity, through its link with health behaviors, stress regulation, and mental health. This study examines whether self-reported interoceptive accuracy and attention is associated with multimorbidity, by identifying multimorbid subgroups and their interoceptive profiles. Methods Morbidity classes were identified through latent class analyses in two Dutch survey datasets, focusing on depression and alexithymia (DA-dataset; N = 671) and lifestyle factors (L-dataset; N = 1022). Linear regression analyses were used to assess interoceptive accuracy and attention (by the Interoceptive Accuracy Scale and Interoceptive Attention Scale respectively) among different subgroups. Results Multimorbid subgroups were characterized by older age, low socioeconomic position, and elevated physical, psychological, and behavioral problems. Multimorbid classes exhibited lower interoceptive accuracy (DA-dataset: B = -1.14, 95% CI = [-2.89, 0.62]; L-dataset: B = -2.36, 95% CI = [-3.83, -0.89]) and higher attention (DA-dataset: B = 3.62, 95% CI = [0.97, 6.27]; L-dataset: B = 1.07, 95% CI = [-1.42, 3.56]) compared to healthier classes. Conclusion Multimorbid populations demonstrated lower interoceptive accuracy and higher interoceptive attention. This highlights the psychosocial complexity of multimorbid populations which may impact their self-management and health behavior. These findings underscore the need to expand treatments to include psychosocial domains for multimorbid patients.

Abstract Background Ketamine has emerged as an effective rapid-acting treatment for treatment-resistant depression (TRD), producing significant antidepressant effects within hours of administration. Given ketamine's capacity to induce states of heightened neuroplasticity and psychological openness, psychotherapy may represent a meaningful complement to its pharmacological effects - facilitating emotional processing, cognitive restructuring, and the consolidation of therapeutic gains. However, the adjunctive potential of structured psychotherapeutic support in ketamine-based interventions remains largely unexplored. Methods This preliminary, non-randomized, open-label clinical trial evaluated the adjunctive effects of ketamine-assisted psychotherapy (KAP) in an outpatient setting. Forty-six patients with TRD received eight weekly sessions of subcutaneous esketamine (0.5-1.0 mg/kg) and were allocated into two groups: esketamine without psychotherapeutic support (n = 23) and esketamine combined with structured KAP encompassing preparation, dosing accompaniment, and post-session integration (n = 23). Depressive symptoms were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory-II (BDI-II) at multiple timepoints during treatment and at follow-up assessments up to six months after protocol completion. Results Both groups showed significant reductions in depressive symptoms throughout treatment. The KAP group demonstrated greater clinical improvement by the end of treatment, with between-group differences on the MADRS emerging at sessions 7 and 8. MADRS response and remission rates were 52.2% and 34.8% in the KET group, and 78.3% and 78.3% in the KAP group, respectively. BDI-II scores indicated earlier subjective improvement in the KAP group, with between-group differences emerging as early as the second session and persisting across multiple timepoints. No significant between-group differences were observed during the six-month follow-up, with both groups maintaining symptom reductions comparable to end-of-treatment levels. Conclusions These findings suggest that structured psychotherapeutic support may be associated with early clinical response and remission rates in subcutaneous esketamine treatment for TRD, potentially through facilitation of emotional processing, psychological flexibility, and behavioural change. Further controlled studies are needed to clarify the specific contribution of psychotherapy, investigate the mechanisms underlying this interaction, and optimize integrated treatment approaches for TRD. The trial was registered at https://ensaiosclinicos.gov.br/rg/RBR-1072m6nv . Keywords: esketamine; treatment-resistant depression; ketamine-assisted psychotherapy; innovative therapies.

Background As lockdown measures was eased, pregnant women faced an elevated risk of COVID-19 infection, potentially impacting their mental health. This study aimed to investigate the prevalence of antenatal depression (AD) post-lockdown and develop predictive models for AD risk using machine learning. Methods A cross-sectional study utilizing the Edinburgh Postnatal Depression Scale was conducted in Beijing and Guizhou, China, from January to August 2023. Data was randomly split into training and test datasets (6:4 ratio), with logistic regression (LR), Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Random Forest (RF), eXtreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT) models trained and compared. The best model underwent further examination, including SHapley Additive exPlanations (SHAP) for feature importance, calibration curve (CC) for discrimination, and decision curve analysis (DCA) for clinical benefit. Results The effective response rate was 91.07% (459/504), with 25.7% (118/459) testing positive for AD. Multivariate analysis identified "sleep disorders," "family support level," and "COVID-19 symptom severity" as independent predictors. RF model showed the highest area under the curve in both training (0.842) and testing (0.724) datasets, with SHAP emphasizing the greatest impact of "sleep disorders" on AD. The RF model's calibration (P > 0.05) and clinical utility across thresholds (8%-95% and 10%-58%) were confirmed by CC and DCA, respectively. Conclusions AD strongly correlated with "sleep disorders," "family support level," and "COVID-19 symptom severity" post-lockdown, and the EPDS-based RF model effectively predicted AD risk.

ObjectivesNeuropsychiatric symptoms (NPS) are prevalent in individuals of cognitive impairement (CI). However, the similarities and disparatenesses in whole-brain dynamics between individuals of CI and NPS are controversy. Electroencephalography (EEG) microstates reflect the whole-brain dynamics. This study aimed to investigate the differential EEG microstates parameters between CI and NPS and to construct related diagnostic model. Methods/designThis study was a cross-sectional study. Clinical and EEG data were collected, and an EEG microstate analysis were performed. The Least absolute shrinkage and selection operation (LASSO) regression model was used to identify significant differential EEG microstates parameters between CI and NPS and to construct a diagnostic model. The model performance was tested by the receiver operating characteristic curve (ROC). ResultsThis study enrolled 78 participants. A total of 36 EEG microstates parameters were identified and included in the differential analysis. In the LASSO regression model, 4 significant differential EEG microstates parameters were selected, including the duration of class C, TPAB, TPBA, and TPDC. The ROC results showed that the diagnostic model for distinguishing NPS patients from CI patients achieved an area under the curve (AUC) of 0.905(95% CI: 0.784-1.000), with a sensitivity of 100.0% and a specificity of 76.9%. ConclusionsThe diagnostic model based on EEG microstate parameters showed a good performance for differentiating NPS patients from CI patients.

Background Psychiatric comorbidities commonly have a negative impact on epilepsy outcomes. However, they are continuously ignored in routine epilepsy care, with focus directed more towards seizure control. There is paucity of data on the burden of psychiatric morbidity among those living with epilepsy in Kenya. This study sought to determine the prevalence and associated factors of psychiatric morbidity among patients living with epilepsy at a tertiary referral hospital in Western Kenya. Methods This was a descriptive cross-sectional study. Consecutive sampling was used to recruit participants, with a sample size of 278. Data were collected using a structured pretested sociodemographic and clinical characteristics questionnaire, and the Mini International Neuropsychiatric Interview (MINI), and analyzed using STATA version 16. Pearson Chi-square test/Fishers Exact test and logistic regression were used to assess relationships at bivariate and multivariate levels respectively. Results The prevalence of psychiatric morbidity was 52.2%. Major depressive disorder was the most prevalent (36%), followed by anxiety disorders (26.2%), psychotic disorders (16.9%), and suicidality (15.1%). Casual/self-employment (aOR=2.590, p=0.020), seizure-related physical trauma (aOR=4.032, p=0.004), antiepileptic polytherapy (aOR=4.280, p=0.001), frequent seizures (aOR=3.801, p<0.001), and comorbid medical conditions (aOR=5.478, p=0.047) were independent predictors of psychiatric morbidity. Having attained a tertiary level of education was protective against psychiatric morbidity (aOR=0.221, p=0.036). Conclusion More than half of the patients living with epilepsy had at least one psychiatric comorbidity. Routine psychiatric screening and integration of mental health services in epilepsy care is essential to improve clinical outcomes.

Background Functional neurological disorder (FND), one of the most common neurological conditions, affects women almost twice as frequently as men. The reasons for this are unknown, and there has been minimal research into how physiological and pathological features of women's health interact with symptoms of FND. Methods We conducted an online survey assessing the effect of several aspects of women's health with the severity of symptoms of FND. Results 484 people completed the survey. Among the 223 who had regular or fairly regular menstrual cycles, a strong difference across the menstrual cycle was seen, with symptoms at their best in the follicular phase, worsening in the luteal phase, and worst in the pre-menstrual period and the menses. This effect was not moderated by a proxy measure of pre-menstrual dysphoric disorder (PMDD). Participants who were taking the combined oral contraceptive (COC, n=43) and progesterone-based contraception (n=80) were more likely to report symptom improvement from starting the medication than worsening. When compared to menstruating participants who were not taking the COC, participants taking the COC reported less worsening in their symptoms of FND in the luteal, pre-menstrual, and menstrual phases. Of the 99 women who had passed menopause since developing FND, 76% reported worsening of their FND symptoms after menopause. Discussion This study demonstrates interactions between several aspects of women's health and symptoms of FND. The observed pattern of symptom fluctuation across hormonal states suggests a potential modulatory role of oestrogen, warranting further targeted investigation.

Background For people with bipolar disorder, recovery from manic or mixed episodes is frequently complicated by depression. Depression after manic/mixed episodes may occur within a broader episode sequence pattern of mania-depression-euthymic interval, proposed as a bipolar disorder subtype for which lithium is effective. However, the window of risk for mania/mixed-to-depression transition remains unclear, as is the relationship with clinical factors and outcomes. Methods In this retrospective cohort study, we identified a cohort of 10,437 people with bipolar disorder (42,314 mood episodes; 90,727 person-years) within the NeuroBlu health record database (United States) with records from 1959 to 2025. We quantified the transition time from manic/mixed episodes to depression, and investigated associations with clinical features, medications and outcomes. Outcomes 25% of all manic episodes and 22% of all mixed episodes transitioned to depression within 1 month: an incidence >11-times higher than the overall per-month depression rate. By 6 months, the depression transition rate had plateaued. Short depression transition time ([&le;]1 month) was associated with previous short transition times (post-mania RR=3.08, 95%CI: 2.65-3.58; post-mixed RR=2.52, 95%CI: 2.12-3.00), higher manic/mixed severity (post-mania RR=1.30 per 1 point CGI-S increase, 95%CI: 1.18-1.44; post-mixed RR=1.35, 95%CI: 1.15-1.57) and hospitalisation for the mania/mixed episode (post-mania RR=1.22, 95%CI: 1.09-1.37; post-mixed RR=1.71, 95%CI: 1.52-1.94). Among medications prescribed during hospital-associated manic/mixed episodes, lithium (post-mania RR=0.75, 95%CI: 0.62-0.91; post-mixed RR=0.72, 95%CI: 0.54-0.95), first-generation sedating antihistamines (post-mania: RR=0.74, 95%CI: 0.63-0.87) and other mood stabilisers (post-mania RR=0.82, 95%CI: 0.71-0.94, post-mixed RR=0.82, 95%CI: 0.72-0.94) were associated with longer transition time. Antipsychotics, antidepressants and benzodiazepines were not. Shorter transition time was associated with more depression-related hospital days (16% fewer days per month delay to depression, 95%CI: 4-25%, p=0.010). Interpretation It is important to monitor for depression soon after manic/mixed episodes. This depression may be predictable, and might be preventable with some medications prescribed during the manic/mixed episode.

The ability to adjust to changing environments (cognitive flexibility) and optimal decision-making are pivotal brain functions that govern successful human behavior. Anxiety and depressive disorders are strongly pervasive psychiatric conditions across the lifespan that profoundly disrupt mechanisms of attention, working memory, and decision-making. Although existing task evidence documents impaired decision-making and flexibility outcomes for both anxiety and depression, there is a growing need to systematically evaluate the role of anxiety and depression and to quantitatively compare the effects of these disorders on these domains. In the present study, we conducted a meta-analysis of anxiety and depression on decision-making and cognitive flexibility. We utilized a random-effects approach, given that a large amount of between-subject heterogeneity was anticipated. Given the scope of this meta-analysis, we used the machine learning tool asReview to more efficiently conduct a meta-analytic search. Across all outcomes, results showed anxiety and depression were associated with reduced cognitive flexibility and decision-making. These effect sizes were then tested for significance using a fixed-effects (plural) model. Subgroup analyses revealed no significant differences between anxiety and depression for either decision-making or flexibility outcomes, consistent with a transdiagnostic perspective. Results are contextualized in light of the biopsychosocial model and potential transdiagnostic factors.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is characterized by persistent inattention, hyperactivity, and impulsivity. While documented in children, research on its persistence into young adulthood in Jordan remains scarce. This gap is critical given the cognitive demands of higher education. This study estimated attention deficit hyperactivity disorder (ADHD) symptom prevalence among Jordanian university students, examined associations with gender and academic performance, and identified barriers to mental health service accessibility. Methods: A descriptive cross-sectional study using web-based sampling recruited 389 university students (aged [&ge;] 18 years) from various Jordanian universities. Participants completed an online survey, incorporating the validated English and Arabic versions of the Adult ADHD Self-Report Scale (ASRS-v1.1) to assess symptom prevalence, alongside inquiries regarding demographics, academic history, and barriers to care. Results: The prevalence of probable ADHD was 37.5% (n=146). Males constituted a significantly higher proportion of positive cases (69.9%) compared to females (30.1%). A strong statistical association was found between positive ADHD screening and negative academic impact (p<0.001), as well as negative effects on emotional well-being (p<0.001). Comorbidities including anxiety disorders and emotional abuse were significantly linked to probable ADHD (p=0.019). Notably, positive-screened participants were significantly more likely to cite social stigma as a primary barrier to seeking professional help (p=0.024). Conclusion: Self-reported ADHD symptoms are highly prevalent among Jordanian university students, correlating with substantial academic underachievement and emotional dysfunction. These findings highlight an urgent need for targeted university-based screening programs, academic accommodations, and de-stigmatization campaigns to facilitate early intervention and improve educational outcomes in this population.

Separate research has evaluated trajectories of posttraumatic stress symptoms (PTSS) and obsessive-compulsive symptoms (OCS), but no study has evaluated OCS trajectories following trauma exposure nor combined PTSS/OCS trajectories. The present study evaluated combined PTSS/OCS trajectories among 585 survivors of Hurricane Helene, spanning three waves of data collection over 12 months. A 3-class solution was supported, including resilient (i.e., consistently low PTSS and OCS), chronic (i.e., elevated PTSS and OCS with gradual reduction over time), and moderate-yet-diverging (i.e., moderate elevations in PTSS and OCS with gradually declining PTSS and persistent and increasing OCS over time) classes. This study shows both overlap and differentiation in symptom trajectories from earlier research, with the moderate-yet-diverging trajectory suggesting unique OCS pathways distinct from PTSS.