Psychiatry Research

BackgroundExisting studies on the economic impact of schizophrenia are fragmented and vary in methodology, hindering an ample understanding of the total economic burden. AimsTo quantify the global economic burden of schizophrenia by synthesizing findings from systematic reviews and meta-analyses, and to assess variations by cost category, world region and income level. MethodWe conducted a protocol-driven umbrella review registered on PROSPERO (CRD42024504092). A systematic search of MEDLINE, EMBASE, Cochrane Library, and APA PsycINFO identified reviews reporting annual per-patient monetary cost estimates for schizophrenia. Monetary values were adjusted for inflation and converted to 2024 US dollars. ResultsTwenty-six systematic reviews involving 152 primary studies were included. The median annual per-patient total cost of schizophrenia was $33,236 (mean $47,872), with direct costs accounting for $23,126 (medical: $19,543; ancillary: $1,152) and indirect costs for $21,333. Costs were varied by income level: in high-income countries, the median total cost was $34,175, compared to $3,345 in upper-middle-income and $3,452 in lower-middle-income countries. Regional disparities were substantial, with Europe & Central Asia reporting the highest median costs among high-income settings. Data from low- and middle-income regions were limited or absent. Methodological heterogeneity, lack of standardization in cost reporting, and underrepresentation of low-resource settings limit generalizability. ConclusionsSchizophrenia poses a significant and unequally distributed global economic burden, driven by hospitalization, long-term care, and productivity losses. To support equitable policy and resource allocation, future research must adopt standardized costing frameworks and expand data collection into low-resource and understudied regions.

BackgroundBrain disorders, including neurological conditions and mental disorders, pose a considerable economic burden in Denmark. However, the costs of illness are not limited to the patients themselves, as the consequences of living with a brain disorder may also impact close relatives. AimWe aimed to assess excess societal costs related to healthcare utilization and income loss for the closest family relatives of patients with brain disorders. MethodsThis population-based cohort study included the closest family relatives of patients with prevalent (by Jan 1, 2021) or incident (during 2016-2021) brain disorders. They were compared with corresponding relatives of matched population comparisons. Patients were categorized into three age strata: children and young people (0-24 years), adults (25-64 years), and older adults (65+ years). We specified criteria for identifying the closest family relative for each age stratum. Using data from national registries, we estimated attributable healthcare costs, and for working-age relatives (18-65 years), we also estimated income loss. ResultsIn 2021, close relatives of patients with brain disorders included 125,495 fathers and 96,154 mothers of children and young people, 880,661 relatives of adults, and 378,826 relatives of older adults. The pooled attributable costs of brain disorders incurred by closest family relatives were 2,407 million EUR for prevalent disease in 2021 and 794 million EUR for incident disease the first year following incidence. The dominating cost component was income loss for working-age relatives. ConclusionThe higher healthcare costs and especially the lower income for relatives of patients with brain disorders adds to the societal economic burden of brain disorders in Denmark. Informal care provided by relatives may contribute to this, underscoring the need to consider their caregiving burden in questions of healthcare prioritization.

IntroductionEvolutionary psychiatry is a rapidly growing field that emphasizes the value of evolutionary explanations for traits that make individuals vulnerable to mental disorders. Some articles that apply evolutionary theory to psychiatric disorders make errors, such as viewing a disease as if it is an adaptation. We assessed the quantity of errors in the most widely cited articles on evolutionary psychiatry and its relationship to citation frequency MethodsTwo reviewers searched PubMed, Web of Science, and Google Scholar on September 8, 2023, using specific search terms related to "evolution" and "psychiatry", in order to find the most highly cited articles in the field. Based on the work of Nesse, we developed a measure for assessing the number of errors and overall quality in evolutionary psychiatry articles. We applied the measure to the 20 most highly cited articles, and calculated the correlations between article quality and number of errors with number of citations. ResultsTwenty highly cited articles, with a mean citation count of 758.95 and publication year range from 1964 to 2011, were rated. While the most highly cited articles had good quality on average, they also made important errors. There was no significant correlation of article quality or article errors and citation count. ConclusionHighly cited articles in evolutionary psychiatry demonstrated strengths but also exhibited weaknesses. The lack of a relationship of quality and error scores with citation rates suggests that other factors influence such citations. Future research should focus on achieving consensus on how best to assess the quality of evolutionary psychiatry articles and on what errors should be avoided.

BackgroundDuring the COVID-19 pandemic period, healthcare systems substantially reorganized their management of several diseases, including acute cardiovascular diseases (ACVD) such as heart failure, stroke, myocardial infarction, and pulmonary embolism. While previous studies have reported changes in hospitalization rates and clinical outcomes, the economic impact of the pandemic on healthcare expenditures for patients with ACVD remains poorly documented. This study aimed to quantify disruptions in healthcare utilization and reimbursement trends among patients with ACVD in France during the pandemic period (2020-2023). MethodsUsing comprehensive French healthcare reimbursement data from 2015 to 2023, this nationwide cohort study analyzed 3.9 million ACVD-related patient-years, totaling {euro}86 billion in reimbursements. A two-step approach was employed: first, a linear regression model based on pre-pandemic trends (2015-2019) was used to project expected expenditures for the years 2020-2023, adjusting for age, sex, calendar year, and comorbidities. Second, expenditures observed during the years 2020-2023 were compared with these projections to estimate potential disruptions related to the pandemic period. Analyses were stratified across 21 expenditure categories. ResultsBetween 2020 and 2023, ACVD-related healthcare expenditures exceeded expected values by {euro}2.3 billion (+6.2%), with the largest gap in 2023 ({euro}1.1 billion above projections). Notably, pre-pandemic annual expenditure growth ({euro}86-212 per patient) sharply accelerated during the pandemic period ({euro}492-1320 per patient). Excess spending was higher in males ({euro}1.4 billion), patients with severe comorbidities ([≥]3 comorbidities: {euro}1.4 billion), and in the 65,195 patients with ACVD and a history of a COVID-19-related hospitalization(s) ({euro}0.9 billion, driven primarily by short stay hospitalizations and rehabilitation care). Among non-COVID-19 ACVD patients, significant increases were observed in drug expenses, short stay hospitalizations, and hospitalizations in psychiatry. ConclusionIn France, the COVID-19 pandemic years were marked by substantial and sustained disruptions in healthcare expenditures among patients with ACVD, extending beyond care directly related to COVID-19. Excess costs were linked both to pandemic-related complications and broader systemic shifts, including increased psychiatric and rehabilitation needs. These findings have critical public health implications: they highlight the need to address ongoing healthcare system disruptions for this vulnerable population while also reinforcing vigilance in future health crises.

This study anonymously examined 2,734 psychiatric patients worldwide for worsening of their pre-existing psychiatric condition during the COVID-19 pandemic. Valid responses mainly from 12 featured countries indicated self-reported worsening of psychiatric conditions in 2/3rd of the patients assessed that was validated through their significantly higher scores on scales for general psychological disturbance, post-traumatic stress disorder, and depression. Female gender, feeling no control of the situation and reporting dissatisfaction with the response of the state during the COVID-19 pandemic, and reduced interaction with family and friends increased the worsening of pre-existing psychiatric conditions, whereas optimism, ability to share concerns with family and friends and using social media like usual were associated with less worsening. An independent clinical investigation from the USA confirmed worsening of psychiatric conditions during the COVID-19 pandemic based on identification of new symptoms that necessiated clinical interventions such as dose adjustment or starting new medications in more than half of the patients.

BackgroundGamma-hydroxybutyrate (GHB) is a Schedule III drug in the US approved for treatment of cataplexy associated with narcolepsy. Narcolepsy with cateplaxy is a rare disorder with an annual incidence of less than one per one-hundred thousand and GHB is a third-line treatment. The purpose of this study was to describe the temporal pattern of GHB distribution and cost nationally and between states for Medicaid and Medicare patients. MethodsGHB prescriptions were extracted from the State Utilization Data Tool from Medicaid.gov and the Medicare part D Prescribers by Provider and Drug Dataset from CMS.gov. GHB prescriptions were examined by state when corrected for population. States outside a 95% confidence interval were considered statistically significant. GHB cost analyses were performed between 2017-2021. GHB prescribers were identified for Medicare in 2019. ResultsThere was a steady increase in prescriptions (+88.5%) from 2019 to 2021 and spending (+39.6%) from 2017 to 2020 for Medicaid. Specialists other than somnologists, were found to prescribe the highest number of GHB prescriptions to Medicare Part D enrollees. In 2019, two states (Hawaii and North Dakota) did not prescribe GHB to Medicare patients versus twenty states for Medicaid patients. Marylands prescribing to Medicare patients was significantly elevated (269.2/100K). ConclusionGHB prescribing has increased to Medicaid and Medicare patients. Further research is necessary to understand how the COVID-19 pandemic and off-label prescribing (e.g. for excessive daytime sleepiness) may have affected these findings including the origins of the pronounced state level disparities.

BackgroundGlobally, more than 700 thousand people commit suicide annually. In Sweden, the yearly incidence is between 1000 and 1500 people, which is higher than the global average. Understanding the economic burden of suicide could help highlight the importance and urgency of finding more effective treatments and preventative measures to help people suffering from suicidal thoughts and support studies evaluating the cost-effectiveness of various interventions. MethodThis national population-based cross-sectional study estimated the indirect costs associated with all suicides in Sweden between 2010 and 2019. Indirect costs were estimated using the human capital approach. Data regarding average salaries and employment rates were extracted from publicly available data in Sweden. Productivity loss was estimated over two time horizons, the year following the suicide and over a lifetime horizon. Estimations were performed in total numbers for the yearly cohorts as well as per person. ResultsBetween 2010 and 2019, 1 406 to 1 591 suicides occurred every year in Sweden. In total, approximately 26 500 productive life years are lost every year due to suicide. In 2019, the productivity loss due to all suicides in Sweden was estimated to be 44 million euros over a one-year time horizon, where 10 million euros are direct losses in local and regional authority taxes. Over a lifetime, productivity losses amounted to 935 million euros. The corresponding estimations per person were 37 and 778 thousand euros respectively over a one-year and a lifetime time horizon Over a one-year time horizon, the productivity loss was highest in the older age groups. ConclusionsThis study provides valuable insights into the economic burden of suicide on Swedish society. It underlines the potential economic benefits of effective suicide prevention, aligning with previous research highlighting the substantial returns--both monetary and in terms of human well-being--that successful prevention strategies can yield.

PurposeSleep aids derived from traditional plant medicines are strong candidates for safely improving insomnia but require wider validation in patient populations. MethodsWe conducted an open label trial of the impact of a compound, Sip2Sleep(R), containing Montmorency tart cherry (prunus cerasus) extract and Venetron(R) (apocynum venetum) on subjective sleep quality, subjective daytime alertness, sleep duration, sleep latency, anxiety, and insomnia in 43 adults with moderate to severe insomnia. Participants collected data over four weeks, with the sleep aid consumed prior to bed during weeks two and four. ResultsThe Montmorency tart cherry and Venetron(R) mixture statistically improved subjective sleep quality, daytime alertness, insomnia symptoms, and anxiety without impacting sleep duration and latency. Subjective improvements in sleep quality exhibited a statistical upward trend across the entire study window, suggesting potential persistence of the compounds days after consumption and greater improvement with longer-term consumption. ConclusionsThe combination of Montmorency tart cherry and Venetron(R) in this commercially available tincture is a promising sleep aid warranting further investigation in larger trials.

BackgroundSuicide and self-harm pose significant global public health challenges and have substantial economic implications. Recent evidence from Australia has indicated significant variations in the prevalence of suicidal behaviours and mortality among diverse populations. Aim: This study aims to examine the economic cost of suicide among culturally and linguistically diverse (CALD) migrants in Australia. MethodsWe evaluated the economic impact of suicide by considering years of life lost, years of productive life lost, and overall economic costs, including direct, indirect, and intangible costs. We used data on suicide deaths in 2020 from the National Coroners Information System. ResultsThe estimated annual economic cost of these suicides is $2.9 billion (in 2023 dollars). The average cost per suicide is $8.04 million for males and $9.23 million for females. The value of a statistical life year is the most significant cost driver, representing 94% of the total economic burden. LimitationThese estimates do not capture costs associated with suicidal ideation, thoughts or self-harm attempts, which may substantially increase the economic burden. ConclusionThis study emphasises the significant economic impacts of CALD suicide in Australia and highlights the urgent need for a comprehensive national suicide prevention program tailored for diverse populations.

BackgroundPost-COVID-19 syndrome affects a significant number of SARS-CoV-2 infected individuals even asymptomatic cases causing several neurological and neuropsychiatric symptoms and signs. Materials and MethodsAn online cross-sectional study with a convenience sample was conducted in Greece from November 2022 to January 2023. We measured demographic and clinical characteristics of patients, post-COVID-19 dysautonomia, quality of life with the EQ-5D-3L, and anxiety and depressive symptoms with the Patient Health Questionnaire-4. ResultsStudy population included 122 patients with post-COVID-19 syndrome. One out of four patients (27.8%) manifested post-COVID-19 dysautonomia, while mean duration of COVID-19 symptoms was 11.6 months. Anxiety and depressive symptoms were worse after the post-COVID-19 syndrome (p<0.001 in both cases). A statistically significant reduction in quality of life was observed among patients after the post-COVID-19 syndrome (p<0.001 for both EQ-5D-3L index value and EQ-5D-3L VAS). Post-COVID-19 dysautonomia increased depression symptoms after the post-COVID-19 syndrome (p=0.02). We found a negative relationship between duration of COVID-19 symptoms and quality of life (p<0.001). Moreover, our results showed that depressive symptoms were more often among females after the post-COVID-19 syndrome (p=0.01). Also, quality of life was lower among females than males (p=0.004 for EQ-5D-3L index value, and p=0.007 for EQ-5D-3L VAS). ConclusionsOur results suggest that post-COVID-19 syndrome causes a tremendous impact on patients quality of life and mental health. In addition, we found that the groups most psychologically affected were patients with post-COVID-19 dysautonomia, females, and patients with longer duration of symptoms. Policy makers should attach priority to vulnerable groups in future psychiatric planning. Policy measures should focus on mental health of post-COVID-19 patients who seem to be particularly vulnerable.

BackgroundStructured clinical diagnostic interviews are widely used in clinical practice and psychiatry research. Nevertheless, the extent to which such interviews have been used in forensic psychiatry is unclear, perhaps because of concerns about feasibility and utility. AimWe undertook a scoping review to investigate publications on structured clinical interviews in the forensic psychiatry context, paying particular attention to issues of feasibility and utility. MethodsA PubMed and PsychInfo database search was undertaken using the terms "structured diagnostic interviews" AND "forensic psychiatry" AND "clinical attitudes" OR "utility" OR "feasibility" OR "acceptability". PRISMA extension for Scoping Reviews (PRISMA-ScR) was used as a guideline in reviewing and including studies. ResultsWe found three articles on the use of structured diagnostic interviews in the forensic psychiatry context. In most publications, these interviews were used to assess the accuracy of symptom measures using existing validation tools. There were no publications that reported on issues of feasibility and utility. ConclusionsLiterature on the use of structured diagnostic interviews in forensic psychiatry is sparse. While this may reflect concerns about feasibility and utility, no publications provide data on the feasibility and utility of such interviews in the forensic setting. This highlights an important area of research to explore.

The COVID-19 pandemic had substantial impact on healthcare systems across the globe, including psychiatric services. Use of electroconvulsive therapy (ECT), a lifesaving intervention for severe mental illness, was reported to have declined during the pandemic in several countries, but nationwide data remain scarce. Using nationwide data from the Danish National Patient Register, we examined all ECT treatments administered in Denmark from September 2019 to May 2025. Weekly treatment numbers were visualized across the three national COVID-19 lockdowns to descriptively assess changes in ECT use. A notable reduction in ECT treatments was observed in the weeks preceding and during the first lockdown (March 11 to May 18, 2020). A post-hoc estimation indicated approximately 1,366 "missed" treatments during the initial pandemic phase in 2020. When these were added to the 27,033 treatments delivered in 2020, the adjusted total approximated annual treatment volumes in 2019 and 2022, suggesting a temporary disruption rather than sustained decline. In contrast, ECT activity during the second and third lockdowns appeared largely unaffected. These findings suggest that ECT provision in Denmark was temporarily reduced during the initial phase of the pandemic but remained resilient thereafter. In the case of a future pandemic, safeguarding timely access to ECT--particularly in early phases-- should be prioritized given its critical role in the treatment of severe mental illness.

ImportanceIntermittent Explosive Disorder (IED) is an understudied psychiatric condition that presents with repeated episodes of impulsive aggression and poorly regulated emotional control, often resulting in interpersonal and societal consequences. Better understanding of comor-bidities will allow for enhanced screening, diagnosis, and treatment of patients. ObjectiveTo investigate prevalence and associations of IED with psychiatric, neurological, and somatic disorders using real-world data DesignMatched cohorts of patients with or without IED diagnosis were identified using data from the TriNetX Research Network (until January 31, 2024). Cox proportional hazard models were used to estimate and compare the probabilities of acquiring other diagnoses using pa-tients available medical records. SettingAnalysis of electronic medical records from two patient populations. Participants30,357 individuals with IED and equal number of demographically matched individuals without IED from the TriNetX Research. ExposureIED diagnosis identified through the associated ICD codes. Main Outcomes and MeasuresThe main outcomes were ICD-10-CM diagnostic categories and root codes for disorders and health conditions in both cohorts. Main measures are total numbers and proportions of patients who had the diagnostic codes, as well as adjusted hazard ratios for IED diagnosis. ResultsAlthough only 0.03% of the total patient population had an IED diagnosis, we found extensive and widespread comorbidities with psychiatric, neurological and somatic conditions. A significant 95.7% of the individuals with IED had another psychiatric diagnosis. All psychiatric sub-categories and 95% of the psychiatric diagnoses were significantly associated with IED, with HRs ranging from 2 to 77. Among neurological conditions, neurodegenerative diseases and epilepsy had the highest HRs, followed by extrapyramidal and movement disorders, cerebral palsy and other paralytic syndromes, and sleep disorders. Notable associations with IED also includes conditions such as obesity, hyperlipidemia, hypertension, and GERD. Conclusion and RelevanceOur findings illuminate the extensive comorbid relationships between IED and psychiatric, neurological, and somatic disorders. This underscores the necessity for an integrated diagnostic and treatment approach that addresses both the psychological and physical health aspects of IED. Additionally, our work highlights the need for more accurate and inclusive diagnosis of IED in patients with mental disorders. Key PointsFocused Question: What is the pattern of comorbidity of IED with other disorders? Findings: Despite being underdiagnosed in the clinical cohort, IED was found significantly associated with a wide range of psychiatric disorders, many neurological, and some somatic disorders. Meaning: The widespread comorbidity highlights the critical need for integrated care approaches that consider the multifaceted health challenges faced by individuals with IED.

Background & AimsMetabolic disorders are tightly linked to sleep disturbances. First evidence showed that time-restricted eating (TRE), a growingly popular approach to combat cardiometabolic diseases, can also affect sleep quality. Recommendations for a preferable eating time window are pending. Our aim was to investigate the effects von early and late TRE on sleep quality in women with overweight and obesity. MethodsA total of 31 women with overweight and obesity were included in the controlled randomized crossover study ChronoFast. After a 2-4-week baseline period, participants were randomly allocated to two-weeks early time-restricted eating (eTRE) or late time-restricted eating (lTRE). The phases were switched after a washout phase. During dietary interventions participants were only allowed to consume caloric foods and drinks in the restricted eating window (eTRE: 8 am toTRE 4 pm; lTRE: 1 pm to 9 pm). Assessment of sleep metrics was performed subjectively, using Pittsburgh Sleep Quality Index (PSQI) and self-report of sleep quality, and objectively, by blinded actigraphy. Hunger and satiety scores were examined using a visual analogue scale (VAS). ResultsWhile subjective sleep quality (PSQI and self-reported sleep quality) remained unchanged, an improvement of sleep efficiency (p = 0.047) and sleep fragmentation index (SFI) (p = 0.029) was observed in eTRE intervention compared to baseline as estimated by actigraphy. There were no correlations between hunger and satiety and sleep quality, with no differences of hunger and satiety scores between eTRE and lTRE assessed in the evening on the last day of each intervention. ConclusionseTRE but not lTRE improved objective sleep-quality, which was not related to the feeling of hunger and satiety. eTRE might be more effective strategy for well-being and sleep-related metabolic health outcomes. ClincialTrials.gov number, NCT04351672 (registered on April 17, 2020).

PurposeProactive integrated consultation-liaison psychosomatics and psychiatry in somatic hospitals may improve patients mental health beyond inpatient stay. The <<SomPsyNet>> project targets SOMatic inpatients and aims to prevent PSYchosocial distress by establishing a structured care NETwork based on a Stepped and Collaborative Care Model (SCCM). We used a hospital-based epidemiological perspective to quantify prevalence and social gradients in mental distress and health-related quality of life (HRQoL). MethodsWe enrolled inpatients from three tertiary somatic hospitals, estimating how sociodemographic factors were associated with clinically relevant depressive symptoms, anxiety symptoms, somatic symptom distress, overall mental distress ([&ge;]1 measure above cut-off), mental, physical, and generic HRQoL, as well as somatic symptom burden. ResultsOut of 3,179 participants, 37% showed mental distress. Mental, physical, and generic HRQoL were substantially impaired, while somatic symptom burden was moderate. Younger age and lower income were associated with higher odds of mental distress, lower mental HRQoL, and greater somatic symptom burden (all p-for-trend<0.05), yet younger patients showed better physical HRQoL, and higher income was associated with better generic HRQoL (p-for-trend<0.05). Having no Swiss citizenship or having an employment situation affected by disability, accident, or illness, was associated with worse outcomes across most (ps<0.01) or all (ps<0.05) indicators, respectively. Other factors showed less consistent associations. ConclusionsA substantial proportion of somatic inpatients in the hospitals studied experienced mental distress and showed impaired HRQoL. Findings identified priority groups for hospital public mental health and inform resource planning for stepped, collaborative care and culturally/linguistically adapted services in acute somatic settings. Statements and DeclarationsDeclaration of Competing Interest & Funding Independent of the Project: G.M. & R.S. received funding in the context of a Horizon Europe project from the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 22.00094. Further, G.M. & R.S. received funding from Wings Health Inc. in the context of a proof-of-concept study. G.M. received funding from the Swiss Heart Foundation under project no. FF21101, from the Research Foundation of the International Psychoanalytic University (IPU) Berlin under projects no. 5087 and 5217, from the Swiss National Science Foundation (SNSF) under project no. 100014_135328, from the German Federal Ministry of Education and Research under budget item 68606, and from the Hasler Foundation under project no. 23004. G.M. is co-founder and holds stock in Therayou AG, which is active in the field of digital and blended mental healthcare. G.M. receives royalties from publishing companies as author, including a book published by Springer, and an honorarium from Lundbeck for speaking at a symposium. Furthermore, G.M. is compensated for providing psychotherapy to patients, acting as a supervisor, serving as a self-experience facilitator ( Selbsterfahrungsleiter), and for postgraduate training of psychotherapists and supervisors. R.S. is co-editor of the German AWMF S3-Guidelines on Functional Complaints, and contributed to the German guidelines on irritable bowel syndrome, and on Lyme Borreliosis. R.S. is chairman of the Basel Institute for Psychosomatic Medicine (BIPM) and founder and managing director of the Psychosomatic and Psychosocial Services GmbH, that develops and implements psychosomatic and psychosocial training and continuing education programs. The authors declare no other potential conflict of interests. The research activities were fully independent and there were no intellectual or financial proprietary claims.

BackgroundPrevious research has shown that people with disabilities are disproportionately vulnerable to symptoms of psychological distress after exposure to armed conflict. Past work has also shown that individuals displaced by conflict are at heightened risk of post-traumatic stress. However, we know of no research that has attempted to examine the association between disability severity and post-traumatic stress symptoms in a general population affected by armed conflict. MethodWe examined the association between levels of functional disability in the Ukrainian population and symptoms of post-traumatic stress during the 2022 Russian invasion of Ukraine. We analysed data from a national sample of 2000 participants from across this country, assessing disability using the WHODAS-12 (six domains of disability) and the ITQ assessment of ICD-11 PTSD symptomatology. Moderated regression examined the impact of displacement status on the disability-post-traumatic stress relationship. ResultsDifferent domains of disability predicted post-traumatic stress symptoms to varying extents, with overall disability score significantly associated with post-traumatic stress symptoms. This relationship was not moderated by displacement status. Consistent with previous research, females reported higher levels post-traumatic stress. ConclusionsIn a study of a general population during a time of armed conflict individuals with more severe disabilities were at greater risk of post-traumatic stress symptoms. Psychiatrists and related professionals should consider pre-existing disability as a risk factor for conflict -related post-traumatic stress. Highlights What is already known on this topicPeople with disabilities are vulnerable to a variety of forms of psychological distress after experiencing disasters of various kinds, including armed conflict. However, associations between levels of disability in the general population and post-traumatic stress during a period of conflict have not previously been examined. What this study addsIncreasing severity of functional disability in the general population is associated with increasing post-traumatic stress symptoms in a conflict exposed population. How this study might affect research, practice or policyMental health professionals dealing with conflict affected populations should take account of the additional vulnerabilities caused by disability status, and work to mitigate this by providing access to functional and social support.

Interoception, the perception of internal bodily signals, is thought to play a key role in health behavior. Interoceptive domains (e.g., accuracy and attention) are associated with mental disorders in various ways, underscoring the need for specific measures for different interoceptive domains. To allow for studying interoceptive domains in the Dutch population, the current study aimed to investigate the reliability and validity of Dutch translations of the Interoceptive Accuracy Scale (IAS-D) and Interoceptive Attention Scale (IATS-D). In a sample of 779 participants (mean age 52.98 {+/-} 16.47, 49.6% female), the IAS-D showed good internal consistency ( = 0.89) with a four-factor structure according to the confirmatory factor analysis (CFI = 0.816, TLI = 0.788, RMSEA = 0.084). The IAS-D had significant negative relations to the Interoceptive Confusion Questionnaire ({beta} = -0.638, p < 0.001), depression ({beta} = -0.298, p < 0.001), and alexithymia ({beta} = 0.528, p < 0.001). The IATS-D showed good internal consistency ( = 0.94) with a three-factor structure according to the confirmatory factor analysis (CFI = 0.852, TLI = 0.833, RMSEA = 0.100). The IATS-D had significant positive relations with the Interoceptive Confusion Questionnaire ({beta} = 0.481, p < 0.001), Body Perception Questionnaire ({beta} = 0.207, p < 0.001), depression ({beta} = 0.377, p < 0.001), and alexithymia ({beta} = 0.528, p < 0.001). The IAS-D and IATS-D are considered reliable and valid instruments for assessing self-reported interoceptive accuracy and attention in Dutch-speaking populations, supporting public health research on the role of interoception in health behavior. HighlightsO_LIInteroceptive domains associate with mental disorders in various ways C_LIO_LISpecific measures for interoceptive domains are needed C_LIO_LIIAS-D and IATS-D are reliable and valid instruments C_LIO_LIIAS-D and IATS-D can distinguish between interoceptive domains C_LI

The authors have withdrawn their manuscript owing to it needing further revision before publication, as well as errors in the author list. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.

IntroductionMedical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. MethodsThe ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). ResultsFifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m vs 15.5 kg/m, p=0.01) and neutropoenia (mean BMI 13.4 kg/m vs 15.4 kg/m, p=0.02). ConclusionIntroduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.

BackgroundAnorexia nervosa (AN) remains difficult to treat, partly due to co-occurring mental health challenges and gastrointestinal symptoms. Emerging research suggests that individuals with AN exhibit gut microbiota dysbiosis and dysregulation in the gut-brain axis (GBA). However, research examining the role of gut microbiota as a potential driver of AN-related pathologies remains limited. The Norwegian Microbiota Study in Anorexia Nervosa (NORMA) will therefore investigate gut microbiota and its interaction with the GBA in AN. MethodsNORMA is a collaboration between the Norwegian University of Life Sciences and seven Norwegian specialized eating disorder inpatient treatment units, consisting of three work packages (WP): a clinical observational trial (WP1), in vitro fermentation experiments (WP2), and animal experiments (WP3). In WP1, 90 patients with AN (age 16-50, BMI<18.5) admitted for treatment and 90 healthy controls (HCs, age 16-50, BMI 18.5-27) will be recruited. Data on mental and physical health, dietary intake, and blood and fecal samples for biomarker and microbiota analyses will be collected at baseline, 6 and 12 weeks after start of treatment for AN patients and once for HCs. Outcomes will be compared between groups, and longitudinal effects of standard treatment examined within the AN group. In WP2, fecal microorganisms from patients and HCs will be grown in vitro to assess influence of prebiotics. In WP3, mice will receive fecal microbiota from AN and HC donors to determine if and how AN-related microbiota affects AN-relevant phenotypes. ConclusionNORMA is pioneering in its integration of clinical, in vitro, and animal studies, providing the most comprehensive gut microbiota study of AN so far. By investigating the role of gut microbiota in AN and effects of standardized treatment on gut microbiota composition, this study aims to inform the development of innovative therapeutic strategies and ultimately improve treatment outcomes and life quality for individuals with AN. Trial registrationNORMA is a registered clinical trial: clinicaltrials.gov as NCT06144905.