Psychiatry Research

Background: While growing enthusiasm for the therapeutic potential of classic psychedelics has led to a rise in non-clinical use, attention to persisting adverse effects has emerged with delay. A subset of individuals reports persisting complications such as hallucinogen persisting perception disorder (HPPD), depersonalization/derealization disorder (DDD), anxiety and depression. Yet few medical services are equipped to address these complications. Aims: This qualitative study examines how societal, medical, and media discourses shape the experiences of individuals with persisting psychedelic-related complications, focusing on help-seeking trajectories. Methods: Thirteen semi-structured interviews with adults experiencing persisting psychedelic-related psychological symptoms (four women, nine men, age 19-49 years; HPPD (n = 10), DDD (n = 6), depression (n = 1), and anxiety (n = 1)) were conducted within a larger study on these complications. Data were analysed using reflexive thematic analysis. Reporting followed the COREQ guidelines. Results: Three interrelated themes emerged: (1) The dissonance between expectation and harm - idealised media and scientific portrayals of psychedelics shaped initial use and complicated recognition of adverse outcomes; (2) Stigma, silence, and self-blame - prohibitionist discourse and internalised shame significantly inhibited help-seeking; and (3) Between systemic absence and self-organised support - participants encountered clinical unpreparedness and epistemic dismissal, which often led them to rely on online peer communities and self-management strategies. Positive clinical encounters, characterised by professional expertise and nonjudgmental engagement, were experienced as helpful. Conclusions: Adequate clinical and conceptual frameworks for persisting psychedelic-related complications are lacking. An interdisciplinary, experience-informed approach integrating realistic risk communication, clinician training, and destigmatisation is required to support affected individuals.

Forensic patients often have complex and costly healthcare needs, even following discharge from secure care. However, little is known about their health and justice outcomes after community reintegration. To address this gap in the literature, we conducted a systematic review and meta-analysis to estimate the incidence of key post-discharge outcomes among community-discharged forensic patients, including any reoffending, violent reoffending, reconvictions, readmissions, all-cause mortality, and suicide. We systematically searched PsycINFO, Embase, CINAHL, Medline, PubMed, and ProQuest Dissertations from database inception to May 2025 (PROSPERO CRD42024529265). Random-effect meta-analyses were used to generate pooled incidence estimates, with heterogeneity quantified using prediction intervals. A total of 49 studies met inclusion criteria (total patient n = 18,871) and contributed to the meta-analyses. The pooled incidence rate per 100,000 person-years was: any reoffending 3,889 (95% CI 2,055, 7,359; 95% PI 290, 52,136); violent reoffending 1,851 (95% CI 1,229, 2,789; 95% PI 201, 17,068); reconvictions 3,291 (95% CI 2,591, 4,179; 95% PI 950, 11,394); readmissions 7,945 (95% CI 5,507, 11,463; 95% PI 1,225, 51,548); all-cause mortality 1,789 (95% CI 1,341, 2,388; 95% PI 673, 4,756); and suicide 407 (95% CI 319, 519; 95% PI 225, 735). Overall, the reoffending rate for forensic patients discharged to the community was lower than that reported for other cohorts of people charged with general and violent offences. However, despite typically receiving long admission periods, discharged forensic patients continue to experience high rates of readmission, all-cause mortality, and suicide relative to other psychiatric patient groups in the community. Together, our findings highlight a need for enhanced post-discharge suicide support for forensic patients living in the community to better facilitate successful, long-term reintegration.

A systematic review and meta-analysis of sleep studies in schizoaffective disorder were conducted using published articles researched in major databases within the period from inception to December 1, 2025. The sleep parameters: total sleep time, sleep efficiency, sleep latency, wakefulness, REM time and percentage, REM latency, REM density, stage 1, 2, 3 and 4 sleep time and percentage, delta sleep time and percentage, of drug-free schizoaffective patients were analyzed and, where available, compared with case-control data of healthy controls, depressed unipolar patients and schizophrenic patients. Forty studies were identified in the systematic review. Nine case-control studies with 67 schizoaffective patients, 88 schizophrenic patients, 79 healthy controls and 131 depressed patients were included in the meta-analyses. The primary outcome was the standard mean difference. Data were fitted with a random-effects model. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Patients with schizoaffective disorder showed reduced total sleep time, increased sleep latency and wakefulness, along with reduced REM time and shortened REM latency, reduced stage 4 sleep time and percentage compared to healthy controls. Patients with schizoaffective disorder differed from depressed patients only for increased sleep latency, while they did not show any difference compared to patients with schizophrenia. SZA showed a non-significant trend (p=0.08) towards increased REM density compared to SCZ, suggesting the need to better clarify the role of REM density in mood and psychotic disorders.

Background Autistic people experience disproportionately high rates of co-occurring mental illness and suicide, yet mental healthcare services routinely fail to meet their needs. Patients unrecognised as autistic are at risk of ineffective or harmful treatment. Autistic psychiatrists occupy a unique position: as members of both medical and autistic communities, they offer dual insider perspectives that may directly shape patient outcomes. Despite being the second largest specialty group in Autistic Doctors International (ADI), this workforce remains largely unrecognised and underutilised. This study examines autistic psychiatrists' perspectives on mental healthcare for autistic people. Methods Loosely structured interviews were conducted with seven senior autistic psychiatrists across child and adolescent, adult, and liaison psychiatry, recruited from a psychiatry-specific subgroup of ADI. Data were analysed using reflexive thematic analysis: codes related to patient care and mental health services were extracted and analysed as a focused subset. Outcomes Nine themes were identified: autistic-to-autistic therapeutic rapport; benefit of recognition and diagnosis; early recognition and education as preventive factors; iatrogenic harm from non-recognition and systemic pathways to misdiagnosis; knowledge gaps and stereotypes; inaccessible services; resource constraints and diagnostic thresholds; autistic psychiatrists as an underutilised resource; and pathways to change. Interpretation Autistic psychiatrists' dual insider positionality affords a unique and under-acknowledged vantage point on what autistic patients experience and where mental healthcare fails them. The mental health burden autistic people carry is substantially shaped by systems not designed for them. Embedding neurodiversity-affirmative practice, closing training gaps, reforming diagnostic pathways, and recognising autistic psychiatrists as a clinical and epistemic resource offer a coherent pathway to improving mental health outcomes for autistic people.

Background: Concerns about "AI psychosis" have swirled in the media since ChatGPT's release, but few systematic analyses exist. We therefore conducted an electronic health record (EHR) analysis to identify the frequency, clinical characteristics, and quality of AI interactions in patients experiencing psychosis treated in a medical center. Methods: AI keywords (e.g., ChatGPT, AI) were used to search Vanderbilt University Medical Center's EHR from 12/1/2022-4/1/2026. Records were discarded if they were not AI-related or if the primary diagnosis did not include psychosis. Three raters read notes to determine if a patient was experiencing AI psychosis and classified the interactions using 4 a-priori categories (Catalyst, Amplifier, Co-Author, Object) formulated to explain how AI-related negative outcomes emerge. Findings: 73 patients met our criteria. 28 patients were rated as experiencing AI psychosis, 17 had neutral interactions, and 28 expressed delusional content related to AI without documented evidence of conversational AI use. ChatGPT was the matching keyword for 53.6% patients experiencing AI psychosis. The majority of AI psychosis cases were documented after ChatGPT's "4o" model was released in May 2024. Notably, the AI Psychosis group had significantly more patients experiencing a first psychotic episode (60.7%) compared to the other two groups. Amplifier was the most common (64.3%) qualitative rating in the AI Psychosis group. Interpretation: "AI psychosis" is an infrequent but real phenomenon observed in clinical practice. Most affected patients were experiencing their first psychotic episode and presented with AI psychosis following the release of the more sycophantic GPT-4o. Among the affected patients, AI most often exacerbated an existing condition by reinforcing distorted ideas.

Objective: Neuropsychiatric presentations are common across neurological and mental health services but they are often inadequately covered by core clinical psychology and clinical neuropsychology training. Consequently, we aimed to identify components for a neuropsychiatry curriculum for clinical psychologists using a Delphi process. Method: We completed a three-round e-Delphi study with 19 experts (clinical psychologists, neuropsychologists, psychiatrists, neurologists, individuals with lived experience of neuropsychiatric disorders). Round 1 collected ratings on 80 syllabus items derived from textbook reviews, conference topics, and a scoping review of neuropsychiatry syllabuses. Items failing to reach consensus were refined, and new topics added via free-text suggestions. Rounds 2 and 3 repeated rating and thematic analysis, culminating in a consensus meeting where items were classified as core or supplementary. Consensus thresholds were set at mean>=2.0, mean distance from the mean<=0.2, and => 75% agreement for final decisions. Results: The process yielded 40 core and 38 supplementary syllabus items. Core topics include autoimmune and neuroinflammatory disorders, delirium, functional neurological disorders, neuropsychiatric sequelae of epilepsy, stroke, traumatic brain injury, dementia, and multidisciplinary working, among others. Supplementary items covered background knowledge of less frequent but still prevalent disorders as well as competencies in interpreting clinical data alongside conceptual and historical issues. The final component list reflects both clinical competencies and emerging areas of practice, emphasising assessment, formulation, psychological interventions, cultural considerations, and medicolegal aspects. Conclusions: The e-Delphi derived curriculum provides a framework for neuropsychiatric competencies for postgraduate psychology training with modification needed for application in diverse healthcare settings.

Background Somatic and psychological symptoms like depression, anxiety, and trauma-related stress often co-occur, especially in young adults, a group facing major life transitions and increased vulnerability. These overlapping symptoms pose diagnostic challenges that traditional disorder-specific models capture poorly. Transdiagnostic and dimensional approaches may offer a more meaningful framework. However, population-based data on symptom patterns in young adults remains sparse. This study investigated the patterns of psychological and somatic symptoms among young adults from Switzerland and compares these results to findings from populations with different stress exposure histories: Ukrainians who fled to Switzerland, and Ukrainians living in different regions in Ukraine during the war. Methods We analyzed cross-sectional baseline data collected in spring 2024 as part of the Mental Health Assessment of the Population (MAP) studies, where we enrolled randomly selected young adults aged 18-24 from Switzerland, Ukrainian refugees in Switzerland, and Ukrainians residing in regions with different degrees of proximity to active war zones. We assessed somatic (PHQ-15) and psychological symptoms (PHQ-9, GAD-7, PCL-5) and explored symptom patterns using descriptive statistics, correlations, and k-means clustering. Results Psychological symptom severity showed highly consistent moderate-to-strong correlations with somatic symptoms (range: 0.53-0.69), across all young adult subgroups and disorders. Rather than identifying disorder-specific patterns, symptoms clustered by overall symptom severity, emerging in three clusters: (1) high symptom burden, (2) moderate symptom burden, and (3) low symptom burden clusters with elevated somatic, depressive, anxiety, and PTSD symptoms. The cluster structure was remarkably stable across Swiss, Ukrainian, and refugee subsamples, despite markedly different stress exposure histories. Conclusion Our results support a symptom-based, dimensional approach to understanding mental health in young adults and to better capture the complexity and co-occurrence of psychological and somatic symptoms in this age group. These findings further suggest that prevention and early detection strategies should more systematically integrate both psychological and somatic symptomatology.

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.

Mental health problems, including emotional problems, are linked to adverse educational outcomes among children and adolescents. This study examines the association between early onset of mental health problems generally, and emotional problems specifically, at ages 5-14, and outcomes from the General Certificate of Secondary Education (GCSE), a secondary education qualification, at age 16 for 4,783 students in England, using the Millennium Cohort Study dataset linked to the National Pupil Database. We found that the onset of mental health problems at ages 5, 7, 11 and 14 had a significant and negative association with all GCSE outcomes. We also found negative associations between early onset emotional problems and GCSE outcomes, although results were most stark for emotional problems that onset at age 11, with statistically significant negative associations with all GCSE outcomes. School absence was identified as a potential mediator of the negative association. Furthermore, this study found that the potential loss of productivity related to mental health problems in general and emotional problems in particular was over 23,000 sterling and 11,000 sterling per affected individual, respectively, which could translate into approximately 2.57 billion sterling and 1.6 billion sterling, respectively at the population level for England. These findings highlight the importance of early intervention for children and adolescents with mental health problems to improve educational and future outcomes.

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.

BackgroundHead and neck cancer (HNC) uniquely threatens communication through its impact on voice and speech. The neural systems linking depressive symptoms with perceived voice handicap remain poorly characterized. We examined whether these symptom domains show dissociable associations with regional brain glucose metabolism. MethodsWe conducted a cross-sectional 18FFDG-PET study in 63 HNC patients following diagnosis. Regional cerebral glucose metabolism (standardized uptake value ratios) was quantified in five a priori regions of interest: Brocas area, Wernickes area, bilateral insula, and bilateral hippocampus. Depressive symptoms (Zung Self-Rating Depression Scale, SDS) and perceived voice handicap (Voice Handicap Index, VHI) were assessed. Spearman correlations with false discovery rate correction, partial correlations, and unique variance analyses were performed. Brain-behavior associations were examined using Spearman correlations with FDR correction. ResultsDepression and perceived voice handicap were strongly correlated ({rho} = 0.64, p < 0.001) and exhibited partially dissociable metabolic correlates. Depressive symptom severity was associated with reduced metabolism in Brocas area ({rho} = -0.31, p_FDR = 0.041) and higher metabolism in the left insula ({rho} = 0.36, p_FDR = 0.039), with graded insular elevation in moderate-severe depression (+14%, p = 0.008). Voice handicap was associated with reduced hippocampal metabolism ({rho} = -0.34, p = 0.016 after covariate adjustment) in exploratory analyses. ConclusionsDepression and voice handicap in HNC arise from partially independent neurobiological processes despite their clinical co-occurrence. This dissociation supports parallel rather than hierarchical supportive care pathways. Routine clinical imaging can be leveraged to generate testable hypotheses for psychosomatic and rehabilitation research. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=170 SRC="FIGDIR/small/26352637v1_ufig1.gif" ALT="Figure 1"> View larger version (32K): org.highwire.dtl.DTLVardef@174642org.highwire.dtl.DTLVardef@5c750org.highwire.dtl.DTLVardef@1607b27org.highwire.dtl.DTLVardef@1355ef9_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOGraphical abstractC_FLOATNO Depressive symptoms were associated with reduced Brocas area metabolism and elevated left insula metabolism, consistent with limbic-cortical dysregulation. Perceived voice handicap was uniquely associated with reduced bilateral hippocampal metabolism, implicating contextual memory and adaptation processes. Arrows indicate direction of association. C_FIG

BackgroundGrowing numbers of people with a borderline personality disorder (BPD) diagnosis are realising they may have undiagnosed autism. Previous qualitative research has not focused on identifying barriers and facilitators to this diagnostic journey, did not explore the perspectives of clinicians, and did not include the experiences of people who are unsure whether they are autistic or not. We aimed to understand lived experience and clinician perspectives on facilitators and barriers to recognising undiagnosed autism, in women and people assigned female at birth (PAFAB) with a diagnosis of personality disorder. MethodsWe carried out in-depth qualitative interviews with 15 mental health clinicians, and 15 women/PAFAB who had a current or prior diagnosis of BPD and identified as definitely or possibly autistic, from across the United Kingdom. We analysed the interview data using reflexive thematic analysis. ResultsBoth clinician and lived experience participants identified many barriers to recognising autism in women and PAFAB with a BPD diagnosis: BPD diagnoses being made with minimal assessment during mental health crises, systemic incentivisation to diagnose BPD in order to access psychological therapies, siloed service pathways, clinician reluctance to question pre-existing BPD diagnoses, pathologizing of patients for questioning their BPD diagnosis, and lack of clinician knowledge about different presentations of autism or about ways that autism presents similarly and differently to BPD. Participants identified numerous ways in which autistic characteristics could be misattributed as symptomatic of BPD, further contributing to missed or misdiagnosis. ConclusionOur findings suggest that improving clinician awareness of different presentations of autism, and of differential diagnosis from BPD is likely to reduce misdiagnosis, alongside avoiding rapid diagnostic decisions during mental health crises. Our study further highlights the value of being open to questioning pre-existing diagnoses, joint working across autism and personality disorder services, and improving transdiagnostic access to psychological interventions. Community BriefO_ST_ABSWhy is this an important issue?C_ST_ABSAutism in adults may be missed, or mis-diagnosed as a mental health condition. Borderline personality disorder (BPD) is the most common perceived misdiagnosis held by autistic people. Unrecognised autism may lead to worsened mental health in BPD-diagnosed people. What was the purpose of this study?We aimed to understand lived experience and clinician perspectives on what gets in the way of recognising undiagnosed autism, in people with a diagnosis of BPD. What did the researchers do?We interviewed 15 mental health clinicians, and 15 women/people assigned female at birth (AFAB), who had a current or prior diagnosis of BPD and identified as definitely or possibly autistic. We asked lived experience participants about their experiences of realising that they may be autistic. We asked clinicians to share their experiences of differentiating autism and personality disorder in clinical practice. We asked all participants to discuss their experiences of what makes it challenging to recognise autism in BPD-diagnosed people, and what helps. What were the results and conclusions of the study?Both clinician and lived experience participants identified many barriers to recognising autism in women and AFAB people with a BPD diagnosis. They said BPD diagnoses are made with minimal assessment during mental health crises. They said clinicians feel that they have to diagnose BPD in order to help people access psychological therapies. They said service pathways separate out autism and BPD rather than considering them together. They said clinicians are reluctant to question pre- existing BPD diagnoses, and that patients questioning of their BPD diagnosis is sometimes seen as symptomatic of mental health difficulties. They said clinicians lack knowledge about how autism can look different in women and AFAB people, and about ways that autism can look similar and different to BPD. Participants identified numerous ways in which autistic characteristics could be misattributed as symptomatic of BPD, further contributing to missed or misdiagnosis. We concluded that improving mental health clinicians understanding of autism, and how it is different from BPD, may help to improve recognition of autism in BPD-diagnosed people. We also concluded its important for clinicians to be open to questioning pre-existing diagnoses, to establish joint working across autism and personality disorder services, and to improve transdiagnostic access to psychological interventions. What is new or controversial about these findings?Its the first time clinician and lived experience perspectives on this issue have been brought together. Its controversial because it suggests that mental health services are sometimes not good at recognising autism in BPD- diagnosed people, and that people are potentially being harmed by this. What are potential weaknesses in the study?We would have liked to understand more about the experiences of ethnically diverse people. Our study may have attracted people who disagree with the idea of BPD and who believe autism is underdiagnosed. How will these findings help autistic adults now or in the future?We hope it will help BPD-diagnosed people with undiagnosed autism to be better recognised and understood by mental health services.

Background: We previously examined the burden and predictors of sustained mental health care engagement in Ugandan first episode psychosis patients by retrospective chart review methods. However, the extensive requirements of chart reviews meant that we could only extract data from a random 10% sample of 1677 newly enrolled Ugandan first-episode psychosis patients at Butabika National Referral Mental Hospital in 2018. The Hekima Platform has been designed to transform handwritten files into datasets for analysis. Objectives: This study aims to: (1) utilize the Hekima Platform to transform paper-based clinical charts of all 1677 Ugandan psychosis patients enrolled at Butabika Hospital for the first time in 2018 into a standardized, anonymized longitudinal database and (2) re-examine predictors of sustained MHC engagement in this cohort. Methods: We will digitize and archive all patient charts. We will then use the Hekima Platform to extract handwritten clinical data into machine-readable text using user-trained machine learning and deep learning models and natural language processing (NLP) techniques to generate a structured, anonymized database. A minimum 10% random sample of extracted data will be manually validated using Cohen's kappa. For the analytical aim descriptive statistics bivariate analysis and multivariable logistic regression will model predictors of sustained engagement. Exploratory machine learning approaches are used as a complementary analytical strategy. Ethical approval has been obtained from the Uganda National Council for Science and Technology and Butabika Hospital's Research Ethics Committee. Expected outcomes: Patient clinical charts are a rich data source but there are extensive requirements to be able to use them for research. This study will generate the first AI-assisted standardized longitudinal database from handwritten psychiatric records in Uganda enabling well-powered analyses of predictors of MHC engagement. Findings will inform targeted interventions to improve retention in care and will offer a scalable model for mental health research in low- and middle-income countries.

IntroductionDespite evidence supporting child and adolescent cognitive behavioural therapy (CBT) globally, interventions remain largely unavailable within public systems. This gap requires implementation models integrating development, training, and scalability research within real-world settings and changes in management structures. Here we developed and implemented manualised psychotherapeutic protocols through a national capacity-building initiative in Greece. MethodsWe designed a structured implementation pathway conducted through the Child and Adolescent Mental Health Initiative (CAMHI), a public-private partnership involving clinical and academic institutions across Greece: (1) pre-implementation research through national reviews and national surveys of health professionals; (2) co-development and iterative pilot implementation of evidence-based interventions through supervised practice within the National Health System; and (3) dissemination research supporting scalability and institutionalisation within public structures. ResultsPre-implementation research identified gaps in the availability of clinical protocols in Greek services; a survey of 120 psychologists and psychiatrists indicated the need for psychotherapeutic training. Three evidence-based protocols were co-developed: CBT for anxiety (6-12 years), CBT for depression (12-17 years), and behavioural parent training (BPT) for disruptive behaviour (4-14 years). During a three-stage pilot, 45 clinicians delivered interventions to 140 cases (anxiety n=52; depression n=25; BPT n=63); 117 (83{middle dot}5%) completed treatment. Significant symptom reductions were observed for anxiety (d=-2{middle dot}92; RCADS-25), depression (d=-1{middle dot}79, RCADS-25), and disruptive behaviour (d=-2{middle dot}3, SNAP-IV), with 63%, 38% and 44% showing reliable improvement at the treatment endpoint. A train-the-trainer model is under implementation for national scale-up. Institutionalisation includes integration into child and adolescent psychiatry curricula. Sustainability safeguards were established through Law 5015/2023, with the Ministry of Health assuming operations by 2027. DiscussionPilot results demonstrate the feasibility of evidence-based psychotherapeutic interventions embedded within real-world child and adolescent services in Greece. Integrated implementation approaches provide a viable pathway for developing, refining, and scaling clinical manuals within public health provision.

BackgroundNarcolepsy is a debilitating sleep disorder caused by hypocretin deficiency. Aside from its role to induce wakefulness, hypocretin is linked to modulated appetite and metabolism, often resulting in weight gain. Study objectivesWe aimed to unravel the comprehensive epidemiological connection between narcolepsy and major cardiometabolic outcomes. MethodsWe analyzed cardiovascular and metabolic disease distribution in the FinnGen study. Using longitudinal electronic health records, we assessed associations between narcolepsy, cardiac/metabolic markers, and prescriptions for relevant drugs. ResultsOur findings demonstrate significant associations between narcolepsy and metabolic traits (OR [95% CI] = 2.65 [1.81, 3.89]) as well as stroke (OR = 2.36 [1.38, 4.04]). Narcolepsy patients exhibit a less favourable metabolic profile, including higher glucose levels (OR = 1.1143 [1.0599, 1.1715]) and dyslipidaemia. This is supported by increased prescriptions of insulin (OR = 2.269 [1.46, 3.53]), simvastatin (OR = 2.292 [1.59, 3.31]), and metformin (OR = 2.327 [1.66, 3.25]), reflecting high metabolic disturbances. Furthermore, positive associations with antihypertensive and antiplatelet medications were observed, consistent with elevated cardiovascular risk. ConclusionTaken together, our findings highlight the cardiometabolic burden in narcolepsy. This study enhances understanding of the metabolic and cardiovascular consequences of narcolepsy and offers timely guidance for effective disease control. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=131 SRC="FIGDIR/small/26351468v2_ufig1.gif" ALT="Figure 1"> View larger version (29K): org.highwire.dtl.DTLVardef@19f5783org.highwire.dtl.DTLVardef@2a648corg.highwire.dtl.DTLVardef@12f2b9eorg.highwire.dtl.DTLVardef@1d8baaf_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background: Sleep debt and irregular sleep patterns are highly prevalent amongst adolescents. However, whether the absence of these sleep behaviours protects against subsequent depression remains unclear. Here, we examined the association of sleep debt, weekend catch-up sleep (WCS), and social jetlag (SJL) in adolescence with depression in young adulthood and identified underlying biopsychosocial mechanisms. Methods: Secondary data analyses were conducted using the Avon Longitudinal Study of Parents and Children. Bedtimes and wake-up times on school days and weekends (i.e., sleep duration) and sleep need were self-reported at 15 years. This was used to generate sleep debt (sleep need minus school day sleep duration), WCS (weekend sleep duration minus school day sleep duration), and SJL (absolute difference in the midpoint of sleep times between school days and weekends). Depression was assessed at 24 years with the Clinical Interview Schedule-Revised. Common mental health symptoms, biological, and school-related factors at 17 years were the mediators. Results: Logistic regression analyses revealed that greater WCS (adjusted odds ratio [AOR]=0.90; 95% CI=0.84-0.97; p=0.004) and lower sleep debt (AOR=1.10; 95% confidence interval [CI]=1.03-1.18; p=0.005) at age 15 reduced the likelihood of depression at 24 years. Irritability at 17 years partially mediated the relationship between sleep debt and depression (bias-corrected estimate=0.003; 95% CI=0.002-0.004; p<0.001). Conclusions: Adolescents who experience less sleep debt (i.e., less discrepancies between their actual sleep and their perceived sleep need) and those who extend their sleep duration on weekends are at reduced risk for depression in young adulthood. These findings underscore the need for greater opportunities for adolescents to obtain more hours of sleep to protect them against later poor mental health outcomes, such as depression. Keywords: Sleep; longitudinal studies; depression; ALSPAC

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: Dissociative experiences encompass a variety of discontinuities in awareness and perception that are elevated in the dissociative disorders and associated with extensive comorbid symptomatology. Accumulating evidence points to developmental trauma and trait responsiveness to verbal suggestions (REVS) as factors that confer risk for severe dissociative symptoms, but they have typically been studied in isolation. This study integrated these measures using prediction modelling to better understand their predictive value for the risk of dissociative psychopathology. Method: 1,104 non-clinical participants completed measures of trauma, dissociation and trait REVS. The predictive model was developed using elastic net logistic regression, internally validated with 10-fold cross-validation, and assessed using receiver operating characteristic (ROC) curve and area under the ROC (AUROC). Variables entered into the model were components of REVS, trauma, age, and their interactions. Results: A dissociative psychopathology at-risk group (7%) was characterised by younger age, greater trauma and elevated REVS, particularly involuntariness during cognitive-perceptual suggestions. The prediction model retained nine of ten predictors, with an AUROC of .77 [95% CI: .73, .82], reflecting good discrimination with moderate sensitivity (78%) but modest specificity (67%). Conclusions: These findings reinforce trauma and trait REVS as risk factors for dissociative psychopathology and demonstrate that they can be integrated in a model that can identify at-risk individuals. Further validation and extension of the model is necessary to improve the identification of individuals at risk for severe dissociative symptomatology and the diagnosis of dissociative disorders with implications for outcome trajectories.

Abstract Schizophrenia (SCZ) and bipolar disorder (BPD) are highly heritable psychiatric disorders with complex polygenic architectures. Genome-wide association studies (GWASs) have identified numerous common variant associations, but rarer variants detectable through whole-genome sequencing (WGS) remain underexplored. We conducted rare variant association analysis using WGS data from the Portuguese Island Collection (PIC), including 28 families with SCZ (n = 53) and 41 families with BPD (n = 83) cases, and population controls (n = 62). Following ANNOVAR and CADD annotation, burden analysis of deleterious variants showed that both affected and unaffected family members from SCZ and BPD pedigrees had significantly higher burdens of rare deleterious variants compared to controls (p < 0.0001), with no significant differences observed between affected and unaffected relatives, consistent with shared familial genetic liability. Polygenic Risk Score (PRS) analysis confirmed significant genetic contributions to both disorders within PIC. Association analyses were subsequently performed using SAIGE-GENE+ identifying 483 and 583 nominally significant (suggestive associations) gene sets (p-value [&le;] 0.05; FDR > 0.05) for SCZ and BPD, respectively, including gene sets related to neurotransmission, synaptic function and structure, neurodevelopment, and neuroinflammation as well as major signaling pathways. Cross disorder overlaps also identified shared suggestive enrichment of GABA and glutamate signaling, synaptic signaling, and Wnt signaling gene sets in both SCZ and BPD. These findings support shared rare variant burden within multiplex psychiatric families and highlight the role of gene-set based rare variant analysis in identifying neurobiological pathways relevant to SCZ and BPD. Keywords: WGS, Rare Variants, Schizophrenia, Bipolar Disorder

Objective: Biopsychosocial models recognize multiple determinants of post-trauma mental disorders, but their relative and interactive effects remain unclear. We quantified the independent contribution of traumatic event severity, preexisting vulnerability, social support, and coping capacity, and tested mediation pathways. Methods: In a Brazilian clinical sample reporting traumatic or stressful events (N = 612), constructs were operationalized as composite scores and a dichotomous clinical outcome was derived from intake assessments. Logistic regression (n = 594) and structural equation modeling evaluated prediction and mediation. Results: Vulnerability was the strongest risk factor (OR = 1.46, p < .001) and social support the main protective factor (OR = 0.60, p < .001). Traumatic event severity remained an independent predictor (OR = 1.39, p < .001), whereas coping capacity was not significant (OR = 0.94, p = .410). Discrimination was good (AUC = 0.80). Mediation indicated vulnerability reduced social support and coping capacity, with a significant indirect effect via social support. Conclusions: Findings support a multifactorial model centered on a triad of vulnerability, social support, and traumatic exposure. Risk is shaped primarily by preexisting vulnerability and relational context, alongside a direct trauma effect, providing a clinically relevant framework for assessment and intervention.