The influence of childhood trauma on social media-induced secondary traumatic stress among college students: the chain mediating effect of self-compassion and resilience

Background: Studies have shown that media exposure to critical public events can lead to secondary traumatic stress (STS). Personal trauma history, self-compassion and resilience are important factors influencing STS in healthy professionals. However, whether these variables are associated with social media-induced STS in college students and the underlying mechanisms remain unclear. The purpose of this study was to explore the complex relationship linking childhood trauma to social media-induced STS in a large sample of college students.Methods: A total of 1151 Chinese college students from Chengdu, Sichuan Province of China completed a web-based cross-sectional survey, which included standard assessments of childhood trauma, self-compassion, resilience and social media-induced STS, as well as sociodemographic questionnaires. The chain mediation model was tested using the PROCESS macro programme in SPSS software.Results: There was a moderate correlation between childhood trauma and social media-induced STS (r = 0.34, p < .001). This association was significantly mediated by self-compassion (indirect effect [95% CI] = 0.14[0.11, 0.17]) and resilience (indirect effect = 0.03[0.01, 0.04]), respectively. Further, a chained mediating effect was observed with self-compassion and resilience consecutively mediated the relationship between childhood trauma and social media-induced STS (indirect effect = 0.02[0.01, 0.03]). These results persisted after sociodemographic characteristics were included as controlling variables.Conclusions: Early life trauma impacts STS induced by exposure to traumatic materials on social media through self-compassion and resilience among Chinese college students. Psychological interventions targeting self-compassion and resilience can be implemented to reduce the risk of STS, especially in vulnerable individuals.

Identification of biomarkers for chronic renal fibrosis and their relationship with immune infiltration and cell death

BACKGROUND

Chronic kidney disease (CKD) represents a significant global public health challenge. This study aims to identify biomarkers of renal fibrosis and elucidate the relationship between unilateral ureteral obstruction (UUO), immune infiltration, and cell death.

METHODS

Gene expression matrices for UUO were retrieved from the gene expression omnibus (GSE36496, GSE79443, GSE217650, and GSE217654). Seven genes identified through Protein-Protein Interaction (PPI) network and Support Vector Machine-Recursive Feature Elimination (SVM-RFE) analysis were validated using qRT-PCR in both in vivo and in vitro UUO experiments. WB assays were employed to investigate the role of Clec4n within NF-κB signaling pathway in renal fibrosis. The composition of immune cells in UUO was assessed using CIBERSORT, and gene set variant analysis (GSVA) was utilized to evaluate prevalent signaling pathways and cell death indices.

RESULTS

GO and KEGG enrichment analyses revealed numerous inflammation-related pathways significantly enriched in UUO conditions. Bcl2a1b, Clec4n, and Col1a1 were identified as potential diagnostic biomarkers for UUO. Analysis of immune cell infiltration indicated a correlation between UUO and enhanced mast cell activation. Silencing Clec4n expression appeared to mitigate the inflammatory response in renal fibrosis. GSVA results indicated elevated inflammatory pathway scores in UUO, with significant differences in disulfiram and cuproptosis scores compared to those in the normal murine kidney group.

CONCLUSION

Bcl2a1b, Clec4n, and Col1a1 may serve as biomarkers for diagnosing UUO. UUO development is closely linked to immune cell infiltration, activation of inflammatory pathways, disulfiram, and cuproptosis processes.

Psychedelic interventions for major depressive disorder in the elderly: Exploring novel therapies, promise and potential

The global population is ageing rapidly, with the number of individuals aged 60 and older reaching 1 billion in 2019 and expected to double by 2050. As people age, neuropsychological health often deteriorates, leading to a higher prevalence of age-related depression. Symptoms may include anxiety, apathy, mood instability, sadness, and, in severe cases, suicidal thoughts. Depression in the elderly is a widespread concern, and conventional treatments such as antidepressants are often limited by side effects, reduced efficacy, and complications arising from polypharmacy. In response, novel therapeutic approaches are being explored, including psychedelic interventions. Recent clinical and preclinical studies suggest that psychedelics could offer a promising treatment for major depressive disorder (MDD) in older adults. These compounds, known for their profound neurobiological effects, have gained attention for their potential to address depression where traditional therapies fall short. This review aims to examine the therapeutic promise of psychedelic substances, focusing on those that show potential for treating MDD in the elderly. We also explore the underlying mechanisms through which psychedelics may exert their effects and highlight the preclinical models that support their use. Finally, we address safety considerations and propose strategies to enhance the effectiveness and safety of psychedelics in future clinical trials, offering new hope for treating age-related depressive disorders.

Exploring study dropout in drug trials for adults with PTSD: insights from a conventional and individual participant data meta-analysis

Background: Dropout rates and factors contributing to dropout in drug and placebo groups in pharmacotherapy trials for posttraumatic stress disorder (PTSD) are not well understood.Objective: This study aimed to examine differences in all-cause study dropouts between drug and placebo groups, using conventional meta-analysis and an exploratory predictor analysis of individual participant data from three trials.Method: We included randomized controlled trials (RCTs) of adults with PTSD, comparing drug monotherapy with placebo. Forty-three RCTs (n = 4829) were included in a conventional meta-analysis. Additionally, we conducted a small exploratory predictor analysis including participant-level data from three RCTs (n = 246).Results: In the conventional meta-analysis, study dropout was marginally lower in the drug relative to the placebo group, but the difference was not significant, RR = 0.92, 95% CI [0.83, 1.02], p = .099. Drug class, dosing regimen, population, study duration, or gender were not related to dropout.In the exploratory predictor analysis, study dropout did not differ significantly between drug and placebo groups (p = .617). In the drug group, gender was a significant predictor for dropout, with males having higher dropout rates (p = .046). When controlling for baseline PTSD symptom severity, gender was no longer a statistically significant predictor (p = .051). None of the other predictors in drug, placebo, and combined group analyses were significant in predicting drop-out.Conclusions: This study demonstrated that study dropout rates in monotherapy pharmacotherapy RCTs for PTSD do not significantly differ between drug and placebo groups. These findings underscore the need for further research to identify the factors contributing to dropout in PTSD pharmacotherapy trials and to develop tailored treatment adherence strategies. Additionally, they highlight the importance of pooling participant-level data to facilitate more comprehensive and granular analyses in future research.

Scoring adherence to voluntary restriction diets (SAVoReD) in the ADAPT study

Voluntary adoption of popular food-group-restricting diets like Paleo and plant-based diets (PBDs) are often health-motivated. However, unlike the theoretical design of these diets, different levels of dietary adherence may result in different diet quality and bodyweight in real-world settings-a limitation to the efficacy of dietary interventions. Scoring Adherence to Voluntary Restriction Diets (SAVoReD) is a metric to quantify and compare adherence across food-group-restricting diets. We applied the score to four diets, whole food plant-based (WFPB), vegan, vegetarian, and Paleo to examine associations between adherence and diet quality (Healthy Eating Index; HEI), body mass index (BMI), and diet duration. We also explored the independent associations of adherence and duration with BMI. Higher adherence to WFPB and vegan diets was significantly associated with lower BMI, but no association was observed for vegetarian or Paleo diet followers. For vegan and WFPB, greater adherence was associated with lower BMI among those following their diet ≥2 years compared to <2 years. Adherence was lowest in the diet with the most restrictions (WFPB); however, the stricter fully plant-based diets (WFPB and vegan) had the healthiest HEI scores and BMIs and many long-term followers. Our results suggest that identification with fully plant-based diets is associated with better diet quality and BMI. Vegan, vegetarian, and WFPB diets are often grouped as 'plant-based diets' despite the differing diet compositions, diet quality, adherence, and BMI of followers-thus, grouping them may distort findings. Individuals may benefit from encouragement following a fully plant-based diet, even without perfect adherence.

Cumulative risk for comorbidity of depression and anxiety in young people

BACKGROUND

Depression and anxiety often co-occur, resulting in a more severe prognosis than either condition alone. Identifying the impact of risk factors on this comorbidity is essential for guiding early interventions.

METHOD

Data from 4563 young participants in the Growing Up in New Zealand (GUiNZ) longitudinal study were analysed to identify risk factors associated with comorbid depression and anxiety. Scores for depression and anxiety symptoms were converted into binary variables using the cut-off of 10 and 60, respectively, and then combined to create the comorbidity outcome. A Cumulative Risk (CR) score was used to measure the impact of multiple risk factors from prenatal to childhood on the likelihood of this comorbidity. CR scores were further grouped into three levels of risk, and their association with comorbidity was examined using univariable and multivariable logistic regression analyses.

RESULTS

The prevalence of comorbidity at age 12 years was 8.9% (406/4563). Among young people, 14.2% (647/ 4563) had no risk factors, 64.7% (2953/4563) had one to three (low CR score level), and 21.1% (963/4563) had four or more risk factors (high CR score level). In the adjusted analyses, young people in the low and high CR levels had 2.6 times and 4.6 times higher odds, respectively, of experiencing comorbidity compared to those with no risk factors.

DISCUSSION

The risk of comorbid depression and anxiety symptoms increases with the number of risk factors experienced from prenatal to childhood. Multi-faceted interventions targeting several risk factors are recommended to improve youth mental health.

Sociodemographic and clinical predictors of depression in children and adolescents at clinical high-risk for psychosis: Results of a two-year follow-up study

Depressive disorders are a main cause of disability already in children and adolescents, in whom the clinical picture somewhat differs from adult-onset depression. Depression is also a frequent comorbidity in somatic and mental disorders and has been considered an actionable outcome for, for example, patients at clinical high-risk for psychoses (CHRP). Thus, we studied sociodemographic and clinical predictors of depression/dysthymia in an underage sample with focus on those considered at CHRP. Our baseline sample (N = 676) included CHR-P patients (n = 183), inpatients admitted for non-psychotic, non-affective disorders (n = 277), and community participants (n = 216) of age 8.0-17.9 years (43.8 % male). They were interviewed for mental disorders and symptoms with various instruments, including the Mini International Neuropsychiatric Interview for Children and Adolescents, which was also used to assess depression/dysthymia in the CHR-P group at one- and two-year-follow up (n = 117/73). Stepwise logistic regression analyses were used to first identify a cross-sectional baseline model in the complete sample that was then tested prospectively in CHR-P patients. The baseline model included nationality and 13 clinical variables, particularly mild depressive symptoms. Variables contributing significantly to the prediction of persistence or new occurrence of depression/dysthymia varied over time, indicating that depression/dysthymia in CHR-P minors may require different predictors depending on the follow-up time. Furthermore, the prospective accuracy of ruling out depression/dysthymia was superior to the accuracy of ruling it in. This lower positive likelihood ratio might be overcome in future by stepwise approaches that further stratify risk in those CHR-P minors identified as at increased risk of depression/dysthymia.

Unraveling the core symptoms across distinct trajectories of problematic Internet use among 27,577 adolescents: Cross-lagged panel network analyses

Problematic Internet Use (PIU) often begins in adolescence and develops along diverse trajectories. Understanding the interaction between PIU symptoms and identifying the core PIU symptoms that drive distinct trajectories among adolescents are crucial. We employed cross-lagged panel network analyses to examine temporal relationships of PIU symptoms among Chinese adolescents across four developmental trajectories over two time points. A total of 27,577 adolescents (Mean age = 13.8, SD = 1.5) participated in this study. Demographic variables and PIU symptoms were collected from December 17 to 26, 2021 (T1) and from May 17 to June 5, 2022 (T2). The symptom "Reluctant to stop" in the resilient group and "Uncontrollable checking" in the alleviating group at T1 were most predictive of remission of other symptoms at T2, while "Empty life" in the deteriorating group and "Feeling of missing" in the persistent dysfunction group were most strongly associated with worsening of other PIU symptoms. Improving self-control is likely to promote healthy and beneficial Internet use among adolescents, while enhancing social connection and fostering exercise habits may help mitigate negative emotions and reduce the emergence of additional PIU symptoms among adolescents who have developed PIU.

Peer problems and prosocial behaviours across development: Associations with anxiety and depression in emerging adulthood

Peer problems in childhood and adolescence are associated with anxiety and depression in emerging adulthood. However, it remains unclear whether prosocial behaviours reduce this risk and whether these associations remain after adjusting for familial factors, including genetics. The present study examined how the development of peer problems and prosocial behaviours across childhood and adolescence were associated with anxiety and depression in emerging adulthood, and whether these associations remained when using a monozygotic twin difference design. The study included up to 31,016 participants (50.4 % female) from the Twins Early Development Study (TEDS; N = 19,758) and the Avon Longitudinal Study of Parents and Children (ALSPAC; N = 11,258), with sample sizes varying across analyses based on data availability. Repeated data were collected from ages 4 to 26/28 (TEDS/ALSPAC). Results from latent growth curve and path analyses showed that higher initial levels of peer problems and prosocial behaviours in childhood, as well as more persistent peer problems and prosocial behaviours during childhood, increased risk for anxiety and depression in emerging adulthood. Associations with peer problems remained significant after adjusting for familial factors using monozygotic twin difference scores, suggesting that individual-specific experiences, like children's responses to peer problems, may explain why peer problems increase risk for later anxiety and depression. In contrast, associations with prosocial behaviours did not remain significant after adjusting for familial factors, indicating that whilst prosocial behaviours in childhood were associated with higher levels of anxiety and depression in emerging adulthood, this was largely explained by genetic or environmental factors shared within the family.

Hemodynamic characteristics at baseline and following repeated transcranial magnetic stimulation treatment

The mechanism underlying the efficacy of repetitive transcranial magnetic stimulation (rTMS) remains unclear, particularly regarding its impact on different severities of depression. From a personalized treatment perspective, evaluating functional improvements by illness severity is crucial. This study investigated changes in cerebral hemodynamics before and after six weeks of rTMS treatment in 45 patients with depression, using functional near-infrared spectroscopy (fNIRS). The aim was to assess changes in hemodynamics according to the severity of depressive symptoms, as classified by the 17-item Hamilton Depression Rating Scale (HAM-D 17). Prior to treatment, patients with higher severity (HAM-D 17 score ≥ 24) exhibited significantly reduced blood flow in brain regions such as the frontopolar area, and dorsolateral and inferior prefrontal areas compared to patients with lower severity. After six weeks of rTMS treatment, a significant increase in hemodynamic response was observed in the frontopolar cortex and left lateral frontal regions. Moreover, a significant increase in hemodynamic response was noted in the frontopolar cortex in both the mild and severe groups, compared to the moderate group. Notably, patients exhibiting increased hemodynamics parameters also demonstrated significant improvements in depressive symptoms, as reflected by reductions in HAM-D scores. These findings suggest a potential correlation between rTMS-induced hemodynamic changes in the frontal region and improved treatment outcomes. Furthermore, the results imply that rTMS may promote neuroplasticity in specific brain regions, thereby contributing to the alleviation of depressive symptoms.

Innovative approaches to managing chronic multimorbidity: A multidisciplinary perspective

The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems, necessitating the development of innovative management strategies to optimize patient care and system efficiency. The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit (HCU) specifically designed to improve the management of patients with chronic complex conditions. By adopting a multidisciplinary approach, the HCU aims to provide comprehensive, patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services. Utilizing a longitudinal analysis of data from the Basic Minimum Data Set, this study compares hospitalization metrics among the HCU, Internal Medicine, and other departments within a regional hospital throughout 2022. The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices. The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity, emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care. This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.

Exploring Alzheimer's disease treatment: Established therapies and novel strategies for future care

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by a gradual decline in cognitive function, memory impairment, and alterations in behavior. As the predominant etiology of dementia, AD affects millions of individuals worldwide, with its hallmark pathological feature being the accumulation of amyloid beta (Aβ) plaques, which disrupt neuronal function and progressively compromise brain structure. Early clinical manifestations often include forgetfulness, disorientation, and social withdrawal. Primarily impacting the elderly population, AD significantly impairs daily functioning and diminishes overall quality of life. Current therapeutic approaches for AD mainly focus on symptomatic relief and decelerating the disease's progression. Cholinesterase inhibitors, such as donepezil and rivastigmine, increase acetylcholine (ACh) levels to enhance cognitive function in individuals with mild to moderate AD. For individuals in more advanced stages of the disease, NMDA receptor antagonists modulate glutamate activity to mitigate excitotoxicity. In addition to pharmacological interventions, lifestyle modifications such as adherence to a balanced diet, regular physical activity, and cognitive engagement are advocated to support brain health. Novel therapeutic avenues are being explored to address underlying pathophysiological mechanisms, such as metal ion dysregulation within the brain. Furthermore, non-pharmacological approaches, including cognitive-behavioral therapy and patient support groups, provide essential behavioral and emotional support. Cutting-edge research continues to investigate innovative treatments, such as immunotherapies targeting amyloid plaques and tau tangles and neuroprotective compounds derived from natural sources. The goal of these multifaceted strategies is to alleviate symptoms, enhance quality of life, and offer hope for individuals and families affected by AD. This review provides a comprehensive summary of both established and emerging therapeutic interventions for the management of AD.

Vascular depression: A comprehensive exploration of the definition, mechanisms, and clinical challenges

Vascular depression (VaDep), which was proposed over two decades ago, is a distinct subtype of depression primarily observed in patients with stroke and cerebral small-vessel disease and is characterized by white matter hyperintensities; however, the lack of standardized diagnostic criteria and consensus limits its clinical application. This review explores the pathological conditions and vascular risk factors that may precipitate VaDep, particularly in relation to stroke and cerebral small-vessel disease. VaDep is distinguished by unique pathophysiological mechanisms and treatment responses. We categorize these mechanisms into three groups: 1) macroscopic mechanisms, including vascular aging, cerebral hypoperfusion, blood-brain barrier disruption, and neural circuit dysfunction; 2) microscopic mechanisms, involving the inflammatory response, hypothalamic-pituitary-adrenal axis dysregulation, impaired monoamine synthesis, and mitochondrial dysfunction; and 3) undetermined mechanisms, such as microbiota-gut-brain axis dysbiosis. These insights support VaDep as a distinct depression subtype, differentiating it from late-life depression and major depressive disorder. Treatment is challenging, as patients with VaDep often exhibit resistance to conventional antidepressants. Addressing vascular risk factors and protecting vascular integrity are essential for effective management. Future research should validate these mechanisms and develop novel diagnostic and therapeutic approaches to improve VaDep outcomes.

The Importance of Treatment Modality in Veterans with Opioid Use Disorder: Implications for Virtual Care

This study examined treatment utilization across in-person and virtual treatment modalities in veterans who were on medications for opioid use disorder (MOUD; N = 139). Treatment records for veterans in addiction treatment on MOUD were examined for 3-months prior to telehealth conversions ("Pre-Telehealth," 12/02/2019-03/14/2020), 3-months during the initial telehealth transition ("Telehealth," 03/15/2020-06/30/2020) and 3-months during post-telehealth transition ("Re-Entry," 07/01/2020-10/01/2020). Analyses examined the relationship between treatment modality and demographic features, psychiatric comorbidities, treatment engagement, and illness severity as measured by psychiatric emergency room (PER) utilization. Results demonstrated that modality was not associated with PER utilization. Past-year PER visits, alcohol use disorder (AUD), and psychotic disorders were associated with PER utilization during Telehealth, while AUD was associated with Re-Entry PER utilization. Given the likelihood of virtual treatment in the future, frequent in-person visits may not be necessary for MOUD; however, individuals with comorbid AUD and psychotic disorders may need additional support to prevent emergency care.

Advancing network meta-analysis in non-invasive brain stimulation: Optimizing post-stroke mood through combined therapies

BACKGROUND

Post-stroke depression and anxiety significantly impact recovery and quality of life. Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS), have emerged as promising therapeutic options. However, the relative efficacy of single and combined NIBS therapies remains unclear. This network meta-analysis aims to identify the most effective combination therapies for optimizing post-stroke mood disorders.

NEW METHOD

A systematic search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and key Chinese databases to identify randomized controlled trials (RCTs) published up to March 2023. Two independent reviewers screened the studies, extracted relevant data, and assessed the risk of bias using the Cochrane Handbook. A network meta-analysis was performed using Stata SE version 15.1 and R software version 4.2.3 to evaluate the comparative effectiveness of different NIBS interventions.

RESULTS

A total of 50 RCTs involving 3852 participants and 18 different interventions (including 11 combination therapies) were analyzed. The findings revealed: COMPARISON WITH EXISTING METHODS: Unlike previous studies focusing on single-modality interventions, this network meta-analysis systematically evaluates the comparative effectiveness of various combined NIBS strategies. Results indicate that combination therapies significantly outperform single-modality treatments, with TMS-based protocols showing the greatest overall benefit in improving both mood disorders and functional independence.

CONCLUSIONS

The findings suggest that optimized combination NIBS therapies offer superior outcomes for post-stroke depression and anxiety. HFrTMS_LFrTMS_WM was the most effective for depression and independence in activities of daily living (ADLs), while tDCS_psychotherapy and TUS_WM were particularly effective for anxiety. These results highlight the clinical potential of integrated NIBS strategies for post-stroke mood optimization and call for further research to refine treatment protocols for enhanced patient outcomes.

MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events. Currently, there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder. In addition, the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment. Evidence suggests that this condition is a multisystem disorder that affects many biological systems, raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder. We performed a PubMed search for microRNAs (miRNAs) in post-traumatic stress disorder (PTSD) that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023. These included four studies with whole blood, seven with peripheral blood mononuclear cells, four with plasma extracellular vesicles/exosomes, and one with serum exosomes. One of these studies had also used whole plasma. Two studies were excluded as they did not involve microRNA biomarkers. Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat, and only two were from recently traumatized adult subjects. In measuring miRNA expression levels, many of the studies had used microarray miRNA analysis, miRNA Seq analysis, or NanoString panels. Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls. The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood; miR-193a-5p, -7113-5p, -125a, -181c, and -671-5p in peripheral blood mononuclear cells; miR-10b-5p, -203a-3p, -4488, -502-3p, -874-3p, -5100, and -7641 in plasma extracellular vesicles/exosomes; and miR-18a-3p and -7-1-5p in blood plasma. Several important limitations identified in the studies need to be taken into account in future studies. Further studies are warranted with war veterans and recently traumatized children, adolescents, and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Lower- versus higher-order suicide-related attentional processing measures as predictors of adolescent suicide ideation and attempt

Cognitive theories suggest that biased suicide-related attentional processing confers risk for suicide ideation (SI) and attempts (SAs), but studies to date, which have been mixed, have not compared lower- and higher-order measures of attentional processes. The present study examined attention fixation, attention disengagement, and semantic interference as predictors of future SI and SA among adolescents, a high-risk age group for onset of SI and SAs. Adolescents (N = 135) (75 % female), ages 12-19 (M = 15.4, SD = 1.9), who presented to emergency or outpatient departments with SI (n = 84) or a SA (n = 51) completed an attention disengagement task (ADT), Suicide Stroop task, and the Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ). A subsample of adolescents completed 3-month (n = 98) and 12-month follow-up assessments (n = 96) of SI severity and SA (n = 118) (based on adolescent or caregiver report). AFSEQ score predicted SI severity at 3- and 12-months, respectively, b = 0.47, p < .05; b = 0.44, p < .01, adjusting for ADT and relevant covariates, and also predicted SA at follow up, OR = 1.06, 95 % CI = 1.00-1.12, p < .05, adjusting for SA history, but not after adjusting for SI. Greater suicide-related attention disengagement difficulty predicted greater SI severity at 12 months, b = 0.03, p < .05, but not at 3 months. Self-reported, higher-order, attentional fixation may better predict future suicide-related risk among diverse adolescents than lower-order cognitive tasks assessing suicide-related attention disengagement or semantic interference.

Schizophrenia-like phenotypes and long-term synaptic plasticity impairment in GluN2A-transgenic mice

While N-methyl-d-aspartate receptor (NMDAR) hypofunction has been suggested as a hallmark of schizophrenia, the role of subunit-specific dysregulation such as GluN2A overexpression remains poorly understood. The present study comprehensively investigated the impact of GluN2A overexpression on behavioral phenotypes, cognitive functions, and synaptic plasticity in transgenic mice with forebrain-specific overexpression of the GluN2A subunit (GluN2A-TG). Behavioral assessments revealed schizophrenia-like phenotypes, including prolonged stereotypic movement duration, impaired sensorimotor gating, reduced social interaction, and diminished nest-building activity in GluN2A-TG mice. Consistently, GluN2A-TG mice exhibited not only deficits in spatial working memory and olfactory working memory but also impaired associative learning. In addition, both long-term potentiation and long-term depression were significantly attenuated in the prefrontal cortex (PFC) of GluN2A-TG mice. Furthermore, electrophysiological analysis of NMDAR-mediated excitatory postsynaptic currents in PFC neurons revealed altered kinetics characterized by a faster decay time and significantly increased amplitude in GluN2A-TG mice. Collectively, these findings suggest that GluN2A overexpression may induce schizophrenia-like phenotypes via impairing NMDAR-dependent long-term synaptic plasticity in the PFC, likely due to altered NMDAR subunit composition leading to disrupted calcium signaling dynamics. These results provide critical insights into the pathological role of GluN2A in schizophrenia.

Validated Survey Tools for Pre-operative Psychological Assessment in Plastic Surgery

Psychological assessment in plastic and reconstructive surgery is gaining recognition, prompting interest in preoperative screening. Surgeons face challenges in integrating these evaluations due to time constraints and unfamiliarity with psychological measures. Patient-reported outcome measures, such as BREAST-Q, FACE-Q, and BODY-Q, assess quality of life and satisfaction in surgical patients. Studies indicate high rates of psychological disorders among cosmetic surgery patients, highlighting the need for screening. Some guidelines, like those from the United Kingdom's National Institute for Health and Care Excellence, recommend preoperative screening for conditions like body dysmorphic disorder. Increased awareness of validated psychological tools can enhance holistic patient care.

The neuroplastic brain: current breakthroughs and emerging frontiers

Neuroplasticity, the brain's capacity to reorganize itself by forming new neural connections, is central to modern neuroscience. Once believed to occur only during early development, research now shows that plasticity continues throughout the lifespan, supporting learning, memory, and recovery from injury or disease. Substantial progress has been made in understanding the mechanisms underlying neuroplasticity and their therapeutic applications. This overview article examines synaptic plasticity, structural remodeling, neurogenesis, and functional reorganization, highlighting both adaptive (beneficial) and maladaptive (harmful) processes across different life stages. Recent strategies to harness neuroplasticity, ranging from pharmacological agents and lifestyle interventions to cutting-edge technologies like brain-computer interfaces (BCIs) and targeted neuromodulation are evaluated in light of current empirical evidence. Contradictory findings in the literature are addressed, and methodological limitations that hamper widespread clinical adoption are discussed. The ethical and societal implications of deploying novel neuroplasticity-based interventions, including issues of equitable access, data privacy, and the blurred line between treatment and enhancement, are then explored in a structured manner. By integrating mechanistic insights, empirical data, and ethical considerations, the aim is to provide a comprehensive and balanced perspective for researchers, clinicians, and policymakers working to optimize brain health across diverse populations.

Risk of corrected QT interval prolongation in patients receiving antipsychotics

Antipsychotic (AP) use has been associated to QT interval prolongation on the surface electrocardiogram (ECG). Our study aimed to determine the incidence of corrected QT (QTc) interval prolongation among patients admitted to a psychiatric hospitalization unit requiring AP treatment and to assess the relationship between administered dose and QTc interval changes. We enrolled 179 patients admitted to the Hospital Psiquiátrico Departamental Universitario del Valle in Cali, Colombia. ECGs were conducted upon admission, and again at 3 and 7 days postadmission. The QT interval was measured, and QTc interval correction was performed using Bazzet's formula. QTc interval prolongation at time points B or C was observed in 9.5% of patients. Clozapine was the most common AP associated with QTc interval prolongation (20.59%), followed by olanzapine (15.38%). The relative risk of QT interval prolongation with clozapine compared to haloperidol was 4.17 (95% confidence interval, 1.14-15.17, P  = 0.02). AP use upon hospital admission was linked to early (within 3 days) QTc interval prolongation. Clozapine and olanzapine were associated with a greater increase in QTc interval compared to haloperidol, indicating a need for rigorous electrocardiographic monitoring with their use.

ADHD and Sex Hormones in Females: A Systematic Review

OBJECTIVE

ADHD is a neurodevelopmental condition associated with elevated symptoms of inattention and hyperactivity/impulsivity. Symptoms of ADHD typically persist into adulthood and can impair functioning and overall quality of life. In females (including women and people assigned female at birth), ADHD is under-recognized, and knowledge about the relationship between ADHD symptoms and sex hormones is lacking. This systematic review aimed to synthesize the current evidence investigating the relationship between ADHD symptoms (including medication effects) and sex hormones in females.

METHOD

Searches were conducted within Ovid MEDLINE, Embase, and PsycINFO from 1980 to January 2025. Included studies investigated ADHD symptoms in the context of hormonal changes in females, including studies specifically exploring ADHD and sex hormones, as well as hormonal life stages (puberty, menstrual cycle, and pregnancy). Narrative synthesis was utilized for data extraction, grouping studies by hormonal phase.

RESULTS

A total of 11 studies were included in this review. Evidence was largely suggestive of a relationship between ADHD symptoms and sex hormones in females, specifically in puberty and across the menstrual cycle. Findings were limited by the small number of studies reviewed, often with small sample sizes and considerable diversity in participant populations and outcome measures.

CONCLUSION

Sex hormones and phases related to hormonal changes (such as puberty and the menstrual cycle) may be associated with ADHD symptom changes in females. Further research is needed to understand the relationship between sex hormones and ADHD symptoms and requires investigation of a wider range of hormonal milestones in females, including menopause.

Postnatal propionic acid exposure disrupts hippocampal agmatine homeostasis leading to social deficits and cognitive impairment in autism spectrum disorder-like phenotype in rats

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by a range of symptoms including impaired social interaction and cognitive deficits. Although the exact pathogenesis of ASD is not well established, recent clinical findings suggest a decline in levels of biogenic amine agmatine in autistic patients. The present study was designed to investigate the impact of postnatal propionic acid (PPA) exposure on hippocampal agmatine homeostasis in male rat pups and to explore a new therapeutic intervention for ASD using agmatine as a biological target. PPA is commonly used in experimental models of ASD due to its ability to induce social deficits, cognitive impairments, and stereotyped behaviors, which closely resemble key characteristics of ASD. Male rat pups were administered with PPA via the intrahippocampal route bilaterally (25 μg/0.25 μl per side) on PND-21 to simulate the ASD phenotype, and its subsequent effect on the endogenous agmatinergic system. The influence of agmatine treatment and its endogenous modulation on ASD-like phenotypes was also investigated. Behavioral assessments revealed that PPA exposure reduced sociability and social preference, caused learning and memory impairment in the Morris water maze, increased anxiety-like behavior in the elevated plus maze, and reduced exploratory behavior in the hole board test. Neurochemical analyses showed a decrease in agmatine concentration and an increase in its degrading enzyme agmatinase in the hippocampus. PPA treatment altered the content of GABA, glutamate, TNF-α, IL-6, BDNF, and also resulted in increased astrogliosis and neurotoxicity within the hippocampus. Chronic agmatine treatment and its endogenous modulation ameliorated the behavioral and biochemical disruptions induced by PPA exposure. This study highlights the critical role of hippocampal agmatinergic pathway in the etiopathogenesis of ASD, positioning agmatine as a promising therapeutic target for its treatment.

Hospitalizations for pediatric catatonia in neurodivergent and neurotypical patients

INTRODUCTION

Catatonia is a neuropsychiatric disorder that occurs in pediatric patients with a range of associated medical, psychiatric, and neurodevelopmental disorders (NDDs). This study describes hospital care of pediatric catatonia patients and compares treatments for neurotypical patients and those with NDDs.

METHODS

Retrospective cohort study from 1/1/2018 to 6/1/2023 of two academic medical centers of patients aged 18 and younger with catatonia. Patients were retrospectively assessed using the clinical global impressions-improvement (CGI-I) by two independent reviewers.

RESULTS

One hundred sixty-five patients were hospitalized for catatonia, of whom 50.3 % had an NDD. Median age was 15. One hundred sixty-four patients were treated with a benzodiazepine, with a median maximum 24-hour dose of 6 mg lorazepam-equivalents, which did not differ for patients with and without NDDs. Electroconvulsive therapy (ECT) was utilized in 14.5 % of patients. Median length of medical hospitalization was 5 days and hospitalizations were longer in neurotypical patients than in patients with NDDs. In an ordinal regression model, the probability of observing at least "much improvement" (CGI < 3) was 88.3 % (95 % CI: 82.4 % to 92.3 %), with patients with a non-medical primary diagnosis and an NDD having a lower odds of response than non-medical primary diagnosis without an NDD.

CONCLUSIONS

The probability of patients achieving a CGI-I score indicating at least "much improvement" was 88.3 %. Administered benzodiazepine dose and ECT treatment were similar for all patients, but neurotypical patients had longer hospitalizations than those with NDDs and had a higher odds of a more favorable clinical response for patients with non-medical primary diagnoses. Research under controlled conditions is needed to optimize and endure equitable catatonia treatment in youth.

Hyperforin-induced gut microbiota metabolite carbocysteine protects against depressive-like behaviors in mice by modulating the colonic mucus barrier

OBJECTIVE

Depression affects millions, and current treatments have limitations, necessitating new approaches. Earlier research confirms Hyperforin's ability to reduce anhedonic behaviors in mice and modulate gut microbiota. This study aims to identify specific metabolic changes induced by Hyperforin that could illuminate its impact on gut microbiome metabolism, possibly uncovering novel metabolites for developing antidepressant therapies.

METHODS

Following the chronic stress model, untargeted metabolomic analysis of fecal samples was conducted to identify metabolic changes induced by Hyperforin. Bioinformatics tools analyzed the origins of differentially expressed metabolites and their correlation with Akkermansia muciniphila and Muribaculum intestinale. The significant metabolite Carbocysteine was further investigated for its antidepressant effects using behavioral assays in a mouse model of depression. Additionally, the response of the colonic mucus barrier was evaluated using Periodic Acid-Schiff (PAS) staining, scanning electron microscopy (SEM), and enzyme-linked immunosorbent assays (ELISA).

RESULTS

Hyperforin significantly altered fecal metabolite profiles in stressed mice, with a notable shift in 239 metabolites mainly associated with co-metabolism pathways and microbiota-specific processes. Among these, Carbocysteine emerged as a key metabolite linked to beneficial bacteria Akkermansia muciniphila and Muribaculum intestinale, with its levels significantly elevated following Hyperforin treatment. Behavioral assessments indicated that Carbocysteine supplementation ameliorated depressive-like behaviors in the chronic restraint stress mouse model. It also enhanced colonic mucus production and integrity.

CONCLUSION

Our research highlights Hyperforin's role in modulating gut microbiota metabolism and identifies Carbocysteine as a potential antidepressant. These findings advance our understanding of the gut-brain axis (GBA) in depression and pave the way for developing new therapeutics.

Function and application of brain‑derived neurotrophic factor precursors (Review)

Brain‑derived neurotrophic factor precursor (proBDNF) plays a critical role in the pathogenesis and progression of various human diseases. Through its interaction with p75NTR and sortilin receptors, proBDNF promotes apoptosis, impairs synaptic plasticity, and contributes to the regulation of immune system function, inflammatory responses and cellular metabolic processes. proBDNF is widely distributed throughout the body, and as such, extensive research has demonstrated that proBDNF is significantly associated with the pathophysiological mechanisms underlying several diseases. In the present review, the mechanisms by which proBDNF contributes to different diseases are summarized to highlight its potential therapeutic and diagnostic implications. Specifically, the role of proBDNF in cognitive disorders, focusing on its effects on synaptic function and neural network dynamics, while analyzing the cascade reactions involving proBDNF and downstream effector molecules in inflammatory diseases, to elucidate its bidirectional regulatory effects in tumor initiation and progression. Furthermore, the function of proBDNF in neurogenesis, the mechanism by which it regulates the memory of fear, and enhances individual behavioral flexibility is discussed. Finally, the potential of proBDNF as a biomarker for disease diagnosis and the therapeutic prospects of targeting it using monoclonal antibodies are highlighted while also proposing future research directions. The present review can serve as a reference for translational medical research on proBDNF and its receptors.

Biomarkers for tracking metabolic changes pre-post nutritional epigenetics diet/intervention to prevent autism and attention deficit/hyperactivity disorders in children

The prevalence of autism and attention deficit/hyperactivity disorders is increasing worldwide. Recent studies suggest the excessive intake of ultra-processed food plays a role in the inheritance of these disorders via heavy metal exposures and nutritional deficits that impact the expression of genes. In the case of the metallothionein (MT) gene, biomarker studies show dietary zinc (Zn) deficits impact MT protein levels in children with autism and are associated with the bioaccumulation of lead and/or mercury in children exhibiting autism/attention deficit/hyperactivity disorders symptomology. The impact of dietary changes on lead and mercury exposures and MT gene behavior could be determined using a randomized test and control group design. Pregnant women serving in the test-group would participate in a nutritional epigenetics education intervention/course designed to reduce ultra-processed food intake and heavy metal levels in blood while increasing whole food intake and MT and Zn levels. Changes in maternal diet would be measured using data derived from an online diet survey administered to the test and control groups pre-post intervention. Changes in maternal lead, mercury, Zn, and MT levels would be measured via blood sample analyses prior to the intervention and after childbirth via cord blood analyses to determine infant risk factors.

Deconstructive meditations and psychotherapy: Transforming the perception of the self

Selfishness, understood as excessive focus on the self, appears to be a predominant feature of contemporary culture. While the degree of self-focus is adaptive for survival and decision-making, self-rigidity has been associated with significant psychological, interpersonal, and social costs. Throughout history, philosophers, religious leaders, and social activists have promoted a “hypo-egoic” way of being, characterized by reduced self-fixation and greater openness to others. However, a key question arises: How can one cultivate a more flexible and interdependent perspective on the self? Deconstructive meditations are a group of contemplative practices that aim to dismantle self-rigidity by exploring perception, cognition, and emotion. Their central mechanism is self-inquiry, an experiential process that involves directly observing patterns of the self, questioning the solidity of identity, and developing new ways to relate to experience. From the perspective of contemplative neuroscience, these practices have been shown to reduce self-narrative identification and promote psychological flexibility. Despite their potential, empirical research on deconstructive meditations remains limited and requires further investigation. This article reviews the essential findings on practices, their connection to psychotherapy, and their potential therapeutic applications. Finally, their clinical implications are discussed along with future research directions to validate their impact on mental health.

Status of anxiety and depression among chronic heart failure patients: Factors influencing poor fluid restriction adherence

BACKGROUND

Anxiety and depression are prevalent among patients with chronic heart failure (CHF) and can adversely contribute to treatment adherence and clinical outcomes. Poor fluid restriction adherence is a widespread challenge in the management of CHF. To effectively manage disease progression and alleviate symptoms, it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.

AIM

To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.

METHODS

Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study. Questionnaires, including the Psychosomatic Symptom Scale, Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Fluid Restriction Adherence Questionnaire were administered to patients. Based on their anxiety and depression scores, patients were categorized into anxiety/depression and non-anxiety/depression groups, as well as fluid restriction adherence and fluid restriction non-adherence groups. General patient data were collected, and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety. Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.

RESULTS

Statistically significant differences in age, New York Heart Association (NYHA) grading, marital status, educational attainment, and family support were observed between depressed and non-depressed CHF patients (P < 0.05). Age, NYHA grading, marital status, educational attainment, and family support were identified as factors influencing the development of depression. The anxiety and non-anxiety groups differed statistically in terms of gender, age, NYHA grading, smoking history, alcohol consumption history, monthly income, educational attainment, and family support (P < 0.05). Gender, smoking, alcohol consumption, monthly income, and educational attainment affected anxiety in these patients. The fluid restriction adherence rate was 28.0%, and thirst sensation, anxiety, and depression were identified as independent influencing factors.

CONCLUSION

CHF patients are susceptible to anxiety and depression, with multiple associated influencing factors. Moreover, anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.

Interplay between insomnia, anxiety, and depression

Insomnia, anxiety, and depression have become critical mental health issues exacerbated by the coronavirus disease 2019 pandemic, highlighting the importance of understanding their interrelationships. This article evaluates the study by Li et al, which investigates the links between insomnia, anxiety, and depression while examining the mediating role of cognitive failures and the moderating effect of neuroticism. The study employed a cross-sectional design with 1011 participants, using validated scales to measure insomnia severity, neuroticism, cognitive failures, and mental health indicators. Li et al found that approximately 40% of participants exhibited symptoms of anxiety, depression, and insomnia, with most cases being mild. The results demonstrated that cognitive failures play a mediating role in the relationship between insomnia and both anxiety and depression. Furthermore, neuroticism moderated the relationship between insomnia and cognitive failures, with a stronger effect observed in individuals with lower levels of neuroticism. These findings underscore the importance of considering personality traits and cognitive processes in understanding mental health outcomes. This study emphasizes the critical need for interventions aimed at reducing cognitive failures and enhancing emotional stability to mitigate the impact of insomnia on mental health. Strategies to improve sleep quality, boost cognitive resilience, and regulate emotional responses could significantly enhance individuals’ mental well-being. Moreover, integrating personality assessments into mental health services could facilitate more effective and personalized interventions. This article provides an original perspective on the effects of the coronavirus disease 2019 pandemic on global mental health. The content of the article addresses the complex relationships between sleep disorders, cognitive function losses, and neuroticism in light of data compiled from existing literature and current research. In addition, how these relationships have deepened during the pandemic and the effectiveness of proposed treatment methods for these phenomena are discussed in comparison with previous studies. The arguments in the article offer new perspectives and suggestions aimed at filling gaps in the literature, and make an important contribution to both clinical practice and public health policies. Li et al’s study provides a comprehensive framework for understanding the connections between insomnia, cognitive failures, and neuroticism, as well as their influence on anxiety and depression. The findings offer valuable implications for public health strategies, emphasizing the necessity of holistic approaches to address post-pandemic mental health challenges.

Perceived stress, risk factors and prognostic monitoring loci for the development of depression

This article examines stress and its potential role in the development of depression. By reviewing existing literature, the article explores the possible role of stress in diagnosing and monitoring depression and highlights the importance of managing personal stress in the treatment of depression. The article also discusses the many ways that stress and depression are connected, and suggests ideas for subsequent investigations. This includes developing more exact ways to measure biomarkers, exploring treatments that are not based on drugs, and looking at the effect that society has on depression.

Closer look at the cardiovascular and metabolic predictors of postpartum depression

Postpartum depression (PPD) is a severe mental health disorder affecting 10% to 15% of postpartum women worldwide. Pre-eclampsia is a hypertensive disorder of pregnancy that has been identified as a significant factor for PPD due to its vascular dysfunction, systemic inflammation and neurobiological alterations. The neuroinflammatory mechanisms common to both pre-eclampsia and PPD, that contribute to depressive symptoms include elevated proinflammatory cytokines (interleukin-6, tumor necrosis factor-alpha), activation of the kynurenine pathway, and oxidative stress. To critically evaluate Wu et al's study, which investigates blood pressure variability (BPV) and gestational body mass index (BMI) as independent predictors of PPD. To integrate recent findings on the metabolic and cardiovascular links between depression, pre-eclampsia, and postpartum mental health outcomes. Pre-pregnancy BMI is found to be a stronger predictor of PPD than gestational weight gain. A vascular-neuropsychiatric connection has been indicated in pre-eclamptic women, indicating a significant correlation between BPV and depressive postpartum symptoms. There is increased susceptibility to depression due to neuroinflammation contributed by blood pressure fluctuations and metabolic dysregulation. The incidence of PPD could be reduced by early identification and intervention for BP fluctuations. Early detection and intervention in high-risk pregnancies should be conducted through public health strategies that prioritize awareness, education, and accessibility to mental health care.

Sleep disorders and mental health: Understanding the cognitive connection

Sleep disorders, particularly insomnia, have emerged as a critical public health challenge, with the situation worsened by the coronavirus disease-2019 pandemic. Insomnia symptoms, which affected up to 45% of the population during this period, highlight the urgent need to understand the mechanisms linking sleep disturbances to mental health outcomes. Recent findings suggest that cognitive failures, such as memory lapses and attentional deficits, mediate the relationship between insomnia and emotional disorders such as anxiety and depression. The role of personality traits, particularly neuroticism, adds further complexity, as it may either exacerbate or buffer these effects under specific conditions. This review explores the study by Li et al, which offers valuable insights into the cognitive-emotional pathways influenced by sleep disturbances. The study makes significant contributions by identifying key cognitive mechanisms and proposing the dual role of neuroticism in shaping emotional outcomes. To advance these findings, this letter advocates for future longitudinal research and the integration of targeted interventions, such as cognitive-behavioral therapy for insomnia, into public health frameworks. By addressing insomnia-induced cognitive dysfunction, these strategies can enhance emotional regulation and foster resilience, particularly in vulnerable populations facing the mental health impacts of the pandemic.

Nutritional psychiatry for hypertensive older adults

Hypertension, a prevalent condition among older adults, has been identified as a risk factor for cognitive decline. Nutritional status is a pivotal factor in preserving cognitive function in hypertensive older adults. Nutritional psychiatry underscores the significance of anti-inflammatory diets in promoting mental and cognitive health. This article examined the mechanisms by which body mass index, serum hemoglobin, serum albumin, and alkaline phosphatase levels predict cognitive function in hypertensive older adults. Nutrition emerges as a modifiable factor that can be targeted to maintain cognitive function in these patients.

Refining smart healthcare care for mental health and substance use disorders: A patient-centred, evidence-based approach

In this article, we comment on the article by Zhang et al, which explores the familiarity, awareness, and usage of smart medical care and its correlation with mental health and personality traits. The use of intelligent healthcare technologies in treating mental disorders and substance use disorders shows significant promise, but involves certain challenges, such as limited access, low technological literacy, and privacy concerns. These barriers disproportionately affect deprived populations and individuals with severe mental health conditions. We highlight the positive impact of smart healthcare solutions, such as telemedicine and wearable technologies, on patient engagement, remote monitoring, and treatment adherence. To overcome these challenges, we propose strategies, such as improving user-friendliness, ensuring equitable access to digital interventions, enhancing cybersecurity, and integrating smart healthcare into clinical workflows. Training healthcare providers and developing policies to ensure the ethical use of patient data are essential. When implemented thoughtfully, smart healthcare technologies can revolutionize mental health and substance use disorder treatment, improve patient outcomes, and reduce healthcare inequities.

Central obesity and post-stroke depression: Implications for stroke recovery

Post-stroke depression (PSD) is a prevalent but often underdiagnosed complication affecting stroke survivors, with significant implications for recovery and quality of life. Emerging evidence suggests that central obesity, as measured by the weight-to-waist index (WWI), may play a crucial role in PSD risk and severity. Traditional obesity metrics, such as body mass index, may not accurately capture the impact of visceral fat distribution on neuropsychiatric outcomes. This letter highlights the growing recognition of WWI as a precise indicator of metabolic and inflammatory disturbances linked to post-stroke mental health. Integrating WWI into routine stroke rehabilitation assessments could facilitate early identification of high-risk patients and improve intervention strategies. Further research is needed to establish standardized WWI cutoff values and explore potential therapeutic targets for PSD prevention.

Association between inequalities in mental health resources and burdens of mental health disorders in 146 countries and territories: An observational study

BACKGROUND

Mental health disorders impose a substantial social and economic burden. We conducted a comprehensive assessment of global mental health resource allocation and the associated burdens of mental health disorders, examining the relationship between these two factors.

METHODS

We utilized data from the WHO Global Health Observatory and GBD 2021 to encompass 146 countries. We employed spatial autocorrelation analysis and Lorenz curves to characterize the spatial distribution. Additionally, we examined the association between mental health resources and the burdens of mental disorders using a generalized linear regression model (GLM).

RESULTS

Countries and territories with higher income levels were more likely to have greater mental health resources (p < 0.05). Globally, the average mental health resource allocation index (IMRA) was 18.14, and Moran's I was 0.509 (p < 0.001). The Lorenz curve of mental health resources lay below the equality line, suggesting that these resources were more concentrated in countries and territories with higher HDI values. Between 2011 and 2021, the age-standardized incidence rate of all mental health disorders increased significantly (EAPC: 1.41 %, 95 % CI: 0.40 % to 2.53 %, p = 0.011). In multivariable GLM, a negative association was observed between the Index of IMRA and total mental health incidence.

CONCLUSION

Inequalities in mental health resources persist, and the burdens of mental disorders are increasing globally. Our findings underscore the critical need to reduce the overall burden of mental health disorders through enhanced allocation of prevention-oriented resources. Countries at different levels of human development face distinct challenges and priorities in mental health resource allocation.

Dysregulation of proBDNF/p75NTR and BDNF/TrkB Signaling in Acute Ischemic Stroke: Different Sides of the Same Coins

Acute ischemic stroke (AIS) is a focal neurological deficit due to sudden occlusion of cerebral vessels in the brain. AIS-induced neuronal injury and associated excite-toxicity and neurodegeneration affect the synthesis and the release of different neurotrophic factors such as brain-derived neurotropic factor (BDNF) and its precursor proBDNF. Both BDNF and proBDNF act on the specific receptors with different neurological effects. BDNF activates tropomyosin receptor kinase B (TrkB) receptor results in promoting neuronal survival, synaptic plasticity, and neuronal growth. However, the proBDNF activates p75 neurotrophin receptor (p75NTR) and sortilin which attenuates synaptic plasticity and promotes neuronal apoptosis. Dysregulation of central and peripheral expression of proBDNF/BDNF is linked with the severity and clinical outcomes of AIS. Therefore, this review aims to discuss the alterations of proBDNF/BDNF signaling in AIS. Findings from the present review illustrated that proBDNF/p75NTR/sortilin signaling pathway is exaggerated whereas; BDNF-TrkB signaling is reduced in AIS leading to neuronal apoptosis. Therefore, activation of BDNF-TrkB signaling, and inhibition of proBDNF/p75NTR/sortilin signaling pathway could be a promising therapeutic strategy in the management of AIS.

Peripheral and central inflammation in depression: How large is the gap and can we bridge it with PET neuroimaging and neural-derived extracellular vesicles?

Major depressive disorder (MDD) presents as a multifaceted syndrome with complex pathophysiology and variable treatment responses, posing significant challenges in clinical management. Neuroinflammation is known to play pivotal mechanism in depression, linking immune responses with central nervous system (CNS) dysfunction. This review explores the interplay between peripheral and central inflammatory processes in MDD, emphasizing discrepancies in biomarker validity and specificity. While peripheral markers like cytokines have historically been investigated as proxies for neuroinflammation, their reliability remains contentious due to inconsistent findings, lack of correlation with neuroinflammatory markers, the influence of confounding variables, and the role of regulatory mechanism within the CNS. Additionally, the human brain shows a pattern of regionalized inflammation. Current methodologies for investigating neuroinflammation in humans in vivo, including neural-derived extracellular vesicles (EVs) and positron emission tomography (PET) neuroimaging using translocator protein, offer promising avenues while facing substantial limitations. We propose that future research in MDD may benefit from combined microglia-derived EV-TSPO PET neuroimaging analyses to leverage the strengths and mitigate the limitations of both individual methods.

A novel framework for industrial pesticide effluent assessment: Integrating chemical screening, multi-endpoint responses and literature-based validation

Industrial pesticide effluents pose substantial risks to aquatic ecosystems, yet comprehensive understanding of their toxicological impacts remains limited. This study presents an integrated approach to evaluate the ecological risks of pesticide manufacturing effluents through chemical screening and multi-endpoints biological responses. Using zebrafish embryos as a model organism, we demonstrated that effluent discharge point (EDP) sample induced 100 % mortality, while diluted samples exhibited significant developmental toxicity, cardiovascular injury, immunosuppression, and behavioral alterations. Non-targeted metabolomics analysis revealed the molecular mechanisms underlying these toxic responses. Through chemical screening and targeted quantification, we identified three predominant azole fungicides - propiconazole (2.11 μg/L), hexaconazole (13.3 μg/L), and tebuconazole (18.66 μg/L) - that exhibited synergistic toxicity. Notably, our innovative meta-analysis framework based on literature data validated the toxicological profiles of detected compounds, providing an efficient alternative to conventional bioassays. This study establishes a comprehensive framework for assessing industrial effluent toxicity and demonstrates the value of integrating chemical analysis with biological responses for environmental risk assessment.

Practical Psychosocial Management for Patients With Bipolar Disorder

The broad acceptance of evidence-based psychosocial interventions as adjuncts to pharmacotherapy for bipolar disorder has been inhibited by the extensive training, supervision, and fidelity requirements of these approaches. Interventions that emphasize evidence-based strategies drawn from these modalities-rather than the full manualized protocols-may broaden the availability of psychotherapy for patients with bipolar disorder. In this article, psychosocial risk factors relevant to the course of bipolar disorder (stressful life events that disrupt social rhythms, lack of social support, family criticism and conflict, and lack of illness awareness or literacy) are reviewed, along with evidence-based psychosocial interventions (e.g., interpersonal and social rhythm therapy, cognitive-behavioral therapy, family-focused therapy, and group psychoeducation) to address these risk factors. The results of a component network meta-analysis of randomized psychotherapy trials in bipolar disorder are discussed. Manualized psychoeducation protocols-especially those that encourage active skill practice and mood monitoring in a family or group format-were found to be more effective, compared with individual psychoeducation or routine care, in reducing 1-year recurrence rates. Cognitive restructuring, regulation of daily and nightly routines, and communication skills training were core components associated with stabilization of depressive symptoms. The authors describe a novel psychoeducational approach-practical psychosocial management (PPM)-that integrates these core strategies into the personalized care of patients with bipolar disorder to reduce recurrences and enhance mood stability. PPM is designed to be implemented, without time-intensive training and oversight, by physician or nonphysician clinicians. Evaluating the efficacy and coverage of PPM will require implementation trials in community settings.

Feelin' the burn: Post-pandemic burnout among United States neuropsychologists

Objective: Burnout is a multidimensional concept in many professions. Research documented increased burnout within the field of neuropsychology during the COVID-19 pandemic. The present study assessed burnout levels in neuropsychology post-pandemic, identified factors contributing to burnout, and assessed the impact of the pandemic on burnout levels. Method: United States neuropsychologists (N = 304, 81.9% women, Mage = 41.77) completed a survey about demographics, professional background, current experiences of burnout using the Copenhagen Burnout Inventory, and the impact of the pandemic on burnout. The authors calculated the frequencies for demographics, professional background, impact of the pandemic, and burnout levels. One-way multivariate analysis of variance and chi-square tests compared subspecialties on demographics and occupation. One-way multivariate analysis of covariance compared subspecialty differences in burnout. An independent sample t-test identified significant differences in burnout levels and demographics. Pearson correlations assessed the relationships between demographics, occupation, and burnout. Results: Respondents indicated moderate personal (M = 53.10, SD = 18.67) and work burnout (M = 52.17, SD = 20.84) and mild patient burnout (M = 36.88, SD = 20.28). While professional burnout increased due to the impact of COVID-19, most respondents reported that their burnout started prior to the onset of the pandemic. Personal and work burnout levels were higher in women. Younger, early-career clinicians were more likely to experience greater levels of personal, work, and patient burnout. Burnout levels did not differ by subspecialty. Conclusions: A need exists to continue monitoring burnout levels and implementing strategies to reduce burnout and optimize patient care post-pandemic.

Prevalence rates of depression, anxiety, and suicidal ideation in patients with ovarian cancer: A systematic review from 1977 to 2024

ObjectiveOvarian cancer patients are more likely to have mental disorders than other patients. However, to our knowledge, there has been no systematic analysis of its global epidemiology. Therefore, a systematic review was conducted to identify the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients in different countries.MethodWe searched PubMed, Embase, Elsevier ScienceDirect, China National Knowledge Infrastructure, WanFang Data Knowledge Service Platform, and Duxiu Academic Search Platform to identify observational studies on depression, anxiety, and suicidal ideation in patients with ovarian cancer published up to 30 June 2024. We estimated the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients worldwide and by region, country, research period, and assessment scales.ResultsA total of 31 studies were identified involving 8315 ovarian cancer patients. The prevalence rates of depression and anxiety were 35% and 37%, respectively. In China, the prevalence of suicidal ideation of ovarian cancer patients was 32%. Ovarian cancer patients in Asia had the highest prevalence of depression, while those in Oceania (Australia, New Zealand, etc.) had the lowest. Additionally, the prevalence rates of depression and anxiety increased considerably worldwide after 2000 and have gradually stabilized since then.ConclusionThis study found that the prevalence of depression and anxiety was high (more than one-third) among ovarian cancer patients. These findings underscore the need for a comprehensive study to address mental health problems in these patients, including the determination of incidence rates, investigation of regional differences, and assessment of comorbidities and treatment strategies.

Peripheral Immune-Inflammatory Pathways in Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: Exploring Their Potential as Treatment Targets

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) are major mental disorders linked to substantial morbidity. Traditional monoamine-based pharmacotherapies frequently produce inadequate outcomes for many patients. The elevated levels of treatment resistance require the exploration of new pharmacological targets. Evidence indicates that peripheral immune-inflammatory dysregulation, characterized by an imbalance between immunological responses and compensatory immune-regulatory systems (IRS/CIRS), together with increased oxidative and nitrosative stress (O&NS), significantly contributes to the pathogenesis of these disorders. This review examines IRS/CIRS/O&NS pathways as new drug targets and highlights novel pharmacological trials. Antiinflammatory drugs have been repurposed as augmentation strategies for the treatment of MDD/BD and SCZ, including nonsteroidal antiinflammatory medications, such as cyclooxygenase-2 (COX-2) inhibitors; cytokine-targeting biologics, such as tumor necrosis factor-α monoclonal antibodies; and minocycline, an antibiotic that attenuates neuroinflammation. N-acetylcysteine, curcumin, and omega-3 polyunsaturated fatty acids demonstrate some efficacy as augmentation therapies in MDD, likely by diminishing IRS activation and O&NS. Strategies aimed at the gut-brain axis and gut dysbiosis, including fecal microbiota transplantation, are under investigation for their capacity to restore immunological homeostasis by improving gut barrier integrity and microbiome composition. This review examines new potential therapeutic targets arising from recent discoveries in neuro-immune interactions and oxidative stress, including particular lymphocyte surface markers, the CIRS, and intracellular network molecules in both affective and psychotic disorders. The evidence underscores the clinical importance of immune-targeted augmentation treatments in psychiatric disorders and supports the ongoing development of these novel pharmacotherapies within a precision medicine paradigm.

Aspartate in the Brain: A Review

L-Aspartate (aspartic acid; C4H7NO4; 2-aminobutanedoic acid) is a non-essential α-amino acid found ubiquitously throughout the body, including in the brain. Aspartate is one of the protein-forming amino acids and the formation of tRNA-aspartate complex is catalysed by aspartyl tRNA synthetase. Free aspartate, which is the main subject of this review, plays key roles in metabolism, as an amino donor and acceptor. It contributes to the synthesis of protein, arginine and nitric oxide, asparagine, N-acetylaspartate and N-methyl-D-aspartate. Its major metabolic role in the brain is recycling reducing equivalents (protons) between the cytoplasm and mitochondrial matrix as part of the malate-aspartate shuttle. L-Aspartate's actions on synaptic receptors, as well as its possible presence in nerve terminals and synaptic vesicles, are, in principle, consistent with a role as an excitatory neurotransmitter. The evidence is far from conclusive and at times controversial. The role of D-aspartate in brain function is even less certain but, it appears that, rather than being a minor neurotransmitter, D-aspartate is more likely to be involved in fine regulation of endocrine and homeostatic processes. Much research remains to be done in this area. The diversity of its functions and chemistry make aspartate a complex molecule to investigate and measure in vivo. Perturbations of aspartate metabolism have been described in a range of neurological deficits, particularly those of white matter. Here, we examine what is known about the various roles of aspartate in brain, its metabolism, transport and compartmentation, its role as a neurotransmitter or a more general signalling molecule, and what is currently known about its role(s) in disease processes.

Effects of depression and suicidal ideation on health-related quality of life in diabetic individuals: findings from a population-based study

OBJECTIVES

The effect of depression or suicidal ideation on health-related quality of life (HRQoL) in diabetic individuals has not been thoroughly investigated. The purpose of this research was to investigate the influence of suicidal ideation and depression on HRQoL in diabetic patients.

METHODS

This study is based on data from 5543 diabetic patients who participated in the US National Health and Nutrition Examination Survey (2005-2018). Diabetes was defined according to the criteria established by the American Diabetes Association and self-report questionnaires. Depression, including its severity, and suicidal ideation were evaluated using the Patient Health Questionnaire-9 (PHQ-9). HRQoL was assessed using the Centers for Disease Control and Prevention HRQoL-4 to evaluate physical health, mental health, days of activity limitation and general health status. Logistic and linear regression models were employed to examine the association of HRQoL of diabetic patients with depression and suicidal ideation. Sensitivity analysis determined the stability of the results.

RESULTS

661 reported depression and 265 reported suicidal ideation, with prevalence rates of 11.9% and 4.8%, respectively. After controlling for demographic factors, risk behaviors, and comorbidities, the PHQ-9 score, as well as depression and its severity, in addition to suicidal ideation, showed a strong association with decreased general health status, more physically and mentally unhealthy days, and activity limitation days for individuals suffering from diabetes (p < 0.05).

CONCLUSIONS

In individuals with diabetes, a decrease in HRQoL is linked to suicidal ideation and depression. Healthcare providers are advised to incorporate concise depression screening evaluations, like the two-question PHQ, into their discussions with diabetic patients. If these screenings indicate elevated depression symptoms, it is advisable to recommend psychological referrals. However, since this study employs a cross-sectional design, it is unable to establish the causal relationships among these factors. Further prospective longitudinal studies are essential to address this limitation.

CLINICAL TRIAL NUMBER

Not applicable.

Mix effect of prolactin on cognitive performance in patients with schizophrenia

Prolactin has a wide range of biological functions, including regulation of cognition. However, there are few studies on the relationship between prolactin and cognition in schizophrenia. A total of 113 patients with schizophrenia were included in this study. Serum prolactin concentrations were collected and MATRICS consensus cognitive battery (MCCB) was used for cognitive assessment. Eighty-four of one hundred and thirteen patients (74.3%) had hyperprolactinemia. There was no significant difference in the incidence rate of hyperprolactinemia between different sex (χ2 = 1.57, p = 0.21), but the serum prolactin concentration of female patients was significantly higher than that of male patients (median = 676.5mIU/L for male and median = 1178 mIU/L for female, Z = 2.53, p = 0.001). Inverse U-shaped relationships were found between prolactin and brief visuospatial memory test-revise (BVMT-R) (F = 4.008, p = 0.021); and Hopkins verbal learning test-revised (HVLT-R) (F = 5.857, p = 0.004). Prolactin may have a mixed effect on cognition depending on its concentration and mild elevated prolactin level is beneficial for cognitive performance in schizophrenia.

Influences of early sexual trauma on brain structural connectome in panic disorder and their relationship with short- and long-term treatment responses

BACKGROUND

Early traumatic experiences, particularly early sexual trauma (EST), are associated with panic disorder (PD). Using connectome-based analyses of diffusion tensor imaging, we examined the effects of EST on the brain structural networks and the associations with symptom severity and short- and long-term treatment responses in patients with PD compared to healthy controls (HCs).

METHODS

188 participants (82 PD patients and 106 HCs) were enrolled. Brain structural networks were constructed using white matter tractography. Network-based statistics with permutation tests examined EST-related connectivity differences between groups. Early Trauma Inventory Self-Report and the Panic Disorder Severity Scale were administered. PD patients were followed up for 1 year to measure the pharmacological treatment response.

RESULTS

Significant PD-EST interactions revealed hyperconnectivity in the parahippocampal gyrus, middle temporal gyrus, and inferior parietal lobule in PD compared to HC groups. After false discovery rate correction, analyses revealed positive correlations between global and local properties of interaction networks and anxiety levels in PD. The eigenvector centrality values of the cingulate gyrus and inferior frontal gyrus were negatively correlated with short- and long-term treatment responses in PD.

LIMITATIONS

Considering recall bias and lack of follow-up imaging, longitudinal studies are needed for long-term changes.

CONCLUSIONS

Our study suggested that PD patients with a history of EST showed distinct brain connectivity alterations related to traumatic emotional memory processing, particularly in regions associated with the default mode network. These structural connectome changes are associated with key PD symptoms and treatment responses across short- and long-term pharmacological interventions.

Mediational effect analysis of childhood emotional abuse on prodromal psychotic symptoms in self-taught examination students

It has been shown that childhood trauma is associated with an increased risk of prodromal psychotic symptoms. However, research on the prevalence of prodromal psychotic symptoms among self-taught examination students and the relationship with childhood trauma remains limited. The aim of this study was to investigate the prevalence of prodromal psychotic symptoms among self-taught examination students, explore the impact of childhood trauma on prodromal psychotic symptoms, and its underlying mechanisms. From January 5 to 18, 2024, a cross-sectional study was conducted on 670 self-taught examination students in Nantong University through the online survey platform "Wenjuanxing" ( www.wjx.cn ). These individuals completed the general information questionnaire, The childhood trauma questionnaire-Short Form (CTQ-SF), The Prodromal Questionnaire-Brief (PQ-B), The Depression Anxiety Stress Scale (DASS-21). Data analysis was carried out using SPSS 25.0 and the PROCESS macro. (1) The prevalence of prodromal psychotic symptoms in self-taught examination students was 20.6% (138/670); (2) The total effect of childhood emotional abuse and prodromal psychotic symptoms in self-taught examination students was 2.9859. The mediating effect of anxiety (effect value: 1.4611), depression (effect value: 0.6201), social support (effect value: - 0.1214), and health conditions (effect value: 0.1954) in the relationship between childhood emotional abuse and prodromal psychotic symptoms of self-taught examination students, accounts for 72.18% of the total effect. Childhood trauma can not only independently predict the risk of prodromal psychotic symptoms among self-taught examination students, but also predict the risk of prodromal psychotic symptoms indirectly by affecting anxiety, depression, social support, and health conditions. Targeted measures should be taken to reduce the prodromal psychotic symptoms in this neglected group of self-taught examination students.

Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with transarterial chemoembolization (TACE) commonly used as a palliative approach for patients who are not candidates for surgical resection. Understanding the factors that influence health-related quality of life (HRQoL) after TACE is essential for improving patient-centered care. This systematic review seeks to consolidate current evidence on the variables that impact HRQoL in HCC patients post-TACE. Methods: In adherence to PRISMA guidelines, a comprehensive search was conducted across five English and Chinese databases-PubMed, Scopus, Web of Science, CNKI, and Wanfang-covering studies from database inception to May 2025. Eligible studies were observational and examined factors affecting HRQoL in post-TACE HCC patients. Two independent reviewers performed screening, data extraction, and quality assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Nine studies met the inclusion criteria, including six cohort studies and three cross-sectional studies. The quality assessment rated seven studies as high quality and two as moderate. A range of validated HRQoL assessment tools was used, with the EORTC QLQ-C30 and FACT-G being the most commonly employed. The factors influencing HRQoL were grouped into five categories: (1) demographic factors (e.g., age, gender, education level); (2) clinical indicators (e.g., liver function, tumor burden); (3) psychological factors (e.g., depression, anxiety, spiritual well-being); (4) social support (e.g., financial status, coping mechanisms); and (5) physical symptoms (e.g., fatigue, pain, appetite loss). Across studies, both symptom severity and psychological distress were consistently associated with lower HRQoL. Conclusions: The HRQoL of HCC patients following TACE is influenced by a complex interplay of demographic, clinical, psychological, social, and symptomatic factors. Tailored, multidimensional interventions addressing these diverse aspects are crucial to optimizing recovery and improving overall well-being.