Neurogenic pulmonary edema (NPE) is a life-threatening complication of severe central nervous system (CNS) injury. Carbon monoxide (CO) poisoning causes significant CNS insults, including direct neurotoxicity and autonomic dysfunction, creating a high-risk neurological state. Electroconvulsive therapy (ECT), while an effective treatment for severe depression, induces profound physiological stress that can exacerbate underlying neuropathology, thereby increasing the risk of NPE. We present the case of a 62-year-old male with severe depression who was hospitalized after a suicide attempt through CO poisoning, who developed NPE after undergoing his first ECT session. Shortly after the first ECT treatment, the patient became hypertensive, agitated and developed respiratory distress. NPE was diagnosed based on clinical findings and radiographic evidence of prominent pulmonary vasculature. Despite medical management, the patient required emergent intubation and intensive care unit (ICU) management. The patient's condition improved with supportive care, and he was successfully extubated the following day. ECT was discontinued. This case highlights a rare but severe complication of ECT in a patient with pre-existing CNS vulnerability from CO poisoning. The physiological stress from ECT likely precipitated the sympathetic surge leading to NPE. This report underscores the potential dangers of performing ECT after recent CO poisoning and, when considered with the related research discussed herein, suggests that recent CO poisoning should be considered a relative contraindication for ECT. Clinicians must be vigilant about this complication and be prepared for its management.

OBJECTIVE: To explore the challenges experienced by U.S. graduate students in a post-pandemic era. PARTICIPANTS: A total of 437 students participated in the study across seven universities; most were younger than 35 years of age (68%), female (68%), White/European American (78%), and enrolled in a STEM-specific program (60%). METHODS: Students voluntarily completed a comprehensive climate survey on demographic, academic, mental health, overall well-being, and financial characteristics. RESULTS: Linear and logistic regression analyses identified several characteristics associated with depression, imposter phenomenon, social isolation, and stress. Perceived financial threat did not appear in multivariable models. However, dose-response relationships were univariately observed across most health measures indicating better responses among those with low financial threat and worse responses among those with high financial threat. CONCLUSION: To effectively address the numerous, multi-dimensional challenges for graduate students, academic institutions must provide structural support to students' interconnected, academic, and cultural environments to supplement traditional student services.

BACKGROUND: Negative aging stereotypes are pervasive and have adverse effects on the well-being of older adults. We studied the consequences of negative stereotypes about the mental health of older adults on their moods, risk tolerance, and patience. METHODS: In a randomized controlled experiment, participants (mean age = 68.9) were exposed to negative (stereotype threat), accurate (inoculation), and control information regarding the mental health of older adults. Participants' moods were tracked throughout the experiment, and their risk tolerance and patience were measured using incentive-compatible procedures after exposure. RESULTS: When exposed to inoculation information, participants experienced positive changes in their moods and avoided the negative mood changes that were experienced by participants in the control and stereotype threat groups. We find no changes in the average levels of risk tolerance or patience due to either treatment condition. CONCLUSIONS: Positive and accurate information regarding aging and mental health stabilizes mood, risk tolerance, and patience, indicating that inoculation campaigns on aging may be beneficial to public health.

Vitiligo is a chronic immune-mediated dermatological condition with substantial psychosocial consequences. Patients' explanatory models shape coping, treatment engagement and quality of life, but evidence on how these models vary by gender outside Western settings remains scarce. Drawing on the biopsychosocial model and the Common Sense Model of self-regulation, we mapped the perceived triggers and progression factors that Brazilian adults with vitiligo deploy when explaining their condition and tested whether men and women converge or diverge in those explanatory accounts. Cross-sectional online survey with a mixed-methods analytic strategy. The sample comprised 232 Brazilian adults with a dermatologist-confirmed diagnosis (68.5% women,  = 37.65 years,  = 12.43). Open-ended responses to a single attribution prompt were coded inductively by two trained psychologists, with inter-rater agreement assessed by Cohen's kappa and disagreements resolved through consensus. We computed code freq uencies overall and stratified by gender and used Similarity Analysis (IRaMuTeQ) to map co-occurrences between attributional themes and gender. Psychological attributions dominated the corpus. The most frequent codes were stress, emotional factors, rumination, genetics, depression, family loss and trauma. Within their gender, women cited stress, depression, sadness and anxiety more often than men did. Men were roughly four times more likely than women to cite genetic inheritance. Progression attributions clustered around generalized psychological state and were similar across gender. Brazilian adults with vitiligo construct gendered explanatory models that mirror broader cultural scripts about masculinity, femininity and the legitimacy of emotional disclosure. Care for vitiligo is likely to be improved by gender-responsive psychological assessment, validation of patient explanatory models and integrated dermatological-mental health pathways.

Adverse childhood events are associated with short- and long-term physical and mental health outcomes, as well as risk of future continued exposure to violence. There is limited research on adverse childhood events in lower resource settings and its impact on mental health among women. Using data from 200 newly married women living in rural Nepal, we explored the impact of adverse childhood events on depressive symptoms and intimate partner violence (IPV) in early adulthood. Most study participants reported at least one adverse childhood experience (ACE) (58.5%), one-quarter depressive symptoms (24.5%), and one-quarter (24.5%) reported any IPV. Each ACE reported was associated with a mean 1.92-point increase in depressive symptom score (95% confidence interval [CI] [1.11, 2.73]) and a mean 0.23-point (95% CI [0.20, 0.36]) increase in severity of IPV. IPV was identified as an independent contributor to but not a significant mediator of depressive symptoms. These findings suggest that ACEs are an important influencer of young adult poor mental health, particularly among women, and inform the unique pathways through which distal and proximate factors such as these influence mental health status. Policies and programs are needed not only to prevent and mitigate the impact of ACEs in the natal home, but also to target the marital home and the transition to marriage as key opportunities to build safe spaces and support for young married women in Nepal and similar contexts.

This paper examines the instrumentalisation of psychiatric procedures and the complicity of physicians and mental health professionals in the state-sponsored terror of Argentina's civil-military dictatorship (1976-1983). Hitherto, these episodes have remained largely underexplored in broader historiography, as have their implications for modern psychiatric ethics. Drawing on archival records, victim testimonies, and secondary sources, this paper outlines how mental health expertise and psychiatric institutions were implicated in the junta's campaigns to subjugate perceived "subversive" tendencies in Argentinian society. To that end, two case descriptions are used to illustrate distinctive modalities of abuse: (1) the "depersonalisation" and "brainwashing" of political detainees in Rawson Prison in Argentinian Patagonia, where psychiatrists and psychologists participated in experimental repression programmes; and (2) the transfer of torture-induced psychiatric patients to military-controlled hospitals, where coercive pharmacological interventions, electroconvulsive therapy, and further physical violence were inflicted. The analysis highlights psychiatry's function as a mechanism for direct torture and a legitimising veneer for political persecution. In doing so, it integrates previously fragmented materials into a unified analytical framework and situates psychiatric abuses within wider transnational patterns of repression characteristic of other Latin American dictatorships. Moreover, in the context of contemporaneous denialist narratives in Argentina and ongoing international instances of psychiatric abuse worldwide, the paper underlines the persistent vulnerability of ethical safeguards, reemphasising calls for proactive measures to protect against future human rights violations.

BACKGROUND: The scientific community continues to debate the relationship between pregnancy depression and oxidative stress marker changes. The study tracked oxidative stress marker development in pregnant women with depression from the beginning to the end of their pregnancy. METHOD: Sixty-two pregnant women were included in the cross-sectional study. According to the Beck Depression Scale, the pregnant women were divided into depressed (n = 23, score ≥ 10) and control (n = 39, score < 10) groups. Catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA) levels were measured in blood samples. RESULTS: The Beck score was 17.83 ± 6.86 in pregnant women with depression and 4.51 ± 2.54 in the control group (p < 0.001). There was no difference between the groups in baseline CAT, SOD, and MDA levels (p > 0.05). MDA levels in pregnant women with depression increased significantly in the third trimester compared to the second trimester (from 4.02 ± 0.49 to 6.19 ± 0.52 nmol/mL, p < 0.01). A positive correlation was found between body mass index and MDA (r = 0.300, p < 0.05). CONCLUSION: The progression of pregnancy leads to increased lipid peroxidation in depressed women but depression itself does not impact oxidative stress markers. The extent of oxidative damage increases when mothers become obese during pregnancy.

BACKGROUND: There is growing support for high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS), but escalation (ESC) approaches remain common. OBJECTIVE: To describe decision-making in a pragmatic trial of early high-efficacy treatment (EHT) versus ESC. METHODS: DELIVER-MS is a multi-center, pragmatic, randomized controlled trial (RCT) with a parallel observational study (OBS), which enrolled treatment-naïve people with RRMS in 31 UK/US sites. Primary outcome was as follows: 36-month brain volume loss according to initial treatment approach (EHT vs. ESC). Stepwise multivariable logistic regression was used to predict participation in RCT versus OBS and choice of EHT versus ESC within the OBS cohort. RESULTS: In total, 816 people with MS were enrolled. Participants declined randomization due to preference for a particular DMT (85%), efficacy concerns (20%), and safety concerns (9%). RCT versus OBS participation was associated with lower relapse rate ( = 0.043) and greater brain parenchymal fraction ( = 0.002). Among 374 in the OBS cohort, 125 (33%) chose ESC and 249 (67%) chose EHT. People commencing EHT had higher education attainment ( < 0.001) and relapse rate ( = 0.025). CONCLUSION: Baseline DELIVER-MS data demonstrate that participants with milder disease are more likely to participate in RCT. The choice of EHT versus ESC was associated with demographic factors and disease activity. CLINICAL TRIAL REGISTRATION: NCT03535298.

Oral ketamine has gained increasing interest beyond anesthesia, particularly for treatment-resistant depression, chronic pain, and pediatric procedural sedation. Despite expanding off-label use, there is no standardized pharmaceutical formulation, and long-term safety remains uncertain. A synthesis of evidence on safety and tolerability of the oral route is therefore needed to inform clinical practice and regulatory development. This systematic review evaluated the safety and tolerability profile of oral ketamine in humans and characterized dosing strategies across randomized controlled trials. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science from inception to November 2025 (PROSPERO CRD420251065295). Randomized placebo-controlled trials evaluating oral (es)ketamine in any clinical population were included. Primary outcomes were safety and tolerability. Risk of bias was assessed using the RoB2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Eighteen trials were included, comprising adults, children, and healthy volunteers. In depression studies (n = 5; 427 participants), adverse effects were predominantly mild and transient. Pediatric premedication trials (n = 239) reported transient neurological effects without clinically significant safety concerns. Pain and experimental studies (n = 372) showed mostly mild adverse events, with dissociative symptoms at higher doses. Comparative analyses indicated higher rates of dizziness, sedation, and dissociative symptoms with ketamine, while serious adverse events were rare. Overall, oral ketamine demonstrates a favorable short-term safety profile. However, the certainty of evidence is low, and long-term safety remains uncertain.

PURPOSE: To describe clinical characteristics, comorbidities, diagnostic approaches, and treatment outcomes in six pediatric cases of non‑24‑hour sleep‑wake disorder (N24SWD). METHODS: We conducted a single‑center retrospective case series of children and adolescents diagnosed with N24SWD clinically evaluated by histories, sleep diaries, actigraphy, and available treatment outcomes. RESULTS: Six sighted children with N24SWD were identified; five had autism spectrum disorder, three had attention-deficit/hyperactivity disorder, and two had anxiety disorders. All demonstrated free‑running sleep cycles (24-29 hours) with progressive delays in sleep and periodic daynight reversal. Behavioral and functional impairments were exacerbated during circadian misalignment. Entrainment strategies utilizing melatonin, bright light therapy, and behavioral interventions showed variable success; long‑term entrainment was rarely achievable due to adverse effects, inconsistent adherence, and family burden. Several families opted to maintain flexible, free‑running schedules, reporting improved mood and function when natural sleep patterns were accommodated. CONCLUSION: Pediatric N24SWD in sighted individuals is frequently associated with neurodevelopmental comorbidities. In all of our reported cases, children with N24SWD were sighted and had neurodevelopmental disorders. Standard circadian‑based treatments may be difficult to sustain. Management should be individualized, family‑centered, and supported by improved diagnostic tools and research into long‑term therapeutic strategies.

CONTEXT: Adults with Tourette syndrome (TS) are more prone to depression and comorbid anxiety disorders than neurotypical individuals. Conflicting findings regarding their cognitive performance may stem from various factors, including comorbidities. OBJECTIVE: Our primary goal is to assess patients' inhibition to interference, motor dexterity, nonverbal memory, and visuospatial functions, and to examine the impact of concomitant anxious-depressive symptoms that often accompany TS. It is hypothesized that individuals with TS who also have anxiety and depression symptoms will demonstrate significantly altered inhibition, motor dexterity, and visuospatial skills compared to both the neurotypical and non-comorbid clinical groups. We also propose identifying neuropsychological variables that best discriminate between comorbid and non-comorbid groups, as well as between these groups and neurotypical controls. METHODS: We compared the neuropsychological profile of 128 participants divided into three groups: a TS+ clinical group with anxiety and depression comorbidities ( = 21), a TS- clinical group without significant comorbidity ( = 37), and a neurotypical control group ( = 70). Neuropsychological assessments included the Stroop Color-Word Test (inhibition), the Purdue pegboard (motor dexterity), and Rey-Osterrieth Complex Figures (visuospatial functions and nonverbal memory). RESULTS: No significant group differences emerged in interference inhibition. Both TS- and TS+ participants outperformed controls in fine motor dexterity tasks. However, only the TS+ group showed impairments in visuospatial functions and nonverbal memory. CONCLUSIONS: These results suggest that anxiety and depressive comorbidity in individuals with TS may specifically alter nonverbal memory and visuospatial functions.

AIMS: To evaluate the health-related quality of life (HRQOL) of adults with Long COVID 2 years and beyond after COVID-19 illness. DESIGN: Cross-sectional study. METHODS: Health status was assessed using the EQ-5D-5L instrument among 226 adults diagnosed in primary care with mild-to-moderate COVID-19 during the 2021 pandemic. Data were collected through a cross-sectional survey using a standardized questionnaire with a set of validated clinical outcomes for Long COVID. The sample consisted of adults aged ≥ 18 years who attended the specified ambulatory settings, tested positive for SARS-CoV-2, and agreed to be interviewed; the response rate was 70%. Health utility scores were compared between adults with and without Long COVID. Multivariate logistic regressions were applied to investigate the relationship between Long COVID and health-related quality of life outcomes. DATA SOURCES: Primary data were collected from six public Family Health Care Units in João Pessoa, Brazil, between May 2023 and July 2024. RESULTS: Adults with Long COVID had statistically significantly lower median utility scores (0.784, IQR: 0.633-0.902) than those without persistent symptoms (1.0, IQR: 0.877-1.0). Poorer HRQOL was more evident among women, older adults, non-White individuals, participants with pre-existing chronic diseases, and those with lower educational attainment. Long COVID was associated with impairments in anxiety/depression, pain/discomfort and usual activities. CONCLUSION: Adults with Long COVID experienced poorer HRQOL 2 years or longer after mild-to-moderate infection compared with those without persistent symptoms, regardless of sex, age, ethnicity, education level or comorbidities. These findings support the implementation of targeted interventions and rehabilitation services in primary care for individuals experiencing long-term health problems following COVID-19 illness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying adults at greater risk of persistent health impairments following COVID-19 may help health professionals, caregivers and policymakers better address the aspects of patients' lives that lack quality and develop a multidisciplinary approach in primary care to managing this condition. IMPACT: What problem did the study address? ○ This study examined the association between persistent symptoms 2 years or longer after non-severe COVID-19 illness and health-related quality of life. What were the main findings? ○ Long COVID was associated with poorer health-related quality of life, particularly in the domains of anxiety/depression, pain/discomfort and usual activities. Where and on whom will the research have an impact? ○ The findings highlight the need for multidisciplinary management of long-term health problems among adult COVID-19 survivors in primary care. REPORTING METHODS: The STROBE checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

BACKGROUND: Weight stigma, a pervasive public health concern, is characterized by negative attitudes, prejudices, and stereotypes directed towards individuals with larger body sizes. Empirical evidence indicates a significant association between experiencing weight stigma and adverse psychological health outcomes, including body image dissatisfaction, eating disorders, and increased risk of depression, anxiety, self-harm, and suicidal ideation. Acceptance and Commitment Therapy (ACT), a third-wave behavioral approach, shows potential in reducing weight stigma by targeting psychological flexibility and values-based action. However, current evidence remains limited and fragmented, often neglecting the complex, multidimensional nature of weight stigma. Therefore, this review aims to synthesize and evaluate existing evidence on the effectiveness of ACT in reducing weight stigma and improving related psychological outcomes. Additionally, we will identify the specific content and delivery features of effective ACT interventions targeting weight stigma. METHODS: We will conduct a comprehensive search of electronic databases, including PubMed, Embase, Web of Science, Scopus, CINAHL, and the Cochrane Library. The Association for Contextual Behavioral Science (ACBS) website will be searched to identify summaries of randomized controlled trials and Google Scholar will be utilized to identify relevant grey literature. Only original research articles published in English from 1994 to 2025 will be included, and the database searches will be updated prior to final manuscript submission to capture the most recent evidence. Screening, data extraction and quality assessment will be conducted independently by the primary reviewer and the second reviewer. Any inconsistencies will be addressed through discussion with a third reviewer. If substantial heterogeneity (I > 75%) or insufficient comparable data precludes meta-analysis, findings will be synthesized narratively. DISCUSSION: This systematic review will synthesize the extant literature on the effectiveness of ACT, encompassing its contents and delivery features in reducing weight stigma and improving related psychological outcomes among individuals experiencing weight-related stigmatization. The evidence generated from this review has the potential to inform public health initiatives, shape future intervention research, and contribute to broader efforts to mitigate the harmful impact of weight stigma on individual and societal levels. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251121507.

BACKGROUND: Among a broader set of household assets that support healthy living, access to water, a refrigerator, air conditioning, and domestic help may be especially relevant for mental health. However, these components of household living conditions vary substantially across regions and have rarely been examined in relation to mental health. This study examines how these key household living conditions relate to depression and anxiety among children and adolescents (i.e., youth) and adults, while also exploring urban and rural differences in these associations. METHODS: Participants were interviewed in collaboration with the Centre for Monitoring Indian Economy (CMIE) that has been conducting a longitudinal survey covering 98% of India's population. The current analysis is based on mental health data collected in June 2023, including 8,205 households living in rural regions and 19,979 households living in urban regions. These households were composed of 29,188 members in rural regions and 67,351 members in urban regions. Among these household members, 37,453 adults provided information on their own depression and anxiety, and 20,397 adults reported on the depression, and 19,363 on the anxiety of youth living in the household. RESULTS: Overall, having unlimited access to water, a refrigerator, and domestic help was associated with lower depression and anxiety among youth and adults. Specifically, having a refrigerator and domestic help were related to lower depression and anxiety when individuals live in rural settings compared to urban ones, whereas air conditioning and water access were linked to lower depression and anxiety in urban settings. CONCLUSIONS: These findings highlight the connection between these living conditions and mental well-being, suggesting that interventions targeting mental health should be designed with the understanding that less access to water, refrigerator, air conditioning, and domestic help is related to poorer mental health.

INTRODUCTION: Borderline Personality Disorder (BPD) is a common condition with significant negative impacts on relatives due to its interpersonal instability and suicidal behaviors. Family Connections (FC) is currently the most empirically supported intervention for family members of individuals with BPD. However, access to FC remains limited. Online delivery could overcome geographic barriers, as digital formats have shown efficacy in psychotherapies for patients, though little is known about their effectiveness for family-oriented interventions. During the COVID-19 crisis, rapid adaptations of psychotherapeutic programs such as FC to online formats created an opportunity to collect data. This study aimed to compare the effectiveness of the online FC with face-to-face format. METHOD: This multicenter naturalistic study extended a previous project involving French-speaking FC participants. The program was first delivered face-to-face (n = 141) and then online (n = 27). FC is a 12-week group intervention providing psychoeducation about BPD and teaching coping skills derived from Dialectical Behavior Therapy. RESULTS: Groups were comparable at baseline, except for certain variables. Controlling for baseline scores, multiple linear regressions showed no significant group differences for post-intervention burden (b=-0.59, p = 0.825) or depression (b = 1.37, p = 0.398). However, the online group improved more in emotion dysregulation (b=-9.05, p = 0.003) but less in coping (b=-0.79, p < 0.000). DISCUSSION: Findings support the online FC format as comparably effective to the face-to-face version, suggesting its potential to enhance accessibility without compromising outcomes. Replication in randomized designs is warranted.

OBJECTIVE: Bipolar Disorder (BD) is a complex psychiatric disorder, characterised by recurrent episodes of mania and depression, and is associated with the dysregulation of stress hormone signalling, immune and inflammatory pathways. However, limited information is currently available on the effects of stress hormones on immune and inflammatory pathways in BD. Ras guanyl releasing protein 1 (RASGRP1) is a pro-inflammatory guanine nucleotide exchange factor involved in Ras-MAPK signalling. Cortisol exerts well-known anti-inflammatory effects; we therefore hypothesized that cortisol exposure would regulate RASGRP1 expression. This study, therefore, examined the impact of cortisol on RASGRP1 transcriptional and translational expression across BD subtypes in lymphoblastoid cell lines derived from BD and non-BD individuals. RESULTS: We observed differential responses to cortisol among the cell lines. Specifically, at the level of transcription expression was elevated in BD II cortisol-treated cells at basal levels vs. stress induced levels of cortisol. Concurrently, RASGRP1 protein was detected only in BD II cells treated with basal levels of cortisol. No protein was detected in untreated cells or those exposed to stress-induced levels of cortisol. CONCLUSION: RASGRP1 expression is responsive to cortisol in a concentration-dependent manner.

BACKGROUND: This study examined patterns of change in athletic identity and their associations with mental health indicators in elite Polish athletes with disabilities during the COVID-19 pandemic. METHODS: In a 3-month longitudinal study conducted from April to July 2021, 91 athletes enrolled in the Polish Paralympic Preparation Program twice completed the Athletic Identity Measurement Scale-Third Generation (AIMS-3G), the Hospital Anxiety and Depression Scale (HADS), and the Revised UCLA Loneliness Scale. Using Bonanno's pooled-SD approach, athletes were classified as showing decreasing, stable, or increasing athletic identity. Group differences in change scores were tested with multivariate analysis of variance and Bonferroni post hoc tests. RESULTS: Most athletes showed stable athletic identity (77%), whereas decreasing (13%) and increasing (10%) patterns were less common. The multivariate effect was significant, F(6, 172) = 4.30, p < .001, Wilks' Λ = .76, ηp2 = .13. Athletes with decreasing athletic identity showed greater increases in depression and loneliness than athletes with stable or increasing athletic identity (p ≤ .01). CONCLUSIONS: Athletic identity remained predominantly stable, but decreases in athletic identity were associated with worsening depression and loneliness. Brief AIMS monitoring alongside mental health screening may be useful for identifying athletes who may require additional support during prolonged disruptions to sport participation.

BACKGROUND: First-time parenthood requires substantial role adjustment and may challenge mental health, particularly in families experiencing medically high-risk pregnancies. Evidence is limited on whether empowerment-oriented dyadic interventions can improve parental role adaptation and depressive symptoms among high-risk primigravidas and their partners. AIM: To evaluate the effects of an empowerment-oriented dyadic intervention on parental role adaptation and depressive symptoms among high-risk primigravidas and their partners. METHODS: A randomized controlled trial was conducted in the maternity clinic of a regional hospital in China. A total of 100 high-risk primigravidas and their partners (100 dyads) were randomized 1:1 to an empowerment-based dyadic intervention (four group sessions, 60 min each) or routine antenatal care. Outcomes were assessed at baseline (late pregnancy, T1), 2-3 days postpartum (T2), and 6 weeks postpartum (T3) using the Family Adaptation Scale and the Edinburgh Postnatal Depression Scale (EPDS). Intervention effects were evaluated using dyad-adjusted linear mixed-effects models under the intention-to-treat principle. RESULTS: Compared with controls, mothers in the intervention group showed higher role adaptation at 2-3 days postpartum (T2) and 6 weeks postpartum (T3), with adjusted mean differences (AMD; Intervention-Control) of 5.96 (p < 0.001) and 6.84 (p < 0.001), respectively. Maternal depressive symptoms were also lower in the intervention group at both follow-ups (T2: AMD = - 2.72, p < 0.001; T3: AMD = - 2.26, p = 0.004). For fathers, role adaptation scores were higher in the intervention group at T2 and T3 (AMD = 4.09, p = 0.013; AMD = 3.40, p = 0.046), although the between-group differences in change from baseline were not statistically significant. Paternal depressive symptoms were lower in the intervention group at T2 (AMD = - 2.12, p = 0.006), whereas the between-group difference at T3 was not statistically significant (AMD = - 1.25, p = 0.112). Overall, intervention effects were consistently observed through 6 weeks postpartum for maternal outcomes, while evidence for paternal benefits was less consistent across outcomes and follow-up assessments. CONCLUSION: This brief empowerment-oriented dyadic intervention was associated with improved maternal role adaptation and reduced maternal depressive symptoms through the early postpartum period. Paternal benefits were observed for some outcomes, but were less consistent over time. Further trials in more diverse and higher-risk populations are warranted. CLINICAL TRIAL REGISTRATION: This trial was retrospectively registered in the Chinese Clinical Trial Registry on 18 March 2025 (ChiCTR2500099055).

BACKGROUND: The marked clinical and biological heterogeneity of major depressive disorder (MDD) suggests that it may be more appropriately conceptualized as a syndrome with multiple biologically relevant patterns. However, traditional stratification approaches based on either clinical symptomatology or isolated biological markers, including neuroimaging data, often fail to capture the complex brain-behavior relationships underlying MDD. METHODS: In this study, we applied regularized canonical correlation analysis to capture multivariate covariation between functional network connectivity (FNC) and symptom profiles. Based on the resulting low-dimensional representation, we performed clustering to explore potential stratification patterns in a cohort of 51 patients with MDD and examined whether these patterns were associated with variation in response to intermittent theta burst stimulation. Transcriptional signatures related to pattern-specific FNC abnormalities were further explored using partial least squares regression. RESULTS: Our study found two stratification patterns in MDD. After false discovery rate correction, only increased connectivity between the ventral default mode network (vDMN) and cerebellar network in MDD2 relative to healthy controls remained significant. In exploratory uncorrected analyses, MDD1 was characterized by increased connectivity between the vDMN and salience network, as well as between the dorsal DMN (dDMN) and orbitofrontal cortex, together with greater depressive severity and more prominent appetite disturbance, whereas MDD2 showed broader connectivity increases and more prominent sleep disturbance. Imaging transcriptomic analysis provided complementary molecular contextualization. Treatment-related connectivity changes were mainly observed in MDD2, while patients within both stratification patterns showed symptom improvement, with appetite disturbance improving in MDD1 and sleep disturbance improving in MDD2. Finally, prediction analyses suggested potential prognostic relevance of baseline FNC features, particularly the connectivity between the dDMN and right executive control network. CONCLUSIONS: By integrating neuroimaging, clinical symptomatology, and transcriptomic data, this study offers a preliminary, data-driven framework for exploring heterogeneity in MDD and its potential relevance to treatment sensitivity. These results may inform future efforts to refine biologically grounded stratification strategies for neuromodulation-based treatment prediction. TRIAL REGISTRATION: The clinical trial number is ChiCTR2100054793, and the registration date is December 27, 2021.

BACKGROUND: While the clinical high-risk for psychosis (CHR-P) has been extensively studied and the clinical high-risk for bipolar disorder (CHR-BD) has gained increasing attention, overlapping symptoms-such as mood instability and subclinical psychotic features-complicate diagnostic boundaries. We aimed to investigate the psychopathological characteristics of high-risk individuals to address the feasibility of early-stage diagnostic differentiation. We hypothesized that CHR-P and CHR-BD could co-occur and that symptom structure would differ depending on overlap status. METHODS: We recruited 231 participants without formal psychiatric diagnoses from a prospective cohort established at the psychiatry clinic of Seoul National University Hospital. We identified CHR-P and CHR-BD using the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Bipolar Prodrome Symptom Interview and Scale (BPSS), respectively. Participants were classified into CHR-P-only, CHR-BD-only, and CHR-P/BD-overlap groups. Participants were then evaluated across multiple psychopathological domains, including delusional ideation, obsessive-compulsive symptoms, perceptual abnormalities, depressive and manic symptoms, and global clinical severity. Symptom severity, inter-domain correlations, and symptom network structures were analyzed and compared across groups. RESULTS: The overlap was substantial: among 158 individuals meeting CHR-P criteria, 106 (67.1%) also met CHR-BD criteria, and among 179 individuals meeting CHR-BD criteria, 106 (59.2%) also met CHR-P criteria. The subgroup distribution was 52 CHR-P-only, 73 CHR-BD-only, and 106 CHR-P/BD-overlap. Symptom structures differed by overlap status. CHR-P-only showed significantly greater social withdrawal compared to other groups. CHR-P/BD-overlap had more severe mood, delusional, obsessive-compulsive, and hallucinatory symptoms. Correlation analysis showed weaker interconnections among symptom domains in CHR-P-only. Network analysis revealed four fragmented communities in CHR-P-only, two tightly integrated communities in CHR-BD-only, and partial integration across three communities in CHR-P/BD-overlap. Central symptoms varied: paranoia in CHR-P-only; mood symptoms and obsessive thoughts in CHR-BD-only; mood symptoms and perceptual abnormalities with religious themes in CHR-P/BD-overlap. CONCLUSIONS: High-risk states for psychosis and bipolar disorder frequently co-occur, suggesting that early psychopathology extends beyond the prodrome of any single disorder. Distinct patterns of symptom networks across high-risk subgroups underscore the value of dimensional and spectrum-based approaches to early psychopathology.

OBJECTIVE: To assess nutritional status across different health-professional disciplines and to examine attitudes toward overweight and obesity and their associated factors among undergraduate health-science students in Vietnam. METHODS: A cross-sectional analytical study was conducted among 764 undergraduate students from medicine, nursing, pharmacy, and other health programs at two universities in Hanoi. Stratified random sampling ensured representation by major and academic year. Nutritional status was classified by BMI using WHO Asian cutoffs. Attitudes toward obesity were measured using the 20-item Attitudes Toward Obese Persons Scale and analyzed in three domains identified by factor analysis. Physical activity, emotional well-being, and resilience were assessed using validated scales. Ordered logistic regression identified predictors of higher BMI category, and Tobit regression examined factors associated with attitude domain scores. RESULTS: Most students had normal BMI, while overweight and obesity were more common in males, in certain living situations, and in general medicine students. Female gender and pharmacy major were associated with lower odds of higher BMI, whereas higher depression scores were associated with higher BMI category. Attitudes toward obesity showed moderate negative stereotypes and relatively positive beliefs. BMI category was associated only with the psychological inferiority domain, with higher scores among students with overweight. Female gender, lower depression, higher happiness and resilience, and moderate physical activity were associated with more favorable attitude profiles. CONCLUSION: Among Vietnamese health-science students, nutritional status and attitudes toward obesity varied across demographic and psychosocial characteristics. Excess weight and weight-related attitudes appear partly independent but influenced by mental well-being and training context. Integrated health promotion and stigma-reduction strategies in health-professional education may improve both student health and future obesity care.

BACKGROUND: Bipolar disorder (BD) is a highly heritable condition characterized by recurrent shifts between manic and depressive states. Here we investigated the potential involvement of the habenula because it plays a central role in negative affect and behavioral regulation. METHODS: We investigated bilateral habenular volume and seed-based resting-state functional connectivity in a discovery cohort (78 BD, 102 controls) and an independent replication cohort (72 BD, 85 controls). Associations among habenular features, clinical symptoms, and molecular correlates were examined by integrating pathway-specific polygenic risk scores and brain-wide gene expression data from the Allen Human Brain Atlas. RESULTS: Across both cohorts, BD was associated with reduced bilateral habenular volume and increased rs-FC between the habenula and right precentral gyrus. Habenular volume correlated positively with severity of mania symptoms and negatively with severity of symptoms of anxiety and somatization. Polygenic risk scores linked the altered volume to dopaminergic pathways and altered connectivity to serotonergic pathways, while transcriptomic data linked the altered connectivity to changes in expression of synaptic membrane structures, transporter complexes, and other proteins involved in synaptic transmission. CONCLUSIONS: Structural, functional and transcriptomic data identify the habenula as a critical neural hub in BD and therefore important for understanding pathogenesis and clinical manifestations. CLINICAL TRIAL NUMBER: Not applicable.

Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide, characterized primarily by motor symptoms such as resting tremor, rigidity, and bradykinesia, accompanied by non-motor symptoms (NMS) including constipation and depression. The underlying mechanisms of PD are multifaceted, driven by a complex interaction between genetic and environmental factors that remain to be entirely understood. In recent years, an increasing body of evidence has confirmed that the abnormal aggregation of α-synuclein (α-Syn), mitochondrial dysfunction, and neuroinflammatory activation are not isolated pathological events; rather, they constitute the core driving mechanism of PD pathogenesis and progression through complex networked interactions. This narrative review examines the independent mechanisms of these three pathological components, provides an in-depth analysis of their regulatory interaction networks, and summarizes therapeutic targets and synergistic treatment strategies for the pathological axes, aiming to provide theoretical support for disease-modifying therapy and early intervention in PD.

Schizophrenia is characterized by striking symptom heterogeneity, yet the mapping between specific clinical phenotypes and their underlying biological substrates remains elusive. To bridge this gap, we applied an integrative, multi-scale framework combining symptom network analysis, connectome-based predictive modeling (CPM), and transcriptomic mapping in a multi-center cohort of schizophrenia patients. This approach revealed a hierarchical dissociation between phenotypic topology and underlying biological mechanisms among the identified high-centrality core symptoms: Conceptual Disorganization, Unusual Thought Content, and Blunted Affect. While Conceptual Disorganization and Unusual Thought Content exhibited clinical coherence as psychosis-related features, CPM uncovered a divergence in their neural substrates. Conceptual Disorganization shared greater neurofunctional isomorphism with Blunted Affect-characterized by converging dysconnectivity within the Somatomotor Network (SMN) and subcortical circuits-whereas Unusual Thought Content displayed a distinct architecture driven by prominent Default Mode Network regulation beyond the shared sensorimotor substrate. Transcriptomic annotation further stratified these dimensions: psychosis-related networks were underpinned by synaptic regulatory genes, whereas Blunted Affect was enriched for intracellular MAPK signaling and metabolic processes. These findings delineate a hierarchical model in which distinct molecular etiologies-synaptic versus metabolic-cascade into shared systems-level failures at the "somato-cognitive interface". We conclude that while symptoms may group clinically, their treatment requires targeting separable molecular pathways that converge on common circuit bottlenecks. This framework reconciles symptom heterogeneity with overlapping biological substrates, advocating for a mechanism-based stratification of schizophrenia.

Anxiety, depression, and stress are common in individuals with diabetes and cancer and are associated with poor self-management and well-being. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) are widely used in nonpharmacological treatments, but their comparative effectiveness remains unclear. We conducted a stratified subgroup meta-analysis to indirectly compare CBT and MBIs in adults with diabetes or cancer, examining moderators including condition, delivery modality, and dose. Following PRISMA guidelines, we searched Scopus, Web of Science, EBSCOhost, and ScienceDirect through October 2025. Randomized trials (N = 107; n = 23,585) reporting validated post-intervention outcomes were pooled using random-effects models, with subgroup and meta-regression analyses performed in RStudio. Overall, CBT and MBIs significantly improved outcomes (SMD = -0.78). CBT showed larger effects, particularly for depression (SMD = -0.95) and diabetes (SMD = -1.21), although comparisons were indirect and heterogeneity was substantial. Stronger effects were observed in group-based interventions lasting ≥8 weeks, providing ≥8 contact hours, and including homework or booster components; higher session frequency was also associated with greater improvement (β = -0.086; p < 0.01). MBIs may offer scalable benefits, particularly in cancer care. These findings support condition-tailored psychosocial strategies, although results should be interpreted cautiously.