BACKGROUND: There is a reciprocal cycle between rumination and depression. However, understanding of the role of self-compassion in the relationship between depressive symptoms and rumination remains limited. AIM: To examine the moderating role of self-compassion in the relationship between depressive symptoms and rumination in community-dwelling older adults. METHODS: The study was conducted using an analytical cross-sectional design. Data were collected face-to-face from 463 older adults aged 65 years and older between September and November 2024. Data were collected using a descriptive information form, Geriatric Depression-15 Scale, Ruminative Thought Style Questionnaire, and the Self-Compassion Scale-Short Form. RESULTS: Analysis revealed that rumination and self-compassion together explained approximately 41.6% of the variance in depressive symptoms among older adults, that rumination positively predicted depressive symptoms, and that self-compassion negatively predicted depressive symptoms. The interaction effect of ruminative thought style and self-compassion on depressive symptoms was found to be negative and significant. CONCLUSIONS: This study showed that when self-compassion was high in older adults, the increasing effect of ruminative thought style on depressive symptoms was weakened. The findings suggest that self-compassion-based interventions implemented by mental healthcare professionals may be beneficial for improving the mental health of older adults who experience depressive symptoms.

This study examines ethnic disparities in abuse and depression and moderating role of social support among older adults in India. Validated scales were used to examine the levels of depression and mistreatment. Abuse was reported among 24.3% of tribal and 43.5% of non-tribal older adults, while depression was prevalent among 51.3% of non-tribal and 32.5 % of tribal older respondents. Lower and moderate social support were significantly associated with increased abuse and depression among tribal older adults. Female sex, lower income, living alone, functional impairment, and widow/widower status were significant risk factors. Findings support culture-specific interventions to protect older people. .

Visual Snow Syndrome (VSS) is a neurological condition characterized by the persistent perception of dynamic, flickering, dot-like visual disturbances across the entire visual field, resembling television static. Increasing evidence indicates that VSS is frequently accompanied by a broad spectrum of psychiatric symptoms, including anxiety, depression, depersonalization, fatigue, and sleep disturbances, all of which substantially impair quality of life. Although the pathogenesis of VSS remains incompletely understood, Current evidence increasingly suggests that VSS may represent a multisystem neuropsychiatric network disorder involving visual cortical hyperexcitability, thalamocortical dysrhythmia, widespread abnormalities in functional connectivity, and limbic system dysfunction. Psychiatric symptoms may partly reflect intrinsic neurobiological mechanisms of the syndrome rather than being solely secondary psychological reactions to chronic visual disturbances. Current pharmacological therapies generally show limited efficacy. Preliminary evidence suggests that non-pharmacological approaches, including neuromodulation, tinted lenses, and mindfulness-based interventions, may offer therapeutic potential with relatively favorable tolerability, although larger controlled studies are still required. Future research should adopt multidisciplinary strategies integrating neurology, psychiatry, neuroimaging, and genetics to further elucidate the mechanisms underlying VSS and facilitate the development of precision diagnostic and therapeutic approaches.

α-Synucleinopathies are marked by persistent neuroinflammation and disabling non-motor symptoms involving nucleus accumbens (NAc) dysfunction, yet the neuroimmune mechanisms linking microglial activation to accumbal synaptic pathology remain poorly understood. Here, we identify α1-antitrypsin (AAT) as a previously unrecognized modulator of cannabinoid receptor 2 (CB2R)-associated signaling in α-syn pathology. An acute transcriptomic screen revealed prominent induction of the Serpina1 gene family, while primary-microglial and chronic AAV-α-syn experiments showed that Cnr2 deficiency amplified Serpina1/AAT responses, consistent with an insufficient compensatory reaction to persistent inflammation. Molecular docking, reciprocal co-immunoprecipitation, and surface plasmon resonance provided complementary evidence supporting an AAT-CB2R association under the respective assay conditions. Functionally, AAT reduced the α-syn-associated elevation of intracellular cAMP in an AM630-sensitive manner and attenuated ATP-evoked Ca⁺ responses, calpain-1 activity, GSK-3β N-terminal cleavage, and NLRP3/caspase-1-related cytokine production; these effects were substantially diminished in Cnr2-deficient microglia. Calpeptin reproduced key molecular effects, implicating calpain-related proteolysis in this neuroimmune response. In vivo, intracerebroventricular AAT preserved NAc synaptic ultrastructure, ameliorated excitatory synaptic abnormalities in dopamine D2 receptor-expressing medium spiny neurons, and improved fear-memory retrieval, spontaneous alternation, and anxiety-like behavior, without affecting novel object recognition or motor performance. Several effects were attenuated under Cnr2-deficient conditions, although selected electrophysiological responses persisted. Our findings identify AAT-CB2R-linked signaling as a modulator of microglial inflammatory homeostasis and support the therapeutic potential of AAT for NLRP3-associated neuroinflammation and non-motor dysfunction in α-synucleinopathies.

Depressive symptoms are common among HIV-positive pregnant women and can negatively affect maternal well-being, antiretroviral therapy adherence, and prevention of mother-to-child transmission. This systematic review and meta-analysis aimed to estimate the pooled prevalence of depressive symptoms and identify associated risk factors among HIV-positive pregnant women in Asia. PubMed, Scopus, and Google Scholar were searched to identify relevant studies from inception to December 2025. Observational studies reporting depressive symptoms among HIV-positive pregnant women were included. Study selection, data extraction, and quality assessment were independently performed by two reviewers. A random-effects model was used to calculate the pooled prevalence in RStudio. Six studies involving 778 participants were included. The pooled prevalence of depressive symptoms was 61.4% (95% CI: 48.2-73.1), with substantial heterogeneity ( = 90.2%, < 0.001). Prevalence was highest in India (66.5%), followed by Thailand (58.0%) and China (54.1%). Studies with large sample sizes exhibited lower prevalence (51.9%) than those with small sample sizes (69.8%). Associated factors included rural residence, primigravida status, inadequate antenatal care, non-disclosure of HIV status, limited partner support, HIV diagnosis during pregnancy, and negative illness perception. Integration of routine mental health screening and psychosocial support into antenatal and HIV care services is essential.

PURPOSE: To identify heterogeneous sleep-quality profiles among pregnant women in the third trimester and characterize profile-specific sleep quality-depressive symptom network structures. PATIENTS AND METHODS: This cross-sectional study included 471 pregnant women in the third trimester attending antenatal care at a tertiary Grade A hospital in China. Sleep quality and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Self-Rating Depression Scale (SDS), respectively. Latent profile analysis was used to identify sleep-quality subgroups, followed by network analysis in subgroups with adequate sample sizes. RESULTS: Four sleep-quality profiles were identified: the moderate multidimensional sleep impairment group (n=177, 37.6%), daytime dysfunction group (n=85, 18.1%), good sleep quality group (n=182, 38.6%), and low sleep efficiency group (n=27, 5.7%). Because of its small sample size, the low sleep efficiency group was excluded from formal network analysis. SDS11 ("emptiness in life") had the highest strength in the moderate multidimensional sleep impairment and good sleep quality groups, whereas SDS1 ("depressed mood") had the highest strength in the daytime dysfunction group. PSQI6 ("daytime dysfunction") had the highest bridge strength in all three analyzed networks. After Holm correction, the moderate multidimensional sleep impairment group showed significantly higher global strength than the good sleep quality group (6.531 vs 4.839; adjusted P=0.012). CONCLUSION: Sleep quality showed substantial heterogeneity among pregnant women in the third trimester, and sleep quality-depressive symptom network characteristics differed across sleep-quality profiles. These findings provide exploratory evidence on subgroup-specific symptom associations and warrant further validation in prospective studies.

Alcohol use in aviation has traditionally been addressed in relation to acute impairment and operational safety. However, the health implications of alcohol extend beyond intoxication and include carcinogenic risk, neurobiological changes associated with alcohol use disorders, and potential effects on cognitive functioning. This narrative review examines these issues within the occupational and aeromedical contexts of professional pilots. It also considers aviation-specific factors that may influence behavioral health and help-seeking, along with the role of the Human Intervention Motivation Study (HIMS) program in treatment, monitoring, recovery, and return to professional flying status. Examining these areas together provides a broader perspective on alcohol and pilot health than an impairment-focused approach. In aerospace medicine, this perspective supports continued attention to prevention, early identification, recovery, and long-term health, while maintaining aviation safety as the primary operational consideration.

BACKGROUND: Anxiety and depressive symptoms are common among medical students, but multicenter evidence from the early years of training in Pakistan is limited. We estimated symptom prevalence and examined sociodemographic, behavioral, academic, and psychosocial correlates of symptom severity. METHODS: We conducted a multicenter cross-sectional survey from January to June 2024 among 1630 of 1800 invited first- and second-year students at 9 medical colleges in Islamabad (response rate, 90.6%). Symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Because the proportional-odds assumptions were not supported and sparse upper-severity categories caused separation, adjusted associations were estimated using bias-reduced multinomial logistic regression with minimal symptoms as the reference outcome. RESULTS: Anxiety symptoms (GAD-7 ≥ 5) were present in 756/1630 students (46.4%; 95% CI, 44.0%-48.8%), and depressive symptoms (PHQ-9 ≥ 5) in 942/1630 (57.8%; 95% CI, 55.4%-60.2%). Peer pressure was associated with moderate versus minimal anxiety (aOR, 6.42; 95% CI, 3.59-11.49), severe versus minimal anxiety (aOR, 37.23; 95% CI, 3.54-391.86), moderate versus minimal depressive symptoms (aOR, 4.07; 95% CI, 2.69-6.18), and moderately severe/severe versus minimal depressive symptoms (aOR, 10.79; 95% CI, 3.79-30.73). Sleeping 7-8 h per night was associated with lower odds of severe anxiety (aOR, 0.11; 95% CI, 0.02-0.59) and moderate depressive symptoms (aOR, 0.22; 95% CI, 0.12-0.38). Severe-category estimates were imprecise because only 20 students had severe anxiety and 34 had moderately severe/severe depressive symptoms. CONCLUSION: Anxiety and depressive symptoms were common among early-year medical students. Peer pressure, harassment, sleep, academic stage, and support were associated with symptom severity, but the cross-sectional design precludes causal inference. Medical colleges should evaluate confidential student-support and referral pathways.

BACKGROUND: Depression is common among individuals with asthma and is linked to increased mortality. However, whether socioeconomic factors contribute to this association remains unclear. We explored whether income may partially account for the association between depressive symptoms and reduced survival in adults with asthma. METHODS: A total of 4945 asthma patients were included using baseline data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 linked to the National Death Index (NDI) mortality follow-up through December 31, 2019. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and mortality was identified through linkage to the NDI. Cox proportional hazards models were used to evaluate the association between depression symptoms and all-cause mortality, and restricted mean survival time (RMST) analysis quantified survival differences over 15 years. Exploratory mediation analysis with quasi-Bayesian simulation was conducted to evaluate whether the poverty-income ratio (PIR) may partially account for the observed association, adjusting for demographic, behavioral, and clinical covariates. RESULTS: Depression was associated with all-cause mortality in asthma patients, and the strength of this association decreased after adjustment for demographic, behavioral, and clinical factors. Over a 15-year period, patients with depression symptoms (PHQ-9 ≥ 10) had markedly shorter survival, losing 9.89 months in RMST (155.2 vs. 165.1 months; < 0.001). In exploratory mediation analysis, PIR accounted for 23.8% of the observed association between depressive symptoms and reduced survival, suggesting a potential socioeconomic contribution to the survival gap. CONCLUSION: Depressive symptoms were associated with reduced survival among adults with asthma, and income may partially account for this observed relationship. These findings should be interpreted cautiously because depressive symptoms and income were measured at baseline, limiting causal interpretation of the mediation analysis. Further longitudinal studies are needed to confirm these findings and clarify temporal relationships.

RATIONALE: Peripheral inflammatory biomarkers are potential predictors of antidepressant response in major depressive disorder (MDD). OBJECTIVE: This study updated a 2022 meta-analysis by extending the literature through January 2026 to clarify these biomarker-response associations. METHODS: PubMed was searched from February 2021 to January 2026. Eligible studies evaluated baseline peripheral biomarkers in adults with MDD before starting ⩾4 weeks of pharmacotherapy, comparing responders vs. non-responders. Standardized mean differences (SMD; Hedges' g) were pooled using random-effects models. Subgroup analyses and meta-regressions examined antidepressant class and publication period. RESULTS: Twenty-four studies (16 from the prior review, 8 new) were quantitatively analyzed. In primary pooled analyses, no baseline biomarkers (including CRP and IL-8) significantly differentiated responders from non-responders. However, exploratory analyses revealed a nominal interaction by publication period for IL-2 (p = 0.0112). In recent studies (2021-2026), baseline IL-2 was nominally lower in responders than non-responders (SMD = -0.81; 95% CI -1.59 to -0.03; p = 0.04). Similarly, in recent studies restricted to Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-norepinephrine reuptake inhibitors (SNRIs), baseline IL-6 was nominally lower among responders (SMD = -0.37; 95% CI -0.69 to -0.05; p = 0.02). Leave-one-out analyses confirmed overall robustness, though IL-6 showed moderate sensitivity. CONCLUSION: While individual baseline biomarkers have limited utility as standalone predictors when pooling all historical data, lower baseline IL-2 and IL-6 emerge as promising signals for predicting treatment response in contemporary studies (2021-2026) and specific antidepressant classes (SSRIs/SNRIs).

Canada legalized the non-medical use and supply of cannabis in 2018. The public health-relevant outcomes of cannabis legalization documented to date have been mixed, with decreases in cannabis-related crime and illegal distribution markets, while with increases for many - acute and chronic - health problem indicators. One public health-relevant aspect of legalization that has not been adequately assessed to date are its potential effects on alcohol and/or tobacco use and related outcomes in the population. Existing literature suggests that cannabis legalization may impact alcohol and/or tobacco use in different ways and directions, through both 'substitution'- and/or 'complementarity'-type dynamics. While cannabis use prevalence has markedly increased through legalization, recent epidemiological indicators suggest the possibility of (small) changes in rspective other substance use, yet it is empirically unclear whether these developments are causally interrelated. Also considering the substantial adverse public health burden arising from alcohol and tobacco use in the Canadian population, this Commentary makes the case for systemic examination of the potential impacts of cannabis legalization on alcohol and/or tobacco use outcomes by way of rigorous analytical methods as part of assessing the overall public health-related effects of cannabis legalization in Canada as well as other jurisdictions where cannabis has been legalized.

BACKGROUND: Older adults with hypertension commonly experience poor sleep quality and reduced health-related quality of life (HRQoL). Previous studies have mainly examined these associations using total scores, providing limited insight into interactions between specific symptom dimensions. This study aimed to construct a component- and dimension-level network linking sleep quality and HRQoL and to compare network differences across depressive-symptom status. METHODS: This study included 2,257 older adults. Sleep quality, HRQoL, and depressive symptoms were assessed using the B-PSQI, EQ-5D-5L, and PHQ-9, respectively. We estimated a component- and dimension-level network based on the EBICGlasso-regularized Gaussian graph model, calculated centrality and bridge centrality metrics, validated stability using the bootstrap method, and compared network differences between the depressive and non-depressive-symptom groups. RESULTS: The final network included 10 nodes and 32 non-zero edges among 45 possible edges, with a density of 0.711. The strongest associations were between sleep efficiency and sleep duration (SE-ST, 0.793), sleep interruption and subjective sleep quality (SW-SQ, 0.583), and self-care and usual activities (SC-UA, 0.560). Usual activities (UA) showed the highest strength centrality and expected influence, followed by subjective sleep quality (SQ), self-care (SC), and sleep efficiency (SE). Sleep efficiency had the highest bridge expected influence, followed by subjective sleep quality. Centrality indices demonstrated good stability (CS = 0.75). No significant differences were found in network structure (M = 0.224, > 0.05) or global strength (S = 0.119, > 0.05); repeated 1:1 subsampling broadly supported these findings. CONCLUSION: Sleep components and HRQoL dimensions formed a closely connected network in older adults with hypertension. Usual activities showed the highest centrality, while sleep efficiency and subjective sleep quality showed prominent cross-community. These domains may be useful for screening or hypothesis generation but should not be interpreted as confirmed intervention targets.

BACKGROUND Depression and anxiety-common among military recruits-are associated with gastrointestinal symptoms. The prophylactic effects of psychological interventions on depression, anxiety, and gastrointestinal symptoms in recruits remain unclear. MATERIAL AND METHODS Overall, 565 military recruits were prospectively screened. Eligible participants had no depression according to the Self-Rating Depression Scale (SDS); no anxiety according to the Self-Rating Anxiety Scale (SAS); no gastrointestinal symptoms according to the Gastrointestinal Symptom Rating Scale (GSRS); and normal stool form according to the Bristol Stool Form Scale (BSFS). Based on the company in which recruits were trained, participants were assigned to the intervention group, which received progressive muscle relaxation training combined with music intervention for 4 weeks (n=60), or the control group, which received no psychological intervention (n=99). SDS, SAS, GSRS, and BSFS questionnaires were completed at baseline, week 4 (ie, upon completion of psychological intervention), and week 6 (ie, 2 weeks after completion of psychological intervention). RESULTS The incidences of depression (1.7% vs 2.0%, P=1.000) and anxiety (3.3% vs 1.0%, P=0.557) at week 4 did not significantly differ between groups. Similarly, the incidences of depression (0% vs 1.0%, P=1.000) and anxiety (0% vs 2.0%, P=0.527) at week 6 did not significantly differ between groups. The incidences of various gastrointestinal symptoms, as well as constipation and diarrhea, also were not significantly different between groups. CONCLUSIONS Progressive muscle relaxation training combined with music intervention may not be effective for preventing depression, anxiety, or gastrointestinal symptoms in military recruits.

BACKGROUND: A considerable proportion of patients experience post-acute sequelae of COVID-19 (PASC). Increasing evidence suggests sex-related differences, yet systematic longitudinal analyses remain limited. This study aimed to examine sex-specific differences in symptoms, psychological burden, work productivity and physical activity over ten months following acute COVID-19. METHODS: In this prospective, dynamically enrolled cohort study, patients with ongoing symptoms after confirmed SARS-CoV-2 infection were followed over a 10-month observation period. Patients conducted at the post-COVID outpatient clinic of the department of respiratory medicine and infectious diseases at Hannover Medical School, Germany. The assessment included patient-reported outcome measures, pulmonary function tests, six-minute walk tests, and capillary blood gas analysis. All outcome comparisons between sexes were adjusted for age, BMI, COVID-19 severity, and comorbidities using generalised linear mixed-effects models, with sex-by-time interaction terms tested to assess whether differences changed over follow-up, and p-values corrected for multiple testing across all outcome comparisons using the Holm method. A sensitivity analysis was performed in the subgroup of patients with complete follow-up at all four visits. RESULTS: Five hundred ninety patients attended to our clinic and a total of 433 patients were eligible and consecutively enrolled. Males were older (56 years vs. 52 years, p = 0.002), had more cardiovascular comorbidities (16% vs. 5%, p < 0.001), and experienced more severe COVID-19 (28% vs. 8%, p < 0.001). After adjustment for age, BMI, COVID-19 severity, and comorbidities, and Holm correction for multiple testing across all 27 outcome comparisons, females showed higher fatigue (Fatigue Assessment Scale, adjusted β = 3.3, Holm-adjusted p = 0.006), higher anxiety (GAD-2, β = 0.5, p = 0.021), lower quality of life (EQ-5D-3L, β = -0.6, p = 0.004), and greater work productivity impairment, both as a continuous score (WPAI-VAS, β = 1.3, p = 0.031) and as a binary indicator of clinically relevant impairment (OR = 3.0, p = 0.020). Females also had higher percent-predicted (pp) total lung capacity (p < 0.0001) and lower pCO (p < 0.0001), whereas males had higher pp diffusion capacity (p = 0.001). Headache (p < 0.001) and chest tightness (p = 0.011) were reported more frequently by females. None of these differences varied significantly over the 10-month follow-up (all sex-by-time interaction p ≥ 0.41), indicating no evidence that these differences changed over time. No significant sex differences remained after adjustment for depression (PHQ-2), lung function parameters, sex/height-adjusted exercise capacity, post-exercise dyspnoea or oxygen saturation, or most acute-COVID-19 symptoms other than headache and chest tightness. Regression models separately for each sex revealed fever (OR = 2.48, 95% CI: 1.11-5.57, p = 0.027) and diarrhoea (OR 2.33, 95%CI: 1.05-5.16, p = 0.038) during acute COVID-19 were associated with higher odds of work productivity impairment (WPAI-VAS ≥ 2) in males. In females, higher BMI (OR = 2.06, 95% CI: 1.13-3.76, p = 0.018) and dyspnoea during acute COVID-19 (OR = 4.38, 95% CI: 1.55-12.40, p = 0.005) were associated with increased odds. Formal interaction analyses showed a significant interaction only for dyspnoea after Holm correction. CONCLUSIONS: After accounting for baseline imbalance in age, BMI, COVID-19 severity, and comorbidities, and after correcting for multiple testing, sex-specific differences persisted for fatigue, anxiety, quality of life, and work productivity impairment, as well as selected lung function parameters. These differences did not change significantly across the 10-month observation period and did not show a significant sex-by-time interaction. The findings support the need for individualised, sex-specific follow-up focused on fatigue, psychological burden, and work productivity in patients with PASC.

Nociceptin orphanin F/Q has been implicated in stress-related depressive phenotypes. Specifically, exposure to chronic stressors upregulates nociceptin receptors (NOPR), whereas NOPR antagonism has antidepressant/anti-anhedonic effects. However, the mechanisms underlying reward-related effects remain unclear. Here, we investigated the role of NOPR in a broad spectrum of reward-related phenotypes (reward consumption, reward learning, motivated behavior) alongside potentially prohedonic effects of NOPR antagonism across species. Study 1 evaluated whether exposure to early-life adversity upregulated ventral tegmental area (VTA) and striatal prepronociceptin (Pnoc) gene expression in adult mice. Study 2 assessed whether NOPR antagonism boosted reward learning in rats using the touchscreen-based Probabilistic Reward Task. Finally, Study 3 tested whether NOPR antagonism modulated decision about motivated behavior using the Effort Expenditure for Reward Task among depressed humans. In Study 1, early-life adversity induced reduced sucrose preference and produced enduring and sex-dependent alterations in effort-related reward behavior, and increased Pnoc expression in the VTA; in females (but not males), early-life adversity increased Pnoc expression in the dorsal striatum. In Study 2, acute administration of 30 mg/kg (but not lower doses) of a NOPR antagonist (BTRX-246040) enhanced reward learning in rats. Finally, in Study 3, relative to placebo, 8-week treatment with BTRX-246040 modulated choice consistency during a motivated task in depressed humans. Collectively, our findings indicate that chronic stress alters Pnoc and mRNA levels of Pnoc-expressing cells in a sex-selective and region-specific manner impacting reward structures, and that NOPR antagonism shows promising efficacy in increasing reward-related behaviors in rodents and humans. Future studies using similar manipulations and outcome measures across species are warranted.

The significant heterogeneity of major depressive disorder (MDD) requires the development of interventions that directly target underlying cognitive or neurobiological mechanisms. This work tested the efficacy of self-modulation of the dopaminergic midbrain with high-field 7-Tesla functional MRI biofeedback in a randomized, controlled, proof-of-principle trial that targeted motivation regulation. A total of N = 62 unmedicated participants (MDD and healthy controls) were randomized to receive either Active or Sham 7-Tesla functional MRI biofeedback and completed clinical assessments pre- and up to 30-days post-training. Factor analysis of clinical symptom change revealed a single latent clinical improvement factor that was significantly improved in the Active MDD compared to the Sham MDD group, immediately post-training (β = 15.85, t = 2.31, p = 0.03), and at 24-hours post-training (β = 22.84, t = 2.45, p = 0.02); effects were diminished and no longer significant at 7-day and 30-day follow-ups. Results of specific phenotypic clinical analysis revealed that depressed mood (F = 5.04, p = 0.029) and negative affect (F = 5.21, p = 0.027), but not positive affect, were most improved by the Active biofeedback intervention. Active biofeedback training engaged functional coupling over time between the VTA and the lateral frontal cortex in the MDD group (F = 6.03, p = 0.017), and greater overall VTA regulation was associated with clinical improvement (R = 0.268, p = 0.048). Together, these results indicate the potential utility of dopaminergic midbrain-based biofeedback training for improvement of mood and negative affect in MDD.

Psychocardiology connects the biological reality of cardiovacular diseases with the subjective experience of the patient. In cases of cardiac arrhythmias, this relationship is particularly evident: cardiac arrhythmias are measurable electrophysiological events but they are also subjectively perceived, emotionally evaluated and embedded in a patient's biography. The objective burden of arrhythmia does not always correlate with the degree of subjective suffering. Although modern electrophysiology provides highly differentiated diagnostic and interventional treatment options, the question of the individual experience of illness often remains secondary. This article discusses cardiac arrhythmias from a psychocardiological and psychosomatic perspective. It focuses on the heart-brain axis, the role of anxiety, depression, hypervigilance and illness perception as well as atrial fibrillation as a model of a biopsychosocial disorder. In addition, the heart is considered as a special organ where its activity can be directly perceived and is culturally associated with life, safety, identity and vulnerability. Psychocardiology is not understood as psychologizing cardiac disease but as an integrative clinical attitude that takes both biological findings and subjective experience seriously.

Vanzacaftor-tezacaftor-deutivacaftor (VTD) is the newest triple-combination CFTR modulator, licensed as an alternative to elexacaftor-tezacaftor-ivacaftor (ETI). Neuropsychiatric adverse effects are recognised with ETI and now carry a specific post-marketing warning for VTD. At our regional adult cystic fibrosis centre (454 patients under follow-up), 87 have been commenced on VTD, mainly for elevated sweat chloride on ETI and dosing preference. Three individuals with pre-existing mental health conditions were proactively started on a reduced dose (one tablet daily); two of three showed sweat chloride improvement below 40 mmol/L, with no reported adverse effects. Among the remaining patients, four (4.6%) developed new-onset or worsening psychiatric symptoms at standard dose. Three had no prior psychiatric history; one had pre-existing depression on long-term sertraline that markedly worsened. Onset ranged from two weeks to four months. Three of four showed a good physiological response, with further sweat chloride reduction and stable or improved lung function; the fourth switched back too rapidly for retesting. Three patients required switching back to ETI, with resolution of symptoms within days; one continued VTD with resolution by three months. This rate is comparable to previously reported real-world ETI rates (7% and 7.9%), though more of our cases involved suicidal ideation and required full discontinuation. Cases were identified clinically rather than through systematic screening, which may affect detection rates. These findings highlight the need for early mental health screening after VTD initiation and a low threshold for psychiatric review. All cases have been reported to the MHRA Yellow Card scheme.

OBJECTIVE: To evaluate the association between interaction with a certified therapy dog prior to awake, in-office laryngologic procedures and patient-reported anxiety, depression, and pain compared with standard care. METHODS: This was a prospective pilot study of adult patients undergoing in-office laryngologic procedures. Participants completed pre- and post- assessments of anxiety, depression, and pain. Patients who were seen with certified therapy dogs comprised the canine group and were compared with a control group of patients who were not seen with therapy dogs. Group differences were assessed using independent-samples t tests or Mann-Whitney U tests for nonparametric data. Within-group changes were analyzed with paired t tests or Wilcoxon signed-rank tests. Group × time interactions were assessed using mixed two-way ANOVA. RESULTS: Fifty patients were included (31 canine, 19 control). Baseline demographics were similar between groups. In the canine cohort, anxiety and depression decreased significantly following the procedure, while pain showed a nonsignificant reduction. In the control group, anxiety decreased significantly, but pain and depression did not change significantly. Post-procedure pain and depression were significantly lower in the canine group compared with controls. "Significant group × time interactions were observed for anxiety, pain, and depression." CONCLUSION: Patients who interacted with therapy dogs was associated with lower patient-reported anxiety and depression, supporting the use of therapy dog programs to improve patient experience during in-office procedures. These findings support further investigation of animal-assisted interventions using randomized study designs and validated outcome measures.

BACKGROUND: Excessive daytime sleepiness and broader hypersomnolence symptoms may persist despite improvement of core depressive symptoms, yet no specific clinical framework currently guides their assessment and management in mood disorders. This work aimed to establish a national expert consensus on the definition, assessment, management and follow-up of residual excessive daytime sleepiness associated with depression (rEDS-dep). METHODS: A nominal group consensus process was conducted from September 2025 to April 2026. A Steering Committee comprised eleven French experts with clinical and scientific expertise in psychiatry, neurology, pulmonology and sleep medicine. After a comprehensive literature review, the experts anonymously generated statements covering four domains: definition, clinical assessment, management and follow-up. Statements were discussed during two collective meetings, then rated anonymously on a 9-point Likert scale. Strong consensus was defined as more than 75% of scores≥7 combined with a median score≥8; good consensus was defined when only one of these criteria was met. Statements not reaching good/strong consensus or requiring clarification were revised and submitted to a second round of voting. RESULTS: The initial nominal group phase produced 70 statements. After two voting rounds, 48 statements were retained: 35 (73%) reached strong consensus, one (2%) reached good consensus and 12 (25%) did not reach consensus. Experts agreed on a pragmatic definition of rEDS-dep as a specific clinical syndrome characterized by a persistent alteration of arousal, associated with a significant distress and/or disability (functional impairment), and increased risk of depressive relapse and/or disability. This diagnosis is made after excluding other better possible explanations: persisting depressive symptoms, psychiatric, other medical cause, iatrogenic, or psychotropic substance-related causes, or causes related to another sleep disorder. Consensus supported a multidimensional definition including excessive daytime sleepiness, daytime drowsiness, prolonged sleep duration, involuntary naps, and/or sleep inertia, persisting daily or almost daily for more than three months despite adequate treatment and improvement of core depressive symptoms. Assessment should integrate symptom frequency and severity, related distress and/or disability, sleep and circadian behaviours, comorbidities, psychotropic exposure, sleepiness related accident risk, sleep diary, actigraphy when indicated, and self-report measures such as the Hypersomnia Severity Index (HSI) questionnaire. First-line management should prioritize reassessment of psychotropic treatments, reduction of sedative co-medications when appropriate, patient information on sleep and circadian behaviours and lifestyle habits, specific circadian interventions including morning light therapy, and occupational adaptations. Wake-promoting agents may be considered only as second-line options in selected patients with persistent distress and/or disability, or sleepiness related accident risk, in coordination with the treating psychiatrist and with regular monitoring of mood, sleep and adverse effects. Follow-up should be provided though a multidisciplinary approach involving the psychiatrist, general practitioner, and sleep specialist, with regular reassessment of hypersomnolence, depressive symptoms, comorbidities, sleepiness related accident risk and the ongoing need for wake-promoting treatment. CONCLUSIONS: This national consensus provides the first structured clinical framework for rEDS-dep. It supports recognition of rEDS-dep as a multidimensional syndrome requiring dedicated assessment, stepwise management and coordinated follow-up, while highlighting the need for observational, pathophysiological and interventional studies.

BACKGROUND: As traditional biomarkers have failed to deliver on promises of personalized diagnosis and treatment in psychiatry, digital biomarkers offer continuous and ecologically valid monitoring. By capturing symptoms directly within patients' everyday environments, they support a systemic approach to psychiatry. However, this ecological dimension challenges conventional validation criteria and requires in situ validation beyond research laboratories. OBJECTIVES: This study has two aims: first, to identify and compare standardization documents that could support validation standards for digital biomarkers in psychiatry; second, to situate these documents within a circulation framework between laboratories and the real world, inspired by the sociology of innovation, in order to analyze their dynamics. Methods Standardization documents relating to the validation of digital biomarkers and smartphone applications in psychiatry were identified through expert selection. Their main dimensions were extracted and mapped onto a framework linking laboratories and the "wider world". This process was conducted by an interdisciplinary consortium combining computer science, psychiatry, and Science and Technology Studies (STS). RESULTS: Four heterogeneous standardization documents were identified. Mapping their components within the circulation framework enabled comparison of the documents and of the design constraints they implement. DISCUSSION: The findings suggest that these standardization documents are not yet stabilized. Rather than fixed standards, they function as tools for negotiation between epistemic communities and actors with unequal power relations, within academic infrastructures that maintain biases. This highlights the need for a socio-technical democracy in mental health. CONCLUSION: STS provides valuable tools for understanding the dynamics of standardization and the plurality of actors involved in validating digital biomarkers in psychiatry.

INTRODUCTION: While recent studies have highlighted sexual dysfunctions as a common comorbidity of several psychiatric disorders very few have focused on social anxiety disorder. However, its shared impact with sexual dysfunctions on interpersonal relationships and self-esteem suggested a potential bidirectional relationship worth investigating. OBJECTIVES: To provide an overview of the available literature on the relationship between social anxiety disorder and sexual dysfunctions, particularly by exploring the frequency and nature of sexual dysfunctions in patients with social anxiety disorder, and the prevalence of social anxiety disorder in sexual dysfunctions populations. METHODS: We conducted the first systematic review (according to PRISMA guidelines) to explore this association. Using three databases (MEDLINE, Google Scholar and Science Direct), we included studies reporting quantitative outcomes of sexual dysfunctions among participants with social anxiety disorder or quantitative outcomes of social anxiety among participants with sexual dysfunctions. RESULTS: Five studies reported data on sexual dysfunctions among 241 subjects with social anxiety disorder, with overall prevalence rates ranging from 33.3% to 36.3%. Premature ejaculation emerged as the most frequently reported condition in men, with prevalence ranging from 33% to 47.4%. Among women, genito-pelvic pain disorders were the most prevalent, with rates reaching up to 42%. Nine studies reported data on social anxiety among 1807 subjects with sexual dysfunctions. Social anxiety disorder prevalence was highest among individuals with PE (9.7-47%), followed by vaginismus (9-9.7%) and dyspareunia (12.5%). Comorbidities and psychosocial factors, such as depression and a history of childhood abuse, appeared to contribute to these associations, although further research is needed to clarify their role. Results for other sexual dysfunctions were mixed, not allowing conclusions. CONCLUSION: This systematic review in a neglected area suggests a potential association between social anxiety disorder and specific sexual dysfunctions, particularly premature ejaculation and genito-pelvic pain disorders. These preliminary findings call for routine bidirectional screening, integration of sexual health into psychiatric care, combined therapeutic approaches, and adapted pharmacological strategies.

OBJECTIVE: To evaluate the feasibility, acceptability and clinical outcomes of the Happiness Toolkit (HTK), a structured, low-intensity, family-delivered intervention for children aged 0-16 years screening positive for social, emotional, behavioural and/or mental health difficulties (SEMHD) in a paediatric outpatient setting. DESIGN: Single-site prospective cohort study; validated age-specific baseline screening, parent-reported outcomes at 6 weeks and 6 months. SETTING: General paediatric outpatient department, secondary hospital, Ireland. PARTICIPANTS: Consecutive paediatric outpatient attendees screening positive for SEMHD on the Ages and Stages Questionnaires: Social-Emotional, Second Edition (under 6 years) or Screen for Child Anxiety Related Emotional Disorders questionnaire (6-16 years) were enrolled for intervention. INTERVENTIONS: The HTK comprises six evidence-based components practised for 5 minutes morning and evening, introduced during routine outpatient consultation. MAIN OUTCOME MEASURES: Primary: consent rate, positive screen rate and 6-week response rate (feasibility); parental willingness to recommend (acceptability). Secondary: parent-reported functional changes at 6 weeks and 6 months, component uptake and adverse events. RESULTS: 240 of 277 families approached across 16 outpatient clinics consented (86.6%); 94 children screened positive for SEMHD (39.2%) and received the HTK. At 6-week follow-up (n=46; 48.9% response rate), 95.2% of parents reported a positive or very positive experience, 73.9% noted improved mood in their child, 43.5% reduced screen time and 37.0% improved sleep patterns. 97.8% would recommend, with no adverse events. At 6-month follow-up (n=13; 13.8% response rate), 61.5% reported sustained child mood improvement and 92.3% would still recommend. CONCLUSIONS: This study demonstrates strong feasibility and high parental acceptability for the HTK when embedded in routine paediatric outpatient care. Parent-reported improvements at 6 weeks and no adverse events at both time points support progression to a controlled evaluation. In Ireland, 4462 children await Child and Adolescent Mental Health Services and over 28 000 await primary care psychology; the HTK represents a promising, pragmatic early and bridging support for emerging SEMHD.