Polypharmacy is often crucial for managing complex and treatment-resistant psychiatric disorders, yet it carries risks such as adverse drug interactions, medication non-compliance, and suboptimal health outcomes. Interprofessional perspectives on polypharmacy significantly influence clinical decision-making and prescribing practices. This research evaluates healthcare providers' knowledge and attitudes regarding psychiatric polypharmacy, comparing the views of psychiatric nurses, psychiatrists, and pharmacists. It also explores how these factors impact prescribing behaviors and interprofessional collaboration. A convergent mixed-methods approach was employed at the Erada Complex for Mental Health and Addiction in Jeddah, Saudi Arabia. The study involved 221 healthcare providers, including psychiatrists (n = 32), psychiatric nurses (n = 158), and pharmacists (n = 31). Quantitative data were collected using validated scales to assess knowledge and attitudes, while qualitative insights were gathered through open-ended responses and group discussions. Knowledge levels varied among the professionals, with psychiatrists possessing the most comprehensive understanding (84.2 ± 11.0), followed by pharmacists (81.5 ± 10.0) and psychiatric nurses (79.5 ± 9.8). Attitudes toward polypharmacy also differed, with psychiatrists showing the most favorable views (3.79 ± 0.49), whereas nurses and pharmacists were more cautious due to concerns about adverse effects and medication burden. A significant positive correlation (r = 0.653, p < 0.05) was observed between knowledge and attitude scores. Sociodemographic factors, such as professional experience and confidence in medication management, influenced both knowledge and attitudes regarding medication management. Qualitative findings highlighted interprofessional tensions, with psychiatric nurses advocating for more conservative approaches, psychiatrists emphasizing clinical necessity, and pharmacists focusing on optimizing medication safety. Healthcare providers demonstrated varying levels of awareness and attitudes toward psychiatric polypharmacy, shaped by their professional roles and responsibilities. While psychiatrists were more accepting of polypharmacy, psychiatric nurses expressed concerns about patient burden, and pharmacists prioritized safety considerations. Enhancing interprofessional collaboration and ongoing education on polypharmacy practices are essential for improving patient outcomes.
A growing body of evidence identifies childhood trauma, encompassing both abuse and neglect, as a potent predictor of suicide attempts across the lifespan. Clear delineation of its mechanisms is essential for advancing trauma-informed psychiatric care. This study examined the role of childhood maltreatment in single and multiple suicide attempts among adult psychiatric inpatients. In this cross-sectional study, 300 adult psychiatric inpatients, with and without a history of suicide attempts, were assessed using the Childhood Trauma Questionnaire - Short Form (CTQ-SF), alongside the collection of sociodemographic and clinical data. Binary logistic regression was employed to evaluate the associations between childhood trauma, psychiatric diagnoses, and suicide attempt history, distinguishing between single and multiple attempts. All CTQ-SF domains were significantly intercorrelated (p < .01), with the strongest associations between emotional neglect and physical neglect (ρ = 0.708) and between emotional neglect and emotional abuse (ρ = 0.683). Emotional neglect was the most prevalent trauma type (93%), whereas sexual abuse was the least common (27%); 90% of participants reported two or more trauma types. Emotional abuse was associated with increased odds of any suicide attempt [odds ratio (OR) = 1.04], while physical neglect was associated with increased odds of multiple attempts (OR = 1.14). Our findings indicate that most forms of childhood trauma may contribute to repeated suicide attempts. Neglect exerts a heightened effect when co-occurring with other maltreatment types, suggesting a dose-response relationship. This synergistic impact underscores the need for comprehensive trauma assessments that capture both the severity and multiplicity of adverse experiences. Childhood neglect was highly prevalent among psychiatric inpatients and was strongly linked to repeated suicide attempts.People who experienced multiple forms of childhood maltreatment were more likely to report recurrent suicidal behaviour, highlighting the cumulative impact of early adversity.Physical neglect, major depressive disorder, bipolar disorder, and borderline personality disorder were key factors associated with repeated suicide attempts, underscoring the need for trauma-informed suicide prevention and early intervention. Antecedentes: Un creciente cuerpo de evidencia identifica el trauma infantil, que abarca tanto el abuso como la negligencia, como un potente predictor de los intentos de suicidio a lo largo de la vida. La delimitación clara de sus mecanismos resulta esencial para avanzar en una atención psiquiátrica informada en trauma. Objectivo: Este estudio examinó el papel del maltrato infantil en los intentos de suicidio únicos y múltiples en pacientes adultos hospitalizados en una unidad psiquiátrica. Método: En este estudio transversal, 300 pacientes adultos hospitalizados en una unidad psiquiátrica, con y sin antecedentes de intentos de suicidio, fueron evaluados mediante el Cuestionario de Trauma Infantil–Forma Abreviada (CTQ-SF), junto con la recolección de datos sociodemográficos y clínicos. Se empleó una regresión logística binaria para evaluar las asociaciones entre el trauma infantil, los diagnósticos psiquiátricos y los antecedentes de intentos de suicidio, distinguiendo entre intentos únicos y múltiples. Resultados: Todos los dominios del CTQ-SF mostraron intercorrelaciones significativas (p < 0,01), siendo las asociaciones más fuertes las observadas entre la negligencia emocional y la negligencia física (ρ = 0,708) y entre la negligencia emocional y el abuso emocional (ρ = 0,683). La negligencia emocional fue el tipo de trauma más prevalente (93%), mientras que el abuso sexual fue el menos frecuente (27%); el 90% de los participantes reportó dos o más tipos de trauma. El abuso emocional se asoció con un aumento de las probabilidades de presentar cualquier intento de suicidio (OR = 1,04), mientras que la negligencia física se asoció con un aumento de las probabilidades de intentos múltiples (OR = 1,14). Conclusión: Nuestros hallazgos indican que la mayoría de las formas de trauma infantil podrían contribuir a los intentos de suicidio recurrentes. Esto subraya la necesidad de evaluaciones integrales del trauma que capturen tanto la gravedad como la multiplicidad de las experiencias adversas.
The prevalence of tobacco smoking and high nicotine dependence (ND) in bipolar disorder (BD) is higher than in the general population but lower than in schizophrenia. This study aims to analyse the relationship of smoking behaviours, including age at onset of daily smoking (AODS), with age at onset of BD and course-of-illness variables -particularly recurrent suicide attempt- in a community sample of BD patients, also compared in their smoking behaviour variables with a sample of non-psychiatric adults. Samples of 108 patients with BD and 290 non-psychiatric adults were compared in their smoking habit. High ND was defined by a score of ≥ 6 on the Fagerström Test for Nicotine Dependence. Logistic regression analyses were employed to identify factors associated with daily smoking and high ND. Hazard curves were used to compare AODS between patients and controls and, among patients, age of BD onset between smokers and non-smokers. Within-subject survival times -AODS and the age at onset of BD symptoms- were compared with a multi-state illness-death model. Compared with controls, BD patients showed higher prevalences of current daily smoking (44% vs. 34%) and high ND (25% vs. 9%); and lower smoking cessation rates (23% vs. 38%). Among BD patients, recurrent suicide attempt showed a strong independent association with both daily smoking and high ND. AODS was later in BD patients than the control group. Among patients, illness onset was earlier in smokers and AODS was earlier than illness onset. Addressing tobacco consumption should be an integral component of BD prevention and treatment strategies.
The history of the transition from Kraepelin's concept of manic-depressive psychosis and endogenous depression to the current model of major depression is traced. In particular, the changes that have characterized the transition from the narrative psychopathology of the positivist era to the operational psychiatry of the DSM-III and its successors over the last century are critically reviewed. The birth of psychopharmacology, with the consequent entry of market interests into psychiatry and de-institutionalization, have shifted psychiatric patients from mental hospitals to outpatient clinics, resulting in enormous changes in both quantity and quality of samples. The changing composition of psychiatric population, with an ever-increasing prevalence of non-psychotic cases, and the progressive abandonment of the phenomenological cultural substratum in favor of more empirical paradigms, has rendered old classifications based on narrative criteria inadequate. Hence the need for more 'scientific' models, driven mainly by the need for reproducibility, was necessary for the application of scientific empirical methods. This article focuses on the changes that the concept of depressive illness has undergone in the transition from descriptive psychopathology to the current operational diagnoses. The various forms of depression described prior to DSM-III (endogenous depression, neurotic depression, reactive depression, atypical depression, seasonal depression, masked depression, involutional depression, depressive pseudodementia), examined in the frame do DSM-5, are either excluded because of the lack of evident depression (masked depression, depressive pseudodementia) or all absorbed into the single broad category of major depressive disorder, which thus becomes a broad container which is likely to lack homogeneity, as has been repeatedly pointed out over the years. On the other hand, what the authors of DSM (the latest edition in particular) have proposed as a remedy, the sub-categorization of the disorder through the description of specific typer (the specifiers), is in fact ignored both in research and in clinical practice.
Developmental programming, a permanent adaptation of the fetus/neonate to maternal environmental signals, underlies many adult physiological and psychiatric disorders. Prenatal stress induced by the synthetic glucocorticoid dexamethasone has been shown to increase anxiety- and depressive-like behaviors and lead to hyperreactive neuroendocrine and autonomic nervous system (ANS) responses to stress in adult female offspring. Prenatal stressors can also cause maternal immune activation (MIA), impact mood/stress circuitry, and program neural development. One way to engage molecular immune signals is to activate toll-like receptors (TLRs). Developmental changes have been seen following gestational exposure to lipopolysaccharide (LPS; TLR4), poly I:C (TLR3), and, most recently, TLR7 agonists resiquimod (RQ) or imiquimod (IMQ). Studies have identified changes in ANS function that may be tied to blood-brain barrier (BBB) changes in the paraventricular nucleus of the hypothalamus (PVN) that coincide with anxiety- /depressive-like behaviors that manifest after fetal programming. These adult dysfunctions are a consequence of prenatal stressors and may have a common underlying mechanism related to the dysregulation of communication between the PVN and critical ANS centers in the brainstem. Studies in humans indicate that brainstem loci may be important centers of ANS regulation that can be targeted to attenuate major depressive disorder (MDD) symptoms in adults. Furthermore, data suggest that select immune and BBB characteristics in PVN and autonomic nuclei in the brainstem are critical targets for future studies, aligning with the hypothesis that immune signaling plays a major role in the development and expression of psychiatric disorders. The overarching goal of this review is to outline the cellular and physiological pathways by which prenatal stressors, mainly synthetic glucocorticoid exposure and MIA, produce long-term, sex-biased programming of adult behavior and ANS function relevant to physiological and psychiatric disorders.
Background: Substance Use Disorder (SUD) is frequently associated with psychiatric comorbidity, including psychotic symptoms, impulsivity and neurodevelopmental traits. The influence of age and duration of substance use on these clinical characteristics and on treatment retention remains insufficiently understood. Objectives: To examine the influence between age, duration of substance use, clinical presentation, patterns of violence, and treatment retention in individuals with SUD. Methods: A prospective 6-month cohort study was conducted at the Alcoholism Treatment Unit of the CAUSA Hospital Complex in Salamanca, Spain. A total of 264 patients with SUD were classified into two groups: prolonged substance use (≥55 years of age or ≥25 years of substance use; n = 127) and shorter substance use trajectories (<55 years and <25 years of substance use; n = 137). Participants completed structured clinical interviews and validated measures of quality of life, impulsivity, autistic traits, addiction severity, psychotic symptoms and violence. Non-parametric analyses were applied (α = 0.05; 95% CI). Results: Younger participants showed a significantly higher prevalence of auditory and visual hallucinations and persecutory delusions at baseline. During follow-up, both groups exhibited a reduction in physical aggression while driving and an increase in insults and verbal threats. No significant differences were observed in recent uncontrolled violence. Positive screening results for ADHD, autistic traits and impulsivity were not associated with treatment retention. Lower baseline physical functioning was associated with reduced completion of the 6-month follow-up assessment. Conclusions: Age and duration of substance use were associated with differences in the clinical presentation of SUD. Younger individuals exhibited a greater burden of psychotic symptoms and violence-related behaviours, whereas poorer physical functioning was associated with lower follow-up retention among individuals with prolonged substance use histories. These findings support the importance of age-sensitive assessment and management strategies in patients with SUD.
Gambling disorder is associated with substantial psychiatric and functional burden, yet few individuals receive treatment. Limited real-world evidence exists evaluating outcomes of virtually delivered behavioral health care for gambling disorder, particularly among clinically complex patients. The purpose of this study was to evaluate gambling symptom severity outcomes among adults with gambling disorder receiving care from Birches Health. We aimed to (1) characterize the clinical profile of adults seeking treatment for gambling disorder; (2) quantify changes in gambling symptom severity over the initial 12 weeks of treatment and examine whether baseline clinical complexity, such as gambling symptom severity, depression severity, and psychiatric comorbidities, was associated with differences in gambling symptom severity improvement over time; and (3) estimate the timing and likelihood of achieving clinically meaningful improvement in gambling symptom severity. This retrospective cohort study included 1305 adults receiving virtual behavioral health treatment for gambling disorder through Birches Health between June 2024 and April 2026. Gambling symptom severity was assessed using the Gambling Symptom Assessment Scale (G-SAS) weekly. Linear mixed-effects models evaluated changes in gambling symptom severity over 12 weeks and associations with baseline clinical characteristics. Clinically meaningful improvement was defined as a reduction of 4 or more points in the G-SAS score. Participants had a mean age of 41.5 (SD 13.1) years, 65.2% (851/1305) were male, and baseline gambling symptom severity was moderate (mean G-SAS score 20.5, SD 11.83). Over half (730/1305, 56%) of participants presented with at least one psychiatric comorbidity, most commonly anxiety disorder (351/1305, 26.9%) and depressive disorder (276/1305, 21.1%). Gambling symptom severity declined significantly over the first 12 weeks of treatment, with G-SAS scores decreasing by approximately 0.099 points per day (P<.001), corresponding to an estimated 8.3-point reduction over 12 weeks. Higher baseline depressive symptom severity was associated with faster improvement in gambling symptoms (P=.01), whereas depressive disorder (P=.03) and attention-deficit/hyperactivity disorder (P=.008) diagnoses were associated with slower improvement trajectories. Among patients with routine follow-up assessments recorded during the initial 12 weeks of treatment (1071/1305, 82.1%), 71.7% (935/1305) achieved clinically meaningful improvement in gambling symptom severity, with a median time to improvement of 14 days. A clinically complex population of adults receiving care through a national virtual behavioral health care provider demonstrated rapid and clinically meaningful reductions in gambling symptom severity. These findings highlight the potential of specialized virtual care models to expand access to gambling treatment and support symptom improvement in routine care settings. Future research should evaluate longer-term recovery trajectories and identify factors associated with sustained improvement and ongoing engagement in care.
The onset of an illness has the potential to induce profound changes in a person's life. However, being diagnosed with a physical illness may not carry the same impact as being diagnosed with a mental health disorder. Among them, psychotic disorders exhibit the highest level of social stigma and acceptance challenges, along with compromised social functioning, diminished quality of life, and disruptions in personal, social, and vocational domains. The Impact of Illness Scale (IIS) measures how an illness has adversely affected a person's life as perceived by that person. This study aimed to assess the psychometric properties of the IIS in a sample of 141 people with a first episode of psychosis (FEP) (mean age 35.7 years, 51.8% female). The study explored the factor structure, internal consistency, convergent and discriminant validity, and temporal stability of the IIS. The confirmatory factor analysis (CFA) model showed an excellent fit of the data, confirming a one-factor structure, internal solid consistency (McDonald's ω = .95; Cronbach's α = .94), theoretically coherent convergent and discriminant validity with measures of internalized stigma, negative beliefs, symptoms of psychosis and general psychopathology symptoms, and moderate test-retest reliability. Overall, these findings support the IIS as a reliable and valid tool for assessing the subjective impact of psychosis, offering clinical and research utility for understanding patient experiences beyond symptom severity.
As a joint effort by the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), these treatment guidelines provide an up-to-date synthesis of published literature on the efficacy, safety, and tolerability of the range of interventions available for the management of obsessive-compulsive disorder (OCD) across the lifespan. The primary goal is to provide clear, easy to use recommendations for practicing clinicians. A global group of OCD experts were divided into panels to develop specific sections based on internal group discussions and the evidence extracted from systematic literature searches. CANMAT-defined Levels of Evidence, as well as level of clinical support were used to inform Lines of Treatment and final treatment recommendations. Drafts were revised based on feedback from individuals with lived experience, expert peer review, and a defined expert consensus process. These OCD Guidelines include seven sections spanning foundations of management and diagnosis, psychological, pharmacological, and neuro-modulation treatment modalities, treatment resistance, children and adolescents, special populations and future directions. Recommendations are summarized in tables for ease of reference and caveats and limitations of the current evidence are discussed. The CANMAT/ICOCS 2025 OCD International Guidelines synthesize the evidence on the efficacy, safety, and tolerability of the range of interventions available for the management of OCD. It is anticipated that these new OCD guidelines will enable psychiatrists and other clinicians to provide systematic, evidence-based care for their patients with OCD across the lifespan.
Germany's longstanding separation of healthcare sectors - most prominently between outpatient and inpatient care - creates risks of fragmented service delivery, disrupted information flows, and ultimately suboptimal outcomes for patients. This position paper examines how cross-sectoral and integrated strategies can effectively mitigate or overcome this fragmentation. During a Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) (6 December 2024), experts presented best-practice models and discussed legal, structural, financial, and regional dimensions of integrated care. The insights from these discussions were synthesized into AWMF's recommendations. Integrated care represents a critical lever for improving the efficiency and quality of the German healthcare system. Promising examples exist across surgical, medical, psychiatric, and regionalized care settings. Key recommendations address the following topics: harmonized financing and remuneration system, regional population-based healthcare networks, interoperable information exchange across healthcare sectors, shared decision-making on care options. Health services research - and especially implementation research - plays an indispensable role in guiding and evaluating these reforms. The AWMF further emphasizes the need for integrated education and postgraduate training, particularly within structured residency networks, and offers AWMF as an important interdisciplinary and interprofessional platform for promoting cross-sectoral care. Broad implementation of integrated care, combined with robust and evidence-based monitoring of implementation, is essential for meeting the challenges posed by demographic change and increasing demands on healthcare delivery. Die bisherige Trennung der Versorgungssektoren in Deutschland – insbesondere zwischen ambulanter und stationärer Versorgung – birgt die Gefahr von unzureichend effizienten Behandlungsabläufen, Informationsverlusten und folglich einer suboptimalen Patientenversorgung. Dieses Positionspapier evaluiert, wie sektorenübergreifende Ansätze diese Fragmentierung verbessern und überwinden können. Im Rahmen eines Berliner Forums der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (6. Dezember 2024) wurden Beispiele guter Praxis sowie rechtliche, strukturelle und regionale Aspekte der sektorenübergreifenden Versorgung durch Expertinnen und Experten vorgestellt und diskutiert. Die Ergebnisse flossen in ein Positionspapier ein, das Empfehlungen der AWMF formuliert. Die sektorenübergreifende Versorgung ist ein zentraler Ansatzpunkt zur Verbesserung der Effizienz und Qualität des deutschen Gesundheitssystems. Beispiele guter Praxis sind ermutigend. Die Empfehlungen der AWMF betreffen die folgenden Themenbereiche: Harmonisierung der Finanzierungs- und Vergütungssysteme, Etablierung regionaler Gesundheitsnetzwerke, interoperabler Informationsaustausch über alle Sektoren, partizipative Entscheidungsfindung zu Behandlungsalternativen. Die Versorgungsforschung spielt dabei eine zentrale Rolle. Die AWMF empfiehlt zudem eine sektorenübergreifende Aus- und Weiterbildung z.B. in Weiterbildungsverbünden und bietet die Nutzung der AWMF als strategische Plattform für interdisziplinäre und interprofessionelle Weiterentwicklung sektorenübergreifender Versorgung an. Eine Ausweitung der sektorenübergreifenden Versorgung mit evidenzbasiertem Monitoring der Implementierungsschritte ist essenziell, um den Herausforderungen des demografischen Wandels und den steigenden Anforderungen an die Gesundheitsversorgung zu begegnen.
Traditional clinical assessments in psychiatric research or clinical practice rely on global retrospective self-report depression measures, which do not adequately capture intra- and interindividual variability in depressive symptoms over time and across contexts. This study aimed to (1) assess the sensitivity of mobile ecological momentary assessment (EMA) for monitoring depressive symptoms compared with traditional depression scales, (2) investigate changes in depressive symptoms and recall consistency observed between the first week (FW) and the second week (SW), and (3) identify subgroups at higher risk for depression and suicidal ideation, and characterize their sociodemographic, psychological, and psychiatric profiles. Participants' self-reports were collected once daily for 14 consecutive days via a mobile app-based EMA to monitor the presence of 20 depressive symptoms based on a 24-hour recall period, thereby capturing naturalistic severity and variability. Baseline questionnaires measured sociodemographic characteristics, digital sensitivity, and personality traits. On day 14, postquestionnaires were administered to assess their clinical symptoms. In addition, modified depression scales were administered on day 7 for 1-week recall, and day 14 for both 1-week and 2-week recalls. For cluster analysis, 3 active EMA-derived features were included: mean symptom severity, within-person symptom variability, and frequency of suicidal ideation. Generalized Linear Mixed Model analysis (model 1) revealed that traditional 2-week recall explained only 35.5% of the variance in daily symptom presence (odds ratio 0.666, 95% CI 0.659-0.674; P<.001). Additional Generalized Linear Mixed Model analysis (model 2) identified a robust interaction, indicating that the consistency between weekly retrospective recall and daily EMA differed significantly between FW and SW (F1, 81876=124.550; P<.001). While overall symptom severity scores significantly decreased from FW to SW across both assessment methods (Cohen d=0.10-0.34; P<.001), the estimated mean of the probability of symptom reporting showed a contrasting upward trend from 0.853 to 0.908. In cluster analysis, 695 participants (244 males and 451 females; aged 19-73 years, mean 36.14, SD 10.71 years) who completed at least 7 EMA sessions over a 2-week period were classified into three distinct clusters: (1) no or low risk (n=445, 64.0%), (2) moderate risk (n=223, 32.1%), and (3) high risk (n=27, 3.9%). While depressive symptom severity, frequency of suicidal ideation, and psychiatric profiles progressively increased across clusters (cluster 1<2<3), the highest symptom variability was observed in cluster 2 (cluster 1<3<2). This study demonstrated that mobile EMA effectively reduced recall bias in assessing depressive symptoms and revealed symptom dynamics. Using a minimal set of active EMA-derived features, we differentiated 3 distinct risk clusters; within-person symptom variability emerged as a clinically significant indicator not captured by traditional 2-week recall-based assessments. Despite the brief 2-week assessment period, these findings suggest that mobile EMA may serve as a robust real-world data collection tool.
A blunted P300, an event-related potential indicator of attentional processes, and blunted late positive potential (LPP), an event-related potential indicator of elaborative processing, confer risk for development of substance use disorders (SUD) in adolescents. However, few studies have examined whether electrophysiological reactivity to emotional stimuli predicts development of SUD in adolescents. It is also unclear whether these neural responses are a risk factor of proximal, precocious development of SUD versus distal SUD later in adolescence. The present study examined whether electrophysiological reactivity to emotional images and targets prospectively associated with the development of cannabis, alcohol, and illicit drug use disorders in adolescent girls. The sample included 491 13.5-15.5-year-old girls with no baseline history of a SUD or depressive disorders. Participants completed the emotional interrupt task, and we recorded electroencephalography to measure the LPP to emotional image distractors and the P300 to targets. Participants also completed the Kiddie Schedule for Affective Disorders and Schizophrenia diagnostic interview to assess the onset of SUD 18 and 36 months later. A blunted LPP to emotional image distractors and a blunted P300 to targets independently associated with increased likelihood of onset of SUD at 18 months (but not 36 months). The LPP and P300 were not correlated, potentially suggesting dissociable pathways. The present study suggests electrophysiological reactivity to emotional images and targets prospectively index risk for the development of SUD in adolescent girls. In addition, these neural measures associate with more proximal, but not distal, onsets of SUD.
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
Video-algorithmic patient monitoring (VAPM) combines remote, noncontact sensors and algorithmic analysis and is increasingly trialed in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises ethical concerns regarding safety, privacy and surveillance. Little is known about how those encountering VAPM in mental health care contexts anticipate its use and potential impacts, including where it has not yet been implemented. This study aimed to explore the views of patients or mental health consumers, specialized mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and anticipated implications of VAPM in mental health inpatient care. This qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, and the workshop discussion was audio-recorded, transcribed, and thematically analyzed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. In total, 16 stakeholders participated, exploring themes concerning (1) contestation over the rationale for VAPM in mental health settings, (2) VAPM reshaping care and relationships, (3) perceived harms of VAPM, (4) perceived observational support for safety and reduced disruption, (5) serious privacy implications of VAPM, (6) the need for appropriate governance, and (7) the potential for VAPM to transform, not augment, service delivery. General views differed across groups. Patients or service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasized safety gains. The findings suggest that the anticipated risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult-the risks are set out in the anticipated experiences of those with lived experience, and the benefits remain hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as nonnegotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted.
Patient navigation programs (PNPs) have been increasingly applied in breast cancer (BC) care of underserved clients, as they can significantly assist them with coordinating services across the care continuum. However, existing evidence has produced inconclusive findings regarding the empirical adequacy of BC-related caring interventions developed from PNPs. Hence, the aim of the present systematic review and meta-analysis was to clarify the benefits of PNPs across all phases of the BC care continuum. Primary outcomes comprised care-continuum indicators extracted predominantly from medical records, while secondary outcomes included client-reported healthcare measures. Five electronic data sources were searched for randomized controlled trials (RCTs) that investigated the effectiveness of PNPs across the BC care continuum from 1995 to January 10, 2025, with no restrictions on clients' sociodemographic characteristics. A random-effects model, using both the DerSimonian-Laird (DL) method and the Hartung-Knapp (HK) adjustment, was applied to estimate standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes, with 95% confidence intervals (CIs). Thirty-seven RCTs met the inclusion criteria, including four cluster RCTs and 33 individual RCTs. Quantitative synthesis was not feasible for time-to-resolution, adherence to adjuvant or post-treatment follow-up care, timely treatment initiation, treatment completion, satisfaction with care, or psychological distress; therefore, the effectiveness of PNPs for these outcomes remains uncertain. Meta-analyses of individual RCTs, all conducted using a DL random-effects model, indicated that PNPs significantly improved diagnostic follow-up compliance (OR, 2.42; 95% CI, 1.64, 3.59; P < 0.001); screening mammogram adherence (OR, 2.18; 95% CI, 1.71, 2.77; P < 0.001); and timely diagnostic resolution (OR, 2.51; 95% CI, 1.21, 5.24; P = 0.014). Using the same DL model, PNPs also improved quality of life (SMD, 0.44; 95% CI, 0.09, 0.79; P = 0.014) and reduced anxiety (SMD, -0.94; 95% CI, -1.66, -0.22; P = 0.010). However, no statistically significant effects were observed under the DL model for depression (SMD, -0.34; 95% CI, -0.71, 0.04; P = 0.076) or BC knowledge (SMD, 0.27; 95% CI, -0.19, 0.73; P = 0.247). Substantial heterogeneity was observed across most pooled outcomes (I2 = 63.9%-93.0%), accompanied by wide prediction intervals that included the null value. After applying the HK adjustment, the previously observed beneficial effects of PNPs on timely diagnostic resolution, quality of life, and anxiety were no longer statistically significant. Although initial analyses suggested that PNPs may improve several BC-related outcomes, these observed benefits were reduced in magnitude and, in some cases, no longer statistically significant after applying more conservative adjustment methods. Moreover, substantial heterogeneity across studies and the overall low methodological quality limit the certainty of the evidence. Therefore, the current findings should be interpreted cautiously, and further high-quality RCTs are needed to draw more definitive conclusions about the effectiveness of PNPs across the BC care continuum. CRD42023487495.
This study examined the prevalence of fear of cancer recurrence (FCR) and its related factors among cancer survivors in South Korea. Between August 2021 and November 2022, 345 cancer survivors were recruited from the National Cancer Center, regional cancer centers, university hospitals, and local communities in South Korea. Participants completed self-report questionnaires, including the Korean version of Fear of Cancer Recurrence Inventory-Short Form (K-FCRI-SF) via mobile platforms, and underwent structured diagnostic interviews using the Korean version of the Mini-International Neuropsychiatric Interview (K-MINI). Logistic regression analyses were conducted to identify key predictors of clinical FCR (K-FCRI-SF of ≥ 22). Overall, 60.87% of participants had elevated FCR, including 31.01% who met the threshold for clinical FCR. Younger age was independently associated with clinical FCR, whereas cancer-related clinical characteristics were not. Across domain-specific multivariable analyses, psychiatric comorbidities (illness anxiety disorder and somatic symptom disorder), psychological factors (thought suppression and catastrophizing), and cancer-related factors (symptom focusing, anxious preoccupation with cancer, negative illness perception, and illness-related ambiguity) were independently associated with clinical FCR. These findings suggest the potential value of greater clinical attention to health anxiety and maladaptive cognitive responses as modifiable correlates of clinical FCR, alongside clearer and more consistent medical communication to address illness-related uncertainty. In comprehensive cancer survivorship, multidisciplinary approaches integrating cognitive-behavioral strategies with accurate medical guidance could be considered a promising avenue for reducing FCR; however, further longitudinal and intervention studies are needed to confirm these preliminary observations.
To investigate the mediating role of nursing students' artificial intelligence (AI) ethics awareness between the association of attitudes toward AI technology and perceived AI utilization. A paucity of studies exists about the role of AI ethics awareness between attitudes toward AI technology and perceived AI utilization, particularly among nursing students. A multisite cross-sectional, correlational research participated by nursing students (n = 765) that were consecutively recruited from four nursing colleges (two private and two public owned) in Saudi Arabia. Three standardized self-report scales were utilized to collect data, and covariance-based structural equation modeling, using maximum likelihood estimation and bias-corrected bootstrap method, and mediation analyses were employed for data analyses. The mean age of participants was 23.98 years old (SD = 4.40), and majority were females (78.90%), were second year students (33.85%), and had a mean grade point average of 4.16 (SD = 0.65). AI technology attitudes were positively associated with AI ethics awareness (β = 0.84, p = 0.001, and 95% CI = 0.76-0.94) and AI utilization (β = 0.55, p = 0.010, and 95% CI = 0.13-0.97). AI ethics awareness was positively associated with AI utilization (β = 0.41, p = 0.043, and95% CI = 0.01-0.84). Mediation analysis showed that AI technology attitudes were indirectly associated with AI utilization (β = 0.36, p = 0.013, and 95% CI = 0.05-0.68) via the mediation of AI ethics awareness. AI technology attitudes measured 72.05% of the R2 of AI ethics awareness, while both AI ethics awareness and AI technology attitudes measured 87.94% of the R2 of AI utilization. Nursing students' AI technology attitudes and AI ethics awareness were positively associated with AI utilization, whereas AI ethics mediated between AI technology attitudes and AI utilization. Policymakers, nursing educational institutions, and educators could integrate AI ethics into nursing curricula to cultivate positive AI attitudes and responsible AI usage, preparing future nurses for an AI-integrated healthcare environment. Nurse administrators in the nursing educational institutions and nurse managers in affiliated clinical training centers should provide a conducive learning environment (i.e., adequate resources, teaching/learning materials, and AI-trained staff) where students can learn AI-integrated technologies through practical or simulated activities.
The importance of mental and physical health is crucial, as it not only affects the quality of individual life, but also influences their behavior and performance at work. The role of burnout and depression is of particular importance in research. Burnout is most often associated with helping occupations, such as healthcare. We used a questionnaire method. Burnout was measured using the BAT-C and BAT-S questionnaires, and depression was measured using the Beck Depression Scale and the Male Depression Risk Assessment Scale, so both types of depression could be examined. According to our N=254 sample, the reliability and validity indicators of the BAT questionnaire in a healthcare sample proved to be adequate. Burnout and depression are positively correlated with each other. Women are more likely to experience emotional suppression, exhaustion, and symptomatic appearance of burnout. Decreased emotions and psychological symptoms predict depression. Masculine depression is also characterized by somatic symptoms. Burnout is closely related to depressive symptoms and various dimensions of burnout. Burnout not only causes mental and physical exhaustion, loss of motivation and concentration difficulties, but can also be accompanied by sleep disorders, anxiety, somatic complaints (e.g. headache, stomach and muscle pain), and these are already a pre cursor to depression. Regular screening with burnout and depression questionnaires is important for prevention and intervention, especially in those who have problems expressing emotions, suppressing emotions, and increased psycho logical or somatic symptoms.
Burnout and compassion fatigue are crucial issues among the nursing workforce that are associated with compassion satisfaction and patient care behavior. Relatively little is known about burnout and compassion fatigue among psychiatric unit nurses (PNs) working in psychiatric units in developing countries, like Pakistan. This study examined and compared the prevalence of burnout, compassion fatigue, and compassion satisfaction among male PNs in public and nonpublic hospitals in Pakistan's capital territory. This study used a cross-sectional research design. This study recruited male PNs from psychiatry inpatient units in public and nonpublic hospitals through purposive sampling between June 2023 and December 2023. The Professional Quality of Life (ProQOL) scale was used to assess PNs' burnout, compassion fatigue, and compassion satisfaction levels. Among PNs, 59% had severe burnout, 88% had higher risk compassion fatigue, and 12% had high compassion satisfaction. Correlation analysis revealed a significant negative association between burnout and compassion satisfaction (r = -0.261, p < 0.01). Intergroup comparison revealed that PNs in nonpublic hospitals demonstrated higher burnout (M = 28.46 vs. 26.98, p < 0.05, Cohen's d = 0.330) and slightly higher compassion fatigue (M = 24.18 vs. 23.88, p > 0.05, Cohen's d = 0.048). In contrast, PNs working in a public hospital reported higher compassion satisfaction (M = 32.53 vs. 29.62, p < 0.05, Cohen's d = 0.442). The findings identify modest statistically significant cross-sector differences in occupational well-being indicators between PNs working in public and nonpublic hospitals, accompanied by small-to-moderate effect sizes. The tentative results highlight the necessity of targeted workplace interventions that may support the occupational well-being of PNs operating within resource-limited mental healthcare systems. This study underscores the necessity of targeted staff well-being interventions within psychiatric inpatient units. PNs in nonpublic hospitals exhibited elevated burnout and diminished compassion satisfaction relative to their public hospital counterparts, whereas compassion fatigue affected nurses across both hospital types equally. Nurse managers can prioritize these disparities by implementing well-being assessments, balanced workload distribution, and tailored psychological support programs. Boosting organizational support may mitigate burnout, enhance compassion satisfaction, improve staff retention, and promote high-quality psychiatric care.
Early recognition of autoimmune encephalitis (AE) is critical but remains challenging because of overlapping clinical features with viral encephalitis (VE) and delays in antibody testing. The UT-Hopkins Score was recently developed to assist in the clinical differentiation of AE from VE at presentation. We aimed to assess the sensitivity of this score in a large national cohort of antibody-mediated AE and across major antibody-defined subgroups. We conducted a retrospective cohort study including 350 patients with antibody-mediated AE diagnosed according to international consensus criteria at the French Reference Center. Antibodies included anti-N-methyl-D-aspartate receptor (NMDAR), leucine-rich glioma-inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), γ-aminobutyric acid type B receptor (GABABR), and glutamic acid decarboxylase 65 (GAD65). The UT-Hopkins Score was calculated using four binary variables. Sensitivity was assessed using a cutoff of ≥ 2 points and analyzed overall, in a reweighted model reflecting national antibody distribution, and across antibody subtypes. Overall, 90.3% (95% CI, 86.7-93.0) of patients scored ≥ 2. In the reweighted model, sensitivity increased to 92.9% (95% CI, 86.3-96.6). Sensitivity was highest in GAD65 (100%) and NMDAR (99%) subgroups, remained high in LGI1 (94%) and CASPR2 (90%), but was lower in GABABR (56%), characterized by higher comorbidity burden, acute onset, fewer psychiatric or memory features, and robust CSF inflammation. In this large cohort of antibody-mediated AE, the UT-Hopkins Score demonstrated high sensitivity across most antibody subtypes, supporting its use to detect autoimmune causes early in patients presenting with encephalitis.