Cannabis policies vary from strict prohibition to commercialised legalisation and are rapidly evolving worldwide. Here, we reviewed evidence for associations between international cannabis policy changes from 2000-25 and cannabis use, cannabis use disorder, and other psychiatric disorders. Commercialised legal markets for non-medical use in Canada and the USA were associated with increased prevalence of cannabis use and cannabis use disorder in adults and increases in cannabis potency since legalisation. There was no consistent evidence for associations between policy change and the prevalence or incidence of psychotic disorders. Commercialised legalisation was associated with an increase in hospital admissions for psychosis, and for psychotic disorders comorbid with cannabis use disorder. Poorly regulated legal access to medical cannabis, in the absence of efficacy and safety data, could increase risk of harm. Policies that limit commercialisation, such as strictly regulated legalisation of medical or non-medical supply, were not as strongly associated with cannabis use or psychiatric disorders, but long-term evaluation is needed. There was little evidence that decriminalisation of non-medical cannabis in Europe, Africa, Oceania, and Asia was associated with cannabis use or psychiatric disorders.
Atypical antipsychotics are common adjunctive therapies for major depressive disorder (MDD) with inadequate antidepressant (ADT) response. In 2025, lumateperone was approved in the US as adjunctive treatment for adults with MDD, and comparative evidence is lacking. This network meta-analysis compared the efficacy and safety of lumateperone with those of other approved atypical antipsychotics for MDD. Registrational randomized clinical trials as documented in US product labeling (RCTs; N = 10; aripiprazole, brexpiprazole, cariprazine, lumateperone, and quetiapine XR) were used to build a star-shaped, 11-treatment-dose node network anchored on placebo + ADT. Outcomes available for ≥ 9 RCTs were considered. Efficacy outcomes comprised change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS), MADRS response and remission, and change from baseline in Clinical Global Impression-Severity (CGI-S) scale. Safety outcomes included weight change from baseline, akathisia, and somnolence. A fixed-effect Bayesian approach was applied. Pairwise treatment effects were compared; a probability of superiority > 85% (< 15%) indicated favored (unfavored) treatment. Network-wide treatment ranking was estimated using Surface Under the Cumulative Ranking (SUCRA) curves. Based on MADRS change from baseline, all atypical antipsychotics were favored versus placebo + ADT, with mean difference from placebo highest for lumateperone 42 mg/day (- 4.70). Other efficacy endpoints showed a consistent pattern, with active treatments favored over placebo + ADT across most nodes for response (10/11), remission (6/11), and CGI-S change (10/11). SUCRA ranking placed lumateperone as the treatment with the highest likelihood of being most efficacious across endpoints. Treatments differed in their safety profiles. Lumateperone was the only node with no weight gain relative to placebo and ranked first for weight-related safety outcomes. Lumateperone also ranked better than average for akathisia risk but below average for somnolence risk. Lumateperone represents an effective adjunctive therapy for adult MDD, with no weight change. Major depressive disorder is relatively common, and many adult patients do not experience sufficient improvement with antidepressant therapy alone. When this occurs, clinicians may prescribe an atypical antipsychotic to be taken with antidepressants. In 2025, lumateperone was approved in the US as an add-on treatment for adults with major depressive disorder. This network meta-analysis compared the efficacy and safety of lumateperone with those of other atypical antipsychotics approved for add-on treatment of major depressive disorder across clinical trials done by each company to obtain approval by the United States Food and Drug Administration. Ten trials compared placebo with different dosages of aripiprazole, brexpiprazole, cariprazine, lumateperone, and quetiapine extended release (for a total of 12 options evaluated) when used together with antidepressant medication. The analysis focused on consistently used measures of depression severity and improvement, including changes in depression rating scale scores, rates of clinical response, and remission of symptoms. Safety outcomes such as weight change, akathisia (inner restlessness), and somnolence were also assessed. Across all measures of symptom improvement, most atypical antipsychotics were more efficacious than placebo. Lumateperone showed the highest likelihood of being the most effective treatment for all efficacy outcomes. Safety differed across treatments, with lumateperone uniquely showing no weight gain versus placebo and ranking better than average for akathisia (inner restlessness) and below average for somnolence. Overall, these results suggest that lumateperone represents an effective treatment used alongside antidepressants for adults with major depressive disorder, with no weight change.
Psychotic disorders, including schizophrenia and affective psychosis, affect ~3% of the population and typically emerge in early adulthood. Cardiometabolic disease accounts for much of the 20-year life-expectancy gap in psychosis. Evidence indicates potentially causal processes, often seen in aging, act within and beyond the brain, and before the onset of treatment; these include inflammation, metabolic and mitochondrial dysfunction. Here we synthesize evidence and propose a framework that proposes psychosis as a multisystem disorder of accelerated aging, and outline implications for aging-targeted interventions.
Psychotic disorders account for significant morbidity and healthcare costs and yet their pathophysiology remains poorly understood. The National Institute for Health and Care Research (NIHR) Severe Mental Illness Longitudinal Evaluation (SMILE) BioResource is a collaborative project that aims to collect clinical data and biological samples from people with psychosis for long-term storage, future projects and recontact for targeted trials. The NIHR SMILE BioResource cohort will initially include up to 2000 UK-based patients with a recorded diagnosis of psychosis. Clinical symptoms will be captured using self-report and clinician ratings. Biosamples will enable genotyping and wider omics as further funding allows. Study data will be analysed to facilitate development of discovery science for underlying mechanisms of psychotic disorders and recall of participants for targeted interventional studies. This study is sponsored by the University of Oxford and received full ethical approval from Wales REC 2. SMILE BioResource biosamples and data will be stored long-term by the NIHR BioResource. Researchers who are interested in applying to use these biosamples and data, and/or recontacting SMILE participants can find further information on the website of the NIHR BioResource.
Positive psychology (PP) has become a key perspective in second language acquisition (SLA), with growing attention to learners' emotions, motivation, engagement, well-being, and self-regulation. However, existing PP-SLA studies have not been sufficiently mapped in terms of how theoretical frameworks are selected, classified, and operationalized. This scoping review aims to map and classify publication characteristics (e.g., geographic distribution, journal rankings) and the theoretical frameworks and models that have guided the application of PP in SLA. Following PRISMA extension for Scoping Reviews (PRISMA-ScR), the review was conducted in two stages. First, review, theoretical, and conceptual articles published between 2021 and 2025 were screened to identify higher-level theoretical discussions in PP-SLA research. Second, empirical studies published in 2025 were examined to capture the most recent operational applications of these frameworks. A total of 38 studies met the inclusion criteria, comprising 6 review articles and 32 empirical studies. Findings indicate that PP functions as the broad conceptual umbrella of the field, while Broaden-and-Build Theory, Control-Value Theory, Grit Theory, Flow Theory, Self-Determination Theory, and Social Cognitive Theory represent the most frequently used specific theories/models. The review further classifies the seven major frameworks into four higher-order categories: well-being and flourishing frameworks, emotion-centered theories, persistence and engagement theories, and motivational regulation theories. This scoping review contributes to PP-SLA research by moving beyond a list of individual theories and offering a hierarchical classification of theoretical framework use in the field. It also identifies key gaps concerning age-sensitive theorization, digital and non-formal learning contexts, cross-cultural applicability, teacher-related dimensions, and the need for stronger longitudinal and experimental designs.
Robust measurement of gender-related beliefs and attitudes is essential for understanding how gender norms operate in higher-education settings. However, little is known about how these constructs are structured among Ghanaian university students or whether widely used instruments retain validity in this context. This study examined the factor structure, reliability, and measurement invariance of adapted versions of the Gender Norm Attitudes Scale (GNAS) and Gender Equitable Men (GEM) Scale among Sociology and Social Work students in Ghana. A cross-sectional survey was conducted among 631 students (98.3% response rate) from two public universities, split for Explorative Factor Analysis (EFA) (n = 339) and Confirmatory Factor Analysis (CFA) (n = 364). EFA used principal axis factoring with oblique rotation on polychoric correlation matrices; parallel analysis guided factor retention. CFA was estimated under maximum likelihood and WLSMV estimators. Reliability was assessed using Cronbach's alpha and McDonald's omega. Measurement invariance was tested across sex, university, programme, and year level using the standard nested sequence of configural, metric, and scalar models, and was evaluated by changes in fit indices (ΔCFI, ΔRMSEA, ΔTLI, and ΔSRMR); differential item functioning (DIF) was assessed using ordinal logistic regression. Data were managed and described using SPSS Version 32; all factor-analytic, reliability, invariance, and DIF analyses were conducted in R (psych and lavaan packages). The GNAS yielded a two-factor, 11-item structure reflecting beliefs supporting men's privileges (α = 0.824, ω = 0.868) and equity for girls and women (α = 0.830, ω = 0.898), with strong fit (CFI = 0.960; TLI = 0.949; RMSEA = 0.057). Polychoric EFA confirmed this, indicating ordinal estimation did not alter the solution. After empirically driven item reduction, the adapted GEM Scale emerged as a modified version of the original instrument, with narrower domain coverage and near-complete loss of the Reproductive Health and Disease Prevention domain; the retained 16-item, four-factor structure covered violence, domestic chores and daily life, sexual relationships, and household authority and obedience, explaining 52.6% of variance with acceptable fit (CFI = 0.888; TLI = 0.865; RMSEA = 0.058), though the Household Authority and Obedience factor rested on only two items and the subscales showing weak Cronbach's alpha values. The students generally rejected inequitable norms, though attitudes toward household authority and domestic roles were more variable. For the GNAS, configural and metric invariance held across sex and university (ΔCFI ≤ 0.005); scalar invariance held across university (ΔCFI = 0.006) and was only partial across sex (ΔCFI = 0.022). For the adapted GEM Scale, metric invariance held across university (ΔCFI = 0.006) but not sex (ΔCFI = 0.016), and scalar invariance was not supported in either grouping. Although preliminary, the adapted GNAS shows acceptable structural validity, adequate-to-strong reliability, and metric invariance across sex and university and scalar invariance across university. In contrast, the adapted GEM Scale should be interpreted cautiously as a substantially modified measure with reduced domain coverage and less stable invariance properties, for which scalar invariance is not yet established. Further validation, confirmation of these invariance results using ordinal (WLSMV) estimators, and exploration of 5- or 7-point response formats are needed before either adapted scale is used confidently in broader research or programme evaluation.
By using three or more ordered response categories and varying the stimulus feature being judged over a large range, it is possible to generate a family of psychometric functions (PMFs), each based on a different partition of the responses. An earlier paper showed how, when it is treated as a probability distribution, the traditional single PMF based on binary-choice data can be decomposed into sensory and decision components, expressed as two independent random variables that are summed to create the PMF. Here we extend this development to the multiple-response procedure, and use it to elucidate the relations among the spreads and shapes of the resulting family of PMFs, which can be described by their first four cumulants. For example, we determine conditions under which the PMFs can have the same spread and shape, differing only by translation on the stimulus axis. Whereas PMFs depend on both sensory and decision processes, differences among the PMFs in a family depend only on the decision processes. Application of this multiple-PMF method to several decision models, whose evaluations depend on the PMF cumulants, shows it to have greater power than the single-PMF method for understanding the perceptual process. Although this work was inspired by experiments on the perception of temporal order, it can be applied to experiments where features of stimuli other than their occurrence times are being compared, such as the pitch of tones or the brightness of lights.
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Bullying of medical students by clinicians is a common problem in medical education that has adverse effects on student psychological well-being, educational experiences and professional development. The hierarchical structure, power imbalances and historical teaching practices present in South African medical schools may contribute to an environment where that mistreatment occurs, but limited synthesis of the evidence exists in relation to South Africa. The aim of this scoping review is to review and map existing literature related to the bullying of medical students by clinicians in South African medical training contexts, including the forms, prevalence, contributing factors, consequences and how institutions respond. The authors will execute this scoping review in conformity with the Joanna Briggs Institute manual for evidence synthesis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidelines. This will be a mixed-method scoping review that incorporates both qualitative and quantitative studies. The review process and procedures will include a search in databases such as PubMed, Cumulative Index to Nursing & Allied Health Literature, Scopus, Web of Science, Psych-Info and African Journals Online (AJOL). Socioecological model is a model that incorporates multiple behaviour change across five domains. The review is expected to take 10 months to complete, commencing on 10 November 2025 and concluding on 10 September 2026. Thematic analysis will be conducted with NVivo data management software. CRD420251179182.
Musculoskeletal (MSK) pain, especially low back pain (LBP), neck and shoulder pain is common among adolescents and imposes substantial health and economic burdens. Understanding predictive factors and factors associated with MSK pain is essential for identifying at-risk adolescents and designing targeted prevention strategies. This systematic review aimed to synthesize evidence on factors associated with or predictive of MSK pain in adolescents, with predictive inferences restricted to evidence from longitudinal studies. A systematic review was conducted, searching ProQuest, PubMed, Scopus, Web of Science, Psych info for studies published up to May 2025. Eligible studies included prospective and retrospective cohort studies, cross-sectional studies, and case-control studies. All studies examined factors associated with MSK pain in adolescents. Cohort studies were prioritized for examining predictive inferences, whereas cross-sectional studies were presented as supportive associative evidence. Data were extracted on study characteristics, patient profiles, outcomes (prevalence, incidence, severity, disability), predictors and associated factors, and measures of association. Risk of bias was assessed using the Joanna Briggs Institute (JBI). A narrative synthesis was performed due to heterogeneity in study designs and outcomes. Our database search resulted in 5,556 articles. Out of the 35 full texts that were screened, we included 19 studies (10 prospective cohort studies, 1 retrospective cohort study, 6 cross-sectional studies, and 2 mixed cross-sectional and longitudinal study) involving 45 to 57,408 participants. Predictors and factors associated with MSK pain included anthropometric factors (e.g., height growth, OR:1.32, 95%CI:1.06-1.65), lifestyle behaviors (e.g., smoking, OR:1.69-1.88), clinical conditions (e.g., inflammatory disorders, OR:1.23-1.45; central sensitization, OR:1.02,95%CI:1.01-1.03), socioeconomic factors (e.g., parental illness, OR 0.41-0.48), and pubertal status (OR:1.34-1.61). Motor tests (e.g., sit-up, Sorensen) showed limited predictive performance for low back pain (AUC ≤ 0.760). Cohort studies provided evidence of temporal associations, while cross-sectional studies provided supportive associative evidence. MSK pain in adolescents is associated with multiple factors, including smoking, inflammatory conditions, and central sensitization. Evidence from longitudinal studies supports some factors as predictive of future pain, whereas cross-sectional studies indicate associations. Lifestyle and psychological factors may contribute to risk, highlighting the potential value of targeted screening and interventions guided by longitudinal evidence. Future research should standardize outcome measures and investigate diverse populations, including low-income settings, to improve the generalizability of findings.
Angiotensin-II receptor blockade (ARB) has been associated with reduced posttraumatic stress disorder (PTSD) symptoms in population-based studies. Pre-clinical evidence further suggests that ARB may play a critical role in modulating the physiological stress response, with results showing reduced cortisol secretion in rodents after chronic ARB, and reduced sympathetic activity in humans watching traumatic films after single-dose ARB. However, despite the critical role of cortisol in PTSD development, ARB effects on the human cortisol response have not been probed directly. In this double-blind study, 60 healthy participants were randomised to receiving a single-dose of the angiotensin-II receptor blocker losartan (50 mg) or placebo, prior to undergoing a computerised 20-minute psychosocial stress paradigm lasting 20 min. Salivary cortisol was assessed pre-stress and directly after the stress paradigm, as well as 20 min post-stress and 40 min post-stress. In addition, subjective stress, heart rate and heart rate variability were measured. After losartan and placebo, increases in salivary cortisol, subjective stress, heart rate, and heart rate variability in response to the stress task were seen, but these did not differ between groups. Exploratory analyses showed that while hormonal contraception users showed a blunted cortisol response to stress, losartan administration seemed to restore their cortisol response while not affecting non-users. This study indicates that single-dose ARB may not affect the stress response towards a psychosocial stressor of moderate intensity in healthy humans, encouraging future research to explore the effects of longer-term ARB.
Treatment resistance (TR) in major depressive disorder (MDD) affects a substantial minority of patients and is hard to recognize early, delaying intensified care. The Esketamine multi-omic biomarker evaluation in MDD (EMBER-MDD) is a non-interventional, investigator-initiated, in-vitro study within the EU Psych-STRATA programme, analyzing biospecimens collected in the randomized INTENSIFY study and the mirror OBS-TR cohort after participants complete treatment. EMBER-MDD aims to discover individual-omic and integrated multi-omic (hypothesis-free) biomarkers and signatures associated with TR risk, and molecular correlates of clinical response to esketamine nasal spray versus treatment as usual (TAU). Biomaterials will derive from approximately 420 adults with MDD (estimated n = 210 esketamine; n = 210 TAU) and include whole blood, RNA-stabilized whole blood, plasma and serum, sampled at baseline and, when feasible, during and after treatment (up to ~ 5,040 aliquots stored at - 80 °C). Genomics will use baseline DNA genotyping on Illumina Infinium GSA v3.0+MD arrays; epigenomics will profile genome-wide DNA methylation across time points using MethylationEPIC v2.0; transcriptomics will employ mRNA-seq (NovaSeq X/ X Plus); and proteomics/ metabolomics will be generated using high-throughput Olink and/ or Biocrates platforms. Each layer will undergo state-of-the-art preprocessing and analyses (e.g., GWAS/ PRS, EWAS, differential expression, WGCNA, pathway and network analyses), followed by integrative strategies including QTL mapping (meQTL/ eQTL/ pQTL/ mQTL) and intermediate-fusion machine learning with nested cross-validation, explainable AI (SHAP/ LIME) and treatment-effect modelling. All outputs are research-only and will not support individual efficacy, tolerability, or clinical decision-making. The study will deliver robust biosignatures and mechanistic hypotheses to guide future validation and inform stratified, molecularly guided intervention strategies in subsequent prospective trials. Trial registration number: 2023-506617-21-00 and 2025-178-f-S.
Altering face feature positioning significantly impairs the recognition of identity, gender, and emotional expression. We evaluated the possible cause of these impairments in terms of three distinct mechanisms: (1) peripheral information loss due to foveated vision when diagnostic features fall distant from fixation, (2) suboptimal adaptation of eye-movement strategies to altered configurations, or (3) mismatch between the incoming face features and learned face templates tuned to upright configuration. In this study, we combined computational modeling and psychophysics to isolate the contributions of these factors to the degradation of perceptual judgments of scrambled dynamic emotional faces. Our results indicate that, although the relative positioning of facial features with respect to observer fixations influences performance through both peripheral information loss and suboptimal fixation strategies, these factors together cannot fully account for the observed performance decrements. Using convolutional neural network models, we show that the use of a learned internal face representations based on the long-term use of a consistent eye movement strategy for viewing upright faces, combined with a foveated visual system, can best explain the performance decrements for altered face configurations. These findings enhance our understanding of how peripheral visual constraints, oculomotor strategies, and learned high-level representations tuned to the statistical distribution of visual information contribute to configuration-dependent face perception.
Histamine was the first canonical monoamine identified in the mammalian brain, yet arguably remains the least understood in its mechanistic contributions to human behaviour. Using a first-in-class causal probe (H3R inverse agonist pitolisant), we show how elevating histamine shapes offline and online temporal-hippocampal dynamics - sustaining episodic learning-related activity and polarising retrieval computations. Beyond this, histamine adaptively shifts neurocomputational strategy under high working memory load, while stabilising value updates during aversive reinforcement learning. These findings uncover a mechanistically grounded influence of this underexplored system on human neurocomputation, supporting its therapeutic potential in psychiatry.
The OECD's first Survey on Social and Emotional Skills (SSES) in 2019 assessed 10- and 15-year-olds across ten cities, employing a framework of 15 skills organized into five dimensions aligned with the Big Five personality traits. While this adult-derived model offers a parsimonious structure for measuring social-emotional skills, its applicability to children and early adolescents across diverse cultural contexts remains largely untested. This study examined the structural validity of the SSES framework employing exploratory graph analysis (EGA)-a network psychometrics technique using skill facets as nodes, regularized partial correlations as edge weights, and the walktrap algorithm for community detection. Drawing on self-report data from 60,440 participants aged 10 and 15 across ten international cities, our analysis revealed that contrary to expectation, the hypothesized five-factor structure did not emerge in any age group or city. Among 10-year-olds, skills remained largely undifferentiated or showed only preliminary clustering in most cities, suggesting developmental immaturity in functional organization. Among 15-year-olds, three to four distinct dimensions emerged, with significant cross-city variation in composition. Developmental trajectories also differed culturally: Houston, Sintra, and Istanbul exhibited early-but-stagnant differentiation, while Suzhou showed rapid progression from undifferentiated to four-dimensional structure. These findings identify key limitations in applying the SSES framework: (1) the pattern of conditional dependencies among skill facets violates the local independence assumption underlying the five-factor model; (2) the organization of skills is not equivalent across ages: 10-year-olds show largely undifferentiated structures while 15-year-olds exhibit clearer differentiation; and (3) dimensional configurations vary substantially across cities, challenging assumptions of cross-cultural universality. The results inform researchers and policymakers about the framework's limitations and highlight the need for age- and culture-sensitive approaches to social-emotional skills assessment.
Patients with traumatic brain injury (TBI) are at a greater risk of subsequent violent victimisation, and a prognostic model can assist in identifying those at highest risk who can benefit from targeted interventions. We aimed to develop and internally validate a clinical prediction model to estimate the risk of violent victimisation following TBI in adolescence. We investigated a cohort of adolescents aged 10 to 24 exposed to TBI between 2009 and 2023, using data from a linked register, covering 86% of the population in Wales, the Secure Anonymised Information Linkage (SAIL) Databank. We fitted a multivariable Cox regression model for the association between predictors and time to violent victimisation identified in medical records, with optimism-corrected bootstrapping for internal validation. Key performance measures, including discrimination and calibration, were examined at 1 and 3 years post-TBI. The cohort included 34 092 adolescents, of whom 332 (1.0%) were violently victimised within 1 year and 701 (2.1%) within 3 years of the TBI. The final model included a range of predictors including calendar age, sex at birth, substance misuse, psychiatric conditions, neurological conditions, conduct disorder, learning difficulties and a history of victimisation or self-harm. The clinical prediction model showed good calibration and moderate discrimination at 1 (area under the curve (AUC)=0.72) and 3 years (AUC=0.67) post-TBI. This brief, scalable and evidence-based prediction model showed moderate predictive performance at internal validation. External validation is necessary to test the model's transportability. A large population-based sample was used to identify risk factors for violent victimisation and develop a novel clinical prediction model for use in adolescents with TBI.
Growing evidence indicates that immune dysregulation contributes to neurocognitive impairment in methamphetamine use disorder (MUD). Interleukin-10 (IL-10), an anti-inflammatory cytokine, has potential neuroprotective effects; however, its relationship with cognitive deficits in MUD remains unclear. Genetic variations, such as IL10 rs1800872 polymorphism, may be associated with cytokine production. This study investigated whether IL10 rs1800872 T > G polymorphism modulates the association between IL-10 levels and cognitive function in MUD. We recruited 568 male patients with MUD from a drug rehabilitation center and 210 male healthy controls (HCs) from the local community. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and plasma IL-10 levels and rs1800872 genotype were determined. Compared with HCs, patients showed widespread cognitive impairment and significantly elevated plasma IL-10 levels. Although rs1800872 genotype was not associated with IL-10 levels, it showed group-dependent associations with attention. Among patients, TT homozygotes showed better attention domain than G-allele carriers, whereas no genotypic differences were observed in HCs. Moreover, the genotype moderated the relationship between IL-10 levels and cognitive function differently in each group. In patients, IL-10 levels showed a nominally significant negative association with total cognitive scores only among G-carriers. In HCs, significant negative associations that survived FDR correction were observed only among TT homozygotes in most cognitive domains. These findings suggest that IL10 rs1800872 may be associated with genotype-specific patterns in plasma IL-10 levels and cognitive function in MUD, providing preliminary evidence for the relevance of inflammatory status and genetic background to substance-related cognitive dysfunction.
Limited self-reported data on the real-world burden of idiopathic hypersomnia exist from a representative sample of the US general adult population. This study described the clinical, humanistic, and economic burden of adults with idiopathic hypersomnia compared to matched adults without idiopathic hypersomnia. This cross-sectional study used 2021 and 2023 US National Health and Wellness Survey data. Propensity score matching (1:2) was performed for adults (≥18 years) who self-reported a physician diagnosis of idiopathic hypersomnia and adults without idiopathic hypersomnia (non-idiopathic hypersomnia cohort). Post matching, outcomes were compared between cohorts using cluster-robust regression models; P values for primary outcomes were not adjusted for multiplicity. Included were 163 adults with idiopathic hypersomnia (64.4% female, mean age 38.45 years) and 326 matched adults without idiopathic hypersomnia (66.0% female, mean age 39.60 years). The idiopathic hypersomnia cohort had higher prevalence of comorbidities (eg cardiovascular, cardiometabolic, sleep, psychiatric), higher mean Charlson comorbidity index scores (1.43 vs 0.34), and reported worse depression (PHQ-9) and anxiety (GAD-7) and poorer mental health, physical function (SF-36v2, RAND-36), and HRQoL (EQ-5D-5L, SF-6D, EQ-VAS) compared to the matched non-idiopathic hypersomnia cohort (P < 0.01). The idiopathic hypersomnia cohort reported more mean healthcare provider visits (13.34 vs 3.14), emergency department visits (0.88 vs 0.45), and hospitalizations (0.95 vs 0.35) in the past 6 months and higher annualized direct medical costs ($46,424.39 vs $14,700.21) than the matched non-idiopathic hypersomnia cohort (P < 0.05). The idiopathic hypersomnia cohort reported greater mean work productivity loss (49.07 vs 32.28) and activity impairment (48.22 vs 30.77), and annualized indirect costs ($15,269.22 vs $10,576.96) than the matched non-idiopathic hypersomnia cohort (P < 0.05). This study highlights the substantial real-world burden, including comorbidity, HRQoL, and economic, of idiopathic hypersomnia compared to the matched non-idiopathic hypersomnia cohort. Idiopathic hypersomnia is a sleep disorder that causes extreme daytime sleepiness, even after a full night of sleep. In this large US survey study, adults with idiopathic hypersomnia were compared with similar adults who did not have the condition. The study found that people with idiopathic hypersomnia had more health problems, including higher levels of depression and anxiety, and reported lower overall physical and mental well‑being than people without the condition. People with idiopathic hypersomnia also described greater challenges in daily life, such as reduced energy, difficulty staying alert, and trouble completing everyday activities. In addition, people with idiopathic hypersomnia used more healthcare services, had higher medical costs, and experienced greater work productivity loss than those without idiopathic hypersomnia. These findings suggest that idiopathic hypersomnia impacts many aspects of life, including health, work, finances, and day‑to‑day functioning, and they highlight the need for better support and treatment options for those living with this condition.
Seasons cyclically alter ecological affordances in human environments, and psychological responses to seasons can differ as a function of life stage. We discuss these differences from an affordance-management perspective, outlining how this perspective can account for previously unexplained findings and generate novel hypotheses too.
Epilepsy is a chronic neurological disorder often associated with stigma, misconceptions, and considerable caregiving responsibilities, particularly in low- and middle-income countries such as Ghana. Caregivers are vital yet frequently undervalued in epilepsy care, confronting emotional, social, and health system-related, access-related and financial barriers. This study explored the lived experiences of caregivers of individuals with epilepsy, highlighting their roles, the difficulties they encounter, and their coping strategies within sociocultural and healthcare contexts. A qualitative study was conducted with 10 caregivers (5 males and 5 females) of people living with epilepsy in the Shai-Osudoku and Ningo-Prampram districts of Ghana. Participants, including mothers, fathers, and a wife, were purposively selected for in-depth interviews. Transcribed data were analyzed using reflexive thematic analysis with the support of NVivo software. Caregivers took on multiple roles, such as monitoring seizures, managing medications, coordinating care, and navigating diverse care systems, including biomedical, traditional, and spiritual treatment options. Their experiences were marked by emotional and psychological stress, ongoing fear and uncertainty, financial strain from out-of-pocket expenses, reduced income, and social exclusion due to stigma. Limited access to affordable healthcare and antiseizure medications further hindered their ability to seek care and maintain treatment continuity. Despite these obstacles and challenges, caregivers showed resilience through reliance on family support, religious coping strategies, and practical knowledge. The findings underscore the need for contextually grounded epilepsy care models that address the interplay of sociocultural beliefs, financial constraints, and barriers to healthcare access. Strengthening and improving caregiver support through accessible mental health services, targeted education, improved access to affordable antiseizure medications, and community-based stigma-reduction awareness initiatives is essential to reduce caregiver burden and improve continuity and quality of epilepsy care in Ghana and similar contexts.