搜索结果：Psychiatric research and clinical practice

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Psychiatric settings are high-risk environments for violence. Coercive measures (CMs) and security technologies (STs) can be used to ensure safety. However, limited evidence exists on how Italian mental health nurses (MHNs) perceive the appropriateness of such practices and the influencing factors. This study aimed to fill this gap. Cross-sectional study. An online survey collected sociodemographic data and validated measures of depression, anxiety, stress, stigma toward mental illness, and humanization of care. The perceived appropriateness of various CMs and STs was rated on a 5-point Likert scale using a validated item set. Data were analyzed using descriptive statistics, bivariate tests, and multilevel mixed-effects linear regression. A total of 707 MHNs participated in the study. CMs were considered moderately appropriate (mean&#x2009;=&#x2009;3.56&#x2009;&#xb1;&#x2009;0.92), with pharmacological restraint and locked-door policies rated as more appropriate than physical restraint. STs were evaluated better (mean&#x2009;=&#x2009;3.74&#x2009;&#xb1;&#x2009;0.95), with alarms and closed-circuit television judged more appropriate than body-worn cameras and metal detectors. CMs were considered less appropriate by non-believers (p&#x2009;=&#x2009;0.009), head nurses (p&#x2009;<&#x2009;0.001), and those in non-acute settings (p&#x2009;=&#x2009;0.004), and more appropriate by those in Central Italy (p&#x2009;=&#x2009;0.036), on daytime shifts (p&#x2009;=&#x2009;0.042), and with higher stigma (p&#x2009;=&#x2009;0.012). STs were considered less appropriate by males (p&#x2009;=&#x2009;0.004), head nurses (p&#x2009;=&#x2009;0.040), and more experienced MHNs (p&#x2009;<&#x2009;0.001), and more appropriate by those in Southern Italy (p&#x2009;<&#x2009;0.001) and in non-acute settings (p&#x2009;<&#x2009;0.001). MHNs consider CMs and STs moderately appropriate. Perceptions are influenced by both individual and contextual factors. Targeted training, anti-stigma education, and inclusive policies are needed to ensure ethical and evidence-based safety practices in psychiatric care. Targeted education and training in mental health nursing, both continuing and post-graduate, are essential to support cultural change among MHNs and ensure the appropriate use of CMs and STs. Integrating anti-stigma initiatives and involving MHNs in policy development can strengthen clinical decision-making and foster safer, more ethical, and person-centred psychiatric care.

Forensic psychiatric nursing staff are exposed to workplace violence, which harms well-being and may undermine safe care. To identify preventive factors for workplace violence on forensic psychiatric wards as reported in incident reports by nursing staff and nurse managers. Qualitative inductive content analysis of workplace violence incident reports over 5&#x2009;years at one Finnish forensic psychiatric hospital, focusing on prevention-oriented free-text fields. Categories were descriptively quantified as the number (%) of reports containing each category. Incident reports portrayed workplace violence prevention as a layered entity covering clinical stabilisation, staffing and work organisation, anticipatory routines, therapeutic interaction and de-escalation, environmental and technological safety measures, restrictions and external-risk control, and information flow, debriefing and organisational learning. Clinical, organisational and environmental factors were intertwined in prevention. Incident report narratives and measures may provide a qualitative source for examining prevention-related practices and follow-up actions in forensic psychiatric care. Single-hospital data, possible underreporting and a nursing-only focus limit transferability. Following recommendations emerging from incident reports, such as ensuring adequate staffing, providing training and maintaining safe work environments, may support workplace violence prevention. Forensic psychiatric inpatient services may benefit from strengthening layered prevention strategies and from using incident report narratives to inform local policy and practice. Workplace violence is a persistent occupational hazard in forensic psychiatric nursing, yet little is known about how prevention is described in workplace violence incident reports. This study analyses prevention-oriented incident report entries from a Finnish forensic psychiatric hospital to examine how nursing staff and nurse managers describe workplace violence prevention. Prevention was described as a layered entity involving clinical stabilisation, staffing and competence, anticipatory practices, therapeutic interaction, environmental and safety measures, restrictions and external-risk control, and post-incident information flow, debriefing and follow-up actions. These findings may inform use of incident reports and prevention planning in similar secure forensic inpatient settings.

Antifungal resistance (AFR) is a significant public health concern. It restricts the available treatments for fungal infections, making them more difficult to possibility of treatment and increasing the risk of serious consequences. Pharmacists could significantly promote the rational use of antifungals, lessen their overuse, and support public health initiatives to stop the spread of resistant fungal infections by participating in antifungal stewardship (AFS) programs. Hence, the current study aimed to evaluate undergraduate pharmacy students' knowledge, attitudes and practices toward AFR. A cross-sectional study was conducted on undergraduate pharmacy students studying their fourth and final year in various public and private universities of Karachi. The study questionnaire consisted of demographic details of students, 10 questions about knowledge, 10 questions about attitude and 10 questions regarding practice. The significance of each variable was evaluated, and the model fit was assessed with -2 Log Likelihood and Nagelkerke R Square. Data was analyzed using IBM SPSS version 20. Out of 1763 students from the 4th year and final year in different universities, 1,325 students responded to the questionnaire, which makes the response rate 75.1%. The students, 75.6% (n&#x202f;=&#x202f;1,002), revealed good knowledge, which improved as the years of education progressed and was statistically significant (&#x3c7; 2&#x202f;=&#x202f;21.06, p&#x202f;<&#x202f;0.001). A positive attitude was observed in 76.1% (n&#x202f;=&#x202f;1,008) students toward AFR and AFS, with statistically significant improvement (&#x3c7; 2&#x202f;=&#x202f;6.94, p&#x202f;<&#x202f;0.001) in incremental study years, being highest in the 5th year (78.4%, n&#x202f;=&#x202f;661/843). Practice score was good in 49% (n&#x202f;=&#x202f;652) students, which was better in the final year (50.1%, n&#x202f;=&#x202f;422/843) compared to the 4th year (47.7%, n&#x202f;=&#x202f;230/482), which was statistically non-significant. The presented research indicated that most students had an understanding of AFR and AFS, which is encouraging because AFR and AFSs are under- and poorly-researched fields in Pakistan. However, there is still a need to improve the lacking areas where students have low scores regarding AFR and AFS by providing educational interventions. Furthermore, strategies should be implemented to reduce the misuse and overuse of antifungals, especially without a prescription, to reduce AFR in Pakistan.

Educational interventions are widely used to promote guideline-concordant psychiatric practice. However, it remains unclear whether participants' subjective satisfaction translates into actual changes in clinical behavior (CB). This study examined the association between subjective assessment (SA) scores of the EGUIDE training programs for schizophrenia and major depressive disorder (MDD) and CB. In this multicenter observational study, we analyzed data from psychiatrists who participated in the EGUIDE training program. SA scores were obtained immediately after training using standardized questionnaires assessing satisfaction with program content, knowledge, skills, and future clinical intentions. CB was evaluated using self-report measures of guideline-concordant practice in general, schizophrenia-specific, and MDD-specific domains. Associations between SA and CB scores were examined using Spearman's rank correlation coefficients. A total of 1399 psychiatrists were included in the analysis. The comprehensive SA score showed a significant positive correlation with the comprehensive CB score (r&#x2009;=&#x2009;0.19, p&#x2009;<&#x2009;0.001). Likewise, schizophrenia- and MDD-specific SA scores were positively correlated with all CB domains, including general guideline use and disorder-specific practices (&#x3c1;&#x2009;=&#x2009;0.14-0.19, all p&#x2009;<&#x2009;0.001). Although effect sizes were small, the associations were consistent across disorders and clinical domains. Higher satisfaction with guideline-based educational programs was associated with greater self-reported guideline-concordant CBs, suggesting that positive educational experiences may support improvements in psychiatric practice at the national level.

Virtual reality (VR) is increasingly used for adjunctive relaxation training in psychiatric care. However, evidence remains limited among hospitalized patients with depressive disorders, particularly in routine inpatient settings in China, and little is known about whether improvement varies by session frequency. This retrospective study examined whether adjunctive VR-based relaxation training was associated with changes in depressive and anxiety symptoms among inpatients with depressive disorders and whether improvement differed by session frequency. We conducted a retrospective, nonrandomized natural-group comparison using complete anonymized medical records from patients hospitalized in Lishui Second People's Hospital between January 1 and December 31, 2022. Patients met International Classification of Diseases, Tenth Revision (ICD-10) diagnostic criteria for depressive episodes or recurrent depressive disorders and were screened using predefined criteria. The analytic sample included 133 inpatients: 63 (47.4%) received adjunctive VR-based relaxation training plus usual care and 70 (52.6%) received usual care only. Usual care included pharmacotherapy and physiotherapy. The VR intervention consisted of 25-minute immersive relaxation sessions delivered approximately 3 times per week. Symptoms were assessed at admission and discharge using the 17-item Hamilton Depression Scale and Hamilton Anxiety Rating Scale. Response was defined as a reduction of 50% or more from baseline, and remission was defined as a total score of 7 or less. Baseline characteristics, outcome scores, response and remission rates, and exploratory session-frequency subgroups were compared. All analyzed variables were checked against complete medical records; no missing values were identified, and no imputation was performed. The VR and control groups did not differ significantly in baseline depressive or anxiety scores. At discharge, adjunctive VR-based relaxation training was associated with lower depressive and anxiety symptom scores than usual care alone. The VR group also showed higher response rates for both depressive and anxiety symptoms and a higher anxiety remission rate, whereas depression remission was similar. Exploratory session-frequency analyses suggested that anxiety improvement may be more consistently associated with VR exposure than depression remission; however, the pattern was not strictly linear and should be interpreted cautiously because treatment frequency was linked to hospitalization duration and routine care factors. This study is innovative in evaluating structured VR-based relaxation training as an adjunct to routine inpatient depression care and in providing preliminary observations on session-frequency patterns in a real-world Chinese psychiatric setting. Unlike many previous VR studies conducted in noninpatient, nonclinical, or short-term experimental contexts, this study reflects everyday clinical practice among hospitalized patients with depressive disorders. The findings contribute practical evidence for integrating immersive relaxation into comprehensive inpatient care, particularly when additional anxiety relief is desired. Because the study was retrospective and nonrandomized, the findings indicate associations rather than causal effects and should be confirmed in prospective randomized controlled trials.

To examine socioeconomic and demographic differences in who complains about healthcare and whether these factors are associated with the outcomes of complaint cases. Nationwide cross-sectional study in Denmark using linked national health, complaint and administrative registers. The Danish healthcare system provides universal coverage and has a centralised system for handling complaints with linked patient-level data to sociodemographic variables. All healthcare contacts in 2022 in general practice (GP), non-psychiatric hospitals and psychiatric hospitals were included. We examined two outcomes: (1) submission of a complaint and (2) whether the authorities upheld the complaint. We then assessed how these outcomes varied by socioeconomic position (SEP), focusing on the contrast between patients with the lowest and highest SEP profiles. Relative risks (RRs) were estimated using modified Poisson regression with cluster-robust variance estimation at the patient level. There were 31.9&#x2009;million GP contacts, 4.8&#x2009;million non-psychiatric hospital contacts and 345&#x2009;000 psychiatric contacts, with 1381, 3545 and 439 complaints, respectively (0.43-12.7 per 10&#x2009;000 contacts). Clear socioeconomic disparities emerged. Low-income patients were more likely to complain about GP and non-psychiatric hospitals, while higher education was associated with fewer complaints in these settings but more complaints about psychiatry. Patients outside the workforce were more likely to complain, whereas elderly patients were consistently underrepresented in the complaints.Low-SEP profiles had notably higher complaint probabilities than high-SEP profiles in GP (RR 2.60, 95%&#x2009;CI 2.22 to 3.70)&#x2009;and non-psychiatric hospitals (RR 1.69, 95%&#x2009;CI 1.40 to 1.98), but not in psychiatric hospitals (RR 0.93, 95%&#x2009;CI 0.47 to 1.38). Although individual SEP indicators showed no consistent differences in complaint outcomes, the combined SEP profiles revealed lower probabilities for complaints being upheld in lower SEP patients in GP (RR 0.58, 95%&#x2009;CI 0.22 to 0.94)&#x2009;and non-psychiatric hospitals (RR 0.70, 95%&#x2009;CI 0.43 to 0.96), while the estimate for psychiatric hospitals was inconclusive (RR 0.71, 95%&#x2009;CI 0.24 to 1.66). In this nationwide study, socioeconomic and demographic factors were linked to clear differences in both complaint submission and complaint outcomes. Except for psychiatric hospital services, patients with fewer socioeconomic resources were more likely to file a complaint yet had a lower probability of having it upheld. These findings point to disparities in who complains and in how complaints are assessed, and they underline the need to consider all complaints, regardless of outcome, when using complaint data to inform quality improvement efforts.

As community mental health services expand in scope and responsibility, mental health nurses are playing a central role in delivering integrated, recovery-oriented care. However, they face substantial challenges in adapting to community practice and sustaining professional development. Clinical supervision can mitigate these demands through its formative, normative, restorative functions. This study explored the supervision experiences of community mental health nurse specialists in South Korea to provide evidence for specifying the effective functions and operational systems of supervision using an exploratory qualitative design. Twelve community mental health nurse specialists participated in three focus group interviews conducted between June 2024 and July 2025. Data were analysed using reflexive thematic analysis. Four themes and 10 subthemes were generated: translating community mental health ideals into professional practice; serving as an anchor in unfamiliar terrain; supervision undermined by superficiality and disrespect; and competency development constrained by structural barriers. Supervision was perceived as a critical space for clarifying clinical direction, regulating emotional involvement and supporting professional adaptation. However, formalistic delivery and structural constraints limited its impact. These findings highlight the need for integrated and systematic supervision approaches aligned with the community mental health paradigm, supported by organisational and policy commitments to protected time, staffing, education and financial resources. Strengthening supervision under such conditions may enhance practitioner development and service user outcomes.

Canadian psychiatry residents must demonstrate consultation competency, assessed using the standardized assessment of a clinical encounter report (STACER). However, opportunities to practice these skills and receive constructive assessment remain limited in clinical settings. This study aimed to evaluate the technical feasibility of an agentic AI system designed to support psychiatry residents' consultation competence through simulated patient encounters with a patient agent and structured feedback from a rater agent. We conducted a two-phase technical feasibility prospective single-arm cohort study of the STACER Agentic System, a large language model-based platform integrating a patient agent and a rater agent. Phase 1 involved automated evaluation of the patient agent using a psychiatrist agent across 227 synthetic major depressive disorder cases. Performance was assessed using DeepEval metrics (correctness, clarity, medical faithfulness, turn relevance, and role adherence) with descriptive statistics and 95% CIs. Phase 2 involved a preliminary user study with 14 convenience-sampled participants: a total of 5 members of the clinical research team and 9 psychiatry residents from the University of Alberta. Participants completed simulated diagnostic interviews and case presentations. Performance was evaluated using STACER-based scoring by the rater agent and 2 psychiatrists. Interrater reliability was assessed using intraclass correlation coefficients (&#x3b1;=.05). Participants rated realism, behavioral consistency, psychiatric nuance, and feedback utility using Likert scales and free-text answers. The patient agent demonstrated high behavioral (51/56, 91.07%) and symptom fidelity (105/110, 95.45%), with strong automated performance (medical faithfulness mean 0.99, 95% CI 0.99-1.00; turn relevance 0.99, 95% CI 0.986-0.992). Participants rated simulations as psychiatrically plausible and diagnostically useful, particularly for depressive symptom representation, although rapport building was moderate (mean 2.78, SD 1.56 to mean 3.00, SD 1.41, out of 5.00) due to limited nonverbal cues. The rater agent generated structured STACER-aligned feedback with high intrarater consistency, especially at the section subtotal level. Interrater reliability with psychiatrists was poor at the item level (intraclass correlation coefficient range=0.25-0.49) but improved to good-to-excellent agreement at the section level for psychiatry resident sessions (intraclass correlation coefficient range=0.89-0.93). The rater agent's scores fell between those of the 2 psychiatrists for the clinical research team and were lower than both human raters for psychiatry residents. The STACER Agentic System demonstrates the technical feasibility of using agentic AI to simulate psychiatric consultations and deliver STACER-aligned formative feedback. By combining adaptive multiturn psychiatric simulation with competency-based evaluation, it shows promise in supporting cognitive aspects of consultation, though it remains limited in facilitating relational skills such as rapport building. These findings suggest agentic AI could expand scalable, low-risk opportunities for deliberate practice and formative feedback in competency-based psychiatric education. Further controlled studies are needed to evaluate educational effectiveness and integration into residency training.

Population ageing is accompanied by a rise in complex multimorbidity, i.e. the co-occurrence of two or more chronic or acute conditions. For a growing number of people, this cumulative disease burden results in unbearable suffering. Using 22&#xa0;years of national data from Belgium, we investigated the prevalence and clinical profiles of such suffering at the end of life, as reflected in requests for voluntary assisted dying (VAD). We analysed all anonymised VAD cases reported to the Federal Commission for Control and Evaluation of Euthanasia between 2003 and 2024 (N&#x2009;=&#x2009;6153). Conditions severity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G, 1-4 scale). Sex-specific multimorbidity clusters were identified and temporal trends were modelled with negative binomial regression incorporating population-adjusted offsets, testing interactions with sex, cluster, age group and language region and with and without spline to address nonlinear trends. Patients had a mean age of 83.1&#xa0;years, with 58.2% female, an average of 2.79 comorbid conditions and a mean CIRS-G of 3.43. Five sex-specific clusters were identified, with females exhibiting musculoskeletal, psychiatric and cardiovascular burdens, and males demonstrating cardio-respiratory and neurological profiles. Overall incidence increased over time, particularly among the oldest age groups. Cluster-specific trends revealed rapid growth in female musculoskeletal-psychiatric profiles and dynamic temporal changes in male cardiac-dominant clusters. Language region and age modified these trends, with Dutch-speaking males showing initially high but declining incidence in cardiac-dominant clusters. VAD for multimorbidity is heterogeneous, evolving and strongly influenced by ageing and cluster-specific disease patterns.

Tobacco smoking is a leading preventable cause of premature morbidity and mortality in people living with severe mental illness. Smoking rates are disproportionately high and abstinence rates low in people with severe mental illness, despite their reported interest in quitting being comparable to that of the general population. Inpatient psychiatry settings have been identified as opportune places to promote and support tobacco cessation amongst people with severe mental illness who smoke, particularly since many hospitals have implemented smoke-free policies. Evidence is needed to guide policy and practice for tobacco cessation interventions within inpatient psychiatry settings. To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. We searched the following bibliographical databases and clinical trial registers from inception until 10 February 2026: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase (Elsevier), PubMed, PsycINFO (EBSCOhost), CINAHL Complete (EBSCOhost), ProQuest Dissertations and Theses Global, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also handsearched the annual meeting abstracts for the Society for Research on Nicotine and Tobacco (SRNT) and screened reference lists of eligible studies. We included randomised controlled trials (RCTs) and cluster-RCTs that assessed interventions for tobacco cessation amongst people of 18 years and older who were inpatients in psychiatry settings. Interventions had to be initiated in the psychiatry inpatient setting and aimed at supporting smoking cessation. Our critical outcome was smoking abstinence at six months (biochemically verified) and our important outcomes included serious adverse events. We used the Cochrane risk of bias tool (RoB 2) to assess the outcomes of our review. We synthesised results using meta-analysis where appropriate, calculating risk ratios using the inverse-variance random-effects model. Where this was not possible, we synthesised results following Synthesis Without Meta-analysis (SWiM) guidelines. We used GRADE to assess our level of certainty in the evidence for our two key outcomes. We included 10 studies that involved 2262 people in total. Three trials were conducted in the USA, two in Australia, two in Taiwan, two in Iran, and one in Israel. The studies took place in emergency or acute and long-stay psychiatric settings. In most studies, the participants had a mix of diagnoses (e.g. mood disorders, anxiety disorders, schizophrenia), and three studies involved only participants with schizophrenia or schizophrenia-type disorders. Five studies tested smoking cessation counselling plus nicotine replacement therapy with post-discharge follow-up support versus usual care; one study tested a group behavioural programme for smoking reduction versus waitlist control; and four studies tested pharmacotherapy interventions including smoking medications (bupropion versus placebo, cytisine versus nicotine replacement therapy) and nicotine replacement therapy (different types and doses). We found low-certainty evidence of increased smoking abstinence from interventions that provided counselling with nicotine replacement therapy and post-discharge support, compared to usual care, when measured six months after the start of the intervention or hospital discharge (RR 1.81, 95% CI 1.33 to 2.47; P < 0.001, I2 = 0%; 5 studies, 1611 participants; low-certainty evidence). Across studies, serious adverse events (SAEs) were low. We pooled four studies reporting deaths at 6 to 18 months after the start of the intervention or hospital discharge. We found that the intervention of smoking cessation counselling plus nicotine replacement therapy with post-discharge support may result in a slight reduction in deaths compared to usual care, but the results are very uncertain due to low event numbers (22), considerable imprecision, and some concerns about risk of bias (RR 0.81, 95% CI 0.34 to 1.96; P = 0.50, I2 = 0%; 4 studies, 1431 participants; very low certainty evidence). People receiving inpatient psychiatry treatment may be more likely to have successfully stopped smoking six months after the inpatient intervention when offered smoking cessation counselling plus nicotine replacement therapy with continued post-discharge support, compared with usual care, but the certainty of the evidence is low. There was insufficient evidence to determine the effectiveness of other smoking cessation interventions initiated in the psychiatry inpatient setting. More randomised controlled trials, especially those evaluating pharmacological interventions, are needed to strengthen conclusions about treatment effects. This Cochrane review had no dedicated funding. Protocol (2024) DOI: 10.1002/14651858.CD015934.

To examine the association between fatalism, diabetes-related stigma and self-care in individuals with type 2 diabetes. A descriptive, cross-sectional study. The study was conducted in the internal medicine outpatient clinic of a training and research hospital in Northern T&#xfc;rkiye (April-December 2024). The study sample consisted of 150 individuals with type 2 diabetes aged 18&#x2009;years and over, who were literate, had no psychiatric or communication problems and voluntarily agreed to participate in the study. Data were collected using the Diabetes Introduction Form, Diabetes Fatalism Scale, Type 2 Diabetes Stigma Assessment Scale and Diabetes Self-Care Scale. Descriptive statistics, correlation analysis and multiple linear regression were performed using SPSS 26. Participants had a mean fatalism score of 51.50&#x2009;&#xb1;&#x2009;9.45 (possible range: 12-72), a stigma score of 39.61&#x2009;&#xb1;&#x2009;15.80 (possible range: 19-90) and a self-care score of 84.39&#x2009;&#xb1;&#x2009;14.96 (possible range: 35-140), with higher scores indicating higher levels of fatalism, stigma and self-care, respectively. Diabetes fatalism and stigma were moderately and negatively correlated with self-care (p&#x2009;<&#x2009;0.001). Regression analysis showed that fatalism (B&#x2009;=&#x2009;-0.466, p&#x2009;=&#x2009;0.001) and stigma (B&#x2009;=&#x2009;-0.174, p&#x2009;=&#x2009;0.030) significantly predicted lower self-care levels, explaining 15.7% of the variance in self-care behaviours. Fatalistic beliefs and diabetes-related stigma have a detrimental impact on self-care behaviours among adults with type 2 diabetes. Interventions targeting psychosocial determinants should be prioritized to improve diabetes self-management. Nurses are in a key position to assess and address fatalistic beliefs and stigma during routine diabetes care. Incorporating psychosocial screening into clinical practice and providing tailored education and counselling may reduce stigma, improve patients' sense of control and ultimately enhance self-care behaviours. Although adults with type 2 diabetes participated in the study as respondents, they were not involved in the design, conduct, analysis or interpretation of the research. The study used validated self-report instruments, and therefore patients or members of the public did not have an active role in shaping the research process beyond providing data.

Lithium remains a first-line treatment for bipolar disorder, but practice varies regarding dosing frequency. Although once-daily and twice-daily regimens are similarly effective, they produce serum lithium profiles that differ over the day, and whether greater fluctuations with once-daily dosing are attenuated in the brain is unclear. The aim of this study was to evaluate whether brain lithium profiles differed across the day with once-daily versus twice-daily dosing regimens. In this repeated-measures, cross-sectional imaging study, euthymic individuals (aged 18-50 years) with bipolar disorder type I or II receiving stable lithium carbonate treatment were recruited at four psychiatric outpatient departments in Dresden, Germany. In the week before assessment, participants received lithium at 2000 h (full once-daily dose or evening dose of the twice-daily regimen) and 0800 (twice-daily regimen only; withheld until after the 0800 h sampling on assessment day). The core assessment was a 1-day protocol in which participants underwent three consecutive 7Li MRI scans and matched serum sampling over a 10-h period (0800, 1400, and 1800h). Whole-brain lithium measurements across timepoints were compared according to regimen using the brain observable lithium threshold region-of-interest approach. Secondary analyses modelled tissue-specific profiles, derived from the Newcastle lithium image voxel evaluation pipeline, and examined the relationship between serum lithium concentration and brain 7Li MRI signal intensity using repeated-measures ANOVA, linear mixed-effects models, and population pharmacokinetics. This study was informed by people with lived experience of bipolar disorder and long-term lithium treatment through patient and public involvement and engagement activities. Between April 19, 2022, and Dec 9, 2023, 44 eligible participants were recruited, of whom three withdrew before assessment. Therefore, 41 euthymic individuals (all White European; 21 [51%] female and 20 [49%] male; mean age 39&#xb7;2 years [SD 9&#xb7;8]) with bipolar disorder receiving stable lithium carbonate treatment (20 in the once-daily dosing group and 21 in the twice-daily dosing group) were evaluated. At 12 h post dose (0800 h), brain 7Li MRI signal intensity and serum lithium concentrations were equivalent across regimens. In the once-daily group, serum lithium declined across the day, whereas in the twice-daily group it increased after the morning dose and then decreased. Brain 7Li MRI signal intensity closely mirrored these regimen-specific serum profiles. Brain 7Li MRI signal intensity was higher in white matter than grey matter in both regimens and brain-to-serum ratios indicated more rapid equilibration in grey matter compared with cerebrospinal fluid and white matter. Brain lithium concentrations followed serum concentrations closely across the day but aligned between regimens at the standard 12-h post-dose sampling timepoint. These findings directly inform ongoing discussions about the applicability of a common reference range across regimens. The difference in brain and serum profiles of lithium with once-daily and twice-daily dosing might inform regimen selection and therapeutic monitoring strategies in clinical practice. Baszucki Brain Research Foundation and Deutsche Forschungsgemeinschaft (German Research Foundation).

Measurement-based care (MBC) is a vital tool in outpatient psychiatric care, enhancing treatment outcomes through systematic symptom monitoring. This study aimed to identify factors associated with remission and response in depression treatment using MBC, focusing on longitudinal changes in Patient Health Questionnaire-9 (PHQ-9) scores. Electronic health records of 4778 patients aged 12+ from an academic outpatient psychiatry clinic were analyzed. Inclusion criteria required a baseline PHQ-9 score > 9 and at least one follow-up PHQ-9 measurement. Factors associated with treatment response and remission, using different definitions, were evaluated using Cox regression models, adjusting for demographic and clinical covariates. Response and remission rates were 46.3% and 28.2%, respectively. For response, significant associated factors were combined treatment (HR&#xa0;=&#xa0;1.189, p&#xa0;=&#xa0;0.014), follow-up PHQ-9 within 4-9&#xa0;months (HR&#xa0;=&#xa0;1.303, p&#xa0;<&#xa0;0.001), and absence of post-traumatic stress disorder (PTSD) (HR&#xa0;=&#xa0;0.817, p&#xa0;=&#xa0;0.018). Key factors associated with faster remission (HR&#xa0;>&#xa0;1) included combined psychiatry and psychotherapy treatment (HR&#xa0;=&#xa0;1.189, p&#xa0;=&#xa0;0.014), timely follow-up PHQ-9 administration within 4-9&#xa0;months (HR =&#xa0;1.255, p&#xa0;=&#xa0;0.002), lower baseline PHQ-9 scores (HR&#xa0;=&#xa0;0.931, p&#xa0;< 0.001), and absence of PTSD (HR&#xa0;=&#xa0;0.751, p&#xa0;=&#xa0;0.010). Alternative remission definitions (PHQ-9&#xa0;< 12 or < 9) yielded similar findings. Integrated psychiatry-psychotherapy approaches, regular symptom monitoring, and addressing comorbid conditions like PTSD are critical for improving depression outcomes. The findings shed light on how MBC can be used to evaluate treatment effectiveness, inform clinical practice, and guide optimized treatment strategies. Integrating MBC into a combined psychiatry-psychotherapy framework and systematically addressing comorbidities provides clinicians with powerful strategies to significantly improve depression remission rates.

We previously found that implementing medication reviews by a physician specialised in clinical pharmacology at interdisciplinary conferences with prescribing physicians and nurses led to a relative reduction in the number of drugs and potentially inappropriate prescriptions (PIPs) in psychiatric outpatients with diabetes. Adhering to the framework of health technology assessments (HTAs) and to facilitate direct implementation, we subsequently demonstrated the intervention as cost neutral. This study aimed to identify contextual, organisational and interprofessional barriers and facilitators in implementing the intervention focusing on nurses' role at interdisciplinary conferences. We conducted semi-structured interviews with available staff and four patients from the intervention group. We conducted a primary thematic analysis with HTA as a framework, while a secondary analysis situated the themes into a contextual understanding. Interdisciplinary dialogue tailors pharmacological recommendations to patients adhering to clinical pragmatism rather than generic prescription guidelines. It enables professional growth and reciprocal learning and levels out an inherent doctor-nurse hierarchy. However, when conferences were online or hybrid, nurses did not benefit to the same extent and had the feeling of being set aside. Interdisciplinary medication reviews in psychiatry may improve the clinical relevance of pharmacological decision-making and level out an inherent physician-nurse hierarchy in psychiatry. Novel clinical interventions may often not be directly implemented due to organisational factors. To ensure direct implementation, researchers must address not only organisational factors affecting implementation but also evaluate the implementation process to better understand contextual factors influencing implementation and consequently outcomes. Based on the framework of &#x2018;health technology assessments&#x2019; (HTA) and by including the understanding of context according to Pawson et&#xa0;al., we analysed the organisational process of implementing physician&#x2013;led medications reviews through interdisciplinary dialogue. Within a facilitating working environment, nurses contribute significantly to pharmacological decision&#x2010;making, and their contribution should not be underestimated.

The Collaborative Care Model, which integrates primary care, behavioral health, and structured care management, is a promising approach to improving outcomes for patients with cognitive impairment and neuropsychiatric symptoms. This study evaluated a pilot of Cognitive Impairment Collaborative Care (CICC) at a large urban academic medical center. Retrospective chart review of adults enrolled in the first year of the program (November 1, 2021 to October 31, 2022). CICC included assessments, biweekly telehealth visits, care management, psychiatric consultation, and therapy. The primary outcome was clinical effectiveness, defined as the change in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Secondary outcomes were adoption (number of clinicians referring), reach (patient enrollment), and implementation (number of encounters and psychiatric case reviews). Twenty-two patients enrolled in CICC; all had depression or anxiety. About 5% of primary care clinicians referred an average of 1.6 patients (SD 1.7) in the first year. On average, patients were enrolled for 144.9 days (SD 79.7), had 2.3 encounters per month (SD 1.0), were case reviewed 8.6 times (SD 5.3), and 50% graduated in the first year. Patients exhibited significant reductions in depression (PHQ-9: mean change -4.7, SD 5.0, p&#xa0;=&#xa0;0.003) and anxiety scores (GAD-7: mean change -4.3, SD 5.5, p&#xa0;=&#xa0;0.01). CICC achieved modest adoption and reach with demonstrated effectiveness in reducing depression and anxiety among patients with cognitive impairment. Amid a shortage of geriatricians and geriatric psychiatrists in the U.S., collaborative care is a possible therapeutic option for the growing geriatric population.

The concurrent use of lithium carbonate and haloperidol is common in psychiatric practice, yet it remains unclear which neurotoxicity-related adverse events are specific to the combination rather than to either agent alone. This study aimed to identify and prioritize the neurotoxicity-related manifestations potentially associated with this drug combination. Neurological and psychiatric adverse event reports were extracted from FAERS covering Q1 2004 through Q4 2025 and stratified into lithium reports without haloperidol, haloperidol reports without lithium, and combination co-administration reports. Drug-event-pair-based reporting odds ratios were used for signal estimation, while report-level dual-comparator screening was used to retain co-administration-associated signals. Retained signals were ranked using a semi-quantitative clinical prioritization system. Sensitivity analysis under a stricter exposure definition assessed robustness. A total of 9745 target reports were included (combination co-administration: 429; lithium without haloperidol: 3688; haloperidol without lithium: 5628). Twenty-eight reporting signals were more frequently reported with co-administration than with reports involving either target drug without the other in the main analysis, with 14 retained after sensitivity analysis. Neuroleptic malignant syndrome, neurotoxicity, encephalopathy, and delirium remained moderate-priority signals in both analyses. Neurotoxicity, neuroleptic malignant syndrome, encephalopathy, and delirium warrant prioritized clinical attention during lithium carbonate and haloperidol co-administration. These hypothesis-generating findings support targeted neurological and neuropsychiatric monitoring for patients receiving this combination.

To estimate the minimal detectable change (MDC) for the Patient Health Questionnaire-9 (PHQ-9) and its eight item (PHQ-8) and two item (PHQ-2) versions including differences by participant and study characteristics. Individual participant data meta-analysis. Medline, Medline In-Process and other non-indexed citations, PsycInfo, and Web of Science, 1 January 2000 to 9 May 2018. Datasets from articles in any language if participants were aged &#x2265;18 years, were recruited from any non-psychiatric setting, and were not recruited because they were seeking mental healthcare. Eligible datasets had a classification for major depressive disorder or major depressive episode based on a validated semi-structured or fully structured interview conducted within two weeks of administering the PHQ-9, PHQ-8, or PHQ-2. Pooled MDCs across studies were estimated for the PHQ-9, PHQ-8, and PHQ-2 with random effects meta-analysis for 95% (MDC95), 90% (MDC90), and 67% (MDC67) confidence that change beyond measurement error occurred. PHQ-9, PHQ-8, and PHQ-2 analyses included 42 548 participants (94 studies), 42 592 participants (94 studies), and 44 085 participants (98 studies), respectively. Mean participant age was 49 years (standard deviation 17), and 60% of participants were women. Overall, 10% of participants had major depression (range 1-57% across studies). MDC95 was 5.72 points (95% confidence interval (CI) 5.54 to 5.90, 95% prediction interval (PI) 4.00 to 7.44) for the PHQ-9, 5.51 points (95% CI 5.33 to 5.68, 95% PI 3.87 to 7.15) for the PHQ-8, and 2.26 points (95% CI 2.15 to 2.37, 95% PI 1.20 to 3.32) for the PHQ-2. For the PHQ-9, MDC95 was highest in inpatient healthcare settings at 6.48 (95% CI 6.05 to 6.92) points. MDC95 for the PHQ-9 increased by 0.40 (95% CI 0.25 to 0.55) points for each 10% increase in the proportion of participants with major depression. Sex and age had minimal or no association. Subgroup and meta-regression findings were similar for the PHQ-8 and PHQ-2. Based on the pooled estimate, a six point difference on the PHQ-9, the PHQ version most used in clinical practice, could be an appropriate MDC threshold in general practice. A higher threshold may be preferred in specialty mental healthcare. MDC67 or MDC90 thresholds would provide less certainty that change has occurred. Alternative strategies, such as using the upper end of a prediction interval, would provide more certainty but a greater likelihood of not recognising change. PROSPERO CRD42014010673.

This study examined how comorbid major depressive disorder (MDD) influences ADHD treatment patterns and compared the associations between specific ADHD medication classes and clinical outcomes in adolescents and young adults aged 10-24&#xa0;years. This retrospective comparative cohort study analyzed electronic health records from the TriNetX US Collaborative Network (2010-2025). Among 1,026,253 patients with ADHD, 223,665 (21.8%) had comorbid MDD. Propensity score matching yielded balanced cohorts (ADHD-only and ADHD&#xa0;+&#xa0;MDD; 159,259 per cohort). ADHD treatment patterns were assessed prospectively over 12&#xa0;months. Within the ADHD&#xa0;+&#xa0;MDD cohort, Cox proportional hazards regression examined whether CNS stimulants versus non-stimulants (including bupropion) differed in their associations with suicidality, antipsychotic initiation, mood stabilizer initiation, and intensive healthcare utilization. Compared with ADHD-only, ADHD&#xa0;+&#xa0;MDD was associated with higher overall ADHD medication prescribing, driven primarily by non-stimulants, particularly bupropion (RR 3.75, 95% CI 3.58-3.92), while racial and ethnic minority patients received fewer ADHD medications. New CNS stimulant prescriptions declined following MDD diagnosis (RR 0.92, 95% CI 0.91-0.93), especially in non-psychiatric settings. Among ADHD&#xa0;+&#xa0;MDD, CNS stimulants were associated with more favorable clinical outcomes compared with non-stimulants (aHRs 0.49-0.68). Bupropion demonstrated outcomes broadly comparable to CNS stimulants for suicidality and mood stabilizer initiation. Comorbid MDD is associated with substantial shifts in ADHD medication prescribing toward non-stimulants, yet CNS stimulants were associated with the most favorable clinical outcomes, with bupropion emerging as a clinically meaningful alternative when a non-stimulant is considered. These findings should be validated in future longitudinal prospective studies and randomized clinical trials.

This study aimed to explore the patient, disease and service-level factors that may influence the psychosocial and functional impact of an unruptured AVM diagnosis. A mixed-methods study was performed in a single-centre, high-volume, tertiary neurosurgical centre. The study comprised of psychological instruments and a semi-structured interview focusing on patient experiences in the early diagnostic journey. 37 patients completed the HADS and SF-36 questionnaires and of those, 33 took part in the semi-structured interviews. HADS and SF-36 questionnaire scores were compared against UK normative data and multiple regression analyses were performed to identify significant predictors of psychosocial and functional burden. Thematic analysis of semi-structured interviews was also performed. All of the HADS and the majority of SF-36 sub-domains were found to be significantly worse compared to UK normative data. Previous psychiatric history was found to be significantly associated with a worsened score in the HADS Anxiety sub-domain (p&#x202f;=&#x202f;0.024) as well as energy (p&#x202f;=&#x202f;0.001), social function (p&#x202f;=&#x202f;0.03) and general health (p&#x202f;=&#x202f;0.004) SF-36 subdomains. Thematic analysis revealed key themes of functional impact, psychological impact, diagnosis and explanation, access to information and follow-up care. This study identifies a significant psychosocial and functional burden on those diagnosed with an unruptured AVM. Our mixed-methods analysis provide potential avenues in mitigating this effect and tailoring neurosurgical practice to improve patient care. Recommendations for further research include longitudinal study to investigate effects of time and AVM treatment on patients' psychosocial and functional burden.