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Skin prick testing (SPT), although minimally invasive, is frequently associated with procedural pain, fear, and anxiety in pediatric populations. This randomized controlled trial aimed to compare the effectiveness of immersive virtual reality (VR) and the Buzzy&#xae; device in reducing procedural distress during SPT.&#xa0;In this randomized pretest-posttest study, 90 children aged 7-10&#xa0;years undergoing first-time SPT at a Turkish university hospital were randomly allocated to VR distraction (n&#x2009;=&#x2009;30), Buzzy&#xae; (n&#x2009;=&#x2009;30), or routine care (n&#x2009;=&#x2009;30). Pain, fear, and state anxiety were assessed before and after the procedure using validated pediatric scales reported by children, parents, and researchers. Group differences were analyzed using one-way ANOVA and chi-square tests. A mixed-design ANOVA examined group-time effects with Bonferroni-adjusted comparisons. Statistical significance was set at p&#x2009;<&#x2009;.05. Groups were comparable at baseline (p&#x2009;>&#x2009;.05). Significant group-time effects were identified for pain (F: 27.06, p&#x2009;<&#x2009;.001, p&#x3b7;2: .38), fear (F: 33.14, p&#x2009;<&#x2009;.001, p&#x3b7;2: .43), and anxiety (F: 44.76, p&#x2009;<&#x2009;.001, p&#x3b7;2: .51). Post-procedure scores were lowest in the VR group, followed by Buzzy&#xae;, and highest in controls. Effect sizes were large across all outcomes, indicating clinically meaningful reductions in procedural distress. No adverse events occurred. Both VR and Buzzy&#xae; were associated with reduced procedural distress during SPT, with VR showing greater reductions than Buzzy&#xae; in this study. These findings suggest that structured, nurse-led distraction interventions may be beneficial; however, further studies are needed to confirm these results across different clinical settings. The findings suggest that integrating structured, nurse-led distraction strategies, particularly immersive VR, may substantially enhance atraumatic, child-centered care in pediatric allergy settings. The trial was registered at ClinicalTrials.gov in NCT06443060 (12/04/2025). &#x2022;VR and Buzzy&#xae; both reduced pain, fear, and anxiety during SPT. &#x2022;Both interventions were safe and feasible in clinical practice. &#x2022;VR was more effective than Buzzy&#xae; in reducing these outcomes. &#x2022;Findings support nurse-led, structured distraction strategies in pediatric allergy settings.

Some veterans are haunted by memories of action they have taken or betrayals they have experienced that violated deeply held moral beliefs; these experiences can lead to moral injury. We have developed a depth-oriented group psychotherapy for U.S. combat veterans, to address moral injury. Depth psychotherapy is an evidence-based form of psychoanalysis; the treatment we have developed is based on Relational psychoanalysis. The aim is for the group members to each develop an organized narrative about morally injurious events and their impact on their current lives to facilitate psychosocial recovery. The hypothesized change agents of this treatment are, in order of their use in the sessions: (1) warm-up team-building activities such as exercises from the improv and psychodrama/sociometry traditions; (2) reflective listening and speaking; (3) sharing moral injury event narratives with trusted others. The clinical model we have developed for treating moral injury emphasizes that veterans will be asked to describe, to the extent that they are able, the feelings, sensations, and fragmentary thoughts that are initially hard to articulate and sometimes difficult to recall. The goal of this article is to describe relevant depth psychology theory, its application to the moral injury context, the relevance of depth-oriented group psychotherapy for moral injury and, further, the depth-oriented group psychotherapy approach we have derived from these ideas.

Psychodermatology is a rapidly evolving field of dermatology that bridges dermatology, clinical psychology, and psychiatry. Psychodermatological disorders comprise a significant proportion of dermatological consultations, with varying prevalence across clinical settings. Numerous classification systems exist for psychodermatological disorders. The recent international consensus has established comprehensive multidimensional frameworks. This review focuses on primary psychiatric disorders, which have a psychiatric etiology but manifest on the skin and mucosae. This group includes disorders ranging from delusional infestations and body dysmorphic disorder to body-focused repetitive behaviors and self-induced skin lesions. Each condition is discussed comprehensively, incorporating contemporary diagnostic frameworks from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, 11 th Revision (ICD-11), alongside evidence-based treatment modalities. A multidisciplinary, biopsychosocial approach integrating dermatological and psychiatric care is central to effective management, utilizing pharmacotherapy, cognitive behavioral therapy, and supportive psychotherapy while addressing the dermatological aspects.

A significant proportion of patients with leukemia experience anxiety disorders, which negatively affect their quality of life and sense of hope. Music therapy, a noninvasive and cost-effective treatment, may help regulate emotions, reduce anxiety, and alleviate pain. This study examined the effects of music therapy as an adjunct treatment on mood and hope levels in patients with leukemia and anxiety disorders. We analyzed 86 adult patients with leukemia and anxiety admitted between August 2023 and October 2024. Patients were divided into a standard treatment group ( n &#x2009;=&#x2009;43, the conventional treatment) and a music group ( n &#x2009;=&#x2009;43, the conventional treatment plus 12 music therapy sessions over 4 weeks, each lasting 60&#x2009;min, based on mindfulness). General data, Medical Coping Modes Questionnaire (MCMQ, coping styles), Profile of Mood States (POMS, mood states), Herth Hope Index (HHI, hope levels), Hamilton Anxiety Rating Scale (HAMA, anxiety), World Health Organization Quality of Life Measurement Scale Brief Form (WHOQOL-BREF, quality of life), and Piper Fatigue Scale (PFS, fatigue) were compared at admission ( T1 ) and 1 month later ( T2 ). At T1 , no significant differences existed between the groups ( P > 0.05). At T2 , the music group showed reduced MCMQ avoidance/resignation scores ( P < 0.05), increased POMS positive mood, diminished negative mood ( P < 0.05), and elevated HHI scores ( P < 0.05). Additionally, their HAMA, PFS, and WHOQOL-BREF scores improved significantly ( P < 0.05). In this study, we found that self-reported levels of hope and mood improved in patients with leukemia and anxiety disorder following music therapy treatment. Further studies are needed to optimize treatment timing and methods to improve efficacy.

Cognitive analytic therapy (CAT) is a relational, time-limited psychotherapy primarily evidenced to support adults with emotional and relational difficulties. The extent of evidence for CAT in younger populations is not known. This paper aimed to collate all published articles describing CAT with under-18-year-olds and establish feasibility and effectiveness of CAT in this population. An initial systematic search was conducted in MEDLINE, PsycINFO and CINAHL databases, with a second search using key terms and author names in the Association for Cognitive Analytic Therapy website bibliography. Thirty-seven articles were found to meet the inclusion criteria, 11 of which contained quantitative studies. Articles described CAT as individual therapy for young people or their parents, group therapy and consultation frameworks for staff and parents. The limited evidence published on CAT in under-18-year-olds suggests that it is feasible and accessible. Further randomised controlled studies and publication of practice-based outcomes are required.

Conditioned pain modulation (CPM) is a set of psychophysical paradigms that is increasingly used clinically to evaluate descending pain modulation pathways. Impairment is common in chronic pain, suggesting CPM may serve as a mechanistic indicator. However, the lack of protocol standardization and reference data prevents clinical use in individual patients. We compared two CPM protocols with different conditioning stimulus intensities, test stimulus types, and interaction timing. We assessed CPM effect size, test-retest reliability and sensitivity to detect loss of descending inhibition. Conditioning with 0&#xb0;C water led to stronger inhibition of pressure pain threshold (PPT) than conditioning with 7&#xb0;C water (Cohen's d&#x2009;=&#x2009;0.52), when tested immediately after conditioning. When tested during conditioning, effects of 7&#xb0;C water immersion on heat pain sensitivity had similar magnitude (D&#x2009;=&#x2009;0.53) and test-retest reliability (ICC&#x2009;=&#x2009;0.77) as those on PPT (D&#x2009;=&#x2009;0.54, ICC&#x2009;=&#x2009;0.73). For all outcomes assessed, 95% confidence intervals (CI) of CPM effect included some facilitation instead of inhibition. The maximum degree of facilitation compatible with normal CPM (upper cutoff of CI) indicates potential sensitivity to detect individual abnormality. This was most favourable for PPT assessed after conditioning with 0&#xb0;C water (decrease by more than 75&#x2009;kPa or 14% of baseline PPT). In conclusion, testing during conditioning stimulation yields medium to large effect sizes and good test-retest reliability. PPT testing immediately after ice water immersion has the narrowest 95% CI and hence offers the potential to generalize CPM assessments beyond group-level differences and compare inhibition among individuals in clinical practice. Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Simultaneous CPM protocols exhibit large effect sizes but are confounded by divided attention. We recommend a sequential protocol and provide model reference data for abnormal facilitation.

Dissociative identity disorder (DID) is a psychiatric condition characterized by the existence of at least two distinct identities. This disorder often serves as a defense mechanism, a response to severe childhood trauma, aimed at protecting the individual from overwhelming emotions or experiences. There is no specific targeted treatment for DID at present. The purpose of this report is to explore the safety and efficacy of electroconvulsive therapy (ECT) in combination with pharmacological treatment for the treatment of concomitant depression in an adolescent female with DID, and to provide new clinical ideas and empirical evidence for similar cases. A 15-year-old adolescent female presented with three distinct personality states, accompanied by hallucinations, negative thoughts, and self-harming behaviors. She was diagnosed with dissociative identity disorder and depression according to DSM-5 criteria. Following combined ECT and medication treatment, the patient's disparate personalities were integrated, and depressive symptoms were alleviated. During ECT administration, no significant adverse reactions occurred beyond mild headaches and transient memory impairment. For adolescent patients with DID comorbid with depression who are at high risk of suicide, ECT combined with pharmacological treatment may be considered an effective and relatively safe treatment strategy in emergency situations. It is likely that the combined use of ECT, medication and psychotherapy has led to an improvement in the patient's condition.

Although they constitute well-established risk factors for suicidal thoughts and behaviors (STBs), few studies have investigated how family factors such as family cohesion and family conflict influence the trajectory of treatment response among depressed and suicidal adolescents. In this study, we examined the association between baseline family factors and response to an intensive outpatient program (IOP) for STBs in adolescents. Participants (n&#x2009;=&#x2009;637) either reported their satisfaction with family cohesion or family conflict levels at baseline and provided weekly self-reports of depression and STBs throughout IOP treatment. We calculated multi-level regression models to test for the interaction effects of treatment-day &#xd7; family-factor-levels and explored further demographic and clinical moderators. Higher levels of family cohesion correlated with more reduction of STBs over time (&#x3b2;&#x2009;=&#x2009;-0.11). Moreover, the effects of family cohesion and family conflict on treatment were moderated by patient age, ethnic minority status, and symptom severity. STBs and depression improved with IOP, with family cohesion partially moderating treatment response. Differences due to family factors were more prominent in older and ethnically minoritized adolescents, and those with more severe symptoms. Future studies should elucidate how family factors co-vary with changes in STBs during treatment to better understand these effects.

Contemporary definitions of delusions highlight their resistance to conflicting evidence as the core feature. However, most etiological models of delusions have focused on delusion formation rather than maintenance and we lack a coherent understanding of why delusions persist. We conducted a systematic literature search of models on delusion maintenance, extracted their core postulates, point to explanatory gaps, and derive an integrated framework. We identified 74 published accounts that include postulated mechanisms of delusion maintenance. We classified the models into six core perspectives that informed them: Bayesian inference (17 models), associative learning theory (6 models), neurobiological (11 models), cognitive-behavioral (23 models), motivational (7 models), and social (6 models). Most models highlight a mechanistic role of avoidance and operant learning, converging on the idea that a delusional explanation is reinforced. Another repeatedly suggested mechanism is that the delusional belief, once formed, influences the way further information is processed. In addition, most models propose a key role of individual deficits and biases. The proposed factors can be combined in temporal progression, including early risk factors and resulting vulnerability, the common proposed mechanism of formation (i.e. search for explanation of ambiguous experiences), and the short- and long-term consequences of the delusional explanation along with feedback loops. By considering numerous factors and their interactions, the integrative model provides a considerably more compelling account of why delusions persist than any single perspective alone. It can help to identify novel directions for research and intervention, such as addressing short-term benefits of delusion maintenance.

Expert neurological care in rural areas remains a major challenge and contributes to disparities in outcomes after acute neurological emergencies. To address this gap, the ANNOTeM project established a comprehensive, digitally enabled "hub-and-spoke" telemedicine network connecting academic neurology centers with regional hospitals in northeast Germany, providing 24/7 remote expertise, standardized operating procedures, and digital quality management. This prospective pre and post implementation study used statutory health insurance claims to compare patient outcomes and costs for acute neurological emergencies across 11 ANNOTeM network hospitals vs. 11 matched non-network hospitals (all hospitals were localized in rural regions). The analysis included all consecutively hospitalized adults with ICD-10 coded acute neurological disorders. The primary clinical endpoint was the composite of 90-day mortality, new need for outpatient or nursing home care. Health economic evaluation included direct medical, non-medical, and indirect costs from the insurer's perspective. Following network implementation, the rate of the primary outcome decreased in ANNOTeM hospitals (33.8% vs. 35.9%; unadjusted absolute difference: -2.1%; adjusted absolute difference: -3.2%; aHR 0.89, 95% CI: 0.79-0.99), with no improvement in control hospitals (40.7% vs. 42.5%; aHR 1.04, 95% CI: 0.85-1.15). Mean 90-day total costs per patient rose modestly from &#x20ac;11,938 to &#x20ac;12,252 (+2.6%, non-significant). Non-network hospitals showed a similar non-significant cost increase. The cost per avoided adverse composite outcome was &#x20ac;14,968 (unadjusted). Implementing a digitally integrated teleneurology network was associated with improved patient outcomes without substantial increases in per-patient costs. These results support the economic sustainability and transformative potential of innovative, network-based telemedicine systems for acute neurological care in underserved, rural regions.

This study examines resilience's role in modulating autonomic nervous system (ANS) responses to repeated psychosocial stress, assessed via heart rate variability (HRV) and heart rate (HR) changes. Sixty healthy males completed the Trier Social Stress Test (TSST) across four sessions, each with six stress phases, to evaluate acute stress response and physiological habituation. Resilience, measured by the Brief Resilience Scale (BRS), was analyzed in relation to HR, HRV indices. Resilient individuals exhibited better physiological recovery after acute stressor, with increased RMSSD and SDNN post-stress and reduced HR, peak HR, and delta HR for repeated stressor. While HR parameters habituated to repeated stress, anticipatory anxiety (pre-TSST STAI) increased, highlighting a distinction between physiological adaptation and psychological stress anticipation. Despite RMSSD, SDNN and LF recovery after acute stressor, resilience did not significantly impact high-frequency (HF) power. Resilience appears to enhance physiological recovery after acute stressor and adaptive physiological regulation under repeated stress, supporting its role as a protective factor. These findings have implications for interventions aimed at strengthening stress resilience and reducing allostatic load.

Problematic social network use (PSNU) has gained increasing attention as a potential disorder due to addictive behavior. However, evidence regarding underlying cognitive mechanisms remains inconsistent. Implicit cognitive processes, such as implicit associations and approach-avoidance tendencies, have been proposed as relevant factors in substance use disorders and behavioral addictions, but their role in PSNU is still unclear. Given similarities in usage behavior between PSNU and tobacco use disorder (TUD), a direct comparison may help to identify converging and diverging mechanisms. In a laboratory study, a sample of N&#xa0;=&#xa0;178 participants was classified into four groups using a structured diagnostic interview: individuals with PSNU (n&#xa0;=&#xa0;53), risky use (n&#xa0;=&#xa0;61), non-problematic use (n&#xa0;=&#xa0;48), and TUD (n&#xa0;=&#xa0;16). Implicit cognitions were assessed using the Implicit Association Test (IAT) and the Approach-Avoidance Task (AAT) with behavior-specific stimuli. Group differences were analyzed using ANOVA and ANCOVA, the latter statistical approach controlling for age and psychopathological symptoms. Significant group differences emerged for the IAT, in individuals with PSNU and risky use showing more positive implicit associations towards behavior-related stimuli than the TUD group but did not remain stable when controlling for age and comorbid psychopathological symptoms. No significant group differences were found for approach-avoidance tendencies across all groups. Our results suggest that implicit cognitions may play a more complex role in PSNU than previously assumed. Implicit associations may already occur in early stages of addictive behaviors and approach-avoidance tendencies may depend on contextual and intraindividual factors. Future research should further address these factors, also by using advanced ecologically valid methods.

Virtual reality (VR) has emerged as a novel non-pharmacological intervention tool, offering immersive environments for pain management and prevention. Despite growing literature on its efficacy, key design elements for effective VR interventions for paediatric chronic pain (CP) remain unclear. Therefore, this scoping review aimed to explore VR design strategies for managing and/or preventing paediatric CP. Following the JBI methodology and PRISMA-ScR guidelines, a comprehensive search was conducted across five major databases: PsycINFO, Medline, Central, Scopus, and Embase, complemented by Google Scholar. Eligible studies were systematically screened and analysed. Twenty studies were included. Several objectives were highlighted. Identified objectives ranged from simple distraction without additional therapeutic goals to more structured skill-development aims, such as fostering relaxation skills or supporting the transfer of pain management strategies to daily life. Between these two extremes, VR was often used to distract the user while simultaneously pursuing another specific therapeutic objective, such as inducing relaxation or promoting movement. VR was also applied for mirror therapy. To support these objectives, a wide variety of virtual environments (VEs) were implemented, some integrating biofeedback. These VEs were grouped into four main categories: relaxing environments, gamified movement-based environments, simulation of everyday settings, and avatar-based interactive environments. These findings informed an adaptation of an existing holistic framework for paediatric VR-based pain interventions, originally developed in the context of acute pain,&#xa0;to paediatric CP. This adapted model integrates intervention objectives, moderators, and implementation barriers to guide the selection and development of VR-based interventions in this context. This scoping review examines the range of VR design strategies and their applications in paediatric CP. An adapted holistic framework is proposed to guide the selection and development of VR interventions for this population. Given the rapid growth and emerging nature of this research field, a structured classification of VR designs is essential to support interpretation, replication, and comparison across studies.

This study investigated the neural mechanisms underlying feedback-based learning of novel-object-novel-word associations, focusing on how feedback-locked event-related potentials acquired during learning relate to subsequent memory performance and acquired association strength. Specifically, we examined whether amplitudes of the feedback-related negativity (FRN) and N170 components after immediate or delayed feedback predicted not only free recall and recognition performance, but also N400 priming effects exerted by the novel objects on the novel words as a neural correlate of the strength of the associations acquired through feedback-based learning. Sixty-six healthy young adults learned novel associations receiving either immediate or delayed deterministic feedback, followed by free recall tests and a newly introduced primed recognition task to measure N400 priming effects. Results showed that FRN amplitudes during learning were associated with recognition performance and predicted frontal N400 priming effects, suggesting a link to procedural, automatically retrieved memories. In contrast, N170 amplitudes were related not only to recognition, but also free recall and to general facilitation of semantic retrieval and integration processes, reflected in reduced N400 amplitudes, indicating a role in declarative memory and familiarity-driven processing facilitation. Overall, feedback-based learning elicited robust N400 priming effects, reflecting successful associative integration. However, no consistent effects of feedback timing or valence were observed, likely due to learning strategies adopted based on the deterministic nature of feedback and the anticipation of the memory tasks after learning. These findings highlight distinct contributions of feedback-related ERP components to different forms of memory representations, linking general mechanisms of feedback-based learning to the resulting representations.

Auditory hallucinations (AHs) are debilitating symptoms of schizophrenia spectrum disorders (SSDs) associated with several negative outcomes. AHs are often resistant to existing pharmacological and psychological interventions. Virtual reality (VR) has emerged as a promising intervention for AHs. This systematic review and meta-analysis aimed to assess the effectiveness of VR interventions in treating AHs in SSDs. A comprehensive literature search was conducted on Embase, APA PsycINFO, and MEDLINE via the Ovid Database. Studies with a randomized controlled trial (RCT) or randomized cross-over trial design that had treatment and active or treatment-as-usual control conditions were included. Random-effects meta-analyses compared the change in the primary outcome of AH severity from baseline to post-treatment and at follow-up between the groups. Eight studies (n&#x2009;=&#x2009;1004) met the criteria for the meta-analyses. Eight studies used avatar therapy (AT), and 1 study used a VR-based mindfulness intervention. Random-effects meta-analyses found that VR interventions were more effective than the control conditions in reducing AH severity immediately post-intervention (Hedges' g&#x2009;=&#x2009;-0.41, 95% CI [-0.62, -0.20], P <&#x2009;.01) and at follow-up (Hedges' g&#x2009;=&#x2009;-0.28, 95% CI [-0.40, -0.17], P&#xa0;<&#x2009;.001). This review was limited by a small sample size, study heterogeneity, and intervention homogeneity. Future research should prioritize larger RCTs of VR-based interventions for psychosis before VR can be reliably used in clinical settings. Overall, the results of this meta-analysis suggest that VR-based AT may be a promising avenue to improve AHs in SSDs.

The randomized SIPR&#xe9;S study, conducted at Montpellier University Hospital, compares an outpatient nursing follow-up program aimed at preventing post-hospitalization suicide recurrence with standard care. Although it has no significant impact on recurrence, this program leads to a better therapeutic alliance and increased spontaneous use of care. This hospital nursing and paramedical research program also promotes the professionalization of nurses and has led to the creation of innovative care pathways in psychiatric emergency departments.

Previous studies showed impaired decision-making in suicide attempters, but the cognitive mechanisms in play and subgroup differences among attempters need further research. Understanding these differences is crucial for developing targeted interventions. For the present case-control study, we recruited 49 depressed patients with histories of both mood disorders and suicide attempts, 34 patient controls with no personal history of suicide attempts, and 49 healthy controls. The participants completed clinical assessments and decision-making tasks: the Iowa-Gambling-Task (IGT), a value-based decision-making battery, a mixed gambling task, and a Go/No-Go task. The study was preregistered at ClinicalTrial.gov (NCT05230043). Both patient groups showed lower IGT performance, and only suicide attempters lower loss aversion than healthy controls. Compared to both patient and healthy controls, suicide attempters exhibited more total and commission errors on the Go/No-Go task. Subgroup analysis revealed that patients who made an impulsive suicide attempt had higher delay discounting and lower loss aversion rates than healthy controls. Meanwhile, attempters who chose violent means performed worse than those with a non-violent means in the first phase of the IGT and had lower loss aversion compared to both control groups. Finally, poorer IGT performance was associated with lower loss aversion and higher suicidal intent. In addition to deficits in response inhibition in depressed suicide attempters, these findings highlight reduced sensitivity to losses, higher delay discounting and impaired value-based learning in impulsive or violent suicidal acts. They, therefore, underscore the heterogeneity within suicide attempters and highlight the need for individualized approaches in future research and clinical interventions.

Phosphorylated tau181 (p-tau181), an Alzheimer's disease biomarker, was recently evaluated in amyotrophic lateral sclerosis (ALS). We investigated plasma p-tau181 in 202 ALS/ALS-FTD patients and 94 healthy controls, assessing cognitive performance, motor function, and longitudinal dynamics. Plasma p-tau181 and NfL were significantly elevated in ALS, with p-tau181 increasing over 1&#x2009;year while NfL remained stable. Neither marker correlated with cognitive performance, and only NfL was associated with disease severity and progression. Plasma p-tau181 was higher in patients with predominant lower motor neuron involvement. The results indicate that p-tau181 reflects peripheral processes in ALS, providing a complementary, mechanistically distinct biomarker from NfL.

Alopecia areata (AA) is a chronic autoimmune-mediated disorder characterized by hair loss from the scalp and/or body. AA patients frequently present with comorbid chronic inflammatory disorders (CIDs), particularly atopic and autoimmune diseases. Genome-wide association (GWA) studies have suggested a genetic link. However, no studies to date have examined genetic factors that are associated with the comorbid development of CIDs directly in individuals affected by AA. We performed an exploratory GWA study in Central European AA patients stratified by self-reported comorbidity status (110 to 1,302 cases with- and 1,030 controls without comorbid CIDs). Comorbidities were analyzed first as broad atopic and autoimmune categories and subsequently as individual conditions, including asthma, atopic dermatitis, rhinitis, vitiligo, and Hashimoto's thyroiditis. No genome-wide significant signals were identified at either the variant or gene level. At exploratory thresholds (pvariant<1x10-5, pgene<0.001), more loci showed potential association with comorbid autoimmunity than with atopy, although the number of implicated genes was comparable. Several identified genes were previously implicated in CID pathogenesis and many loci contained variants with known regulatory effects on gene expression in skin and immune cells. For comorbid atopy/autoimmunity overall, PHF11 was the most frequently implicated gene, consistent with its previously described role in T- and B-cell biology. Network analyses highlighted cytokine, hormone, and transcription factor signaling pathways as potential mechanisms underlying comorbid CID development in AA. Our study provides initial mechanistic insights for comorbid CID development in AA, and a foundation for larger-scale studies.