Machine learning (ML) in digital health applications is becoming more popular for the general management of population wellness and the promotion of large-scale prevention, risk stratification, and the use of data to formulate data-driven decision-making in the field of population health. Although there has been a rapid increase in this area, the available reviews are highly fragmented and frequently tend to concentrate on particular technologies or predictive performance, yet provide minimal synthesis of the effectiveness, equity, implementation, and governance at the population-level. This review followed the Preferred Reporting Items for Systematic Reviews and Scoping Reviews (PRISMA-ScR) guidelines and employed a hybrid scoping and bibliometric approach. of the peer-reviewed literature published between 2018 and 2025 and indexed in PubMed/MEDLINE, Scopus, Web of Science, and IEEE Xplore. The review of the literature was in the form of scoping and concerned the digital form of healthcare, roles of ML analytic, the domains of outcome, and bibliometric analysis was performed to map the trends in publications, thematic groups, and evolving research areas. The results show significant increases in interdisciplinary studies in the field of public health, medical informatics, and data science in health. Most studies reported predictive-performance and short-term behavioral outcomes, whereas evidence on long-term population-level health effects and healthcare utilization remained limited. Nevertheless, there is little evidence regarding long-term population-level health effects and changes in healthcare use. Equity assessments have rarely conducted, and there have been repeated debates pertaining to data representativeness and algorithmic bias. Governance and implementation issues (such as model interpretability, privacy, data sharing, and regulatory uncertainty) have been continuously found to be obstacles to wide-scale and responsible deployment. All in all, this review offers a combined evaluation of efficacy, equity, and governance in ML-enabled, digital health to manage population wellness. The conclusions also show that there is a need to shift away from technology-focused assessments in favor of outcome-driven, equity-based, and governance-informed ways of encouraging sustainable and responsible population-level action.
In polarised sociopolitical and information ecosystems, public-professional commentary from psychiatrists is an increasingly contested ethical space. The World Psychiatric Association (WPA) defers to local norms in this area, positioning its Member Societies as key conduits for ethical governance; the most prominent example is the American Psychiatric Association's (APA) Goldwater Rule, which forbids professional opinions on individuals in public life without examination and consent. Beyond this, the extent to which other national-level associations have operationalised comparable ethical standards is largely underexamined. A cross-national analysis of all N = 145 WPA Member Societies was conducted in October 2025, examining accessible ethical codes for content addressing different forms of public-professional commentary. Specifically, these covered: press engagements, social media conduct, Goldwater-type restrictions, accuracy in public-facing statements, and misinformation prohibitions. Enforcement mechanisms were also recorded. Only 13 WPA Member Societies (8.96%) incorporated relevant provisions, whereas 83 (57.24%) had no identifiable ethical code. Where discernible, accuracy stipulations and Goldwater-type prohibitions predominated across socioculturally disparate contexts, with the latter closely mirroring the APA's formulation. Notably, rubric regulating social media conduct and misinformation was conspicuously sparse, as was enforcement infrastructure, with many ethical materials instituted or last revised over a decade ago. Ethical governance of public-professional commentary remains fragmented and outdated throughout global psychiatry, generating potential ambiguities in professional expectations and reputational vulnerabilities. Accordingly, coordinated WPA and Member Society leadership, supported by periodic reviews, interdisciplinary exchanges, and educational initiatives, is essential to ensure psychiatric authority continues to be exercised responsibly amidst ongoing societal shifts.
To explore the network relationships and core symptoms of mental health status of patients attending psychiatric outpatient clinics in general hospitals through symptom network and centrality analysis. A cross-sectional study. A total of 15847 patients who attended the psychiatric outpatient clinic of a tertiary-level general hospital in Shandong Province from September 2021 to January 2025 were selected to investigate the mental health status of the patients by using the Symptom Check List-90 (SCL-90) and analyzed by symptom network analysis. Descriptive statistics showed that the mean SCL-90 total score of psychiatric outpatients was (236.55 ± 78.79), and the difference between the SCL-90 scores of psychiatric outpatients and the scores of the norm was statistically significant (P < 0.001); the network showed the strongest relationship between the symptoms "interpersonal sensitivity" and "paranoiel ideation", with a regularized partial correlation coefficient of 0.40. The results of the centrality analysis showed that the symptom "interpersonal sensitivity" was the node with the highest strength centrality and the highest bridge strength. Among the mental health symptoms of psychiatric outpatients, "interpersonal sensitivity" is the core symptom and the bridge symptom, suggesting that the development of targeted interventions based on the symptom "interpersonal sensitivity" as the core target may help to prevent and treat psychiatric problems in a precise way. This study identified "interpersonal sensitivity" as the most influential core and bridging node among mental health symptoms in psychiatric outpatient patients. The findings will facilitate the development of personalized and precise interventions to mitigate the negative impact of interpersonal sensitivity on mental health issues. This study adheres to the STROBE guideline of reporting. This study did not include patient or public involvement in its design, conduct or reporting.
With the rapid advancement of artificial intelligence (AI) technologies, increasing numbers of researchers have explored the integration of AI into depression research. In this study, we conducted a bibliometric analysis of research related to the application of AI in depression research. Our findings revealed a substantial growth trend in publications since 2020 with China and the United States leading this expansion. Institutions such as the University of Toronto and Sichuan University have played prominent roles as key contributors. Notably, prolific authors have advanced the integration of AI algorithms into areas such as depression diagnosis, symptom classification, and risk prediction. This trend is further supported by our keyword co-occurrence analysis, which reveals a strong positive correlation between terms such as "machine learning" and "prediction", as well as between "feature extraction" and "electroencephalography". Moreover, our analysis suggests that while AI applications in depression research share common methodological frameworks, they also exhibit distinct patterns based on age, gender, and population characteristics. This bibliometric study provides a comprehensive overview of research trends, influential contributors, and emerging directions in the field of AI-assisted depression research, offering valuable insights for future interdisciplinary development.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
Evidence on the associations of intra-familial ACEs and DepS with cardiometabolic multimorbidity (CMM) remains limited. We aimed to evaluate the joint associations of intra-familial ACEs and DepS with CMM and to determine whether DepS mediates the relationship between intra-familial ACEs and CMM. The study sample consisted of adults aged 50 years and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020) and the Health and Retirement Study (HRS, 2012-2020). CMM was defined as the concurrent presence of at least two cardiometabolic conditions, including diabetes, heart disease, and stroke. The associations of intra-familial ACEs and DepS with CMM were estimated using Cox proportional hazards models. We further explored the mediating role of DepS using mediation analysis. Among 14829 participants (CHARLS, n = 7210; HRS, n = 7619), 844 (11.7%) incident CMM cases occurred over a median follow-up of 9.0 years in CHARLS and 698 (9.2%) over 7.8 years in HRS. Participants with coexisting 2 or more intra-familial ACEs and DepS showed the highest CMM risk relative to those with 0 or 1 intra-familial ACE and non-DepS (CHARLS: HR, 2.07; 95% CI, 1.72-2.50; HRS: HR, 2.09; 95% CI, 1.60-2.72). DepS mediated 14.58% (95% CI, 7.69-25.78) of the association between intra-familial ACEs and CMM risk in CHARLS and 11.84% (95% CI, 3.61-31.16) in HRS. Intra-familial ACEs and DepS were linked to elevated CMM risk, and the relationship between intra-familial ACEs and CMM was partially mediated by DepS, highlighting the importance of integrated intervention for CMM.
Schizophrenia treatment has increasingly shifted toward the use of second-generation antipsychotics (SGAs), yet real-world prescribing often involves complex polypharmacy. Evidence from Asian countries, particularly regarding adjunctive psychotropic use at treatment initiation, remains insufficient. This study aimed to describe changes in antipsychotic prescribing patterns among newly diagnosed patients with schizophrenia in South Korea from 2012 to 2023 and to examine socioeconomic and clinical factors. We analyzed nationwide National Health Insurance (NHI) claims data covering 2012-2023. Adults aged 20-65 years with newly diagnosed schizophrenia (ICD-10 F20.0-F20.9) were included (n = 320,591). Annual prescription rates were examined for antipsychotics, benzodiazepines, anticonvulsants, and antidepressants. Logistic regression was conducted to identify sociodemographic and clinical correlates of drug use. SGA use increased steadily from 84.0% in 2012 to 94.2% in 2023 (p for trend <0.0001), indicating a shift toward guideline-recommended treatment at initiation. In contrast, benzodiazepine use remained persistently high (72.5-73.7%) with no significant trend, while anticonvulsant use remained stable (∼21-23%). Antidepressant use increased from 32.4% to 45.1% (p for trend <0.0001). Medical Aid beneficiaries were less likely to receive SGAs (adjusted OR = 0.55, 95% CI 0.53-0.56). Over the past decade, initial treatment of schizophrenia in Korea has increasingly shifted toward SGA-based therapy. However, persistent use of benzodiazepines and early socioeconomic disparities highlight ongoing challenges in achieving rational and equitable pharmacotherapy. These findings highlight the importance of continued monitoring and targeted policy efforts to improve the appropriateness and equity of psychotropic prescribing.
This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.
Cognitive reserve has been shown to modulate the onset and progression of Alzheimer disease (AD) symptoms. Although its role in sporadic AD is well-studied, how cognitive reserve influences the timing and progression of symptoms in dominantly inherited AD (DIAD) remains unclear. This study aimed to quantify cognitive reserve in DIAD carriers and test whether higher cognitive reserve is associated with later symptom onset and slower functional decline. We analyzed data from the Dominantly Inherited Alzheimer's Network study. Cognitive reserve was modeled using a residual-based latent variable approach, decomposing cognitive performance into demographic (CogD), biomarker (CogB), and reserve or residual (CogR) components. Primary outcomes were age at clinical symptom onset (CDR >0) and longitudinal change in the Clinical Dementia Rating-Sum of Boxes (CDR-SBs). Data were analyzed using Cox proportional hazards models and linear mixed-effects models, adjusting for estimated years from onset (EYO). A total of 710 Dominantly Inherited Alzheimer Network (DIAN) participants were included in the analysis, comprising 271 non-DIAD carriers (nMC), 284 asymptomatic DIAD carriers (aMC), and 155 symptomatic DIAD carriers. In asymptomatic carriers, using a zero-inflation model adjusted for EYO showed that a 1 SD increase in the reserve component (CogR) was associated with a 4.06-fold increase in the odds of being clinically unimpaired (CDR-SB = 0; 95% CI 1.84-8.95). Similarly, a 1 SD increase in the demographic (CogD) and biomarker (CogB) components increased the odds of being CDR-SB = 0 by 2.60 (95% CI 1.10-6.16) and 5.16 (95% CI 2.00-13.33), respectively. Among symptomatic carriers, only the reserve and the biomarker components were significant. A 1 SD increase in CogR was associated with a 0.81-fold reduction in baseline CDR-SB score (95% CI 0.72-0.92), and a 1 SD increase in CogB was associated with a 0.60-fold reduction in CDR-SB (95% CI 0.50-0.71). Our findings indicate that higher cognitive reserve values are associated with delayed conversion to mild cognitive impairment and slower progression on clinical dementia rating scales. These findings suggest that cognitive reserve plays a protective role in modifying the clinical trajectory of genetically determined AD.
To systematically review and meta-analyze randomized controlled trials (RCTs) and non-randomized studies (non-RCTs) evaluating the efficacy of transcranial magnetic stimulation (TMS) for anhedonia in adults with mood disorders. PubMed, Scopus, and ClinicalTrials.gov were searched through March 2025. Studies were included if they specifically assessed the effects of TMS on anhedonia in adults (≥18 years) with major depressive disorder or bipolar depression. The primary outcome was change in anhedonia severity measured by the Snaith-Hamilton Pleasure Scale (SHAPS), the Temporal Experience of Pleasure Scale (TEPS), and the Dimensional Anhedonia Rating Scale (DARS). Secondary outcome was change in depression severity. Random-effects meta-analyses with Hartung-Knapp adjustment were performed for sham-controlled RCTs. Fourteen studies (eight RCTs, six non-RCTs) were included. Sham-controlled RCTs showed a small but statistically significant improvement in anhedonia favoring active TMS (SMD = 0.27, 95% CI 0.02, 0.52; p = 0.042). Exploratory analyses of studies using TEPS demonstrated a significant effect on anticipatory anhedonia (Hedges' g = 0.27, 95% CI 0.09, 0.45). No significant effect was observed for depression severity in RCTs (SMD = -0.14, 95% CI -0.45, 0.17; p = 0.30). Non-RCTs reported larger improvements in both anhedonia and depression; however, studies have substantial heterogeneity and are not directly comparable to sham-controlled RCT findings. TMS is associated with a small improvement in anhedonia. The absence of a significant effect on depression severity should be interpreted cautiously and may suggest that anhedonia could represent a partially distinct neuromodulation target; however, this interpretation remains hypothesis-generating given the limited number of studies and statistical power. Unmet needs include the standardization of anhedonia assessment favoring multidimensional scales and powered designs with anhedonia as a primary outcome.
Early-onset dementia (onset before age 65 years) is an important health concern, but much of our understanding of its risk factors is inferred from studies of late-onset dementia (onset after age 65 years). We investigated associations between several demographic, clinical, and lifestyle factors with early-onset dementia and compared those estimates against their associations with late-onset dementia. Data from five community-based longitudinal cohort studies from the UK and USA were pooled and rigorously harmonised: UK Biobank, Atherosclerosis Risk in Communities Study, Framingham Heart Study, Multi-Ethnic Study of Atherosclerosis, and Whitehall II Study. Dementia was ascertained via hospitalisation and death records with or without clinical assessments according to each cohort's protocol. Risk factors included sex, self-reported race or ethnicity (Hispanic, White, Black, Asian, and Other), low education, hypertension, diabetes, obesity, hypercholesterolaemia, depression, alcohol overconsumption, smoking, and physical inactivity. Cox regression models, with age as the timescale and time-varying coefficients, were fitted to estimate hazard ratios (HRs) for early-onset dementia and late-onset dementia and to test whether the HRs differed by age of onset. In 544 442 participants, there were 807 incident early-onset dementia cases and 14 253 incident late-onset dementia cases over a median follow-up of 13·7 years (IQR 12·9-14·4). Female participants had a lower hazard of early-onset dementia compared with males (HR 0·70 [95% CI 0·61-0·80]). Black versus White race (1·61 [1·23-2·11]), grade school education or less (1·99 [1·67-2·38]), diabetes (2·45 [1·99-3·03]), depression (2·73 [2·34-3·20]), smoking (1·86 [1·56-2·22]), obesity (1·24 [1·04-1·48]), physical inactivity (1·33 [1·11-1·59]), and alcohol overconsumption (1·22 [1·01-1·47]) were independently associated with higher hazards of early-onset dementia. Hypertension stage 1 (HR 1·19 [95% CI 0·97-1·47]), hypertension stage 2 (1·16 [0·94-1·43]), and hypercholesterolaemia (1·11 [0·92-1·34]) had positive effect estimates but were not statistically significant. All risk factors had stronger associations with early-onset dementia than with late-onset dementia except race, physical inactivity, and alcohol overconsumption. Our findings demonstrate the importance of modifiable risk factors in the development of early-onset dementia and guide future research for identifying high-priority targets for primary prevention. US National Institutes of Health, the National Institute for Neurologic Disorders and Stroke, and the National Institute of Aging.
Stressful life events (SLEs) are common exposures and act as major proximal and distal risk factors for perinatal depression. Pregnancy represents a critical period in which SLE-related psychosocial vulnerability may manifest as depressive symptoms. This study investigated the presence of major SLE occurring during pregnancy, and examined their associations with depressive symptomatology, relevant psychological and clinical variables. A multicentre cohort of 2633 women in their third trimester was recruited within a regional perinatal depression screening program and women reporting depressive symptoms were followed postpartum (7 days, 1 month, and 6 months). Longitudinal follow-up assessments were restricted to participants screening positive for depressive symptoms, in accordance with the screening program design. Major SLE were assessed using the Holmes-Rahe Stress Scale, while depressive symptoms, personality, attachment, resilience, coping strategies, and quality of life were all measured with validated instruments. 4.9% (n = 128) of participants experienced major stressful life events (SE ≥150), independent of age, education, employment, or obstetric history. Women exposed to major SLE showed higher baseline and early postpartum depressive symptoms, greater neuroticism, insecure attachment, lower resilience, and poorer quality of life (all p < 0.0001). Major stress exposure was also associated with reduced caregiving support and higher partner psychiatric morbidity. Multivariate analysis identified depressive symptoms, neuroticism, lower psychological wellbeing, absence of a caregiver, and prior perinatal psychopathology as factors independently associated with major stressful life events. These findings highlight the need for comprehensive psychosocial screening in perinatal care. Targeted interventions aimed at strengthening resilience, adaptive coping, and relational support may mitigate stress-related risk and prevent perinatal psychopathology.
Objective: This exploratory post hoc analysis examined the safety/efficacy of the aripiprazole once-monthly 400 mg (AOM 400) long-acting injectable (LAI) in Black/African American patients diagnosed with bipolar I disorder (BP-I). Methods: Data were from a 52-week, open-label trial of AOM 400 maintenance treatment in patients diagnosed with DSM-IV-TR-defined BP-I. Outcomes included treatment-emergent adverse events (TEAEs), clinician-rated extrapyramidal symptoms (EPS), patient stability, Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression-Bipolar Version-Severity (CGI-BP-S) scores, functioning, and quality of life (QoL). Data analyses comprised descriptive statistics and a mixed model for repeated measures. Results: Outcomes were analyzed in 464 patients (Black/African American, n=104; White, n=255; Asian, n=94; other racial groups, n=11). No notable increase in TEAEs, serious TEAEs, or TEAEs leading to discontinuation were observed in Black/African American patients vs those in other racial groups. Rates of akathisia, tremor, increased weight, or hypertension were lower/similar in Black/African American patients vs other racial groups; changes in EPS scores were minimal in all groups. At last visit, 90.1% of Black/African American patients were stable, similar to other racial groups. Small changes in YMRS total score occurred in all groups, with MADRS total score and CGI-BP-S scores largely unchanged. Functioning and QoL improved in Black/African American patients, to a similar/greater degree than other racial groups. Limitations include the open-label design, prior aripiprazole stabilization, and sparse metabolic laboratory data, constraining causal inference and metabolic conclusions. Conclusion: The safety and efficacy of AOM 400 is comparable between Black/African American and non-Black/African American patients with BP-I. The data provide valuable evidence supporting second-generation LAI antipsychotic use in these patients. Trial Registration: ClinicalTrials.gov identifier: NCT01710709.
Maternal sensitivity to children's emotional cues is a fundamental determinant of healthy child development, yet childhood trauma can disrupt the neurobiological processes underlying this sensitivity, contributing to the intergenerational transmission of adversity. This study investigated how childhood trauma (CT) and trauma-specific reflective functioning (RF-T) influence the neural processing of children's emotional expressions. Using event-related potentials (ERPs) in a sample of mothers with histories of maltreatment (N = 30), we examined three functionally distinct stages: early structural encoding (N170), attentional allocation (P300), and sustained emotional engagement (LPP). Participants completed a passive viewing task involving child facial expressions (happy, fearful, angry) while EEG was recorded. Results revealed that higher CT significantly predicted attenuated N170 amplitudes specifically for happy child faces (β = -0.55, p = .006), indicating a selective disruption in the early perceptual encoding of positive socio-emotional cues. Conversely, CT did not affect P300 or LPP components, and RF-T showed no neural associations. These findings suggest that early adversity may recalibrate sensory gating to deprioritize social safety cues. Yet, preserved later evaluative processes indicate neurocognitive resilience. This dissociation identifies a bottleneck in maternal attunement and a targeted pathway for interventions to disrupt intergenerational trauma transmission.
This scoping review aims to explore the Indian literature on behavioural and psychological symptoms of dementia (BPSD) published over the past two decades, focusing on epidemiology, symptom profiles, clinical and psychosocial correlates, caregiver burden, and management strategies. The databases PubMed, EMBASE, and Scopus were searched for Indian studies addressing BPSD. Observational, interventional, qualitative, and mixed-methods studies were included. Data were extracted on study characteristics, dementia subtypes and severity, assessment tools, BPSD correlates, caregiver burden, and management. Thirty-three studies published between 2006 and 2025 across diverse Indian regions were included. Commonly reported BPSD included sleep disturbances, apathy, irritability, agitation, and affective symptoms, with variation across dementia subtypes. Severity was highest in frontotemporal dementia and dementia with Lewy bodies. BPSD intensity was consistently associated with severity of cognitive impairment, illness duration, pain and sociodemographic factors. Caregiver burden was strongly associated with BPSD severity in addition to cognitive decline. Most interventions evaluated were non-pharmacological therapies which reduced BPSD severity and caregiver distress. Pharmacological studies were limited, largely examining prescribing patterns and providing preliminary evidence for herbal formulations. Indian literature highlights the burden of BPSD, its subtype specific presentation and the associated caregiver burden. Although non-pharmacological approaches have shown substantial promise, the evidence base remains heterogenous, limited by majority of cross-sectional study designs, warranting further research in the form of longitudinal studies.
Emotional prosody is essential for social communication and is frequently disrupted in schizophrenia. However, the relationships among emotional prosody recognition, expressive acoustic characteristics, and psychiatric symptoms remain incompletely understood. This study examined speech emotion prosody (SER) recognition, acoustic features of emotional expression, and their associations with symptom dimensions in schizophrenia. Ninety-six patients with schizophrenia and 54 healthy controls completed standardized emotional prosody recognition tasks and an emotional video-induced spontaneous speech task. Acoustic features were extracted using the eGeMAPS feature set. Psychiatric symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Patients exhibited significantly impaired recognition accuracy across emotions, accompanied by increased confusion rates, both of which were associated with greater symptom severity, particularly negative symptoms. Acoustic analyses revealed flatter and less dynamic vocal patterns in patients, characterized by reduced loudness variability, constrained fundamental frequency range, and altered spectral-formant features, which were most strongly related to negative symptoms. Stepwise regression analyses demonstrated that models combining SER performance and expressive acoustic features provided substantially better prediction of symptom severity than models based on either domain alone, explaining over one-third of the variance in negative symptoms. Deficits in emotional prosody recognition and expression are closely coupled and jointly reflect core psychopathology in schizophrenia. The findings preliminarily support the utility of integrating perceptual and expressive prosodic markers as objective, quantitative indicators of symptom severity and highlight emotional prosody as a promising target for assessment and intervention in schizophrenia.
Cross-cultural empirical evidence on the validity of measures of depression and anxiety symptoms in adolescents is scarce and inconclusive. The present study investigated the cross-national measurement invariance and convergent validity evidence of the Depression and Anxiety scales of the Depression Anxiety and Stress Scales (DASS-21). We sampled 16,802 adolescents (58.1% female) aged 14-19 years across 30 countries from five continents. Both exact and approximate measurement invariance were tested. The results provided evidence for the exploratory structural equation model (ESEM) as the best representation of the data in most countries. Full scalar invariance was not supported when tested across all countries, but only among two Southern Asian countries (Bangladesh, India), two Northern European countries (Estonia, Lithuania), the six former republics of Yugoslavia, and European and American countries grouped by UN subregions. Results of the alignment method supported the approximate invariance of the ESEM model across 29 countries. Associations between Depression and Anxiety ESEM factors and life satisfaction, positive affect, and negative affect conformed to the theoretical expectations in most countries. Our findings indicate that the Depression and Anxiety scales of the DASS-21 have potential for use in cross-national research on adolescent internalizing symptoms, but we highlight issues of using it outside of Western (European, North American) settings.
Negative symptoms are a major cause of disability in schizophrenia. The molecular and cellular mechanisms underlying this symptom domain remain unknown. We hypothesized that gray matter volume (GMV) alteration in schizophrenia patients with predominantly negative symptoms (PNS) may be associated with gene expression profiles of neurons and oligodendrocytes. This cross-sectional study comprised 253 subjects, including 75 with PNS, 84 with predominantly positive symptoms (PPS) and 94 healthy controls. Group differences in GMV were analyzed, and partial least squares regression was employed to examine the association between GMV alterations in the PNS group and spatial gene expression patterns derived from the Allen Human Brain Atlas. A series of bioinformatics analyses-including functional enrichment, protein-protein interaction network analysis, and cell type-specific expression profiling-were conducted to identify potential molecular and cellular mechanisms underlying GMV alterations in the PNS group. Relative to healthy controls, the PNS group displayed a greater number of regions with abnormal GMV than the PPS group, and exhibited smaller GMV in TE1.0/TE1.2_R but larger GMV in lsOccG_L in direct comparison with the PPS group. Genes associated with GMV alterations in the PNS group were enriched in biological processes at the synapse, protein catabolism and localization, etc., and shared enriched pathways with schizophrenia GWAS risk genes. The interregional profile of GMV differences in PNS was both negatively associated with expression profiles specific to excitatory and inhibitory neurons, and positively with those of oligodendrocytes. This multimodal integration of neuroimaging and transcriptomic data suggests that GMV alterations in PNS may reflect disruptions in neurons and oligodendrocytes biological functions.
Patients with schizophrenia experience a markedly increased risk of sudden cardiac death that cannot be fully explained by conventional cardiovascular risk factors or QTc prolongation alone. Novel electrocardiographic markers reflecting ventricular repolarization heterogeneity may provide more sensitive indicators of arrhythmic vulnerability. We conducted a systematic review and meta-analysis of observational studies published between 2015 and 2025 comparing traditional and novel ECG repolarization markers in adults with schizophrenia and healthy controls. PubMed, Scopus, Embase, and Web of Science were searched. Outcomes included heart rate, QT/QTc indices, frontal QRS-T angle, Tp-e interval, Tp-e/QT ratio, and dispersion measures. Pooled mean differences (MDs) with 95% confidence intervals were estimated using random-effects models, with subgroup analyses according to treatment status (drug-naïve vs medicated). Eleven studies comprising 5648 patients with schizophrenia and 23,636 healthy controls were included. Compared with controls, patients with schizophrenia exhibited a higher heart rate (MD = 6.24 bpm, 95% CI 2.01-10.46), increased QT dispersion (MD = 13.00 ms, 95% CI 3.58-22.42), and markedly elevated QTc dispersion (MD = 21.23 ms, 95% CI 18.23-24.23), while QTc prolongation was modest and QT interval showed no significant difference. Novel repolarization markers demonstrated pronounced abnormalities, including an increased frontal QRS-T angle (MD = 26.11°, 95% CI 19.10-33.11), prolonged Tp-e interval (MD = 3.92 ms, 95% CI 2.35-5.49), and greater Tp-e dispersion (MD = 8.21 ms, 95% CI 6.56-9.85), whereas the Tp-e/QT ratio did not differ significantly. These electrophysiological alterations were consistently observed in both drug-naïve and medicated patients. Schizophrenia is associated with pronounced ventricular repolarization heterogeneity that extends beyond conventional QTc prolongation and is evident even in drug-naïve patients. To our knowledge, this is the first systematic review and meta-analysis to comprehensively quantify both traditional and novel ventricular repolarization markers in schizophrenia.
Cannabis-induced psychotic disorders represent 12-35% of first-episode psychosis presentations globally. Traditional clinical wisdom holds these conditions carry favorable prognosis based on rapid symptomatic improvement, yet this narrative rests almost exclusively on symptomatic outcomes, overlooking functional, cognitive, and subjective recovery dimensions. To systematically review multi-dimensional recovery trajectories following cannabis-induced or cannabis-associated first-episode psychosis, characterizing patterns of concordance and discordance across outcome domains and identifying predictors of recovery profiles. We searched five databases (PubMed/MEDLINE, PsycINFO, Embase, Web of Science, Cochrane Library) from inception to December 2024. longitudinal studies (≥6 months follow-up) assessing ≥ 2 outcome domains among symptomatic, functional, cognitive, and subjective recovery in cannabis-induced first-episode psychosis. Two independent reviewers screened studies and assessed quality using Newcastle-Ottawa Scale. Data were synthesized narratively. Thirty-three studies encompassing 18,117 participants were included (mean follow-up 24 months, range 6 months-10 years). While 50-70% achieved symptomatic remission within 6 months, functional recovery revealed substantial heterogeneity and frequent symptom-function dissociation. Continued cannabis use emerged as strongest predictor of poor outcomes across domains (persistence rates 35-65%), though cessation demonstrated significant benefits (functional recovery effect size 1.26). Cognitive findings were heterogeneous, and subjective outcomes remained poorly characterized (assessed in only 38% of studies). Only 15% of studies employed person-centered trajectory modeling, revealing five distinct recovery profiles. Symptomatic improvement frequently fails to translate into functional recovery following cannabis-induced psychosis. The field's understanding of "favorable prognosis" inadequately captures comprehensive multi-dimensional recovery, necessitating interventions targeting functional, cognitive, and subjective domains beyond symptomatic remission.