Polypharmacy is often crucial for managing complex and treatment-resistant psychiatric disorders, yet it carries risks such as adverse drug interactions, medication non-compliance, and suboptimal health outcomes. Interprofessional perspectives on polypharmacy significantly influence clinical decision-making and prescribing practices. This research evaluates healthcare providers' knowledge and attitudes regarding psychiatric polypharmacy, comparing the views of psychiatric nurses, psychiatrists, and pharmacists. It also explores how these factors impact prescribing behaviors and interprofessional collaboration. A convergent mixed-methods approach was employed at the Erada Complex for Mental Health and Addiction in Jeddah, Saudi Arabia. The study involved 221 healthcare providers, including psychiatrists (n = 32), psychiatric nurses (n = 158), and pharmacists (n = 31). Quantitative data were collected using validated scales to assess knowledge and attitudes, while qualitative insights were gathered through open-ended responses and group discussions. Knowledge levels varied among the professionals, with psychiatrists possessing the most comprehensive understanding (84.2 ± 11.0), followed by pharmacists (81.5 ± 10.0) and psychiatric nurses (79.5 ± 9.8). Attitudes toward polypharmacy also differed, with psychiatrists showing the most favorable views (3.79 ± 0.49), whereas nurses and pharmacists were more cautious due to concerns about adverse effects and medication burden. A significant positive correlation (r = 0.653, p < 0.05) was observed between knowledge and attitude scores. Sociodemographic factors, such as professional experience and confidence in medication management, influenced both knowledge and attitudes regarding medication management. Qualitative findings highlighted interprofessional tensions, with psychiatric nurses advocating for more conservative approaches, psychiatrists emphasizing clinical necessity, and pharmacists focusing on optimizing medication safety. Healthcare providers demonstrated varying levels of awareness and attitudes toward psychiatric polypharmacy, shaped by their professional roles and responsibilities. While psychiatrists were more accepting of polypharmacy, psychiatric nurses expressed concerns about patient burden, and pharmacists prioritized safety considerations. Enhancing interprofessional collaboration and ongoing education on polypharmacy practices are essential for improving patient outcomes.
Generative artificial intelligence (GenAI) has increasingly entered psychiatric practice through patient-facing chatbots, self-help tools, and clinician-facing workflow support. Although prior research has examined clinicians' attitudes, readiness, and anticipated use cases, less is known about how frontline encounters with GenAI shape psychiatrists' interpretations and implementation priorities. Health care foresight also remains methodologically underdeveloped and has focused mainly on external signals, overlooking clinically consequential signals emerging from everyday practice. This gap is especially important in psychiatry, where GenAI-related benefits and harms may depend on patient vulnerability, crisis sensitivity, and the therapeutic relationship. This study aims to qualitatively examine how South Korean psychiatrists described clinical experiences with GenAI, how they interpreted its roles and limits in psychiatric care, and what implementation priorities they emphasized. Selected concepts from horizon scanning informed the organization of the analysis by orienting attention to practice-based signals, interpretive patterns, and implementation priorities. In this qualitative descriptive study, directed content analysis and codebook-based thematic synthesis were used to analyze responses to 3 open-ended survey questions administered to members of the Korean Neuropsychiatric Association. Invitations were distributed through the association's official email system from October 27 to December 26, 2025. The qualitative analysis included respondents who provided an interpretable response to at least 1 item. The questions addressed (1) GenAI-related clinical experiences, (2) perceived advantages and limitations of GenAI relative to human therapists, and (3) priorities for the safe introduction of GenAI into mental health care. An exploratory participant-level cross-question thematic alignment analysis was also conducted to examine recurring adjacent-item pairings across the experience-interpretation-priority sequence. Of 408 total survey respondents, 311 respondents provided a meaningful response to at least 1 open-ended item. Psychiatrists described GenAI as a clinically ambivalent technology whose implications depended on context, intensity of use, and patient vulnerability. Practice-based signals clustered around patient-led use, clinician-led use, GenAI as a relational object, and GenAI-mediated changes in the patient-clinician interface, with high-risk and destabilizing scenarios cutting across these themes. Respondents viewed GenAI as potentially useful as an adjunct, but also as relationally limited and unacceptable as a replacement for human therapists. Implementation priorities centered on governance, crisis and vulnerability safeguards, technical reliability and clinical validation, and education, supervision, and structural readiness. Cross-question analysis suggested recurrent alignments between frontline signals, a view of GenAI as standardized and tireless but relationally thin, and governance- and validation-oriented implementation priorities. In this qualitative descriptive study, GenAI emerged in psychiatric practice as an access tool, a workflow aid, and, at times, a competing interpretive reference point in clinical encounters. The key implementation challenge is therefore not whether psychiatry will encounter GenAI, but how its use should be bounded, supervised, and governed in light of patient vulnerability, psychiatric risk, and the relational demands of care.
Nurses play a key role in person-centered psychiatric care by supporting patient recovery, fostering independence, and building trusting relationships. However, organizational rules may conflict with nurses' ethical values, leading to moral distress, burnout, and resignation. Drawing on the theory of positive deviance, previous research has identified how nurses may engage in positive rebel leadership, leading and practicing nursing in ways that diverge from prevailing norms, rules, codes of conduct, and workplace strategies. This study explores how such leadership in psychiatric care can support professional standards and improve patient outcomes. The aim was to describe nurses' experiences of rebel nurse leadership in psychiatric care. A qualitative descriptive design was employed, using semistructured individual interviews with 33 nurses experienced in psychiatric care. A qualitative content analysis and meta-synthesis were conducted, with the support of generative artificial intelligence in the synthesis process. The results describe nurses' experiences of rebel nurse leadership in psychiatric care as taking responsibility, guided by professional competence and an internal ethical compass; leading change and challenging hierarchies to enable holistic care that respects patients' rights and dignity; relying on the support of colleagues and management, while facing the risk of exclusion. The study shows how rebel nurse leadership, grounded in professional competence and ethical conviction, might support person-centered and high-quality psychiatric care. The findings illustrate how such leadership emerges in response to organizational norms that constrain nursing practice and frame acts of resistance as expressions of professional responsibility. The study emphasizes the importance of supporting nurses' autonomy to enable improvements in care quality and patient outcomes.
Deep brain stimulation (DBS) is an emerging intervention for treatment-resistant psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Despite strong evidence of efficacy, its acceptability remains limited among psychiatrists, especially in France. Understanding professional attitudes is essential for its clinical integration. We conducted a mixed-method study using the script method, combining qualitative item development with quantitative analysis through a self-administered online questionnaire. The survey, based on a multidimensional model of acceptability, assessed French psychiatrists' perceptions of DBS across dimensions such as utility, usability, reliability, risk, and professional culture. Data were analyzed using network clustering analysis, centrality metrics, and community detection, allowing exploration of structural relationships among acceptability factors. Subgroup analyses were conducted by gender, professional seniority, practice type, and theoretical orientation. Among 418 respondents, the most central determinant of DBS acceptability was adherence to professional guidelines. Other influential factors included perceived utility, self-acceptability, and the classification of DBS as part of psychiatry's therapeutic arsenal. Peripheral concerns, such as cost or multidisciplinary logistics, were weakly connected to the core network. Gender and seniority influenced network structure: male psychiatrists showed stronger associations between adherence to professional guidelines and viewing DBS as a legitimate psychiatric treatment, while senior psychiatrists exhibited denser patterns of associations between acceptability-related factors. No significant differences were found by practice type or theoretical orientation. DBS acceptability among French psychiatrists hinges on institutional validation and perceived alignment with psychiatric norms. These findings highlight the need for guideline-based dissemination strategies and tailored communication to support the ethical and effective adoption of DBS in psychiatric care.
Standardized diagnostic interviews (SDIs) are structured assessments based on established criteria to improve the consistency and reliability of diagnoses. The pooled test-retest reliability of SDIs for adult psychiatric disorders is unknown. To estimate the test-retest reliability of SDIs used to classify common adult psychiatric disorders, examine variations in test-retest reliability between disorders, and assess prespecified factors associated with between-study heterogeneity. MEDLINE, Embase, Emcare, PsycINFO, and Applied Social Sciences Index and Abstracts were searched without date or language limitations from inception until September 2025. References of eligible articles and relevant reviews were also screened. Primary studies that evaluated test-retest reliability of SDIs assessing adult psychiatric disorders were selected. Disorders were selected based on estimated prevalence in the general adult population, clinical relevance, and frequent appearance in SDIs. Data were extracted and study quality was assessed based on the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Multilevel random-effects meta-analysis and meta-regression were performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Test-retest reliability estimates (Cohen κ) of SDI-based adult psychiatric disorder diagnoses. Pooled estimates were calculated for 5 groups of mental disorders (anxiety, bipolar, depressive, personality, and nonaffective psychoses) and 8 groups of substance use disorders (SUDs; alcohol, cannabis, cocaine, hallucinogens, opioids, sedatives, stimulants, and tobacco). Fifty-seven studies were analyzed, 46 of which were included in the meta-analysis (535 κ estimates; N = 8146 participants [mean age range, 22.0-54.3 years]). The pooled estimate of SDI test-retest reliability was κ = 0.69 (95% CI, 0.66-0.72), with substantial between-study heterogeneity (Q534 = 23 578.7; P < .001; I2 = 93%). Reliability was higher for SUDs than for mental disorders (κ = 0.72 [95% CI, 0.69-0.72; 292 estimates] vs 0.65 [95% CI, 0.61-0.69; 243 estimates]; z = 3.74; P < .001) and varied among disorder types. Reliability for mental disorders ranged from κ = 0.55 (95% CI, 0.44-0.66) for nonaffective psychoses to κ = 0.74 (95% CI, 0.56-0.91) for bipolar disorders. Reliability for SUDs ranged from κ = 0.59 (95% CI, 0.49-0.70) for hallucinogens to κ = 0.81 (95% CI, 0.74-0.88) for opioids. Univariate meta-regression indicated that diagnostic criteria partially explained between-study variation in SUDs, whereas methodological quality indicators (eg, small sample size and retest interval) did not. In this systematic review and meta-analysis, SDIs showed moderate and heterogenous test-retest reliability that varied substantially across common adult psychiatric disorders. The findings indicated that structural standardization alone may not be sufficient to ensure consistent psychiatric diagnosis and highlighted the importance of considering contextual and phenomenological information into diagnostic assessment and research practice.
Patient safety competency among nurses is increasingly emphasized, yet research on patient safety competency among psychiatric nurses remains scarce. To deeply explore the cognition of psychiatric nurses on patient safety competency and explore the demands of nurses for enhancing patient safety competency. The study was conducted from June to July 2025 with 16 psychiatric nurses. Data were collected through in-depth personal interviews and thematic analyzed using Colaizzi's seven-step phenomenological analysis method. Three main themes and 13 subthemes are formed: (1) The connotation of patient safety competency, including "protecting one's own safety is the prerequisite for ensuring patient safety," "understanding patients," "observation," "nurse-patient communication," "nurse-patient relationship," and "handling adverse events;" (2) influencing factors of patient safety competency, including "manpower resources," "leadership," "teamwork," and "adverse event management system;" and (3) the demand for improvement of patient safety competency, such as "emphasize theory over practice," "outdated training content and monotonous formats," and "desire for more experience sharing." This study conducted an in-depth investigation into the connotation, influencing factors and improvement demands of patient safety competency among nurses in the field of mental health, revealing the specificity of psychiatric nurses' perceptions of patient safety competency. This provides a basis for health administration departments and hospital managers to develop relevant on-the-job training programs and intervention strategies to enhance the patient safety competency of psychiatric nurses, thereby improving the quality of nursing care and delivering superior services to patients. It holds practical significance for the optimization of specialized psychiatric nursing and even the broader healthcare field.
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.
Fibromyalgia syndrome (FMS) is a chronic condition characterised by the presence of complex multiple symptoms, often accompanied by psychiatric comorbidities and sleep problems. The wide spectrum of symptoms and comorbid problems complicates treatment and management of the ensuing disability and symptoms. Physiotherapy approaches and mind-body practices including yoga and mindfulness are among the non-pharmacological treatment methods commonly used in FMS treatment. While there is initial evidence for these interventions, definitive conclusions about their effectiveness are still lacking and research on their combined effectiveness is limited. Therefore, this study aims to evaluate the effectiveness of a multimodal integrative protocol, the PhYoMind (PYM) intervention, which combines specific physical therapy modalities with yoga and mindfulness practices on the overall impact of fibromyalgia and functional impairment. This monocentric study uses a parallel-group (1:1) randomised controlled design, in which the outcome assessor and statistician are blinded to group allocation. Individuals with a clinical diagnosis of FMS (n=40) will be included in the study (Cohen's f=0.675; α=0.05; power=0.80). Participants will be randomised to receive either PYM intervention in addition to Home Exercise (HE) programme or HE programme alone. The intervention period for both groups will last 8 weeks; PYM sessions will be held twice a week for 75 min each. The primary outcome is the broad disease impact and functional impairments measured by the total score of the Fibromyalgia Impact Questionnaire. Secondary outcomes include central sensitivity, as assessed by the Central Sensitisation Index; autonomic nervous system function, as measured objectively by heart rate variability; pain perception (current, average, worst), as assessed by the Visual Analogue Scale; fatigue, as assessed by the Multidimensional Fatigue Inventory; stress, as assessed by the Perceived Stress Scale; and sleep quality as assessed by the Pittsburgh Sleep Quality Index. Adherence and adverse events will be assessed for both interventions. Repeated measures ANOVA will be used to analyse the effect of time, intervention group and their interaction on primary and secondary outcomes under an intention-to-treat principle. Ethics approval was granted from the Ethics Committee at the Medical Faculty of Eberhard Karls Tuebingen University and at the University Hospital of Tuebingen (260/2025BO2) on 30 April 2025. The trial will be conducted in accordance with the updated principles of the Declaration of Helsinki. The study's findings will be disseminated and documented in a peer-reviewed publication, adhering to the Consolidated Standards of Reporting Trials guidelines. After completion of the study and publication of the results, participants who are interested will be offered a brief summary of the aggregated study findings. NCT07145788.
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 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 = 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 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.
A significant proportion of patients with obsessive-compulsive disorder (OCD) are admitted to inpatient hospital facilities. This most often occurs within general psychiatric units, given the scarcity of options specialized to OCD. This study surveyed 69 adults with self-reported OCD who had experienced 1 or more inpatient hospitalizations, with the goal of exploring perceptions of OCD-related care in general inpatient settings. Overall, participants reported negative views of their providers' attention to OCD-specific needs. Nearly half indicated that none of their providers appeared proficient in or confident working with OCD. Participants were also dissatisfied with the OCD treatment they received. At the same time, more positive perceptions of providers' ability to treat OCD were associated with a greater likelihood of perceived OCD symptom reduction during hospitalization. These findings are among the first to empirically highlight potential limitations in the standard of care for OCD in general psychiatric units. We discuss avenues for future research, including the need to develop and evaluate provider approaches that balance reducing accommodation of compulsions with supportive responding, which may lay the groundwork for evidence-based practices to better prepare providers to work with patients who have OCD in inpatient settings.
Recreational therapies, including music therapy, singing therapy, dance therapy, art therapy, game therapy, creative story therapy, and combined therapy, are essential for individuals with mild cognitive impairment and dementia. However, research comparing their effectiveness is limited. This study aimed to evaluate the effectiveness of recreational therapies in improving cognitive function, neuropsychiatric symptoms, and psychosocial outcomes in individuals with mild cognitive impairment and dementia. We identified eligible randomized controlled trials of recreational therapies for individuals with mild cognitive impairment and dementia in eight electronic databases, including CINAHL, CENTRAL, Embase, EBSCOhost, Ovid MEDLINE, PubMed, Scopus, and Web of Science. A frequentist network meta-analysis with random-effects model was performed in R Software presenting standardized mean differences for data analysis. The primary outcome was cognitive function, which is classified into global cognition, fundamental processes (immediate and delayed memory, attention, and processing speed), intermediate processes (language and verbal fluency), and higher-order processes of cognitive function (executive function); while secondary outcomes were neuropsychiatric symptoms and psychosocial outcomes (depression, anxiety, and quality of life). Netrank was used to rank the interventions. Cochrane Q, I2, and τ2 statistics were used to assess heterogeneity. The quality of the evidence was graded using the Confidence in Network Meta-Analysis. In total, 71 randomized controlled trials involving 6692 participants were included. Game therapy (standardized mean difference: 0.71), art therapy (0.68), and music therapy (0.29) significantly improved global cognition. Most recreational therapies enhanced fundamental processes, with the strongest effects noted for singing therapy on immediate memory (0.62), music therapy on delayed memory (0.34), creative story therapy on attention (1.08), and art therapy on processing speed (-0.28). Dance therapy (0.51) and art therapy (0.59) improved language and verbal fluency, whereas singing therapy improved executive function (0.78). Dance therapy (-0.43), music therapy (-0.38), and combined therapy (-0.35) alleviated neuropsychiatric symptoms. Regarding psychosocial outcomes, game therapy reduced depression (-0.70), music therapy reduced anxiety (-1.17), and art therapy improved quality of life (0.65). Recreational therapies yield domain-specific benefits across outcomes, supporting their use as effective mild cognitive impairment and dementia care strategies. These findings highlight the need to integrate recreational therapies into routine practice, offering evidence-based to enhance care and patient well-being. The protocol for this network meta-analysis was prospectively registered in International Prospective Register of Systematic Reviews (registration number: CRD 420251021190).
Family caregivers play a critical role in the rehabilitation and ongoing care of relatives diagnosed with mental illness. This involvement of families in the care of their relatives with mental illness not only improves patient outcomes but also encompasses the stress and burden experienced by family caregivers. This study aimed to explore and describe the perceptions of psychiatric mental health nurses regarding the needs of family members caring for people diagnosed with mental illness in Lobatse, Botswana. A qualitative explorative, descriptive, and contextual research design was used. Data were collected from 15 psychiatric mental health nurses using semi-structured in-depth interviews. The psychiatric mental health nurses were purposively sampled. The data were analysed using content data analysis. Comprehensive Criteria for Reporting Qualitative Research guidelines were followed. The results yielded three themes: healthcare interventions, informational support, and tangible support needed by family caregivers of people living with mental illness. Family members caring for individuals diagnosed with mental illness need various support interventions to help them cope with the strain of caregiving and alleviate the impact of caregiver role strain. Mental health nursing care that recognizes the need for caregiver-oriented care practice is needed to promote a better quality of life and enhance caregivers' coping with caregiver role strain.
This study examines forensic psychiatric inpatient care through a philosophical analysis of empirical findings from five lifeworld phenomenological studies, interpreted through Foucault's work. All studies were conducted in forensic psychiatric settings from a nursing perspective. The findings were reanalyzed using phenomenological meaning analysis to develop a general structure in line with reflective lifeworld research principles. The analysis identified three interrelated constitutive dimensions of nursing practice: (1) care practice as conduct and counter-conduct in the tension between institutional demands and patients' needs, (2) interpretive work as conduct and counter-conduct in responding to patients' expressions, and (3) emotional endurance as conduct and counter-conduct in resisting professional detachment. Together, these dimensions illustrate how care in forensic psychiatry is enacted within, rather than in opposition to, institutional power relations. The findings show how everyday encounters are shaped by a ward culture oriented towards safety, control, and predictability, while also giving rise to subtle, situated forms of counter-conduct. These practices open limited, fragile spaces for alternative care. By highlighting the interpretive, emotional, and moral labor involved in nursing practice, the study contributes a practice-based Foucauldian understanding of care in forensic psychiatric contexts.
The history of the transition from Kraepelin's concept of manic-depressive psychosis and endogenous depression to the current model of major depression is traced. In particular, the changes that have characterized the transition from the narrative psychopathology of the positivist era to the operational psychiatry of the DSM-III and its successors over the last century are critically reviewed. The birth of psychopharmacology, with the consequent entry of market interests into psychiatry and de-institutionalization, have shifted psychiatric patients from mental hospitals to outpatient clinics, resulting in enormous changes in both quantity and quality of samples. The changing composition of psychiatric population, with an ever-increasing prevalence of non-psychotic cases, and the progressive abandonment of the phenomenological cultural substratum in favor of more empirical paradigms, has rendered old classifications based on narrative criteria inadequate. Hence the need for more 'scientific' models, driven mainly by the need for reproducibility, was necessary for the application of scientific empirical methods. This article focuses on the changes that the concept of depressive illness has undergone in the transition from descriptive psychopathology to the current operational diagnoses. The various forms of depression described prior to DSM-III (endogenous depression, neurotic depression, reactive depression, atypical depression, seasonal depression, masked depression, involutional depression, depressive pseudodementia), examined in the frame do DSM-5, are either excluded because of the lack of evident depression (masked depression, depressive pseudodementia) or all absorbed into the single broad category of major depressive disorder, which thus becomes a broad container which is likely to lack homogeneity, as has been repeatedly pointed out over the years. On the other hand, what the authors of DSM (the latest edition in particular) have proposed as a remedy, the sub-categorization of the disorder through the description of specific typer (the specifiers), is in fact ignored both in research and in clinical practice.
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
Nurses play a crucial role in preventing pressure ulcers, as they are at the forefront of patient care and are responsible for implementing preventive measures. The current study aimed to explore nurses' knowledge, attitudes, and practices regarding pressure ulcer (PU) prevention in Intensive Care Units (ICUs) and to identify any correlation between these variables and nurses' burnout. This study was conducted in the intensive care units of Zagazig University Hospitals in Egypt, with data collection from January 2024 to May 2024. The study included 131 nurses working in these units. Data were collected using a self-administered questionnaire that included sociodemographic information, nurses' knowledge, attitudes, and practices related to pressure ulcer prevention, and a burnout assessment tool. Nurses exhibited moderate knowledge of pressure ulcer prevention (16.1 ± 4.6). Nurses demonstrated moderately favorable attitudes overall, with strong agreement on key prevention principles (e.g., the avoidability of PUs and the need for risk assessments), but perceived challenges with time and prioritization. However, adherence to recommended practices was low, with 54.8% of checklist items not completed. Additionally, these nurses experienced a notable level of burnout, particularly in cognitive and emotional domains (3.6 ± 0.8 and 3.6 ± 0.9, respectively). A significant, moderate positive correlation was found between nurses' knowledge of pressure ulcer prevention and their practices (r = 0.353, p < 0.001). ICU nurses demonstrated moderate knowledge and a relatively positive, moderate attitude toward pressure ulcer prevention. However, they also identified several potential obstacles to the effective implementation of preventive practices. ICU nurses experienced very high levels of burnout, particularly in cognitive and emotional domains. The knowledge and attitudes of ICU nurses concerning pressure ulcer prevention emerged as essential factors influencing their clinical practices.
Mental health nursing in inpatient psychiatry is shaped by control and standardisation, yet little is known about how these conditions are sustained in everyday care for persons with anorexia nervosa. This study aimed to explore how nursing staff experience and understand care for persons with anorexia nervosa within general psychiatric inpatient care settings, with particular attention to the conditions shaping what comes to count as legitimate nursing practice. Nine nursing staff with experience caring for persons with anorexia nervosa in general psychiatric inpatient care in Sweden participated in the study. Data were collected in 2025 using semi-structured qualitative interviews and were subjected to qualitative content analysis with a Foucauldian-inspired abductive approach. Findings are presented as two themes, Nursing practice governed by a risk-oriented care logic and Responsibility as a burden and a possibility within nursing practices. Within those themes are five sub-themes, Making sense of AN through risk and stabilisation; Enacting control through routines and treatment plans; Normalising coercion in everyday care; Navigating responsibility under unstable care conditions and Producing alternative care practices through relational work. Findings suggest that discourses of risk and stabilisation organise nursing practice through a risk-oriented care logic that shapes what is recognised as legitimate care and professional competence. Within these conditions, relational and individualised nursing practices become difficult to sustain while responsibility and coercive measures are framed as necessary responses to risk. This study is reported in accordance with the COREQ guidelines.
Clustering longitudinal symptom trajectories is increasingly used to characterise clinical heterogeneity in psychiatric disorders. However, the relative performance of distance-based and model-based approaches remains insufficiently studied in psychiatric settings, where limited follow-up waves, measurement variability, and heterogeneous patient responses may affect clustering reliability. We aimed to systematically compare distance-based and model-based (Latent Class Mixed Models, LCMMs) methods, evaluating their performance in recovering the number of groups, classification accuracy, and clinical interpretability. We analysed longitudinal symptom data from 237 first-episode psychosis patients (PEPs cohort). We also performed simulations (500 replicates per scenario) with known group structures (3 or 4), varying group-size distributions (balanced/unbalanced) and levels of group separation (well-separated, partially overlapping, strongly overlapping). Recovery of the true or optimal number of groups was assessed using multiple validity indices. Classification accuracy was measured by weighted Cohen's [Formula: see text]. Clinical interpretability was evaluated in terms of within-group homogeneity, stability across replications, and minimum group size. In the PEPs cohort, distance-based methods consistently identified two stable and clinically interpretable trajectory groups, whereas LCMMs frequently suggested more complex structures, often including very small classes. Concordance between methodological families was low, indicating that patient stratification was strongly method-dependent: distance-based methods grouped patients primarily by overall symptom severity, whereas LCMMs distinguished groups according to trajectory slope. In simulations, both approaches performed well when groups were clearly separated, but performance declined with increasing overlap and group-size imbalance. Distance-based methods generally produced more stable and homogeneous partitions, whereas LCMMs showed greater variability across replications. In psychiatric longitudinal studies with few assessment waves and moderate sample sizes, distance-based clustering methods may provide a robust strategy for trajectory-based partitioning. Model-based approaches such as LCMMs may offer advantages when complex nonlinear trajectories are expected, but their stability may be limited under noisy or weakly separated conditions. Combining multiple evaluation criteria and considering clinical interpretability are essential for reliable subgroup identification.
People with autism in complex situations often have somatic needs that go unrecognized. An analysis of a prospective one-year activity dataset highlights the essential role of advanced practice mental health nurses: clinical assessments, prevention, care pathway coordination, and team support. The integration of somatic vigilance, understanding of the neurodevelopmental profile, and care organization appears to be critical. A clinical case study illustrates the impact of this role in the early detection of a serious complication and in ensuring continuity of care.
Cancer survivors, defined as those living with or beyond a cancer diagnosis, experience more than double the prevalence of psychopathology when compared to the general population. Categorical diagnostic systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), remain dominant in psycho-oncology despite concerns about reliability, validity, and clinical utility for this population. Dimensional frameworks, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), offer a more precise alternative; however, they have not yet been widely applied in cancer survivors. Accordingly, the objective of this research was to examine the applicability of HiTOP to cancer survivors. Data from 1389 participants in 28 countries (n = 728 cancer survivors; n = 661 community/psychiatric) were collected using the 405-item HiTOP-SR, alongside demographic, clinical, and cancer-specific measures. The HiTOP-SR normative sample (n = 780) was also used. Analyses included parametric, non-parametric, and factor analytic approaches. All HiTOP-SR scales demonstrated strong homogeneity and reliability in cancer survivors. Cancer survivors showed significant elevations across Internalising and Somatoform spectra, with current cancer associated with additional elevations in domains of Thought Disorder and components of Disinhibited and Antagonistic psychopathology. An 11-factor model was developed and supported for both cancer and community/psychiatric samples, though the magnitudes of the factor loadings sometimes varied between samples. External validity was strong with theoretically aligned associations. The HiTOP-SR appears reliable within cancer survivors and provides utility in quantifying a broad array of psychopathology experienced. The results highlight the potential applicability and utility of HiTOP to improve cancer research and clinical practice in psycho-oncology.