Increased rates of clozapine prescribing are essential to improving timely patient access within treatment-resistant schizophrenia (TRS) management. The extent of geographical variation in its use suggests it is possible to develop interventions to increase clinician engagement. To inform intervention development, a contemporary review of barriers and facilitators to increased clozapine prescribing is required. We aimed to conduct a systematic review of research addressing barriers and facilitators to clozapine prescribing among clinicians within TRS management.

The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, CINAHL, and PsycINFO were searched from inception to July 2025. Results were synthesized qualitatively.

Fifteen studies were included. Barriers related to clinicians, patients and carers, and healthcare institutions. Primary clinician-related barriers included insufficient knowledge of, and confidence in, managing clozapine treatment and the associated administrative burden. Primary patient-related barriers included concerns regarding patients' willingness to consistently adhere to clozapine treatment and associated monitoring requirements. A lack of dedicated systems of care to facilitate clozapine initiation and shared community care were the leading institutional barriers. Major facilitators included improved education for clinicians, access to point-of-care testing, and increased availability of dedicated clozapine clinics.

Most barriers to systematically increasing clozapine prescribing rates are beyond the influence of individual prescribers. Instead, structural interventions focusing on (i) reducing the administrative burden associated with establishing clozapine treatment, (ii) increasing access to standardised training and supervision opportunities, and (iii) providing longitudinal support to clinicians when managing clozapine treatment, are required.

En Uruguay, la Ley de Salud Mental N° 19.529 plantea el deber de notificar las internaciones involuntarias, judiciales y voluntarias de más de 45 días por parte de los prestadores de servicios de salud. Las notificaciones deben dirigirse a la Comisión Nacional de Contralor de la Atención en Salud Mental y a la Institución Nacional de Derechos Humanos, iniciando la recepción de las mismas en 2019. El período de ejercicio de la Comisión de Contralor es de tres años, por lo que se tomó ese período para realizar un estudio observacional descriptivo de corte transversal sobre las notificaciones de internación recibidas por la INDDHH. El estudio implicó la sistematización y descripción de diferentes variables contenidas en un formulario elaborado por la Comisión de Contralor para que los prestadores de salud realizaran las notificaciones. Se sistematizaron 194 formularios de los que resulta que las notificaciones se dan en un mayor número por parte de prestadores públicos y se concentran en la capital del país y zonas aledañas, constatándose la inexistencia de notificaciones en gran parte del país. Los contenidos relevados en el formulario permiten constatar que es necesario ampliar la información recogida y la riqueza de la misma para alcanzar un seguimiento efectivo de las internaciones. Además, se evidencia la centralidad en la dirección técnica del establecimiento en el llenado de los formularios, que al vincularla con la preeminencia de las estrategias de intervención y las terapéuticas indicadas muestran la débil presencia e incidencia de los equipos interdisciplinarios.

Introducción: Los pacientes en tratamiento con antipsicóticos enfrentan desafíos, como la variabilidad en la percepción de su enfermedad, que pueden dificultar la aceptación del diagnóstico y la adherencia terapéutica. Este estudio investigó las barreras en la psicoeducación relacionadas con la conciencia de enfermedad. Métodos: Estudio cualitativo que reclutó 10 médicos/as de consultorios externos. Los sujetos convocados aceptaron mediante consentimiento informado, y participaron de entrevistas semiestructuradas, grabadas y transcriptas para su posterior análisis temático, en el período de mayo a noviembre de 2022. Resultados: Se identificaron múltiples barreras en la psicoeducación relacionadas con la conciencia de enfermedad. Por parte del paciente y su entorno: a) oposición explícita a recibir atención médica; b) negación del diagnóstico y la necesidad de tratamiento, expresado con conductas como la modificación de medicación sin supervisión médica. Por parte de los profesionales: c) ocultar información para preservar el vínculo, como evitar el uso de la palabra "antipsicótico", o no informar sobre efectos adversos; d) expectativas inadecuadas para con pacientes con trastornos mentales que rechazan el tratamiento. Conclusiones: Superar las barreras identificadas exige un enfoque centrado en estrategias individualizadas, que consideren la autopercepción de los pacientes y su contexto. Dado que el tratamiento con antipsicóticos está asociado a efectos adversos severos, es esencial fomentar un proceso asistencial que promueva la alianza terapéutica, y empodere a las personas en la gestión de su propia salud. La difusión de información clara y accesible, junto con una adecuada adaptación a las particularidades clínicas es fundamental para alcanzar los objetivos psicoeducativos.

Breast cancer (BC) is a leading cause of mortality among women. Comorbidity with mood disorders is a condition either disregarded or underdiagnosed in BC patients, but that might ultimately jeopardize health trajectories. This is supported by evidence indicating that the same biological pathways relevant for mood disorders may also underlie tumorigenesis. In this study, we aimed at deriving a reliable biosignature of mental health vulnerability in BC patients. We conducted a cross-sectional study in a population of 44 women diagnosed with BC who underwent surgery before receiving adjuvant chemotherapy. All subjects were scored for symptoms of depression, anxiety and stress; blood samples were used to measure relevant biomarkers of inflammation, energy homeostasis and brain plasticity, while circadian cortisol rhythm was assessed in the saliva. Based on a rigorous statistical approach, we identified a specific immune- metabolic biosignature of depression relying upon each subject's BMI, IL-5 and leptin. Following the validation of the model, we defined a cut-off value to identify those subjects who are at elevated risk of poor prognosis based on our biosignature. This signature holds potential for the timely identification of those individuals for whom depressive symptoms are sustained by a deranged immune-metabolic milieu and might therefore be at higher risk of poorer health outcomes. Our results strengthen the importance of accounting for brain-body communication in cancer and suggest that routine screening for mental health in BC patients should be prioritized in order to put in place tailored intervention strategies to improve health outcomes.

Cognitive dysfunction ("brain fog") is a commonly reported post-COVID-19 symptom. Leveraging data from five general population cohorts across four European countries (Estonia, Iceland, Norway, and Sweden), we assessed long-term prevalence of impaired subjective cognitive function among individuals diagnosed with COVID-19 by acute illness severity.

The included cohorts consisted of adult participants recruited from March 2020 and followed with self-report measures of cognitive function and past COVID-19 infection (except one cohort consisting of clinically confirmed COVID-19 cases) through February 2023. In a cross-sectional analysis we contrasted the prevalence of impaired cognitive function among individuals with and without a COVID-19 diagnosis, overall and by illness severity up to 32 months post-diagnosis. We adjusted for age, gender, education, relationship status, binge drinking, body mass index, previous psychiatric diagnosis, number of chronic medical conditions, and response period. In a longitudinal analysis, we assessed potential changes in cognitive function scores before and after COVID-19 diagnosis.

The study population consisted of 153,841 participants (71% women), with 31,359 (20.4%) reporting a positive COVID-19 test. Overall, a COVID-19 diagnosis was not statistically significantly associated with increased prevalence ratio (PR) of impaired cognitive function (PR 1.30 [95% CI: 0.98-1.71]). Individuals bedridden due to COVID-19 for 1-6 days (PR 1.38 [95% CI 0.96-1.99]) or ≥ 7 days (2.59 [1.55-4.33]) had higher prevalence of impaired cognitive function compared to those never diagnosed, while individuals never bedridden had a lower prevalence to those never diagnosed with COVID-19 (0.89 [0.80-1.00]). These findings were corroborated in the longitudinal analysis where a pre- to post diagnosis decline in cognitive function was observed among individuals bedridden due to COVID-19 (p < 0.0001).

The data indicates that a severe COVID-19 acute illness course is associated with impaired cognitive function up to 18-32 months after COVID-19 diagnosis.

The Pearson sample correlation between two biomarkers across a group of individuals can sometimes be much stronger than expected by chance. In the context of psychosis risk, we previously analyzed blood plasma protein data from initial presentations as collected in the North American Prodrome Longitudinal Study 2 (NAPLS2). We found enhanced correlation between proteins SERPINE1 and TIMP1, both promoters of coagulation and inhibitors of remodeling of extracellular matrix (ECM). Participants were unaffected community controls vs. others of clinical high risk. The SERPINE1-TIMP1 correlation was consistently higher in individuals at clinical high risk for psychosis who later converted to a psychotic disorder vs. participants who were nonconverters or unaffected community controls. Here, we extend those findings using data from a larger cohort, the North American Prodrome Longitudinal Study 3 (NAPLS3). Again, the correlation between SERPINE1 and TIMP1 remained higher in psychosis high-risk converters vs. the other groups. In NAPLS3 we added an assay for PLAT (anti-coagulation plasminogen activator strongly inhibited by SERPINE1). Comparing the three NAPLS3 groups we found a decreased correlation between SERPINE1 and PLAT in converters. In summary, the increased correlation of SERPINE1 and TIMP1 in converters is consistent with restricted brain circuit remodeling and increased tendency to coagulation. Rigorous application of permutation testing yielded NAPLS2 vs. NAPLS3 consistency of SERPINE1-TIMP1 correlation patterns with empirical p-value 0.03.