This study aimed to define the clinical and electrodiagnostic characteristics of COVID-19-associated Guillain-Barré syndrome (C + GBS) diagnosed during a multicenter GBS study performed in Istanbul.

From the patients with GBS who were prospectively included in the multicenter study conducted from April 2019 to March 2022, two groups were extracted: (1) pre-pandemic patients (PP, April 2019-February 2020); and (2) C + GBS, consisting of patients with a positive COVID-19 polymerase chain reaction test within 4-6 weeks before the onset of symptoms. Clinical features and electrodiagnostic data acquired twice in the first 21 days of GBS and between the 4th and 6th weeks of the illness were compared between the groups.

There were 22 patients in the C + GBS and 69 in the PP groups. Patients with C + GBS were older than those in the PP group (58.9 ± 15.4 vs. 49.8 ± 17.5, p = 0.047). Motor signs/symptoms were more prevalent in the C + GBS group than in the PP group. In the C + GBS group, demyelinating subtype was significantly more frequent (82% vs. 52%, p = 0.031), and CSF cell count was lower (0.8 ± 1.8 vs. 5.7 ± 11.7 cells/all, p = 0.007) compared with the PP group. The clinical severity scores, treatment strategies and the time from the symptom onset to the nadir did not differ between the groups. None of the C + GBS patients, except one, had anti-ganglioside antibodies. The only significant parameter was the demyelinating subtype in the multivariate analysis.

Patients with C + GBS seemed to show a predominantly demyelinating subtype with no discernible differences in clinical features.

The President's Cabinet and panel of Past Presidents of the International Society of Physical and Rehabilitation Medicine (ISPRM) convened a strategy session following the World Congress 2026 in Vancouver, Canada. Participants examined challenges and future strategic directions across the four ISPRM pillars: Advocacy, Communication, Education and Research, and Operations and Fiscal Health, using participatory Problem and Objective Tree Analysis methodology. This article provides an analysis of the strategy session and highlights the future trajectory of ISPRM and its role within the broader rehabilitation landscape. Participants identified a common strategic priority: strengthening regional and national society capacity whilst maintaining a coherent global framework, across all four pillars. For 'Advocacy', the emphasis was on demonstration of economic and societal value of rehabilitation; 'Communication' emphasized multilingual engagement and stronger relationship with regional and national societies; 'Education and Research' highlight the need for globally accessible evidence-generation and knowledge-sharing platforms; and 'Operations and Fiscal health' concentrated on creating sustainable governance and finance mechanisms. The discussion aligns closely with contemporary global rehabilitation initiatives, including World Health Organization (WHO) Rehabilitation 2030, the World Health Assembly resolution (WHA76.6) on 'Strengthening Rehabilitation in Health Systems', and the World Rehabilitation Alliance (WRA). The strategy session represents an important transition from aspirational goals toward measurable organizational transformation and provides a roadmap for positioning ISPRM as a leading global advocate, knowledge-broker, and catalyst for rehabilitation medicine development worldwide. Successful implementation of the strategies will depend on leadership accountability, prioritization of foundational activities, sustainable finance, and meaningful regional and national empowerment.

Psychosis is a significant cause of reduced social and occupational function in those aged 18-35 years. This study investigates the feasibility of enhancing currently available Early Intervention for Psychosis (EIP) care using a moderated online intervention comprising therapist-supported online therapeutic interventions and peer-to-peer social mentoring and networking.

Study design: The Moderated Online Social Therapy (MOST) trial is a feasibility study for a randomised controlled study. Participants & Setting: Patients attending early intervention for psychosis (EIP) services in Ireland. Analysis: The trial explores data relevant to establishing the feasibility of delivering MOST to patients enrolled in EIP services and estimation of effect sizes for pre-post measures administered to inform power calculations for a full trial.

A total of 35 patients with early psychosis were recruited during the study period, with 17 (48.6%) retained in the study at 6 months. In the intervention arm, 65.4% of participants engaged with MOST for 5 weeks or more but only 15.4% continued to engage at six months. At six months, calculation of effect sizes for pre-post changes indicated small to moderate improvements in social and occupational function, small changes in clinical symptom severity and no changes in cognitive performance.

Findings partially supported the feasibility of conducting a trial of MOST in Irish EIP services. Recruitment and study procedures were successfully completed, while retention and sustained engagement suggested that intervention duration, delivery, and positioning within the care pathway may require consideration for further study of this promising intervention in the Irish context.

We evaluated the frequency and patterns of comorbidity and multimorbidity in adolescents with congenital heart disease (CHD) using data from a multisite population-based surveillance project.

Adolescents aged 11 to 18 years with at least 1 CHD-related diagnosis code and residing in one of 5 geographic areas in the US were identified using linked clinical and administrative data sources for the years 2011 to 2013. Sites linked data on all inpatient, emergency department, and outpatient visits. Multivariate Poisson regression with robust error estimates was used to assess the association of comorbidity with age, sex, insurance type, race, ethnicity, and CHD severity.

The study included 9626 adolescents. Of these, 26% had severe CHDs. Overall, 68% had at least one comorbidity during the study period, and 46% had multiple comorbidities. Noncardiac comorbidities (55%) were more frequent than cardiac comorbidities (40%). Major noncardiac comorbidities included mental health conditions, neurodevelopmental disorders, pulmonary obstructive disease, nutrition-related (overweight, obesity) conditions, and endocrine conditions. Cardiac comorbidities included arrhythmias and residual cardiac disease. Variations by age and sex were minimal, but a higher burden of comorbidity and multimorbidity was associated with CHD severity, multiracial background, and public insurance.

Comorbidities, both cardiac and noncardiac, are prevalent in adolescents with CHD, underscoring the need for targeted care strategies in this age group and effective transition programs from pediatric to adult CHD care.

Major depressive disorder (MDD) is a common psychiatric illness that is primarily treated with antidepressant medications in clinical practice. Depression that responds poorly to antidepressant therapy is referred to as treatment-resistant depression (TRD). However, the definition and pathogenesis of TRD are unclear, which may contribute to delayed diagnosis and management for some patients, ultimately affecting their prognosis. Although antidepressant drug therapy remains the first-line treatment for MDD, a growing body of evidence suggests that physical therapies may offer advantages over pharmacological treatments in improving depressive symptoms in selected patients. This review summarizes and comparatively analyzes recommendations from major international guidelines, including CANMAT, RANZCP, WFSBP, APA, and NICE, regarding the definition of TRD and physical treatment strategies. Widely used physical therapies for TRD are evaluated with respect to efficacy, safety and tolerability, clinical positioning, target populations, and regulatory status. Current evidence supports ECT and rTMS as the principal established treatment options for TRD. VNS may be considered for highly refractory TRD characterized by chronicity, recurrent episodes, and failure of multiple treatments, although it is generally positioned as a later-line intervention. Acupuncture and Neurofeedback may serve as adjunctive interventions with limited supporting evidence. Emerging techniques, including tACS, DBS, MST, EpCS, and FUS, lack sufficient high-quality evidence and standardized treatment protocols and should currently be conducted primarily in specialized centers or research settings. In addition, this review also highlights novel physical approaches and combination strategies with potential therapeutic value for TRD, provides scientific evidence and treatment references for clinical practice.

Mefloquine is an effective antimalarial drug widely used for malaria treatment and chemoprophylaxis. However, its use has been associated with a range of neuropsychiatric adverse effects, ranging from mild sleep disturbances to severe psychiatric reactions. The aim of this study is to systematically review the available evidence on neuropsychiatric adverse effects associated with mefloquine use and to characterize their clinical spectrum, time to onset, and reported outcomes. A systematic literature search was conducted to identify studies reporting neuropsychiatric adverse effects associated with mefloquine. Studies meeting the predefined eligibility criteria were included, and relevant clinical and adverse effect data were extracted. The methodological quality of included studies was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Of 207 records identified, 25 studies were included after removing duplicates and applying the eligibility criteria. These comprised 17 case reports and 8 clinical studies. The case reports described 19 patients aged 7-63 years with a wide range of neuropsychiatric manifestations. Frequently reported adverse effects included hallucinations, depression, anxiety, and insomnia, while psychosis, confusion, and mania were also reported. Other manifestations included paranoia, delusions, restlessness, nightmares, depersonalization/derealization, suicidal ideation, and delirium. The time to onset ranged from a few hours to several months after exposure. Clinical studies demonstrated variable frequencies of neuropsychiatric adverse effects across different populations and study designs. Mefloquine is associated with a broad spectrum of neuropsychiatric adverse effects, ranging from mild symptoms such as anxiety and insomnia to severe psychiatric manifestations. Early recognition and careful patient selection are important when prescribing mefloquine.

Adolescent suicide is a global public health concern. Emerging evidence from the gut-brain axis and interoception framework suggests links between functional gastrointestinal disorders, visceral bodily signals, and mental health vulnerability. However, evidence on the association between irritable bowel syndrome (IBS) and adolescent suicidality remains scant. This study aimed to examine the longitudinal associations of IBS with suicide risk and attempts among Chinese adolescents.

Data were drawn from a school-based prospective cohort study with citywide census-style recruitment in Southern China. IBS, demographic, behavioural, and emotional symptom measures were assessed, along with two suicidality outcomes: overall suicide risk and past-12-month suicide attempts as a behavioural indicator. Mixed-effects multivariable logistic regression was used to examine the associations between baseline IBS and follow-up suicidality. Subgroup analyses (sex, age group, residential area, only-child status, and subjective SES) tested the robustness of these associations. Alternative indirect pathways linking IBS, depressive and anxiety symptoms, and suicidality outcomes were examined.

The analytic sample comprised 92,120 adolescents with matched baseline and 12-month follow-up data (46,852 [50.9%] females, M = 13.27 years, SD = 1.99). IBS prevalence was 7.0% (n = 6435). Suicide risk and suicide attempts had incidence rates of 6.1% (n = 4454) and 3.5% (n = 3035), respectively. IBS was prospectively associated with increased suicide risk (OR [95% CI] = 2.33 [2.18, 2.49], p < 0.0001) and attempts (OR [95% CI] = 2.17 [1.93, 2.44], p < 0.0001). These associations remained significant after adjustment for demographic, behavioural, emotional symptom, and baseline suicidality covariates (suicide risk: aOR [95% CI] = 1.27 [1.18, 1.37], p < 0.0001; suicide attempts: aOR [95% CI] = 1.21 [1.06, 1.38], p = 0.0060). Depressive and anxiety symptoms partially mediated these associations.

IBS was prospectively associated with adolescents' elevated risk of suicidality. IBS may serve as a meaningful marker of suicide risk, potentially reflecting altered gut-brain and interoceptive processes, and underscoring the need to integrate mental health screening with gastrointestinal care for early suicide identification and prevention.

Research fund of Vanke School of Public Health, Tsinghua University.

Artificial intelligence (AI) is rapidly transforming healthcare delivery, research, and medical education. Within psychiatry, advances in machine learning, natural language processing, large language models (LLMs), and AI-enabled simulation are reshaping clinical practice and trainee education. Educational and clinical applications include personalized learning, virtual patient encounters, clinical decision support, longitudinal electronic health record (EHR) synthesis, automated feedback, and documentation assistance. These tools may strengthen diagnostic reasoning, psychopharmacology education, psychotherapy training, and administrative efficiency while allowing more time for patient-facing care. However, algorithmic bias, misinformation, privacy, academic integrity, cost, and overreliance may undermine independent clinical judgment. These risks are especially important for novice learners and in child and adolescent assessment, where chronological age does not capture cognitive development, cultural context, or nonverbal and affective cues. Empirical outcome data evaluating formal AI curriculum implementation in psychiatry residency and fellowship programs remain limited, with few studies assessing effects on trainee competence, clinical reasoning, error recognition, patient safety, or sustained clinical performance. This narrative review examines current applications, limitations, and ethical considerations and proposes a staged, competency-based curriculum in which trainees establish core interviewing, observation, and diagnostic skills before progressing to supervised clinical AI use. AI should augment, rather than replace, human interpretation, therapeutic relationships, and professional accountability. Accordingly, this review is primarily directed toward graduate medical education leaders, psychiatry residency and fellowship program directors, and clinical educators who are responsible for the development, implementation, and oversight of competency-based AI curricula within psychiatric training programs.

Acute poisoning is a major public health challenge and a frequent cause of emergency department (ED) admission in Tunisia and North Africa. This study aimed to describe the epidemiological, clinical, and therapeutic characteristics of acute poisoning cases and to identify factors associated with mortality.

A retrospective, single-center study was conducted at the ED of Taher Sfar University Hospital, Mahdia, from January 2022 to January 2024. All patients aged ≥12 years admitted for acute poisoning were included. Variables reflecting in-hospital interventions were excluded from the multivariate model to avoid reverse causality; only variables available at ED presentation were considered as candidate predictors. Multivariate logistic regression identified factors associated with in-hospital mortality.

Among 7645 ED admissions, 234 cases (3.06%) were for acute poisoning. The mean age was 30 years, with a female predominance (67.5%). Intentional poisoning accounted for 86.3% of cases. Pharmaceuticals (51.7%) and pesticides (30.3%) were the most common agents. The overall mortality rate was 12.8%, highest with aluminium phosphide (68.4%). Multivariate analysis identified three independent predictors of mortality, all available at ED presentation: altered mental status (GCS ≤ 8) (aOR=8.9, 95% CI 3.2-24.7), tachypnea (aOR=9.4, 95% CI 3.2-27.6), and poisoning by aluminium phosphide (aOR=10.2, 95% CI 3.5-29.7).

Acute poisoning in this cohort predominantly involves intentional self-harm by young women, with high mortality linked to specific toxic agents and early clinical severity markers. These findings highlight the need for enhanced mental health services, stricter regulation of highly toxic pesticides, and optimized emergency care protocols in similar settings.

This study examined the feasibility and preliminary clinical indications of an imagery rescripting intervention integrating the Pathological Affective Dependence framework (ImRs-PAD) in survivors of Intimate Partner Violence (IPV). Pathological Affective Dependence (PAD) refers to a trauma-related relational vulnerability associated with difficulties in disengaging from abusive intimate relationships.

A multiple case series design was used with three female IPV survivors referred by a mental health center in Italy (mean age = 31.3 years, SD = 2.08). All participants reported histories of abusive relationships, marked difficulties with separation, and clinically significant levels of PAD. Participants received an online ImRs-PAD intervention. Repeated self-report measures assessed changes in PAD, trauma-related symptoms, depression, anxiety, somatic symptoms, resilience, self-compassion, and psychological well-being.

Across cases, reductions were observed in PAD, depressive and anxiety symptoms, and trauma-related and somatic complaints, alongside increases in resilience, self-compassion, and overall psychological well-being. The online delivery of the intervention was feasible, with no technical or safety issues reported.

The findings provide preliminary support for the potential clinical relevance of ImRs-PAD for IPV survivors. Addressing PAD may facilitate disengagement from violent partners and reduce the risk of re-exposure to severe forms of violence.