Nonsuicidal self-injury (NSSI) is a severe and prevalent mental health problem. Measures to detect which individuals are at risk of engaging in NSSI would be valuable for clinical practice. However, we still lack strong predictors of future NSSI behaviour, with the most notable exception being prior NSSI behaviour. Yet, the measurement of prior NSSI behaviour with self-report measures can be difficult because individuals may be motivated to conceal this harmful behaviour. To overcome this problem, an implicit measure was developed that assesses automatic responding to statements about prior NSSI behaviour (i.e., the Past Nonsuicidal Self-Injury Implicit Association Test: P-NSSI-IAT). Previous studies tested the predictive utility of this measure in online studies with samples of at-risk participants and produced promising results. The current study examines the predictive utility of the P-NSSI-IAT for NSSI in clinical samples.

Outpatients (N = 68) completed the P-NSSI-IAT and reported on past-year and past-month NSSI, as well as perceived likelihood of future NSSI.

Patients with recent NSSI had significantly higher IAT scores than those without a history of NSSI. The P-NSSI-IAT predicted past-year NSSI but did not significantly predict past-month NSSI or perceived future likelihood of NSSI. It did not add predictive value beyond self-report risk factors in multivariate models.

These findings suggest that the P-NSSI-IAT may help detect prior NSSI in clinical contexts but offers limited added value for the prediction of NSSI beyond existing self-report measures.

Cognitive deficits are prevalent in major depressive disorder (MDD), span multiple cognitive domains, and often persist during remission. However, long-term associations between cognitive functioning and depression remain unclear. This study explores bidirectional associations using 20-year longitudinal data, providing follow-up twice as long as previously reported.

Individuals in remission of recurrent MDD underwent neuropsychological assessments at baseline (n = 137, 21-65 years) and 20-year follow-up (n = 33), covering multiple domains. Psychiatric assessments occurred at eight time points. Cox proportional hazard models and linear mixed-effects models tested bidirectional associations between cognitive functioning and depression. Group-level cognitive change was tested using paired sample t-tests and Bayesian analyses, and individual-level change using reliable change indices (RCI's).

No cognitive domains significantly predicted time-to-depressive-relapse, the number of depressive episodes, or total time depressed over 20 years. Similarly, the number of episodes, total time depressed, and changes in depression severity did not significantly predict cognitive changes. At follow-up, we observed declines in speed of information processing (p < .001, d = -0.73, RCI: 32.1% deteriorated) and speed of memory processing (p = .015, d = -0.49, RCI: 39.3% deteriorated). Learning and memory improved (p < .001, d = 1.19, RCI: 28.6% improved). Working memory and executive functioning remained stable. Findings were not explained by selective drop-out.

We found only minor long-term cognitive change, with no clear worsening or evidence of scarring and state effects. Cognitive functioning remained relatively stable, and we observed no link to depression trajectories over 20 years, providing a more optimistic outlook for depressed patients.

The definition of psychological treatments and psychotherapy has various implications for communication within research and clinical care, as well as for legal issues - particularly in countries with psychotherapy acts. It can define what should be covered by public healthcare systems and who should be permitted to provide these services.

We assembled a group of psychotherapists in Germany to develop an inclusive, scientific definition of psychotherapy. This definition should serve as an umbrella that is not limited to traditional treatment schools and is suitable for science, clinical care and legal acts. The group comprised people with different therapeutic backgrounds (e.g., CBT, psychodynamic and systemic therapy), experts from various disciplines (e.g., psychology, psychiatry and psychosomatic medicine), people focusing on different age groups (e.g., adults and youth), individuals with lived experience of psychotherapy and early career clinicians.

A literature review led us to consider four aspects of a definition. What are the treatment means or 'tools'? (modality of treatment); how does the treatment work? (Proposed change mechanisms, assumptions about causal and evidence-based processes and concepts); who receives psychotherapy? (target group); and who provides psychotherapy? (Provider). Based on these aspects, we offer a definition of psychological therapy.

Our suggested definition is not bound to specific treatment orientations, but is intended to encompass both traditional approaches and innovative developments. Our aim is to promote the evidence-based provision of psychological therapy within healthcare systems and legal frameworks.

The global aging demographic has precipitated a surge in late-life mental disorders (LMDs)-including late-life depression (LLD), anxiety, and behavioral and psychological symptoms of dementia (BPSD)-posing critical public health challenges. This review synthesizes current evidence on the unique pathophysiology, clinical management, and emerging frontiers of geriatric mental health, emphasizing the interplay of neurobiological aging, multimorbidity, and psychosocial stressors. Key pathophysiological mechanisms include "inflammaging" (microglial overactivation), cerebral small vessel disease (CSVD), and senescence of monoaminergic systems, which collectively reduce neural resilience and complicate diagnosis. Clinical challenges-such as atypical symptom presentation (e.g., somatic masking of depression), polypharmacy risks, and diagnostic ambiguity between LLD and pseudodementia-necessitate tailored interventions. Notably, caregiver burden represents an independent predictor of patient institutionalization. Multiple systematic reviews and meta-analyses have consistently identified caregiver burden and distress as significant predictors of nursing home admission, with carer stress sometimes serving as the single determining factor for this transition. This underscores the critical need to integrate caregiver well-being into routine clinical assessment. Pharmacological strategies prioritize SSRIs/SNRIs but require cautious dosing due to age-related pharmacokinetic alterations (e.g., reduced renal clearance) and cardiovascular/metabolic risks. Emerging targets (e.g., ketamine for treatment-resistant LLD, anti-inflammatory agents guided by biomarker profiling) highlight a shift toward precision. Psychotherapeutic adaptations-including modified cognitive behavioral therapy (CBT), problem-solving therapy (PST), and life review therapy-address cognitive and psychosocial needs, while integrated care models (e.g., Collaborative Care Model [CoCM]) demonstrate superior outcomes over fragmented care. Lifestyle interventions (exercise) and neuromodulation (rTMS) further expand treatment options. Critical gaps remain, including underrepresentation of older adults in clinical trials and pervasive polypharmacy. Future directions emphasize pharmacogenomics, AI-driven early detection, and culturally equitable care to advance precision psychiatry for LMDs. This synthesis provides clinicians and researchers with a roadmap to navigate the complexities of geriatric mental health, advocating for multidisciplinary, patient-centered approaches to improve outcomes in aging populations.

Emergency Department (ED) length of stay is a key performance indicator of healthcare services, as prolonged stays are associated with adverse patient outcomes, increased financial burden, and higher mortality. This study aimed to assess ED length of stay and associated factors among patients in public hospitals in Kellam Wollega, Ethiopia, 2025.

An institution-based mixed-methods cross-sectional study was conducted in four public hospitals in the Kellam Wollega Zone, Ethiopia, from April 1-30, 2025. For the quantitative component, 399 adult ED patients were selected using systematic random sampling and interviewed using a structured questionnaire. Clinical and service-related data were supplemented through review of patient charts and ED logs. Descriptive statistics summarized patient characteristics, while multivariable logistic regression identified factors associated with prolonged ED length of stay (p < 0.05). For the qualitative component, 18 healthcare providers were purposively selected for in-depth interviews. Quantitative and qualitative findings were integrated through triangulation to strengthen interpretation.

Some 390 participants completed the questionnaire, yielding a response rate of 97.7%. More than half, 208 (53.3%; 95% CI: 48.2-58.4), experienced prolonged length of stay. Multivariable analysis showed that night-time presentation (AOR = 17.8, p < 0.001), comatose status (AOR = 2.8, p = 0.04), and referral after the ED visit (AOR = 8.0, p = 0.02) were significantly associated with prolonged stays in the ED. Qualitative analysis identified 12 length of stay assessment points, categorized into two themes: patient-related and hospital-related factors.

More than half of the patients experienced a prolonged ED length of stay. Factors significantly associated with prolonged stay included time of presentation, triage category, mental status, post ED visit destination, absence of a laboratory test menu, consultation delays, and lack of inpatient beds.

Obstructive Sleep Apnea Syndrome (OSAS) is a chronic condition that negatively affects not only the patient but also the partner, influencing their sleep quality, psychological well-being, and couple relationship. However, scientific literature has given little attention to the partner's experience, especially regarding the impact of Continuous Positive Airway Pressure (CPAP) treatment on their partners' health. The aim of the present study is to investigate sleep quality, couple relationship quality, and quality of life (QoL) in Italian-speaking partners of patients with OSAS treated with CPAP, compared to partners of healthy individuals.

The study involved 100 participants, with a final sample of 48 partners of OSA patients and 49 partners of healthy subjects as a control group, assessed using the Pittsburgh Sleep Quality Index (PSQI), the Dyadic Adjustment Scale (DAS), and the SF-36 Health Survey. Statistical analysis included independent samples t-tests and Pearson's correlations.

Partners of patients with OSAS reported significantly poorer sleep quality (PSQI), lower levels of dyadic consensus and cohesion (DAS), and reduced perception of physical and mental health (SF-36) compared to the control group. Correlations revealed that sleep quality was negatively associated with relationship quality and perceived health, while years of relationship were positively associated with affection and cohesion, but negatively with sleep quality.

The findings confirm the interconnection between sleep quality and relationship functioning. A clinical approach that includes the partner in OSA treatment pathways may improve the overall well-being of the dyad.

Elevated cerebrospinal fluid (CSF) inflammatory proteins have been reported in Alzheimer's disease (AD), yet whether they reflect peripheral immune cell infiltration or central nervous system (CNS)-intrinsic pathological processes remains unclear. We tested whether AD exhibits a distinct CSF protein signature and how it relates to CSF immune cell composition.

We conducted a cross-sectional study of 64 participants: 22 with biomarker-confirmed AD (bioAD), 22 non-AD biomarker-negative cognitive controls (NAD-CC), and 20 other neurological disease controls (OND). CSF proteins were quantified using the Olink Target 96 Inflammation panel, and immune cell populations were characterized by multiparameter spectral flow cytometry. Cell-protein associations were assessed using hierarchical generalized linear models adjusted for age and sex.

BioAD showed widespread inflammatory and trophic protein elevation versus NAD-CC, with 21 proteins significantly increased (false discovery rate [FDR] q < 0.05), whereas NAD-CC was largely indistinguishable from OND. MMP-10 showed the largest effect (geometric mean ratio [GMR] = 2.10, 95% confidence interval [CI]: 1.53-2.88, p < 0.001). CSF immune cell populations did not differ significantly between groups; only discrete T-cell alterations were detected: reduced regulatory T cells in bioAD relative to NAD-CC (odds ratio [OR] = 0.69, 95% CI: 0.54-0.88, p = 0.023), but not relative to OND and minor memory subset shifts. CD8+ effector memory T cells and TNFSF14 showed the only detected AD-specific association: in bioAD, a 10-fold increase in CD8+ EM2 cells corresponded to 70% higher TNFSF14 (GMR = 1.70, 95% CI: 1.39-2.09, p < 0.0001).

In this feasibility-sized, cross-sectional cohort, CSF inflammatory proteins in AD appeared dissociated from immune-cell composition, potentially reflecting CNS-intrinsic processes and/or altered CSF barrier dynamics. The identified signature, including MMP-10, is hypothesis-generating and may complement conventional biomarkers for diagnosis and treatment monitoring, pending longitudinal validation.

A person's ability to adapt to a given context is a critical determinant of mental health and psychopathology, which has been redefined by network approaches and Ecological Momentary Assessment (EMA). This study examined whether including adaptive processes in EMA enhances the informational value of idiographic network models.

Forty-five university students participated in a multi-week EMA protocol assessing psychological dimensions using bipolar visual analogue scales ranging from maladaptive to adaptive. Participants were randomly assigned to two groups: one assessed only maladaptive processes; the other included both maladaptive and adaptive processes.

Network analyses indicated higher density and connectivity in the adaptive-maladaptive group, as well as significantly reduced floor effects across all variables. Greater response dispersion was associated with more differentiated network structures. Motivation emerged as the most central node across conditions, highlighting its relevance as a transdiagnostic treatment target. Cognitive processing showed strong associations with other variables, underlining its clinical importance.

The findings suggest that incorporating adaptive dimensions into EMA facilitates a more comprehensive understanding of psychological functioning and improves the interpretability of idiographic models. The study represents an initial feasibility investigation and a basis for further investigations in clinical practice.

Sleep disturbance and cognitive impairment are common in depression. Trazodone is often used for sleep problems and may improve cognition by modifying sleep architecture. However, its effects on specific polysomnography-derived sleep stages remain unclear. This systematic review and exploratory meta-analysis aimed to investigate trazodone's effects on sleep architecture in patients with depression and sleep disorders.

Seven databases were searched for interventional studies published up to October 2025. Random-effects models were applied to estimate pooled mean differences (MDs) and risk ratios (RRs), as appropriate.

Eight studies involving 980 patients were included: five randomized controlled trials and three single-arm studies. Compared with baseline, trazodone was associated with increased total sleep time and sleep efficiency, and with reduced sleep latency. Regarding sleep architecture, trazodone was linked to reduced non-rapid eye movement sleep stage 2 (N2) proportion (MD = -9.09, 95% CI -16.60 to -1.59, P = 0.017) and increased slow wave sleep (SWS) proportion (MD = 8.05, 95% CI 3.42 to 12.68, P = 0.001). No significant effects were observed for wake after sleep onset, NREM stage 1 percentage, rapid eye movement sleep percentage (REM), and REM sleep latency. Secondary outcomes suggested reduced HAMD-17 scores and higher response rates versus placebo, but more adverse events, especially somnolence and dizziness, with trazodone.

Trazodone may improve objective sleep continuity and may be associated with changes in sleep architecture, including increased SWS and reduced N2 sleep, in patients with depression, without significantly altering REM sleep. These potential benefits should be weighed against increased adverse events.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251173354.