Neurological disorders are a leading cause of disability, morbidity, and mortality globally, imposing a substantial and growing economic burden. In Europe, several factors including demographic aging and improved diagnostics have increased the prevalence of these conditions. Despite their significant societal impact, comprehensive and comparable estimates of the economic burden of neurological disorders across Europe remain limited. Existing studies are mostly outdated, disease-specific, or geographically narrow. The Cost Of Illness in Neurology in EUrope (COIN-Eu) study addresses this gap by developing a standardized framework to assess the disease- and country-specific economic burden of major neurological disorders across all 47 member countries of the European Academy of Neurology (EAN).

This burden-of-disease study employs a prevalence-based approach to estimate three key economic measures per disorder and country: (1) annual per-patient costs by cost type, (2) total annual costs on a national level, and (3) relative total costs as a percentage of GDP. The study includes twelve major neurological disorder groups affecting adults (≥ 20 years). Epidemiological data are primarily sourced from the Global Burden of Disease Study 2021, supplemented by systematic literature reviews where necessary. Cost data are extracted from systematic reviews of peer-reviewed publications and converted to 2019 Euros using standardized procedures. Data gaps are addressed through structured imputations based on income group stratification. Final estimates are validated by an expert panel from the EAN.

The framework enables the generation of harmonized cost estimates across countries and disorders, accounting for direct and informal care costs and indirect costs. Expert review ensured plausibility and consistency of the results.

The COIN-Eu study framework provides a comprehensive and transparent methodology to estimate the economic burden of neurological disorders in Europe. It facilitates evidence-based health policy planning, highlights data gaps, and supports future cross-national burden-of-disease assessments in neurology and beyond.

Background: Early identification of posttraumatic symptoms in children and adolescents is essential for timely intervention. The Child and Adolescent Trauma Screen-2 (CATS-2) is a brief, freely accessible instrument that simultaneously assesses DSM-5 PTSD, ICD-11 PTSD, and ICD-11 complex PTSD (CPTSD) symptoms across child and caregiver report forms. Cross-cultural validation of the CATS-2 in underrepresented settings remains limited. This study examined the psychometric properties of the Turkish CATS-2 in a clinical sample.Method: Participants were 196 children and adolescents referred to a child and adolescent psychiatry outpatient clinic. ICD-11 PTSD and CPTSD diagnoses were established through clinician-administered assessments. Internal consistency, test-retest reliability, convergent and discriminant validity, child-caregiver agreement, confirmatory factor analysis (CFA), known-groups validity, and diagnostic accuracy were examined.Results: The CATS-2C showed good to excellent internal consistency (α=.81-.94) and test-retest reliability (ICC = .86-.90). CFA supported a two-factor correlated model of ICD-11 PTSD and disturbances in self-organization (DSO), and the DSM-5 four-factor model, for both forms. The CATS-2C showed strong convergent validity (r = .79-.89) and negligible associations with externalizing symptoms (r = .08-.12, ns). Known-groups validity was excellent for the CATS-2C (η² = .48-.58) but limited for the CATS-2P (η² = .076-.119). Diagnostic accuracy was good to excellent for the CATS-2C (AUC = .868-.947) and poor to acceptable for the CATS-2P (AUC = .606-.735), all subscales significant. Optimal CATS-2C cut-offs against clinician ICD-11 diagnoses were ≥7 for ICD-11 PTSD (sensitivity = 84%, specificity = 78%), ≥17 for ICD-11 CPTSD (93%, 85%), and ≥30 for DSM-5 PTSD (85%, 89%). Child-caregiver agreement was poor (ICC = .259-.344).Conclusions: The Turkish CATS-2C demonstrated sound psychometric properties, supporting its use as a reliable screening tool in child and adolescent mental health settings. The CATS-2P showed acceptable structural validity and internal consistency but more limited diagnostic discrimination, underscoring the importance of directly assessing symptoms from the child. These findings contribute preliminary evidence regarding ICD-11 PTSD and CPTSD constructs in an underrepresented, middle-income clinical setting.Trial registration: ClinicalTrials.gov identifier: NCT06975852.

Sleep-related and chronotype traits have been shown to impact health in observational studies. To identify whether these associations are potentially causal, we conducted phenome-wide Mendelian randomisation analyses of short sleep, insomnia symptoms, total sleep duration, long sleep, snoring, daytime sleepiness and morning chronotype with a broad range of health-related phenotypes. We assessed the association between the genetic predisposition to these traits and the occurrence of 702 health-related phenotypes, using summary statistics of the largest genome-wide association studies in European individuals. Results that were significant (multiple comparisons: False Discovery Rate) and valid (robust genetic instruments, unaffected by horizontal pleiotropy) were validated using data from the second largest European genome-wide association study. Genetically determined short sleep was associated with increased risks of attention-deficit/hyperactivity disorder and neuroticism, musculoskeletal conditions, asthma and gastroesophageal reflux and lower educational attainment. Genetically determined insomnia symptoms showed associations with increased risk of coronary artery disease, major depression and osteoarticular disease. Genetically determined long sleep was linked to higher risk of iron deficiency anaemia and lower bone mineral density. Genetic predisposition to snoring was associated with more falls, greater body mass and higher low-grade inflammation. Genetically determined morning chronotype was related to higher vitamin D levels and lower risk of irritable bowel syndrome. No associations were found for daytime sleepiness. Overall, these findings indicate that genetically determined short sleep duration and insomnia symptoms are associated with mental and neurological problems, cardiovascular disease and musculoskeletal disorders, suggesting a potentially preventive, causal role of healthy sleeping patterns on chronic disease.

Family caregivers play critical roles in supporting the home-based recovery of patients with schizophrenia, but they often encounter substantial challenges and receive insufficient systemic support. Understanding caregivers' involvement in home-based recovery is essential for aligning community mental health services with families' capacities and needs. This study aimed to explore family caregivers' involvement and adaptive processes in supporting home-based recovery of patients with schizophrenia in China.

A qualitative study using interpretative phenomenological analysis was conducted through semi-structured interviews. Family caregivers were purposively recruited from four community health service centers (CHSCs) across urban and rural areas of Beijing. All interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed iteratively to identify themes and subthemes.

A total of 20 family caregivers were recruited, including 11 from two urban districts and 9 from a rural district in Beijing. Five themes were identified: Caregivers' redefinition of recovery as stability rather than cure; Routine recovery involvement in medication management and symptom monitoring; Experienced tensions between the patient's independence and relapse prevention; Bearing family obligation and personal strain in sustained caregiving involvement; and Uncertainty in sustaining caregiving and the patients' future stability. Caregivers reported persistent challenges in supporting patients' independent living, participation in family activities, communication, and social interaction.

Family caregivers gradually develop their capacity to support home-based recovery, but continue to encounter complex challenges while receiving limited support from CHSCs. Strengthening recovery-oriented family support within community mental health services, particularly through accessible psychoeducation and rehabilitation guidance, may enhance caregivers' capacity to support patients' independence and social participation, thereby promoting sustainable home-based care and long-term functional recovery.

Current psychiatric models, while clinically valuable, remain limited in their ability to account for the complexity, variability, and context dependence of mental disorders. Converging evidence from neuroscience, complexity science, and psychedelic research suggests that psychiatric symptoms may be better understood as stable patterns of organization within dynamic, multilevel systems rather than as outputs of isolated biological dysfunction. This paper proposes a systems-based framework in which therapeutic change is conceptualized as a phased process of perturbation, reorganization, and consolidation. Within this model, interventions act by modulating system stability and plasticity, with outcomes determined by interactions among biological, psychological, relational, and environmental factors over time. Psychedelic-assisted therapies provide a particularly revealing case, as they reliably induce transient destabilization of entrenched patterns, increasing flexibility and enabling reorganization under supportive conditions. This formulation suggests a generalizable mechanism of healing across modalities: the strategic destabilization of rigid system states followed by the consolidation of more adaptive configurations. Accordingly, recovery is reframed not as symptom reduction alone, but as increased coherence, flexibility, and adaptive capacity across domains of functioning. This perspective has implications for assessment, ethics, clinical implementation, and research design, including the need for longitudinal, context-sensitive outcome measures and hybrid methodologies. A systems-based psychiatry does not replace mechanistic models but reorganizes them within a framework that accommodates emergence, temporal dynamics, and context, offering a foundation for more integrative and preventive approaches to mental health care.

Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful ulcerative skin lesions and a lack of definitive diagnostic tests. It is frequently mistaken for infectious conditions, often resulting in inappropriate antibiotic use and delayed immunosuppressive therapy. To describe the clinical and demographic characteristics of patients with pyoderma gangrenosum initially assessed in an infectious diseases setting and identify patterns that may aid in earlier diagnosis and management. A retrospective case series was conducted at a Cellulitis Clinic. Patients with a PARACELSUS score ⩾10 were included. Ten patients met inclusion criteria. Median age was 61.5 years; 60% were female and 90% Caucasian. Autoimmune diseases were present in 90%, mental health disorders in 50%, and endocrine abnormalities in 60%. Notably, 20% developed pyoderma gangrenosum at sites of healed scars-a rare presentation. Early recognition and multidisciplinary management are essential for timely treatment and improved outcomes.

[This corrects the article DOI: 10.3389/fpubh.2026.1833997.].

Ultra-processed food (UPF) exposure has increased markedly worldwide and is now a major contributor to total energy intake in many countries. Evidence from large prospective cohort studies suggests that higher UPF exposure is associated with adverse health outcomes, including overweight and obesity, type 2 diabetes, cardiovascular disease, selected cancers, depression, and increased all-cause mortality. Short-term experimental studies further indicate that diets rich in UPFs can promote excess energy intake and weight gain, supporting biological plausibility. Several mechanisms have been proposed, including poor nutrient quality, high glycemic load, altered food structure and satiety signaling, exposure to additives and contaminants, gut microbiome perturbations, and displacement of minimally processed foods. Nevertheless, the field remains debated. Major controversies concern the Nova classification system, substantial heterogeneity within the UPF category, challenges in reproducible classification, and the extent to which observed associations reflect processing itself rather than nutrient profile, dietary patterns, or broader food environments. These issues hinder causal inference and sustain ongoing debate over whether UPFs act as independent etiological factors or function as markers of unhealthy diets. Policy responses vary internationally, ranging from explicit inclusion of UPFs in dietary guidelines to predominantly nutrient-based or hybrid frameworks. This narrative review summarizes current evidence linking UPF exposure to health outcomes, critically examines methodological and conceptual limitations, and discusses implications for future research and public health policy. See also the graphical abstract(Fig. 1).

Migration is a well-established risk factor for psychosis, yet limited research has examined long-term clinical trajectories following first-episode psychosis (FEP) in migrant populations within Southern European settings. This study investigates how country of origin and time since migration influence psychiatric outcomes in a naturalistic FEP cohort.

A 5-year longitudinal study was conducted on 184 patients with FEP attending the Early Intervention Service from Hospital Universitari de Mataró. Patients were grouped by geographic origin (Spanish, Latin American, Maghrebi, Sub-Saharan) and migration recency (≤5 years vs. >5 years). Primary outcomes included treatment adherence, use of long-acting injectable (LAI) antipsychotics, relapse, and service disengagement. Logistic regression and survival analyses were used to identify associations.

Maghrebi origin was associated with lower treatment adherence (OR = 0.32, 95% CI [0.12-0.89], p = 0.030). In time-to-event analyses, Maghrebi patients showed a higher hazard of service disengagement compared with Spanish-born patients (HR = 2.42, 95% CI [1.10-5.34], p = 0. 028). Recent migrants (≤5 years in Spain) also had a significantly increased hazard of disengagement (HR = 2.89, 95% CI [1.30-6.40], p = 0.009). Sub-Saharan origin was strongly associated with earlier initiation of long-acting injectable antipsychotics (HR = 3.40, 95% CI [1.58-7.32], p = 0.002), alongside higher overall odds of LAI use. No significant differences were observed in relapse rates across groups.

Both migrant origin and recent arrival were associated with differences in psychiatric care trajectories following FEP. These findings highlight the need to consider adaptation of treatment approaches for migrant populations according to their origin and migration context in order to improve long-term outcomes.

The use of generative artificial intelligence (AI) based chatbots in mental health interventions is rapidly evolving, but evidence of their efficacy and safety is scarce. This randomized pilot trial investigated the feasibility, efficacy, mechanisms, and unwanted effects of a generative AI chatbot (ChatGPT-4) vs. human conversational agent as a cognitive behavioral micro-intervention for procrastination.

62 university students (M_age 23.60 years, 93.5% female) were analyzed and assigned (concealed) to a three-session chat-based intervention with either the chatbot or human conversional agent. Outcomes were assessed using questionnaires at baseline, post-intervention, and 6-month follow-up. The primary outcome was self-reported procrastination. Secondary outcomes included depression, anxiety, worry, and rumination. Additionally, unwanted negative effects and common factors of therapeutic change were assessed.

Intention-to-treat analyses revealed a non-significant group × time interaction effect (p = .117, η² _p = 0.05). Unwanted negative effects at post-assessment were reported by 43.1% of participants, with no significant group difference. Common factors were rated similarly across groups and did not mediate change in procrastination.

Our findings do not indicate superiority of either conversational agent and both interventions had comparable, rather high rates of unwanted effects, indicating that more research in larger, clinically meaningful samples is needed to confirm the efficacy and safety of AI-based (micro-)interventions.