Cognitive reappraisal (CR) is one of the most widely studied emotion regulation strategies and is considered central to psychological well-being. Given its protective role in mental health, a growing body of research has examined factors that influence the effectiveness of CR. However, prior studies have been conducted in controlled settings, typically relying on standardized, laboratory-induced stressors, which may limit ecological validity of the findings. The present study aimed to address this gap by investigating CR in the context of real-world stressors. We recruited 100 young adults who used a mobile application, ReApp, to record their daily stressors and practice CR three times per day, over a three-week period. Our findings suggest that the effectiveness of CR is highly context-dependent, and certain aspects may be more relevant and contributing to CR effectiveness than the other. Specifically, higher positive affect and greater stressor severity were associated with more effective CR. By contrast, higher negative affect and lower reappraisal affordance predicted reduced CR effectiveness. We provide the first evidence that CR effectiveness varies across stressor domains, suggesting it may be better suited to some types of real-world stressors (i.e., health-related stressors) than others (i.e., lack of resources). In contrast, neither subjective stress nor the time spent on generating reappraisals influenced CR effectiveness. Being one of the first outside-laboratory study examining contextual factors contributing to CR effectiveness, these results carry clinical implications, suggesting that CR trainings may be optimized by adjusting practice to specific contextual factors, and warrant the need for further research.

The aim of this study was to identify the optimal stimulation sites for subthalamic nucleus (STN) deep brain stimulation (DBS) in treating Meige syndrome using long-term follow-up data from a large sample cohort, evaluate the whole-brain functional connectivity patterns associated with favorable treatment responses, and validate these findings in an independent cohort.

The authors retrospectively analyzed long-term outcomes in 65 patients with Meige syndrome who underwent bilateral STN-DBS in two centers. The local stimulation effects within the STN and the distributed functional connectivity associated with motor improvement were investigated using advanced imaging and modeling tools, including the Lead-Group Toolbox, DBS Sweet Spot Mapping Explorers, and DBS Network Mapping Explorers. To ensure the model's reliability and generalizability, both internal validation through multiple cross-validation strategies and external validation using independent cohorts were conducted.

STN-DBS yielded significant and sustained motor improvements in both cohorts, with mean Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score reductions of 63% in the training cohort (n = 50) and 56% in the validation cohort (n = 15) (p < 0.001). At the local level, the optimal stimulation sites were consistently located in the dorsolateral sensorimotor subregion of the STN, extending bilaterally toward the associative subregion and centered at MNI coordinates x = ±12, y = -13, z = -6. At the network level, favorable outcomes were primarily associated with positive functional connectivity to the cerebellum and negative connectivity to the somatosensory cortex. Both the sweet spot and connectivity models developed using the training cohort showed significant correlations with clinical outcomes in the independent validation cohort (R = 0.59, p = 0.020; R = 0.74, p = 0.002, respectively) and remained robust across different cross-validation strategies.

The optimal therapeutic efficacy of STN-DBS for Meige syndrome depends on precise targeting within the dorsolateral STN and modulation of a distributed functional network involving the cerebellum and sensorimotor cortex. These findings may aid in developing personalized targeting strategies and adaptive programming paradigms, ultimately improving the therapeutic efficacy of DBS in this challenging disorder.

Trigeminal neuralgia is a debilitating facial pain condition. Managing trigeminal neuralgia in patients with co-existing conditions like idiopathic thrombocytopenic purpura, which increases bleeding risk, presents a significant clinical challenge, especially when considering interventional procedures.

We present the case of a 54-year-old woman with refractory right-sided trigeminal neuralgia and idiopathic thrombocytopenic purpura. Due to her idiopathic thrombocytopenic purpura and a new acute cerebrovascular accident, she was not a candidate for microvascular decompression. Initial gamma knife treatment provided only transient relief. Because of her bleeding risk, less invasive peripheral trigeminal branch blocks were performed, followed by cryoneurolysis of the infraorbital and mental nerves, which provided significant and sustained pain relief for 11 months.

This case highlights that for patients with trigeminal neuralgia who have a high bleeding risk due to conditions like idiopathic thrombocytopenic purpura, peripheral trigeminal branch blocks under ultrasound guidance, followed by cryoneurolysis, can be a safe and effective alternative to more invasive procedures, offering long-lasting pain relief.

Importance: At present, the diagnoses of many psychiatric and neurological disorders are based on clinical symptoms and behaviors, neglecting the laboratory test indicators. This narrative review assessed the existing published literature on the role of microRNAs (miRNAs) in psychiatric and neurological disorders. Observations: The miRNAs are involved in numerous biological processes, and their dysregulation can lead to neuropsychiatric disorders. They also play a prominent role in neurotransmitter signaling pathways, and their impairment can lead to psychiatric disorders. The miRNAs act as key regulators of neuronal functions such as neuroplasticity, differentiation, and protection of neurons and also play a role in establishing memory and cognition. Neurodegenerative processes therefore involve miRNAs as potential targets for treatment and early detection. The functional regulation of miRNAs of several genes has made miRNAs potent targets for therapeutic development. Conclusions and Relevance: miRNAs have the potential to be used as biomarkers for diagnosis and treatment response in psychiatric and neurological disorders. Prim Care Companion CNS Disord 2026;28(2):25nr04069. Author affiliations are listed at the end of this article.

Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neurological emergency triggered by an adverse reaction to dopamine receptor antagonists, particularly antipsychotics. Its clinical significance lies in both its high mortality risk and the diagnostic and therapeutic challenges NMS presents. Integrated Behavioral Health (IBH) models emphasize collaborative, interdisciplinary care that unites medical and mental health providers to address the full spectrum of patient needs. Nurse practitioners (NPs), with their holistic and patient-centered framework, are uniquely positioned to lead and contribute meaningfully within IBH teams. This case highlights the application of an NP-led IBH team in the successful early recognition of NMS in a resource-limited homeless shelter setting. Despite the diagnostic complexity and significant fatality risk associated with NMS, the NP's role was central in diagnosis with timely escalation of care, care coordination, and continuity of treatment through an integrated approach.

The mental health development of preschool children has garnered increasing societal attention. However, empirical studies on mental health curriculum programs for preschool children in China remain limited. This study aims to evaluate interventions suitable for emotion regulation and stress coping strategies among preschool children and to provide a reference for early intervention that promotes their mental well-being.

This study was designed as a cluster randomised controlled trial conducted in two public kindergartens in Shanghai. Preschool children from middle and senior classes were recruited. To minimise classroom contamination, cluster randomisation was performed to assign classes to either the intervention group or the waiting-list control group. The intervention group received a 10-week Child Emotion and Stress Intervention Program (CESIP), delivered once weekly for 30 min, while the control group continued their regular kindergarten curriculum during the study period and did not receive any CESIP-related training or activities. Parents or caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Inventory of Callous-Unemotional Traits (ICU) at baseline (pre-intervention) and immediately after the intervention (post-intervention). Group differences in changes from pre- to post-intervention were examined using a difference-in-differences (DID) framework, operationalised through the group-by-time interaction term.

A total of 211 children (intervention group: n = 97; waiting-list control group: n = 114) completed both assessments. DID analyses showed no significant group differences in changes across SDQ subscales (all p > 0.05). In contrast, compared with the waiting-list control group, the intervention group demonstrated significantly greater reductions in ICU uncaring scores (DID estimate = -0.16, 95% CI [-0.31, -0.01], p = 0.039) and ICU total scores (DID estimate = -0.11, 95% CI [-0.20, -0.01], p = 0.035).

The CESIP intervention did not produce differential effects on behavioural difficulties but was associated with significant improvements in callous-unemotional traits, particularly uncaring characteristics, among preschool children. These findings suggest that classroom-based emotion and stress interventions may be beneficial for specific aspects of emotional development in early childhood.

Athlete burnout significantly affects both athlete well-being and performance, potentially influenced by dietary patterns, sleep quality, screen time, and stress-coping strategies. However, the mechanistic interplay among these factors remains unclear. This study utilized a cross-sectional design to examine the relationships between daily health behaviors (including diet, sleep, and screen time), stress coping strategies, perceived psychological strain and athlete burnout among Chinese competitive swimmers.

A comprehensive questionnaire was developed, encompassing demographic information, eating behavior (BEDA), sleeping behavior (ASSQ), screen time, stress coping strategies (CSCA), perceived psychological strain (APSQ), and athlete burnout (ABQ). This questionnaire was administered online and distributed to participating athletes through a snowball sampling method during the 2024 Shanghai Youth Swimming Competition to enhance the sample size.

Data from 1,071 swimmers (477 females, 44.5%) revealed through Lasso regression analysis that perceived psychological strain emerged as the strongest predictor of athlete burnout (β = 5.07), followed by age (β = 2.19) and athlete level (β = 3.76). Sleep disturbances (ASSQ) demonstrated a weaker yet significant contribution to ABQ (β = 0.92). A temporal inflection point in age-related burnout trajectories was identified at 19 years.

This study identified psychological strain (APSQ) as the strongest predictor of burnout (ABQ) among Chinese swimmers (β = 5.07), underscoring the critical need for strain-specific management in prevention strategies. The significant effects of advancing age (β = 2.19) and increased training load (β = 3.76) further revealed the developmental nature of burnout across career stages, necessitating age-targeted interventions. Although sleep disorders (ASSQ) had a weaker influence (β = 0.92), their significant role supports the integration of sleep quality enhancement into a holistic strain-sleep intervention framework. These findings provide a novel pathway for athlete mental health management through prioritized strain regulation, hierarchical age-specific interventions, and synergistic sleep-stress protocols.

The recreational use of cannabis is a significant (and growing) contemporary public health issue, confounded by the rapidly changing state and federal marijuana regulation and legislation. As of 2025, 24 states and the District of Columbia have legalized cannabis for medicinal and recreational use, and 39 of the 50 states have legalized it for medicinal use. With the increased use of recreational and medicinal marijuana, there has been an uptick in emergency department (ED) visits for cannabis-related illnesses, including gastrointestinal, cardiac, and mental health disorders. Nausea and vomiting, which are the hallmarks of cannabinoid hyperemesis syndrome (CHS), have been reported as the most common reasons for cannabis-related ED visits in nationwide ED data set analysis. Emergency department staff need to be familiar with CHS, its presentation, pathophysiology, and treatments to quickly recognize, diagnose, and triage/treat patients suffering from this acute cannabis-related GI illness.

Combination therapies with immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) have revolutionized the landscape of cancer treatment, improving the quality of life and overall survival of patients. A deep knowledge of the side effects of ICIs and TKIs combination therapy is mandatory to ensure patient compliance and improve clinical outcomes. Both ICIs and TKIs may cause endocrinopathies such as thyroid dysfunction, adrenal insufficiency, hypophysitis, and diabetes mellitus. To avoid life-threatening conditions and improve patient’s compliance and outcomes, an early diagnosis of endocrine toxicity should be achieved and a multidisciplinary approach involving both endocrinologists and oncologists may be beneficial. This review specifically examines the endocrine adverse events reported in the clinical trials of ICI plus TKI combined treatment, their underlying mechanisms, and practical management guidelines.

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Approximately 10% of cancers are attributable to heritable germline variants, yet identification of individuals at risk remains suboptimal.

To assess the feasibility of personal history and family health history (FHH) risk assessment technology via the electronic medical record (EMR) to enhance identification of patients at risk for a broad array of inherited cancer syndromes.

This single-arm, nonrandomized clinical trial was completed from October 1, 2021, to September 1, 2023, with no follow-up period in unselected patients receiving care at Vanderbilt University Medical Center. Adult patients (aged ≥18 years) were invited through their EMR patient portals to complete an eligibility survey. Eligible participants completed the survey, were English speaking, and had no prior genetic counseling. The data analysis was performed between August 15 and November 7, 2025.

Electronic medical record-integrated risk assessment platform that collected self-reported personal history and FHH to assess risk for 24 hereditary cancer syndromes.

The primary outcome was the completion rate of the risk assessment platform. Secondary outcomes included the percentage of newly identified participants meeting guideline criteria for genetic counseling and whether previsit FHH collection increased genetic counseling capacity by decreasing time spent in counseling.

A total of 1685 patients were consented to participate (mean [SD] age, 55.4 [15.1] years; 1217 female [72.2%]; 95 of Black or African American [5.6%] 1405 of White [83.4%], and 181 of other [multiracial, other, or unknown] [10.6%] race; 38 of Hispanic or Latino [2.3%], 1388 of non-Hispanic or Latino [82.4%], and 111 of unknown [6.6%] ethnicity). Among participants consented, 1483 (88.0%) were provided access to the risk assessment, 1106 (74.6%) started the assessment, 636 (57.5%) completed it, and 544 (49.1%) received a risk report. Younger age and unknown race and ethnicity were the only significant variables associated with completion (mean [SD] age, 53.5 [15.3] vs 56.9 [14.8] years for completers vs noncompleters, respectively; unknown race, 77 [14.2%] vs 43 [7.6%] for noncompleters; unknown ethnicity, 49 [9.0%] vs 20 [3.6%] for completers vs noncompleters, respectively). Among participants who completed the risk assessment, 155 (28.5%) met guideline criteria for genetic counseling, yet 74 (47.7%) were previously identified as at risk by billing codes. A total of 31 participants (20.0%) eligible for genetic counseling attended. Manual outreach efforts and counseling duration did not differ between risk assessment-assisted and usual care visits.

In this nonrandomized clinical trial, almost one-third of the population met national genetic counseling criteria for an inherited cancer syndrome, highlighting a substantial gap in usual care identification. Integrating patient-facing FHH collection and assessment tools for primary care patients improves inherited cancer risk identification and highlights opportunities to further enhance both risk assessment processes and genetic counseling attendance.

ClinicalTrials.gov Identifier: NCT05079334.