Background: Individuals with mental health conditions frequently experience stigmatization and discrimination. Among the primary objectives in the fight against stigma is to examine groups that play a crucial role in addressing it, such as healthcare professionals. Although research has examined stigma among healthcare professionals, few studies have specifically addressed how nurses perceive and contribute to the stigmatization of individuals with mental health conditions. Objective: The aim of this review was to compile and compare the scientific literature addressing nurses' stigma toward individuals with mental health conditions. Methods: Following the methodological guidelines of the Joanna Briggs Institute and in accordance with the PRISMA 2020 guidelines, an integrative review was conducted of MEDLINE (PubMed), EMBASE, APA PsycInfo (EBSCO), and CINAHL Complete (EBSCO). Database-specific indexing terms were combined with the Boolean operators AND/OR. Studies with quantitative or qualitative methodologies, published in Spanish or English and without restrictions by year of publication, were included. Two independent reviewers selected the studies and performed the critical appraisal. Results: The search retrieved 4256 records, of which 32 articles were finally included. A content analysis of the selected studies was conducted. Most studies used validated questionnaires to assess stigma and its associations with various variables, while only a limited number employed qualitative designs. Across the 32 studies (n = 6283 nurses from 29 countries), stigma was observed across settings but tended to be lower among mental health specialists. Insufficient training and limited contact were consistently associated with higher levels of stigma, whereas specialization and positive contact were linked to lower levels. Associative stigma emerged as a recurrent theme with implications for psychiatric nursing identity. Conclusions: Nurses working in mental health settings generally demonstrate more positive attitudes toward individuals with mental health conditions compared with those in other clinical areas; however, stigma persists across all settings. Associative stigma may be influencing the development and advancement of psychiatric nursing. Specific academic training, capacity building, and specialization in mental health are essential to counteract stigma. Further qualitative research is required to achieve a deeper understanding of this phenomenon.

Background: Nurses' teaching skills in the clinical setting are crucial to ensuring that students receive high-quality training. Despite the growing importance of competency frameworks, there is little research on the relationship between nurses' teaching competence and sociodemographic, professional, training, and research variables. Methods: This was a cross-sectional, descriptive, and correlational study conducted at nine hospitals linked to the clinical placement subjects of the Bachelor of Nursing of the University of Barcelona. The study population comprised all nurses directly involved in clinical teaching. Participants' level of self-reported teaching competence was evaluated using the Spanish version of the Capabilities of Nurse Educators (S-CONE) questionnaire, and the sociodemographic, professional, and academic variables were collected in an ad hoc questionnaire. Descriptive statistics, non-parametric tests, and linear and logistic regression models were used to analyse the associations between the S-CONE total score and the variables collected. Results: The mean age of the participants (n = 596) was 41.9 years (standard deviation: 8.82), and 85.6% of them were women (n = 510). The overall mean S-CONE score was 3.81 (SD: 0.73). Higher scores were observed in those with advanced academic degrees, formal teacher training, and participation in academic activities. Professionals with mixed roles (clinical mentor and academic tutor) self-reported significantly higher competence levels. Multivariate analyses identified participation in conferences, tutoring of undergraduate theses, and involvement in research or development projects as the main predictors of higher teaching competence as measured by the S-CONE questionnaire. The lowest-scoring factor was research and evidence, which points to a potential area for improvement. No significant associations were found with age, sex, or years of clinical experience. Conclusions: Participants had a high self-reported level of teaching competence and rated themselves as competent overall, especially in professional practice and curriculum design. However, we identified areas for improvement related to pedagogical innovation and the use of evidence. The findings reinforce the importance of professional development and academic involvement to strengthen teacher competence.

Background/Objectives: Multiple sclerosis (MS) is a chronic neurological disease characterized by demyelination, inflammation, and autoimmunity, leading to progressive physical and psychological impairments. Anxiety and depression are among the most prevalent neuropsychiatric comorbidities in MS, significantly impacting patients' quality of life (QoL). This study aimed to assess the evolution of anxiety and depression in individuals with relapsing-remitting multiple sclerosis (RRMS) over a six-month follow-up period, identify associated factors, and explore potential predictors of these psychological conditions. Methods: A prospective observational study was conducted with 35 RRMS patients diagnosed at the Lucus Augusti University Hospital between January 2023 and March 2025. Psychological symptoms were assessed at baseline, after 3 months, and after 6 months using the Goldberg Anxiety and Depression Scale (GADS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Data were analyzed using non-parametric tests to account for the small sample size and non-normal distribution of variables. Results: Anxiety and depression were prevalent and persistent in the study population, with no significant changes in mean scores over time (p > 0.05). However, specific symptoms, such as pessimism and loss of pleasure, showed worsening trends, while sadness and guilt remained stable. Sociodemographic factors, including lower income and employment status, were significantly associated with higher anxiety and depression scores (p < 0.05). Additionally, clinical factors such as autoimmune comorbidities and a history of mononucleosis were linked to higher depressive symptoms. Baseline anxiety and depression scores emerged as strong predictors of future levels (p < 0.01), emphasizing the importance of early assessments. Conclusions: Anxiety and depression are prevalent and persistent in RRMS patients, with specific symptoms fluctuating over time. Sociodemographic and clinical factors play a significant role in psychological outcomes, highlighting the need for integrated care models that address both physical and psychosocial aspects of MS. Early psychological assessments and targeted interventions are critical for improving QoL and mitigating the long-term burden of mental health challenges in RRMS.

Background: Treating depression and anxiety in adolescents can be challenging due to interindividual variability in medication response. With current trial-and-error prescribing practices, adolescents may undergo multiple medication changes over months or years before an effective and tolerated drug and dose are identified. Pharmacogenomic (PGx) testing can identify interindividual differences in drug metabolism, and evidence supporting PGx-guided prescribing in adults with mental disorders is growing. However, its impact on pediatric psychotropic prescribing remains underexplored. Methods: This is a protocol for a parallel-arm, multicentre, randomized controlled trial. Canadian adolescents aged 12-17 years who are initiating or switching a selective serotonin reuptake inhibitor (SSRI) for depression and/or an anxiety disorder under physician care are eligible. A total of 452 participants will be randomized 1:1 to PGx-guided SSRI prescribing (experimental) or SSRI prescribing based on current practice guidelines (control). Participants, caregivers, prescribing clinicians, outcome assessors, and investigators will be blinded to treatment allocation. Dual primary outcomes are symptom remission at 12 weeks, measured with the Quick Inventory of Depressive Symptomatology-Adolescent (QIDS-A17-SR) and the Screen for Child Anxiety Related Disorders (SCARED). Secondary outcomes, assessed at 4, 8, and 12 weeks, include participant- and physician-rated changes in depressive and anxiety symptoms, role functioning, health-related quality of life, health care utilization, cost-effectiveness, side-effect burden, medication burden, and adherence. Multiple testing will be addressed using the Hochberg method, and a parallel gated analysis will account for non-actionable genotypes. Secondary analysis will estimate minimal clinically important differences for symptom and role-functioning change with PGx-guided therapy. Discussion: At the time of writing, 36 participants have consented and been randomized to an intervention. This trial will evaluate whether PGx-guided prescribing improves symptom remission in adolescents treated with SSRIs. If efficacious, results should be interpreted with existing pediatric pharmacokinetic, observational, and adult trial data to inform PGx use in managing pediatric anxiety and depressive disorders.

The kynurenine pathway (KP) is the primary route of tryptophan metabolism and a key interface linking immune activation, metabolic state, and neurochemical signaling. Although KP biomarkers are widely studied in psychiatric disorders, their interpretation remains inconsistent, in part due to biological context and compartmentalization. In this narrative review, we integrate evidence across peripheral and central systems to clarify how age, sex hormones, metabolic health, inflammation, and behavioral factors systematically bias KP flux and shape biomarker readouts. We re-examine the interpretation of the kynurenine/tryptophan ratio in light of differential IDO1 and TDO2 regulation, blood-brain barrier constraints, and cell-specific downstream metabolism that governs neuroprotective and neurotoxic outputs. We further synthesize clinical evidence linking KP alterations to symptom severity, cognitive dysfunction, treatment resistance, and suicidality, highlighting quinolinic acid as a mechanistic node connecting immune activation to glutamatergic dysregulation. Together, this framework reframes the kynurenine pathway not as a static biomarker of disease, but as a context-sensitive metabolic system with direct implications for study design, risk stratification, and personalized approaches in psychiatry.

Background/Objectives: Combined chronotherapy (CCT), which combines repeated sleep deprivation and light therapy, is used in the clinical treatment of severe depression. Despite its potential to rapidly reduce depressive symptoms, CCT is infrequently used in clinical practice. We explored whether actigraphy-derived within-patient changes in physical activity, sleep parameters, and sleep-wake patterns prior to CCT can help identify those most likely to benefit from this treatment, supporting personalized mental health care. Methods: Actigraphy data from nine severely depressed patients were collected before, during, and after CCT. Data were assessed with a questionnaire on depressive symptoms (Inventory of Depressive Symptomatology-Self Report, IDS-SR) and actigraphy measures for sleep-wake patterns and physical activity: daily mean activity level, rhythm (intradaily variability (IV), interdaily stability (IS)), Midpoint of Sleep (MSF), time in bed, sleep efficiency (SE), and the fragmentation index (FI). Variables were compared before and after CCT by systematic visual inspection due to the small sample size. A prior set Minimal Clinically Important Difference (MCID) of a 30% change in IDS scores from before and the week after CCT was used to categorize patients as responders (n = 3) or nonresponders (n = 6) to CCT. Results: After CCT, for both responders and nonresponders, there was a notable decrease in IDS, IV and FI. Prior to CCT, responders, compared to nonresponders, were characterized with higher IDS, more time in bed and higher FI, while having lower SE. Conclusions: We concluded that actigraphy assessments during regular CCT are feasible and found preliminary evidence that patients with the most disrupted sleep-wake patterns prior to treatment may benefit most from CCT.

Background: Major depressive disorder (MDD) is often accompanied by generalized anxiety disorder (GAD), a comorbidity linked to greater illness burden and potentially poorer outcomes. Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are established treatments for MDD, yet the impact of comorbid GAD and concomitant medications remains unclear. This study aimed to compare rTMS/iTBS treatment outcomes between patients with MDD with and without comorbid GAD, and to examine the association between concomitant psychotropic medication use, stimulation protocol, and treatment response in a real-world clinical setting. Methods: We conducted a retrospective observational analysis using registry data from 108 patients (MDD + GAD: n = 36; MDD only: n = 72). Patients received either Left-iTBS or Right-rTMS. Baseline severity, percentage change in Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAMD-17) scores, response, and remission were assessed. Logistic and linear regression models adjusted for age, sex, and baseline severity were applied. Sensitivity analyses stratified by stimulation protocol and benzodiazepine (BDZ) use were performed. Results: Baseline severity did not differ between groups. MADRS reduction was numerically lower in the comorbid GAD group (48.3% vs. 52.7%, p = 0.09), whereas HAMD-17 reduction was comparable. Response and remission rates did not differ significantly. Medication use and stimulation protocol did not show statistically significant independent associations with outcomes. Sensitivity analyses confirmed equivalent outcomes between Left-iTBS and Right-rTMS. BDZ users showed a non-significant trend toward lower MADRS improvement and remission. Conclusions: rTMS/iTBS produced substantial clinical improvement and was well tolerated in both patients with MDD and those with MDD comorbid with GAD. Although comorbid anxiety showed a modest tendency to attenuate MADRS score reduction, overall response and remission rates were comparable between groups. Neither concomitant medications nor stimulation protocol significantly affected treatment outcomes, while the potential influence of BDZ exposure warrants further investigation.

Post-Traumatic Stress Disorder (PTSD) is a global mental health concern, with recent research focussing on the psychological mechanisms that contribute to its development and maintenance. Alexithymia, characterised by difficulty identifying and expressing emotions, has been identified as a potential risk factor for PTSD. This study was a preliminary investigation of a model of the relationship between alexithymia and PTSD symptoms, focussing on the potential mediating roles of self-compassion and difficulties in emotional regulation. Participants (N = 332), who were university students and members of the community, completed self-report measures of the key variables. As expected, alexithymia was strongly associated with higher levels of PTSD symptoms. Three mediation pathways were also significant. In one, alexithymia was associated with greater regulation difficulties for negative emotions, which was associated with higher levels of PTSD symptoms. In the second, higher alexithymia was associated with greater difficulties regulating positive emotions, which was associated with higher levels of PTSD symptoms. The final pathway involved a serial mediation in which higher alexithymia was associated with lower self-compassion, and lower self-compassion was associated with greater difficulties in regulating negative emotions, which were associated with higher PTSD symptoms. Contrary to expectation, self-compassion had no direct relationship with PTSD symptoms and did not relate to difficulties in regulating positive emotions. The general pattern of results was evident for the PTSD subtypes of negative alterations in cognitions and mood and alterations in arousal and reactivity. However, mediation by difficulties in regulating positive emotions was nonsignificant for the symptoms of re-experiencing and avoidance. The theoretical and clinical implications of the findings are discussed.

People living with and beyond cancer often face ongoing challenges related to nutrition, wellbeing, and long-term health. Many individuals express a need for evidence-based, tailored dietary support, yet practical approaches to sustaining healthy eating behaviours remain limited. Culinary nutrition interventions, which integrate nutrition education with hands-on culinary skills, may help address these needs; however, their effects have not been systematically synthesised. This systematic review evaluates the impact of culinary nutrition interventions, delivered alone or in combination with physical activity or mental health components, on dietary intake, psychosocial and health-related outcomes, anthropometric measures, clinical and metabolic markers, and feasibility among individuals living with or beyond cancer. Following PRISMA guidelines, 18 studies were identified across PubMed, Scopus, EMBASE, CINAHL, and Web of Science (last searched in April 2025) and narratively synthesised. A total of 1173 participants were included, with sample sizes ranging from 4 to 190 participants per intervention. Interventions were well received and rated as highly acceptable, with strong engagement and minimal adverse effects. Across studies, statistically significant improvements were reported in dietary intake (7/13 studies), quality of life (4/5), mental health (5/6), self-efficacy (2/3), symptom management (3/4), self-reported cognitive health (1/1), food-related behaviours (2/2), selected anthropometric measures (4/8), and selected metabolic biomarkers (4/6). The evidence suggests that culinary nutrition interventions hold promise as supportive, behaviour-focused strategies aligned with oncology nutrition guidelines and responsive to patient needs. However, due to heterogeneity across interventions and outcomes, and variability in methodological quality as assessed using the Cochrane risk of bias tool, quantification of effects was not possible, limiting interpretation of the evidence. Further high-quality studies using comparable outcome measures and longer-term follow-up are needed to quantify the magnitude of effects, assess their durability over time, and inform the integration of culinary nutrition programmes into cancer care. This systematic review is registered under the PROSPERO ID CRD42024567041 and was funded by the RCSI Research Summer School Fund.

The glymphatic system supports metabolic waste clearance during sleep and is essential for brain homeostasis. Disruption of this system has been linked to sleep disorders, yet the overall prevalence of sleep disorders in populations showing impaired glymphatic-related function remains unclear. This systematic review and meta-analysis evaluated the prevalence of sleep disorders in human cohorts with structural, functional, or biochemical imaging markers of impaired glymphatic activity. Following PRISMA guidelines, major databases were searched up to August 2025. Eligible observational studies reported sleep disorder prevalence in populations characterized by enlarged perivascular spaces, white matter hyperintensities, DTI-ALPS (DTI-ALPS: Diffusion tensor image analysis along perivascular space) alterations, ultrafast fMRI (fMRI: functional magnetic resonance) indices, or CSF/PET (CSF: cerebrospinal fluid; PET: positron emission tomography) clearance deficits. Random-effects models generated pooled estimates, and heterogeneity, publication bias, and moderators were examined using I² statistics, Egger's test, trim-and-fill, and meta-regression. Nineteen studies (≈4500 participants) met the inclusion criteria. The pooled prevalence of sleep disorders in populations with impaired glymphatic-related function was 44.9% (95% CI: 34.9-55.3%), with substantial heterogeneity (I² ≈ 95%). Meta-regression identified older age and case-control design as significant contributors, while imaging modality, sex distribution, and sample size were not. Publication bias was minimal. Sleep disorders are common among individuals with impaired glymphatic-related markers, reflecting co-occurrence rather than causality. Standardized longitudinal studies are needed to clarify mechanisms and clinical relevance.