Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie à deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.

Given theoretical and methodological criticisms surrounding coping strategies, this study examines coping profiles and differences between mothers and fathers at the time of their child's autism diagnosis.

Multi-group confirmatory factor analyses (MG-CFAs) were conducted to improve construct validity of the French Ways of Coping Checklist-Revised in 554 parents in France and to test measurement invariance between mothers and fathers. Linear mixed models were performed to examine parental status (mother vs. father) differences in coping strategies. Dyadic latent profile analysis (LPA) was used to identify distinct coping profiles and the R3STEP approach to examine differences in latent profile membership by parental status.

MG-CFAs supported four coping dimensions (problem solving-positive reappraisal, seeking social support, wishful thinking, and self-blame) and demonstrated configural and metric invariances, with partial scalar invariance between mothers and fathers. Fathers reported a significantly lower use of all coping strategies except wishful thinking. LPA identified three coping profiles -Varied Coping, Adaptive-Dominant Coping, and Maladaptive-Dominant Coping-with no significant differences in latent profile membership between mothers and fathers. In both parents, coping profiles differed by anxiety symptoms; additionally, maternal profiles were associated with socio-economic status, stress levels, and the child's internalizing difficulties, and paternal profiles with depressive symptoms.

These findings provide a more nuanced understanding of mother-father differences in coping among parents of autistic children and underscore the need for tailored, profile-based interventions in clinical practice and future research.

Life's Essential 8 (LE8) provides a multidimensional framework to assess cardiovascular health (CVH) in aging populations. The objective of this study was to describe LE8 component scores and their variation by age, sex, and psychosocial factors in middle-aged and older adults from Cádiz, Spain. Cross-sectional data were analyzed from 495 adults aged 50-79 years (59.4% women; 34.7% ≥ 65 years). LE8 scores were calculated following American Heart Association guidelines. Group comparisons used t-tests, ANOVA, and chi-square tests to explore differences across demographic and psychosocial variables. Age- and sex-adjusted linear regressions were fitted for CVH, health behaviors (HB), and health factors (HF). Most participants showed moderate CVH, HB, and HF scores (76.6%; 53.1%; 62.2%). Diet quality had the lowest mean (40.8 ± 31.7), while physical activity and sleep health were the highest (88.3 ± 30.6 and 85.0 ± 22.2). Middle-aged adults presented higher CVH and HF scores (mean differences [MD]: 2.5 ± 0.3; 7.8 ± 1.5), whereas older adults scored better in HB (MD: 2.8 ± 1.4). Women exhibited higher CVH, HB, and HF scores than men (MD: 3.6 ± 0.3; 2.8 ± 0.4; 4.4 ± 0.4), with middle-aged women showing the most favorable CVH profile (73.0 ± 10.5) and older men the least favorable (66.4 ± 11.0). Higher self-rated health (β = 0.240; R2 = 0.096) and educational attainment (β = 0.235; R2 = 0.090) were the strongest correlates of CVH (both P < 0.001). LE8 scoring revealed an intermediate CVH profile, with disparities by age, sex, and psychosocial context. Middle-aged women showed the most favorable profiles, while self-rated health and educational attainment emerged as key psychosocial markers for CVH assessment.

Adolescent idiopathic scoliosis (AIS) affects 1-3% of children in the United States, with approximately 38,000 patients undergoing posterior spinal fusion (PSF) annually. The relationship between preoperative patient-reported outcomes, postoperative recovery, and long-term clinical significance remains unclear. This study assesses longitudinal changes in Scoliosis Research Society-22r (SRS-22r) scores. It evaluates clinical significance using the Minimum Clinically Important Difference (MCID) in AIS patients undergoing PSF.

Retrospective study using prospectively collected data.

A retrospective study was conducted using prospectively collected data on AIS patients who underwent PSF at a single academic institution between 2012 and 2022. Patient-reported outcomes were assessed using the SRS-22r questionnaire at preoperative, 6-month, 1-year, and ≥ 2 years postoperative time points. MCID threshold achievements were determined using anchor-based criteria from Bago et al. The percentage of patients achieving MCID and predictors of MCID achievement were analyzed using logistic regression.

A total of 161 patients (mean age 15.26 ± 2.15 years; 65.8% female) were included. At 1 year, MCID achievement ranged from 30.1% (Self-Image) to 43.4% (Mental Health). By ≥ 2 years, MCID rates declined in Pain (25.9%) and Self-Image (22.8%) but increased in Function/Activity (44.1%). Lower preoperative SRS-22r scores consistently predicted MCID achievement across all domains. A documented mental-health history reduced the likelihood of Pain MCID at 1 year, and larger postoperative Cobb angles independently decreased the odds of achieving Self-Image MCID at both follow-up points. Neighborhood opportunity (Child Opportunity Index) was not associated with outcomes. Sensitivity analyses demonstrated that complete-case ≥ 2 year MCID rates were consistently bounded by best- and worst-case values and closely approximated LOCF estimates, supporting robustness despite attrition.

Meaningful postoperative improvement after PSF varies substantially by SRS-22r domain. Pain and mental-health gains occurred early and stabilized, whereas function demonstrated ongoing recovery, and self-image improved rapidly and remained stable. MCID achievement was most likely in patients with greater preoperative symptom burden, while mental-health history and residual postoperative deformity diminished domain-specific improvements. The stability of MCID patterns across sensitivity analyses reinforces the reliability of long-term findings. These results highlight the importance of incorporating psychological assessment, expectation management, and attention to postoperative alignment into perioperative care for AIS patients.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major advancement in obesity treatment, offering robust efficacy in weight loss and metabolic regulation. Beyond these effects, emerging evidence indicates that GLP-1 RAs also modulate appetite, reward sensitivity, and self-regulation, domains that intersect with behavioral and psychological functioning. This review adopts a biopsychosocial perspective to examine how GLP-1 RAs interact with eating behavior, mood, identity, and self-regulation, particularly in individuals with binge eating disorder (BED) or other psychiatric comorbidities. A clinical framework is proposed to integrate pharmacotherapy with lifestyle and psychological interventions. The temporary reduction in appetite and food reward may create a "low-drive window" in which behavioral strategies such as self-monitoring or stimulus control become more effective. However, high emotional eating, mood symptoms, or identity conflicts may moderate treatment response. Given the high prevalence of psychiatric comorbidities, structured screening using tools like the Patient Health Questionnaire-9 (PHQ-9) or Binge Eating Scale (BES) is recommended. A stepped-care approach from brief digital interventions to formal psychotherapy may help address varying support needs. Crucially, weight regain after discontinuation is common. The review discusses behavioral, psychological, and social mechanisms of relapse and highlights strategies for long-term stabilization. These include emotion regulation, body image work, and maintenance-focused behavioral interventions. GLP-1 RAs should therefore be seen not as standalone treatments but as facilitators of self-directed, sustainable change within integrated care models. Future research should define composite outcomes, explore digital tools for relapse prevention, and develop adaptive pathways tailored to individual psychological profiles.

Obesity and binge eating disorder (BED) are global health concerns that share overlapping neural mechanisms. These include alterations in the brain's reward and control systems leading to heightened sensitivity to food cues and impaired self-regulation, which underpin overeating. Identifying neuroimaging-based biomarkers that index these mechanisms could advance individualised treatments. This scoping review examined evidence on fMRI food cue reactivity as a potential approach for developing predictive and response biomarkers relevant to the treatment of obesity and BED. A systematic search of MEDLINE, Scopus, PsycINFO, and Embase (to July 2025) identified 57 eligible studies incorporating fMRI cue reactivity measures in the context of pharmacological, surgical, psychological, and lifestyle interventions. Of these, 7 reported predictive outcomes only (6 for adults with obesity and 1 for children and adolescents with obesity), 41 reported response outcomes only (36 for adults with obesity, 3 for children and adolescents with obesity and 2 for adults with binge eating), and 9 reported both predictive and response outcomes (8 for adults with obesity and 1 for adults with binge eating). Across paradigms and intervention modalities, there was consistent involvement of reward (striatum, insula, orbitofrontal and ventromedial prefrontal cortex) and cognitive control regions (dorsolateral and dorsomedial prefrontal cortex) as response outcomes from successful treatment. Reductions in reward-system reactivity following interventions were consistently associated with improved clinical outcomes, supporting the potential of fMRI food cue reactivity as a candidate biomarker of treatment response. However, this finding is highly skewed towards obesity, given the limited number of studies that report results for BED (3 studies). Furthermore, consistent evidence for reliable predictive biomarkers was also limited, likely due to methodological variability and small sample sizes. Overall, this review supports the potential of response outcomes from fMRI food cue reactivity as an indicator of treatment efficacy in obesity and highlights the limited evidence in BED. We also emphasise the need for further standardisation of paradigms and biomarker validation efforts.

BackgroundMany patients with incurable cancer are expected to live for a considerable period of time, yet with the knowledge of their disease's inevitable end-of-life outcome. This duality can lead to existential concerns. A single one-hour meaning-making conversation was developed in which a patient explores their sources of meaning together with a spiritual counselor.AimTo explore how patients experience and benefit from a conversation aimed at supporting meaning-making, in order to inform further refinement of this intervention.DesignWe conducted a formative mixed method pilot study. Evaluation interviews assessed patients' experience and reported benefits. A reflexive thematic analysis was conducted. Key themes were compared and contrasted by intervention timing and patients' experience of existential concerns. Validated questionnaires were administered to assess patients' existential wellbeing, problems, and needs pre- and post-intervention.Setting/ParticipantsTwenty-one patients with advanced solid malignancies and a prognosis >1 year participated at two different hospitals.ResultsAll patients experiencing existential concerns appreciated the meaning-making conversation and reported benefits, such as reflection, validation, insight and actions related to sources of meaning. Half of the those not experiencing existential concerns reported no benefits, and some reported a negative experience. Quantitative data suggest a decrease in most existential problems and needs post-intervention. Existential wellbeing increased post-intervention.ConclusionsA meaning-making conversation can support the process of meaning-making for patients living long-term with incurable cancer. Refinement of the intervention should focus on targeting patients experiencing existential concerns.

ObjectivesThis study aimed to compare serum leucine-rich repeat and fibronectin type III domain-containing protein-5 (LRFN5) and olfactomedin-4 (OLFM4) levels and aggregate index of systemic inflammation (AISI) values between hospitalized subjects with bipolar disorder (BD) experiencing acute manic episodes with psychotic features and healthy controls (HCs), and to examine their associations with clinical features and symptom severity.MethodsIn this cross-sectional study, participant characteristics and clinical features were assessed by structured clinical interviews. LRFN5 and OLFM4 levels were measured in the BD (n = 37) and HC (n = 35) groups using Enzyme-Linked ImmunoSorbent Assay kit.ResultsSerum LRFN5 (adjusted P = 0.0117) and OLFM4 (adjusted P = 0.0117) levels were significantly lower, whereas AISI (adjusted P = 0.0005) levels were significantly higher in the BD group compared with HCs, after adjusting for age, gender, body mass index, and smoking status. Within the BD group, a strong positive correlation was observed between LRFN5 and OLFM4 levels (r = 0.702, adjusted P = 0.006) and AISI showed a significant positive correlation with manic symptom severity score after controlling for age, gender, body mass index, and smoking status (r = 0.472, adjusted P = 0.030). In binary logistic regression analysis adjusted for age, gender, body mass index, and smoking status, lower OLFM4 levels (odds ratio (OR) = 0.970, P = 0.020, adjusted P = 0.003) and higher AISI values (OR = 1.008, P = 0.002, adjusted P = 0.001) were independently associated with BD status, alongside smoking status (OR = 19.213, P = 0.005, adjusted P = 0.001) (apparent area under the curve (AUC) = 0.914, optimism-corrected AUC = 0.884). After repeated stratified holdout validation, the mean and median test AUCs were 0.868 and 0.876, respectively.ConclusionsSubjects with BD experiencing acute manic episodes with psychotic features exhibited decreased circulating LRFN5 and OLFM4 levels alongside an increased systemic inflammatory burden, as reflected by AISI. AISI showed the strongest association with BD status and symptom severity and OLFM4 remained significant in adjusted analyses. Rather than indicating definitive diagnostic utility, the observed alterations may instead reflect underlying biological processes related to BD.

Work in eating disorder (ED) services presents unique challenges and rewards that may affect clinicians' work-related and personal wellbeing. However, research on ED clinician needs, views, and experiences is still sparse, despite major service changes since the COVID pandemic. This study aims to explore and conceptualise NHS ED clinicians' work-related experiences, challenges, and needs, in order to inform future clinicians wellbeing and service improvement strategies.

Clinicians working in ED services (N = 19) were interviewed using a semi-structured interview guide that probed their professional experiences, work-related needs, and views. Interviews were analysed using NVivo, following guidance from Braun and Clarke (2006) for reflexive thematic analysis.

A holistic ecological systems framework for ED services was created, comprised of five levels of influence: intrinsic, intra-personal, departmental, systemic, and societal. These levels contain nine themes: [1] clinician motivation for working in ED services [2], complexities of ED management [3], clinician personality and emotional disposition [4], team dynamics [5], supervision, management, and organizational support [6], service-level concerns [7], macro-level systemic concerns [8], broader societal challenges in ED care, and [9] COVID-related challenges. Key concerns included the chronic nature and risk of EDs, growing service demands amid limited resources, and regulation through guidelines and commissioning targets.

This presented framework illustrates the multifaceted array of complexities faced by ED clinicians. The interplay of personal, inter-personal, and systemic factors is explored, with clinicians' interest in and commitment to ED care at the core of the framework. These areas can be targeted to improve clinician job satisfaction and reduce burnout risk, with the goal to provide optimal patient care.

Emotion regulation is essential for adaptive behavior and mental health. Dominant theoretical frameworks, together with influential neuroscientific accounts, suggest that emotion regulation is closely linked to cognitive control processes; however, behavioral evidence supporting this link remains inconsistent. To quantify these associations, a comprehensive meta-analysis was conducted to examine the relationship between individual differences in cognitive control (updating, inhibition, shifting) and four emotion regulation strategies: reappraisal (k = 70 studies, N = 10,524), suppression (k = 45, N = 5,104), rumination (k = 109, N = 10,637), and worry (k = 36, N = 3,385). Individuals with stronger cognitive control abilities showed more frequent and more effective use of reappraisal and engaged less in rumination and worry, whereas suppression showed no consistent relation. Component-level analyses suggested associations with inhibition and updating, but not shifting, with stronger effects for regulation ability than for strategy use frequency. While all notable effects were conceptually consistent, their magnitudes (rs < |.15|) were small and substantially lower than those implied by prior theoretical frameworks and influential empirical studies. Moreover, the effects showed considerable heterogeneity and substantial uncertainty. Overall, these results challenge the widely held assumption that cognitive control and emotion regulation are closely linked, indicating instead that their associations are weaker and more specific than commonly assumed. They further suggest that dominant theoretical frameworks may overestimate the strength of this link at the behavioral level, highlighting the need for more ecologically valid assessments of both cognitive control and emotion regulation.