To refine the Chinese version of the Dimensional Anhedonia Rating Scale (DARS) and evaluate the psychometric properties of the Revised Chinese DARS (RC-DARS) in a large sample of first-visit psychiatric outpatients.

The study was conducted in two sequential phases at a specialized psychiatric hospital. In Phase I (n = 277), the existing Chinese DARS underwent semantic and cultural refinement in accordance with ISPOR and TRAPD guidelines, incorporating cognitive interviews and back-translation procedures. In Phase II (n = 788), the RC-DARS was administered alongside the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and the MMPI Suicide Ideation Subscale (MMPI-SI). Exploratory and confirmatory factor analyses were conducted using common-factor extraction and the WLSMV estimator for ordinal indicators. Internal consistency, gender-based measurement invariance, and convergent validity were evaluated.

Exploratory analyses supported a four-factor domain structure. Confirmatory factor analysis demonstrated good model fit for the domain-based model (χ²/df = 3.81, CFI = 0.98, TLI = 0.97, RMSEA = 0.08, SRMR = 0.05), with substantially superior fit relative to an alternative reward-processing model. Internal consistency was excellent (Cronbach's α = 0.95; McDonald's ω = 0.96). Multi-group analyses supported configural, metric, and scalar invariance across gender (ΔCFI < 0.01). RC-DARS total scores were significantly negatively correlated with depressive symptoms (r = -0.443), anxiety (r = -0.317), sleep disturbance (r = -0.494), and suicide risk (r = -0.312) (all p <.001). Individuals with severe depressive symptoms exhibited significantly lower RC-DARS scores than those below the clinical threshold.

The RC-DARS demonstrates robust psychometric properties in a first-visit outpatient sample. The revision primarily enhances semantic precision and structural differentiation without materially altering score distributions. The scale may serve as a refined instrument for dimensional assessment of anhedonia in similar clinical contexts, pending longitudinal and multi-site validation.

The present study aimed to establish a consensus on a definition of forensic mental health systems and services, and to identify principles and components of forensic mental health systems.

A Delphi consensus-building process was employed among 23 experts in forensic mental health, defined by lived experience of forensic mental health services, professional, clinical or management practice in forensic settings, or academic research in the field. Items were rated on a 9-point Likert scale, with consensus defined as ≥75% of panelists rating an item between 7 and 9. Across three Delphi rounds, items were revised, merged, or added based on participant feedback. Data were collected anonymously using LimeSurvey, with reminders sent to maximize participation, followed by a structured consensus meeting to resolve remaining areas of disagreement.

The final consensus statement comprises three components: (1) a definition of forensic mental health services; (2) a general statement including 12 guiding principles; and (3) 43 core components organized across 10 thematic domains addressing models of care, pathways and processes, programs and activities, physical health, service user and peer involvement, evaluation and improvement, service integration, safe environments, restrictive practices, and other system-level considerations. While all items achieved consensus at the consensus meeting, areas of sustained discussion related to the integration of cultural expertise, the inclusion of a lived experience workforce, and the distinction between descriptive and aspirational elements of forensic mental health services.

This international consensus statement provides a structured framework for understanding forensic mental health systems. By articulating shared principles and core components while allowing flexibility across jurisdictions, the framework offers a foundation to support service development and evaluation across diverse jurisdictions.

Dissociative identity disorder (DID) is a psychiatric condition characterized by the existence of at least two distinct identities. This disorder often serves as a defense mechanism, a response to severe childhood trauma, aimed at protecting the individual from overwhelming emotions or experiences. There is no specific targeted treatment for DID at present.

The purpose of this report is to explore the safety and efficacy of electroconvulsive therapy (ECT) in combination with pharmacological treatment for the treatment of concomitant depression in an adolescent female with DID, and to provide new clinical ideas and empirical evidence for similar cases.

A 15-year-old adolescent female presented with three distinct personality states, accompanied by hallucinations, negative thoughts, and self-harming behaviors. She was diagnosed with dissociative identity disorder and depression according to DSM-5 criteria. Following combined ECT and medication treatment, the patient's disparate personalities were integrated, and depressive symptoms were alleviated. During ECT administration, no significant adverse reactions occurred beyond mild headaches and transient memory impairment.

For adolescent patients with DID comorbid with depression who are at high risk of suicide, ECT combined with pharmacological treatment may be considered an effective and relatively safe treatment strategy in emergency situations. It is likely that the combined use of ECT, medication and psychotherapy has led to an improvement in the patient's condition.

A machine learning approach to identify a multidimensional signature associated with relapse and long-term outcome in alcohol dependence treatment.

In this observational naturalistic study, inpatients with alcohol dependence received qualified detoxification plus CBT (Cognitive Behavioral Therapy) and were followed up 6-months after discharge to assess abstinence and drinking behavior. Cross-validated multivariate sparse partial least squares analysis (SPLS) was used to investigate the relationship between clinical features and four long-term outcome variables.

Germany.

152 patients (on average 47.8 years old, 72% male) with alcohol dependence, who received inpatient qualified detoxification plus CBT.

35 clinical features were used to cover all three phases of inpatient treatment (pre-, within-, post-treatment). Among these, sociodemographic characteristics, ICD-10 psychiatric diagnoses, previous detoxification treatments, and somatic measurements as well as inpatient treatment setting such as withdrawal medication, liver ultrasound, further information about the patients´ stay, and post-inpatient care were assessed. The four outcome dimensions included: continuous abstinence, abstinence at follow up, daily alcohol consumption, and days of abstinence after discharge.

Six months after withdrawal treatment 46% of the patients achieved continuous abstinence. Socioeconomic, clinical and somatic features across the treatment timeline were analyzed and summarized into a multivariate signature associated with long-term treatment outcome. Thereby, the SPLS algorithm identified regular completion of withdrawal treatment, higher education, and employment status to be most strongly associated with a positive outcome. Alcohol-related hepatic and hematopoietic damage, number of previous withdrawal treatments and living in a shelter were most profoundly associated with a negative outcome.

Conceiving treatment outcome as a multidimensional signature and moving beyond simple binary classifications of relapse versus abstinence may improve the understanding of relapse pathways and support more individualized treatment strategies.

Interoception-the perception and integration of internal bodily signals-is fundamental to emotion regulation, bodily self-awareness, and predictive coding. Emerging evidence suggests that interoceptive disturbances may contribute to core psychopathological features of schizophrenia. Our research group recently conducted a systematic review and meta-analysis demonstrating significant impairments in interoceptive accuracy and sensitivity among individuals with schizophrenia. However, the neural mechanisms underlying these deficits remain unclear.

This cross-sectional protocol will recruit 30 individuals with schizophrenia and 30 age- and sex-matched healthy controls. Participants will complete (1) behavioral interoceptive assessment using the heartbeat counting task; (2) subjective interoceptive questionnaires, including the Multidimensional Assessment of Interoceptive Awareness (MAIA) and the Body Perception Questionnaire (BPQ); (3) clinical symptom ratings (PANSS, HAM-A, HAM-D); and (4) cognitive testing (TMT, animal fluency, DSST). All participants will undergo multimodal MRI scanning, including structural T1-weighted imaging, resting-state fMRI, and diffusion tensor imaging. Neuroimaging data will be preprocessed and analyzed using DPABISurf, SPM12, and GRETNA. Expected Results: We anticipate that individuals with schizophrenia will show reduced interoceptive accuracy, altered subjective interoceptive awareness, and abnormal intrinsic neural activity and connectivity within interoception-related circuits, including the anterior insula, anterior cingulate cortex, amygdala, and thalamus. Structural abnormalities within thalamo-cortical pathways are also expected. Interoceptive deficits are hypothesized to correlate with symptom severity and cognitive performance.

This study will provide an integrated characterization of interoceptive dysfunction and its neural correlates in schizophrenia. Findings may advance understanding of bodily self-disturbance and emotional dysregulation and support the development of future interoception-focused therapeutic approaches.

https://www.chictr.org.cn/, identifier ChiCTR2500110551.

There is little longitudinal research investigating links between violence exposure and mental disorders among children in low- and middle-income countries (LMICs), despite high rates of violence. We examined cross-sectional and longitudinal violence-mental health associations among children in a large South African birth cohort, the Drakenstein Child Health Study, including direct clinical interviews capturing children's mental disorders.

In this birth cohort ( N =974), we assessed lifetime violence exposure and four subtypes (witnessed community, community victimization, witnessed domestic, domestic victimization) at ages 4.5 and 8-years via caregiver reports. At 8-years, caregivers completed the Child Behaviour Checklist; and psychiatric disorders were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents, a self-report measure. We tested for associations using linear/logistic regressions, adjusted for confounders.

Most children (91%) had experienced violence by 8-years. Cross-sectionally, total violence exposure was associated with total (B =0.49 [95% CI 0.32, 0.66]), internalizing (0.32 [0.17, 0.47]), and externalizing problems (0.46 [0.31, 0.61]), and with increased odds of disorder at 8 years (aOR=1.09 [1.05, 1.13]). Longitudinally, total violence exposure up to 4.5-years was associated with total (B=0.27 [0.03, 0.52]), internalizing (0.24 [0.04. 0.44]), and externalizing scores (0.23 [0.008, 0.45]) at 8-years, but not with increased risk of psychiatric disorders. The strongest and most consistent associations were observed for domestic versus community violence subtypes.

Our strong cross-sectional but weaker longitudinal findings suggest that recent violence exposures may be more critical than early exposures for children's mental health. Longitudinal exploration of other violence-affected LMIC populations is urgently needed.

Subsyndromal generalized anxiety is highly prevalent and associated with impaired well-being, elevated stress, and functional limitations, yet affected individuals often do not meet criteria for guideline-based treatment. Scalable, low-threshold digital interventions that target psychophysiological regulation may help address this gap. Guided self-hypnosis and aromatherapy using essential oils have each demonstrated anxiolytic and relaxation-promoting effects. Combining these approaches may enhance efficacy and allow for conditioning of relaxation responses via olfactory cues.

This study protocol describes a randomized controlled trial evaluating the efficacy and conditioning potential of a digital self-hypnosis intervention combined with essential oil inhalation in adults with subsyndromal generalized anxiety. A total of N = 630 participants will be randomized into six groups. Four groups enter the primary efficacy analysis: (1) self-hypnosis + bergamot essential oil, (2) self-hypnosis + lavender essential oil, (3) self-hypnosis without essential oil, and (4) a minimal-intervention control. The intervention is delivered online over six weeks (Phase 1), followed by a two-week conditioning phase without hypnosis (Phase 2), in which stimulus-specific effects of the essential oils are tested. The primary outcome is subjective relaxation, measured by the Multidimensional Mood Questionnaire (MDBF) at baseline, post-intervention (6 weeks), and post-conditioning (8 weeks). Secondary outcomes include anxiety symptoms, perceived stress, sleep quality, well-being, and worry. In a voluntary subsample, heart rate variability (HRV) and pulse wave variability (PWV) will be assessed as physiological correlates of relaxation. In addition, the questionnaires are expanded to include open-ended questions, enabling an exploratory assessment of participants' experiences, attitudes, and reflections on the intervention and its potential for sustainability. This approach complements quantitative results with qualitative insights and may reveal new perspectives for future research.

This study is expected to provide evidence on the efficacy of essential oil-enhanced digital hypnosis for subsyndromal anxiety and will examine whether repeated pairing of hypnosis and olfactory stimulation induces conditioned relaxation responses. If effective, this multimodal, low-intensity intervention could represent a scalable preventive approach for individuals with increased anxiety who are not receiving formal treatment and have been medically diagnosed.Clinical Trial Registration: https://www.drks.de/search/de/trial/DRKS00039047/details, Identifier DRKS00039047.

Autoimmune neurological syndromes (AINS) associated with anti-GAD65 antibodies encompass a spectrum of disorders, including limbic encephalitis (LE), stiff-person syndrome (SPS), and cerebellar ataxia (CA). Despite the universal presence of anti-GAD65 antibodies across these syndromes, patients exhibit remarkable clinical phenotypic diversity. Exploring the overall B-cell receptor (BCR) profile of patients with anti-GAD65 AINS may provide clues to the molecular pathological mechanisms underlying this phenotypic diversity.

We performed high-throughput B-cell receptor (BCR) heavy-chain sequencing (Illumina NovaSeq 6000) on peripheral blood samples from 9 anti-GAD65 AINS patients (7 LE, 1 SPS, 1 CA/SPS overlapping) and 11 healthy controls (HC). Analysis encompasses clonotype profiling, somatic hypermutation (SHM) rates, CDR3 physicochemical characterization, repertoire diversity, and machine learning-based VDJ feature identification.

Anti-GAD65 LE showed significantly reduced repertoire diversity versus HC (Chao1: p-adjusted = 0.0023; Hill: p-adjusted = 3.7 × 10^-⁵), lower SHM rates (3.54% vs. 4.73%), and enrichment of hyperexpanded clones. Distinct IGHV/IGHJ usage was identified, notably decreased IGHV1-2 and IGHV1-46 with elevated IGHV3-7. A random forest classifier built on characteristic VDJ clonotypes achieved near-perfect diagnostic performance (AUC > 0.99). Cross-patient shared clonal clusters further highlighted disease-associated BCR convergence.

BCR repertoire heterogeneity across anti-GAD65 AINS subtypes illuminates the immunological underpinnings of phenotypic diversity. The identified VDJ signatures and common clonotypes represent candidate biomarkers for precise diagnosis and rational targets for BCR-lineage-directed immunotherapy.

Workplace mental illness stigma is associated with negative consequences for individual, social, and structural (e.g., employment) aspects. Thus, multilevel interventions such as the Canadian program The Working Mind (TWM) are needed to address all aspects of stigma simultaneously. Regarding stigma reduction, few studies have examined the potential to also increase mental health literacy and resilience or addressed personal values.

In this first international adaptation of TWM, we culturally adapted and evaluated TWM in the context of a German university regarding stigma, mental health literacy and resilience, while examining the role of values.

The study followed a quasi-experimental, sequential explanative mixed-methods research design (QUAN → qual) with assessments before, after the intervention and at 6-month follow-up. The sample consisted of managers and employees (intervention group: N = 69; control group: N = 49).

The intervention group showed significantly higher mental health literacy post-intervention compared to the control group after adjusting for baseline values, with a large effect size. Other effects were mainly small- to medium-sized but non-significant. Personal values of self-transcendence did not moderate the effect on mental illness stigma. Qualitative results showed an improvement on resilience for managers and employees and replicate the increase in mental health literacy.

Overall, we observed positive effects and trends of TWM regarding stigma, mental health literacy, and resilience. Possibly due to power limitations, baseline-adjusted group differences in stigma and resilience did not reach statistical significance. Value-based measures may explain inter-individual differences. Replication studies are needed to examine the observed effects in larger samples.

Affective disturbances are a core feature of schizophrenia, yet patients' capacity to experience momentary affective shifts in real-world settings remains underexplored. Although consummatory pleasure appears preserved, studies suggest low levels of positive affect and high levels of negative affect in daily life. Physical exercise provides an ecologically valid context for probing short-term affective reactivity. This study examined whether high-intensity interval training (HIIT) elicited greater affective change than an active control condition (ACC), whether baseline symptom levels were associated with affective state, and whether baseline symptoms moderated affective reactivity.

In a randomized controlled trial, 69 outpatients with schizophrenia were randomized to a 12-week intervention involving either supervised HIIT or an ACC involving low-intensity, interactive video gaming. Affective state was assessed immediately before and after the 12th session using the Positive and Negative Affect Schedule (PANAS). Depressive (CDSS), negative symptoms (PANSS-N), and apathy (AES) were measured at baseline. Linear mixed-effects models tested Group × Time effects.

HIIT did not produce significantly greater changes in positive or negative affect than the active control. Across interventions, participants showed increases in positive affect and decreases in negative affect. Higher baseline symptom levels were associated with lower pre-session positive affect. Exploratory analyses indicated that participants with more severe negative symptoms showed greater positive affective gains following HIIT.

A single session of structured activity, regardless of intensity, was associated with small but measurable affective improvements. These findings highlight the value of accessible activity-based interventions for enhancing affective well-being in schizophrenia.