The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables.

A prospective cohort study was conducted over six months (September 2021-March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors.

The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders.

Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care.

Clinical remission is a major therapeutic goal in systemic lupus erythematosus (SLE) because of its association with improved long-term outcomes. However, its relationship with patient-reported burden, quality of life, and disease perception remains incompletely understood. This study aimed to evaluate patient-reported outcomes (PROs) in patients with SLE in clinical remission, identify factors associated with impaired health-related quality of life (HRQoL), and assess physician-patient discordance in disease activity perception.

A total of 106 adult patients with SLE in clinical remission according to the definition proposed by Zen et al. were enrolled at a single rheumatology center. Patients were classified into complete remission, clinical remission off corticosteroids, or clinical remission on corticosteroids. Demographic, clinical, and treatment-related data were collected, including organ damage (SLICC-SDI) and disease activity (SLEDAI-2K). Patients completed PRO measures including SF-36, Global Health (GH), pain VAS, STAI-Y1 and STAI-Y2, Zung Depression Scale, Insomnia Severity Index, and HAQ. Disease activity was assessed by both the patient (PGA) and the physician (PhGA); a PGA-PhGA difference >25 mm was considered clinically relevant discordance.

Among patients in clinical remission, mild anxiety was observed in 17.1% according to STAI-Y1 and in 27.9% according to STAI-Y2, mild-to-moderate depressive symptoms in 47.1%, and mild insomnia in 25.5%. Of the 106 patients, 24 (22.6%) were in complete remission, 27 (25.5%) in clinical remission off corticosteroids, and 55 (51.9%) in clinical remission on corticosteroids. Patients in clinical remission on corticosteroids showed worse patient-reported outcomes than those in complete remission or clinical remission off corticosteroids. In multivariable analyses, poorer physical HRQoL was independently associated with functional disability, pain intensity, and depressive symptoms, whereas poorer mental HRQoL was independently associated with trait and state anxiety. Clinically relevant physician-patient discordance was observed in 22.6% of the cohort and was almost exclusively driven by higher patient than physician scores. Pain intensity emerged as the most robust independent correlate of discordance.

A substantial patient-reported burden may persist in patients with SLE despite clinical remission. Pain, psychological distress, insomnia, and functional disability contribute to impaired HRQoL, while physician-patient discordance appears to reflect a broader mismatch between inflammatory disease control and the patient's lived experience of illness. These findings support a more comprehensive and patient-centered approach to remission assessment in SLE.

Background/Objectives: In recent years, research on psychosis has increasingly focused on prevention, aiming to implement early interventions that mitigate or reduce its impact. Within this framework, the analysis of linguistic markers in individuals with at-risk mental states (ARMS) has proven valuable for identifying those at risk and predicting psychosis onset. Artificial intelligence tools, particularly natural language processing (NLP), have emerged as effective resources for detecting these language-based indicators. This study aims to synthesize the existing scientific evidence on linguistic markers analyzed through NLP techniques in individuals with ARMS. Methods: A systematic review following the PRISMA 2020 protocol was conducted. Three databases (PubMed, PsycInfo, and Scopus) were searched for published articles from their inception to October 2025. Rayyan software was used to manage references and article downloads. Out of ninety initial search results, fifteen studies involving 1313 participants from diverse groups were included in the review. Results: The findings indicated that alterations in semantic coherence, syntactic complexity, referential cohesion, and speech/content poverty differentiated ARMS individuals from healthy controls. Several of these markers, analyzed with NLP methods, predicted the onset of psychosis with accuracy levels ranging from 79% to 100%, although these findings should be interpreted with caution due to the significant methodological heterogeneity and variability in sample sizes across the included studies. Conclusions: NLP techniques offer a powerful approach for detecting language alterations that distinguish ARMS individuals and provide meaningful predictions of psychosis onset, highlighting their potential as a complement to traditional clinical assessments for early identification and prevention.

Mast cells can release different kinds of molecules as a response to different stimuli, particularly proinflammatory mediators that contribute to neuroinflammation. The enrichment of mast cells in specific areas of the nervous system and gastrointestinal tract, together with their degranulation, histamine and neuropeptide secretion, such as substance P, and mast cell-microglia interactions, may promote neuroinflammatory signaling in neurological and psychiatric disorders during childhood and adolescence. The aim of this review is to explore the mast cell-related molecular aspects of the main neuropsychiatric disorders of the developmental period, such as ADHD, autism spectrum disorder, and epilepsy, as well as anxiety and depression. The translational analysis of molecular pathways and the relationships involved may contribute to the development of innovative and targeted therapeutic approaches.

Pharmacological antidepressant treatments alter the molecular and functional reactivity of stress-sensitive neural networks. However, how classical versus rapid-acting antidepressants differentially modulate acute stress-induced transcriptional responses across brain regions remains unclear. Here, we compared imipramine and ketamine in mice exposed to acute swim stress, assessing transcriptional adaptations across the frontal cortex, hippocampus, and striatum. Swim stress induced significant widespread activation of cFOS, which led to drug-specific modulations: imipramine primarily significantly dampened cortical and striatal cFOS expression, whereas ketamine preserved stress-evoked neuronal activation. In contrast, hippocampal activation was significantly robust but largely unaffected, indicating that acute antidepressant drug effects during stress coping preferentially target cortical and striatal plasticity mechanisms. In contrast, BDNF expression was altered only within the striatal region, where imipramine attenuated the stress-related increase in BDNF expression. Statistical analysis of behavioral outcomes during the swim stress confirmed a shared facilitation of active coping, yet these similar outcomes emerged from distinct molecular programs. Together, the data demonstrate that the treatment effects of the two substances diverge mechanistically, revealing cortical and striatal transcriptional signatures of classical versus rapid-acting antidepressant action. While these findings suggest potential translational relevance for understanding distinct mechanisms, further studies in humans are required to validate these signatures and their clinical implications.

Background: This study aimed to further explore the application of genetic risk assessments in 24 metabolic bariatric surgery (MBS) patients to predict weight loss outcomes three years after the procedure. Methods: Participants were assessed using the Genetic Addiction Risk Severity (GARS) test, which evaluates neurogenic polymorphisms linked to addiction and reward deficiency. Genetic and psychosocial data collected prior to surgery were analyzed in relation to post-operative weight loss measures, including weight change, body mass index (BMI), percentage of total weight loss (%TWL), and percentage of expected weight loss (%EWL). The analysis examined associations between specific genetic risk alleles, weight-related outcomes at three to four years post-surgery, and psychosocial trait scores. Results: Spearman's correlations revealed that the DRD2 risk allele is negatively correlated with 3-year BMI (r_s = -0.481, p < 0.05, 95% CI: -0.746 to -0.083). One-way ANOVA indicated that there is a significant difference in 3-year BMI (p = 0.018) between 0 and 1 DRD2 risk allele copy. There is also a significant difference in ∆weight (p = 0.022), ∆BMI (p = 0.014), and %EWL (p = 0.032) among the different SNP expression values of the MAOA risk allele. In addition, Spearman's correlation revealed that FCQ scores are negatively correlated with ∆BMI (r_s = -0.470, p < 0.05, 95% CI: -0.767, -0.005), %TWL (r_s = -0.561, p < 0.05, 95% CI: -0.814, -0.129), and %EWL (r_s = -0.533, p < 0.05, 95% CI: -0.800, -0.090) at 3 years post-surgery and positively correlated with 3-year weight (r_s = 0.576, p < 0.05, 95% CI: 0.151, 0.821) and 3-year BMI (r_s = 0.552, p < 0.05, 95% CI: 0.117, 0.810). Lastly, GARS scores are positively correlated with 3-year ∆weight (r_s = 0.422, p < 0.05, 95% CI: 0.010, 0.712).

This study aims to investigate the relation between inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-monocyte ratio, and suicide attempts in adolescents with bipolar disorder and to define a patient phenotype based on inflammatory markers. All patients under 18 years old diagnosed with bipolar disorder type I according to the diagnostic and statistical manual of mental disorders-5 criteria were included the study. NLR, platelet-to-lymphocyte ratio, LMR, and neutrophil-to-monocyte ratio were calculated. The median-split classification yielded 12 distinct inflammatory phenotypes (low-high-high-high [LHHH], low-low-low-low, high-high-high-high, low-low-high-high, low-high-high-low, high-low-low-high, high-high-low-low, low-high-low-low, high-high-low-high, low-low-high-low, high-low-high-high, and high-low-low-low). A total of 145 patients with bipolar disorder type I were included in the analysis. Thirty-five patients (24.1%) had a lifetime history of suicide attempts. None of the 4 inflammatory ratios differed significantly between patients with and without suicide attempt history (NLR: 1.93 ± 0.93 vs 2.11 ± 1.49, P = .864; platelet-to-lymphocyte ratio: 122.37 ± 41.74 vs 123.64 ± 50.23, P = .837; LMR: 3.97 ± 1.66 vs 3.76 ± 1.33, P = .600; neutrophil-to-monocyte ratio: 6.91 ± 2.49 vs 7.14 ± 4.59, P = .762). We identified 12 distinct inflammatory phenotypes represented markedly different suicide risks ranging from 0% to 57.1% (LHHH: 57.1%, low-low-low-low: 40%, high-high-high-high: 35.7%, low-low-high-high: 30.8). The LHHH phenotype, characterized by low NLR but high other ratios, emerged as a particularly high-risk profile requiring intensive clinical attention. The inflammatory phenotypes identified here may be a first step toward biologically informed suicide prevention in bipolar disorder.

ObjectiveMental Health Short Stay Units (MHSSUs) have emerged across Australian emergency departments as an alternative pathway for managing acute psychiatric and substance-related crises. This scoping review aimed to systematically map and synthesise the characteristics, patient populations, and reported outcomes of MHSSUs in Australian health systems.MethodsFollowing Joanna Briggs Institute protocols and PRISMA-ScR guidelines, systematic searches were conducted in Medline, PsycINFO, Embase, the Cochrane Database of Systematic Reviews, and Google Scholar. Eligible studies were qualitative or quantitative, published in English within the past 20 years. Extracted data included unit models, patient demographics, clinical presentations, and service outcomes.Results15 studies were included, covering a range of unit types such as Psychiatric Emergency Care Centres (PECC), Psychiatric Assessment and Planning Units (PAPU), Behavioural Assessment Units (BAU), Short-Stay Units/Pathways (SSU/SSP), Mental Health Alcohol and Other Drugs Hubs (MHAOD), and the Missenden Assessment Unit (MAU). These units typically provide short admissions (≤72 h) for medically stable patients. Descriptive findings suggested potential improvements in emergency department flow and reduced use of restrictive practices. However, variations in unit design, patient populations, and outcome measures limited comparability across studies.ConclusionsThis review provides a descriptive synthesis of MHSSUs in Australia and highlights variation in service models and patient cohorts. The current evidence base is constrained by small study numbers, observational designs, inconsistent reporting, and limited qualitative data. Consequently, while MHSSUs may offer promising alternatives to conventional emergency pathways, stronger and more standardised research is required to determine their clinical and operational effectiveness.

This study evaluated a brief deliberate practice-based training program ('Facilitative Interpersonal and Relational Skills Training') aimed at enhancing therapists' facilitative interpersonal skills (FIS) in a sample of experienced clinicians.

Using a waitlist-controlled design, two groups of therapists (N = 68) sequentially received a two-day workshop followed by two booster sessions over two months. They completed performance-based FIS assessments at three time points, along with self-reported FIS and therapist self-efficacy. Piecewise mixed-effects models tested pre-post change in each group and effects across the eight specific FIS.

No significant group × time interaction emerged. One group showed significant within-group improvement in FIS following training (g = .42, 95% CI [.15, .70], p = <.01), wheras the other showed a small, non-significant improvement (g = .21, 95% CI [-.20, .62], p = .31). Skill-specific analyzes indicated the largest gains in alliance-related skills, namely alliance bond capacity and rupture-repair responsiveness. No significant effects were found for self-reported FIS or therapist self-efficacy.

Modest improvements emerged in FIS after the training, especially alliance-focused capacities. Effects were smaller than in prior trainee-trials on FIS training, likely reflecting higher baseline skill levels and limited power. Larger studies are needed to evaluate clinical impact.

Prenatal cannabis use is increasing in the United States, despite evidence of potential harms to pregnant individuals and their offspring. Elevated rates of anxiety and depression among those who use cannabis during pregnancy suggest that mental health difficulties may contribute to prenatal cannabis use. In line with the affect regulation hypothesis, many pregnant individuals endorse using cannabis to manage mood. However, no studies have examined this relationship in real time. Moreover, the acute effects of cannabis on mood during pregnancy remain understudied, limiting knowledge of whether negative affect (NA) relief reinforces continued use. Addressing these gaps, the present study examines the relationship between momentary NA and cannabis use in pregnant adults and explores the effect of cannabis on NA.

Participants (N = 20, M_age = 30.15, M_{gestationalage} = 22.5 weeks, 60% White) completed a baseline session followed by a 14-day ecological momentary assessment burst (average of 14.95 cannabis use events per burst).

Generalized linear mixed-effects models tested whether momentary ratings of depression, anxiety, and irritability predicted subsequent cannabis use (Aim 1), and linear mixed-effects models tested whether cannabis use predicted subsequent changes in NA (Aim 2). Aim 1 results indicated that greater levels of NA (momentary depression, anxiety, and irritability) were associated with greater odds of using cannabis. Aim 2 results suggest cannabis use was followed by reductions in depression, anxiety, and irritability, reflecting short-term NA relief.

Findings provide the first real-time evidence supporting the affect regulation hypothesis in pregnancy and highlight the potential reinforcing role of NA relief in sustaining prenatal cannabis use. (PsycInfo Database Record (c) 2026 APA, all rights reserved).