The revised McDonald criteria (2024) introduced new imaging and laboratory biomarkers, allowing earlier and more accurate diagnosis of Multiple Sclerosis (MS).

To assess the applicability of the new criteria in Portugal and identify diagnostic tool availability and implementation barriers.

We conducted a national survey of neurologists from public hospitals involved in MS diagnosis and follow-up. Descriptive statistics and Pearson's chi-square tests identified factors associated with systematic implementation.

24 of 30 centres responded (80.0%). MRI protocols are routinely implemented in 58.3% of centres, with active Neuroradiology collaboration in 41.7%. CVS and PRLs were not routinely analyzed in 37.5%. OCBs are mostly performed locally (58.3%), while κFLC index is routinely measured in 41.7%. VEPs were timely in 75.0%, while OCT had inadequate response times in 54.2%. Systematic application was reported by 70.8% and associated with higher patient volume (p=0.035), Neuroradiology collaboration (p=0.022), and shorter CSF biomarkers turnaround times (OCB/κFLC index, p=0.003). Main barriers were limited technical resources (78.9%) and time constraints (42.1%).

Access to advanced biomarkers remains heterogeneous. Systematic implementation is associated with higher volume centres, Neuroradiology collaboration, and faster access to CSF biomarkers, highlighting priorities for equitable and timely adoption of the revised criteria.

Obsessive-compulsive disorder (OCD) is clinically heterogeneous, and traditional threat-based models do not fully explain this diversity. Intolerance of uncertainty (IU) and not-just-right experiences (NJREs) have emerged as clinically relevant features of OCD, but their associations with spontaneous brain activity remain unclear.

Fifty-seven patients with OCD and 38 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging. Regional spontaneous activity was assessed using the amplitude of low-frequency fluctuations (ALFF). Clinical measures included the Intolerance of Uncertainty Scale, the Not-Just-Right Experiences Questionnaire-Revised, the Yale-Brown Obsessive Compulsive Scale, and the State Anxiety Inventory. Group differences in ALFF were examined, and partial correlations were performed within the OCD group after controlling for age, sex, education, mean framewise displacement, state anxiety, and medication status.

Compared with HCs, patients with OCD showed increased ALFF in the bilateral orbital middle frontal gyrus and decreased ALFF in the left precuneus and right superior parietal gyrus. They also exhibited significantly higher IU scores. Within the OCD group, greater IU was associated with more severe NJREs and obsessive-compulsive symptoms (both Bonferroni-corrected p < 0.0125). Although IU was not associated with regional ALFF, greater NJRE severity was associated with both higher symptom severity and increased ALFF in the right orbital middle frontal gyrus (r = 0.380, p = 0.006).

OCD is characterized by altered frontoparietal spontaneous activity and elevated IU. The observed associations among IU, NJREs, symptom severity, and orbitofrontal ALFF suggest that uncertainty-related vulnerability, incompleteness-related experiences, and altered intrinsic brain activity are interconnected clinical features of OCD.

Rest intolerance, the experience of negative emotions when attempting to rest, is an emerging public health concern, yet its population-based epidemiology remains poorly understood.

This study systematically investigated the prevalence, distribution, and health correlates of rest intolerance among adults in China, with particular focus on its manifestation in highly educated and younger populations.

We analyzed cross-sectional data from 24,405 adults in the 2024 Psychology and Behavior Investigation of Chinese Residents (PBICR) survey. Rest intolerance (Rest Intolerance Scale-8 [RIS-8]), mental health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-R3 [GAD-R3], and Perceived Stress Scale-4 [PSS-4]), and quality of life (EQ-5D-5L or EuroQol visual analog scale [EQ-VAS]) were assessed. Cutoffs were derived via cluster analysis and latent profile analysis, followed by regression and moderation analyses.

The overall prevalence of high rest intolerance was 14.94% (3645/24,405). Notably, rates were significantly elevated among younger adults and those with higher educational levels. Rest intolerance was significantly associated with adverse mental health outcomes (anxiety: β=0.406; depression: β=0.402; and perceived stress: β=0.440; all P<.001) and reduced quality of life (EQ-5D: β=-0.115 and EQ-VAS: β=-0.117; both P<.001). Moderation analyses further revealed that these adverse associations were stronger among highly educated and younger individuals.

Rest intolerance affects 14.94% of adults in China, with highly educated and younger populations constituting particularly high-risk groups. The condition demonstrates robust associations with adverse mental health outcomes and diminished quality of life, especially among these populations. These findings underscore the need for targeted psychological interventions and workplace health policies addressing rest-related distress in contemporary performance-oriented societies.

Emergency medical services (EMS) clinicians operate in environments characterized by repeated trauma exposure, operational unpredictability, shift work, moral distress, and cumulative occupational stress. A substantial body of evidence demonstrates elevated rates of post-traumatic stress symptoms, depression, anxiety, substance use, sleep disturbance, burnout, and suicide among EMS clinicians and other public safety professionals compared to the general public. The implications extend beyond individual well-being, affecting workforce sustainability, clinical performance, and high quality patient care. Mental health in EMS is therefore not solely an individual concern, but a systems issue. Therefore, the National Association of EMS Physicians (NAEMSP) recommends that:Organizational leadership should recognize EMS clinician mental health as foundational to workforce sustainability and safe patient care.EMS clinician mental health awareness, management, and treatment options should be a core part of EMS education.EMS systems should take a multi-faceted approach to mental health, with an emphasis on ensuring access to confidential and culturally competent resources for EMS clinicians and other public safety professionals including telecommunicators, law enforcement officers and firefighters.EMS systems should engage in quality improvement to identify and improve practices affecting EMS clinician mental health.EMS systems should achieve meaningful and sustainable improvements in EMS clinician mental health through legislative advocacy and building strong partnerships with local, regional and national agencies including public health and research institutions.

Menopause is an important biological transition with up to 72 symptoms that shapes aging trajectories across organs and encompasses ~40% of the female lifespan. Although menopause awareness is increasing, research on strategies for menopause symptom management and optimizing health in the postmenopausal period is lacking. This Review highlights that menopause characteristics, such as type, timing, and symptom burden, influence health outcomes and later-life disease risk. Similarly, menopause hormone therapy comes in >200 varieties that differ by dose, formulation of estrogens and progestogens, and timing, each with their own distinct risk-benefit profiles. These distinctions are often missed in the literature but have considerable repercussions for outcomes. Optimized menopause care necessitates a precision medicine approach that considers menopause symptoms, genetics, and previous hormone exposures.

U.S.-based Latino older adult populations face disproportionate barriers to accessing behavioral health services. We examined associations between multifaceted mental illness stigma and help-seeking from different sources of behavioral health supports among understudied Latino older adults with behavioral health problems.

Data come from a cross-sectional survey that included U.S.-based Latino residents ages 50-86 (N=274; 2021). The survey measured mental illness biopsychosocial causal beliefs, treatment efficacy beliefs, and social rejection beliefs as multiple facets of mental illness stigma that may influence mental and physical health help-seeking behaviors from four sources: traditional media, online/digital media, family/friends, and healthcare providers. Linear regression models examined associations between each stigma component and each help-seeking outcome, adjusting for personal/family factors in the full sample of Latino older adults and among a subsample reporting a self/familial behavioral health problem (n=173).

Among Latino older adults with self/familial behavioral health problems, higher biopsychosocial causal beliefs were associated with increased mental and physical health help-seeking from healthcare providers (p<0.05), while social rejection beliefs were associated with decreased mental/physical health help-seeking from healthcare providers (p<0.05). Similarly, higher biopsychosocial causal beliefs were associated with increased mental health help-seeking from traditional media (p<0.05) among those with self/familial behavioral health problems. No associations were observed between stigma components and mental/physical health help-seeking from online media or family/friends. Similar results, though attenuated, were found in the full sample.

Multifaceted anti-stigma interventions for multi-generational Latino families may be an opportune strategy for increasing help-seeking for behavioral health problems among Latino older adults.

This study reports a multisite program evaluation of Stress Inoculation Training-Health Sustainment and Restoration, a manualized, group-based intervention delivered within routine Veterans Affairs care for veterans with posttraumatic stress, depression, and related comorbidity. The purpose of the evaluation was to examine feasibility across implementation periods and delivery contexts and to describe symptom and functional improvement during participation, rather than to test intervention efficacy. A total of 281 veterans enrolled across three implementation periods and multiple Veterans Affairs sites; measure availability varied by period and outcome. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition; Beck Depression Inventory-II; Alcohol Use Disorders Identification Test; Brief Addiction Monitor; and Situational Adaptation to Stress Scale were used as available at pre- and posttreatment. Linear mixed-effects models were treated as the primary inferential analyses because they accounted for repeated measurement, site-level clustering, and incomplete data, whereas measure-specific Wilcoxon signed-rank tests and site/period comparisons were treated as secondary sensitivity analyses. Participants improved during program participation on posttraumatic stress disorder, depression, alcohol use, and stress adaptation outcomes, with the largest gains observed for stress adaptation and functioning. Mean Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, scores decreased from 50.56 to 42.52, and mean Beck Depression Inventory-II scores decreased from 31.35 to 25.46, while mean Situational Adaptation to Stress Scale scores increased from 20.82 to 31.13. Improvement patterns were observed across implementation periods and in both in-person and telehealth delivery contexts. An overall difference in Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, scores was observed between Periods 2 and 3, but change over time did not differ significantly by period. Overall, these findings support the feasibility of implementing Stress Inoculation Training-Health Sustainment and Restoration across Veterans Affairs settings and suggest that participation in the program was associated with symptom reduction and functional improvement. As the design was observational and lacked a comparison condition, the results should not be interpreted as establishing intervention effectiveness, equivalence across formats, or scalability beyond the contexts studied. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Racial stress and trauma profoundly affect the mental health of racialized individuals, yet culturally responsive therapeutic approaches remain underdeveloped. Art-based activities may provide alternative pathways for emotional processing and engagement. This study explored therapists' perspectives on integrating art-based activities into racial trauma treatment, focusing on clinicians trained in the Healing Racial Trauma Protocol, a manualized cognitive-behavioral intervention.

Semistructured interviews were conducted with 10 therapists (six Black, Indigenous, and People of Color, four White; M_age = 36.6 years; 70% female) who had delivered the Healing Racial Trauma Protocol. Framework analysis was used to identify themes related to prior use of art-based activities in psychotherapy, perceived benefits and barriers, client suitability, therapists' experiences of discomfort discussing race, and conditions necessary for effective integration.

Therapists reported multiple benefits of art-based activities, including increased engagement, emotional expression, and insight. Creative activities were considered particularly helpful for clients with limited verbal expression or tendencies toward overintellectualization. Barriers included client hesitancy, cultural considerations, and practical constraints. White therapists described discomfort navigating racial dynamics, highlighting the importance of cultural humility and supervision. Effective integration depended on flexible timing, individualized adaptation, and adequate training and support.

Findings support a preliminary process model identifying key components for the ethical and effective integration of art-based activities into racial trauma treatment. Results inform therapist training and culturally responsive clinical practice. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Premature loss of enlisted active component personnel is costly and challenges force readiness. Enlisted personnel who experience serious illness or injury during their first contract may be especially vulnerable to negative military outcomes, despite access to additional medical support provided by temporary limited duty (LIMDU) programs. This study is the first to examine post-LIMDU military career outcomes among enlisted Sailors and Marines assigned to LIMDU during their initial military contract.

Archival data included comprehensive records from the Sailor and Marine Readiness Tracker (SMART) as well as military personnel data for personnel who entered LIMDU during their first contract and were in active LIMDU status between fiscal years 2017 and 2022 (N = 22,500). The post-LIMDU military career outcomes examined included the timing of and reason for release or discharge from active duty service. Loss timing was categorized as first-term attrition (before completing first contract), later discharge (after completing first contract but before fulfilling the full 8-year military service obligation [MSO]), or continued MSO (fulfilled MSO or still on track to meet MSO). Loss type was characterized as met requirements, disability, poor performance, or misconduct. Multinomial logistic regression analyses examined demographic, military, medical, and LIMDU-related factors as potential predictors of both loss timing and loss type; interaction effects were included to explore service differences in predictors.

The military prematurely terminated enlistment contracts with more than 60% of the sample, 38.04% through first-term attrition and 22.68% through later discharge. The most common reasons for post-LIMDU active duty losses were medical disability (43.30%) and met requirements (39.85%). Poor performance and misconduct losses were most frequently associated with first-term attrition; later discharges were most often because of disability. Although predictors varied across the outcomes considered, being in the Marine Corps and starting LIMDU during a later contract year were strong and consistent predictors of positive outcomes, whereas entering LIMDU for mental and behavioral health or "other" medical conditions (vs. injury, musculoskeletal, or pain issues) were among the strongest and most consistent predictors of negative outcomes. Service differences were observed in both predictors and outcomes, and service moderated the impact of several predictors on outcomes.

This study provides novel information about patterns and predictors of service loss among Sailors and Marines who enter LIMDU during their first term of service, including findings regarding the timing and causes of military attrition, predictors of positive military career outcomes, and service-specific differences in both predictors and outcomes. These results raise important questions about the frequency with which service members in the LIMDU program can return to full duty; by incorporating additional data regarding the duty status of service members upon release from LIMDU, future investigations may provide critical information to inform policy and practice to maximize the effectiveness and efficiency of the LIMDU program.

Individuals often consume tasty, calorically dense foods in response to negative emotions, a phenomenon exemplified by notions of 'stress eating' and 'comfort food'. While this link between food and mood can become pathological in binge eating, the decision-making processes underlying this link are poorly understood. Here, we investigated the impact of acute increases in negative affect on when and how strongly the perceived tastiness and healthiness of foods influence food choices in healthy adults and individuals with bulimia nervosa (BN), an eating disorder characterized by cycles of over- and under-consumption of food. In a randomized crossover design, 25 women with BN and 21 healthy controls completed two sessions where they received either a neutral or negative affect induction and then completed a food choice task. Using a time-varying diffusion decision model, we assessed how negative affect influences food choice dynamics for high- and low-fat foods. In the neutral affect condition, individuals with BN considered tastiness relative to healthiness of high-fat foods sooner than healthy controls but maintained a restrictive food choice policy by reducing the weight on tastiness. After a negative affect induction, both groups showed a stronger bias toward considering tastiness before healthiness, but this bias was exaggerated in individuals with BN. This affect-induced bias for high-fat foods predicted more frequent subjective binge episodes over 3 months. These results provide insights into how negative emotion influences food choices and may explain why binge eating in BN is more likely during high negative affect, while dietary restriction is more likely during low negative affect.