Despite their negative effects on cognitive function and cognitive decline risk, drugs with anticholinergic properties are commonly prescribed, particularly in older individuals. In this observational study we aimed to shed light on the relationships between anticholinergic burden (ACB) and depressive symptoms and cognitive and functional performance in a real-world clinical setting.

The study included individuals seeking care at the old-age psychiatry outpatient clinic of Patras University Mental Health Services. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale; cognitive function was tapped using the Cognitive Telephone Screening Instrument, the Montreal Cognitive Assessment, and the Mini-Mental State Examination; and functional performance was assessed using the Bristol Activities of Daily Living Scale. Differences in demographic and clinical variables across the four diagnostic groups were analyzed. Regression analyses were performed to examine the associations between ACB, cognitive and non-cognitive symptoms, and demographic variables. In addition, clustering analyses were conducted to identify distinct, naturally occurring examinee subgroups and to assess if ACB differed across them.

The study sample consisted of individuals without cognitive impairment (N = 301), people with mild neurocognitive disorder (MiND, N = 264), major neurocognitive disorder caused by Alzheimer's disease (ADMaND, N = 114), or other diseases (nonADMaND, N = 63). Significant associations were detected between ACB and depressive symptoms (0.72, p < 0.001), short-term memory (-0.11, p = 0.017), long-term memory (-0.24, p < 0.001), working memory (-0.24, p = 0.001), attention/concentration (-0.13, p = 0.004), verbal fluency (-0.57, p = 0.003), inductive reasoning (-0.17, p = 0.002), basic activities of daily living (0.29, p = 0.001), and instrumental activities of daily living (0.58, p < 0.001). The clustering analyses indicated that in the cluster including individuals with more advanced cognitive decline, poorer functional status, and more severe depressive symptoms, ACB was higher compared with the second group identified by the analyses (p < 0.001).

ACB is related to different aspects of the clinical phenotype of cognitive decline. Despite the lack of solid evidence regarding causal relationships and need for further research, minimizing ACB in clinical settings may embody a potential pragmatic strategy in managing cognitive decline in ageing.

PurposeTo identify a consensus-based subset of NANDA-I nursing diagnoses (NDs) specifically relevant to mental health and addiction care, facilitating their integration into clinical practice and electronic health records (EHRs).MethodsA multiphase e-Delphi study was realized engaging 33 international nurses with experience in the fields of interest and in standardized nursing languages. Participants evaluated the relevance of 267 NANDA-I NDs (12th edition) using a 9-point scoring system, allowing for the immediate inclusion of 130 NDs with high consensus (median scores of 7-9). Further five uncertain NDs were included after undergoing a second Delphi round.FindingsA total of 135 NDs (50.6% of NANDA-I taxonomy) were identified as essential for mental health and addiction care. Domains such as self-perception, coping/stress tolerance, and interpersonal relationships had the highest inclusion rates, reflecting the psychosocial and cognitive complexity of care in these settings. Conversely, NDs belonging to domains like growth/development, safety/protection, and elimination/exchange were selected in a more focused way, limiting to conditions reflecting expected side effects of psychiatric medications or substance misuse or risks for other- or self-directed injuries.ConclusionsThe identified subset of NDs seems to have the potential to capture the multifaceted nature of mental health and addiction nursing. This targeted approach addresses the unique needs of these populations and highlights nursing's critical role in holistic care delivery.Implications for Nursing PracticeImplementing this NDs subset into EHRs can streamline clinical reasoning, enhance interdisciplinary communication, and align interventions with patient needs. By focusing on a refined set of diagnoses, nurses can improve care quality, optimize outcomes, and contribute to evidence-based decision making in mental health and addiction care. Future research should evaluate the subset's impact on patient outcomes and healthcare efficiency.

Refugees carry a cumulative burden of past trauma and ongoing post-migration stress, yet the mechanisms linking these to mental health functioning remain incompletely understood. Sense of coherence - a salutogenic orientation comprising comprehensibility, manageability, and meaningfulness - may help account for these associations. We tested sense of coherence as a mediator of both associations and compared the relative weight of the two stressor domains.

A cross-sectional sample of 151 refugees and asylum seekers in the Netherlands (84.1% with a residence permit) completed the LEC-5, PMLP, SOC-13, and OQ-45.2 in person with research-assistant support across Dutch, English, and Arabic. We conducted multiple regression and three PROCESS Model 4 mediation analyses, including a parallel mediation with sense of coherence and post-migration stress as simultaneous mediators.

Both stressors predicted poorer functioning, with post-migration stress substantially stronger than trauma exposure (b = .40 vs. .17). Sense of coherence was the strongest correlate of functioning (r = -.57) and statistically mediated both cross-sectional associations. In the parallel mediation, sense of coherence and post-migration stress mediated the trauma-functioning association, and the direct effect was no longer statistically significant once both were included. Family-oriented stressors dominated the burden profile: worries about family in the country of origin (78.8%), missing family (73.5%), and uncertainty about the future (70.9%).

As a personal-resilience construct shaped by - not insulated from - external conditions, sense of coherence warrants sustained attention in this population.

Schizophrenia is associated with substantial disability, persistent symptoms, and significant unmet treatment needs. The ketogenic diet has emerged as a metabolic intervention of growing interest for serious mental illness. This study reports quantitative and qualitative findings from a large international Change.org petition advocating for the resumption of a halted randomized blinded inpatient study investigating a ketogenic diet intervention for individuals with schizophrenia. The petition received 21,637 signatures and 1,105 comments from individuals across 151 countries. Participant comments were analyzed using top-down theme consensus coding and Latent Dirichlet Allocation (LDA) topic modeling. Results revealed widespread interest in nutritional and metabolic approaches to mental health, concerns regarding the limitations of current treatment options, and support for further investigation of ketogenic interventions in schizophrenia. Many petitioners described personal or observed experiences with ketogenic diets and emphasized the need for additional research. As this was a self-selected advocacy-driven sample, findings may overrepresent individuals supportive of ketogenic diet research and are not representative of the broader population. These findings provide insight into the perspectives and experiences of petitioners and highlight interest in expanding research on novel treatment approaches for schizophrenia, such as ketogenic dietary interventions.

Digitized imaging of the spatial distribution of a targeted metal over a given area converts a continuous spectrum of data into a set of discrete pixels of intensities that ideally correlate strongly with the areal density map. This should be independent of the metal imaging modality, allowing semiquantitative analysis. In practice, correlation strength may vary between data sets obtained by different modalities. One enduring problem for all modalities is selecting a cutoff threshold intensity appropriately distinguishing the true signal from background noise. This may entail subjective choices between "conservative" thresholds prioritizing specificity over sensitivity (i.e., true positives despite possible false negatives) and "discovery-driven" thresholds prioritizing identification of putative effects for subsequent validation (i.e., true negatives despite possible false positives). Computerized data processing may help make this more objective by comparing outcomes for the set of all possible threshold values, termed cumulative threshold analysis. We address pitfalls in performing valid cumulative threshold analysis using ImageJ/Fiji for relative quantification of brain iron in mice with normal or genetically elevated iron, assessed by classical histochemistry or synchrotron X-ray fluorescence. In addition to pitfalls in choosing settings for generating analysis histograms, these include data loss with conversion between bit depths and selecting both appropriate X-axis directionality and image display range minima and maxima for analyzing multiple images. If these factors are handled appropriately, cumulative thresholding provides a powerful approach for more objective analysis of biometal imaging. This has important applications for metal imaging in research and clinical settings.

Positive mental well-being is increasingly recognized as an important component of cardiovascular care, particularly among patients with heart failure or myocardial infarction. However, validated Chinese-language instruments for assessing positive mental well-being in this population remain limited.

This study evaluated the psychometric properties of the Chinese-language 14-item Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in patients with heart failure or myocardial infarction.

In this cross-sectional validation study, 392 patients with heart failure or myocardial infarction completed the Chinese-language WEMWBS. Construct validity was examined using exploratory and confirmatory factor analyses. Convergent validity was assessed using factor loadings, composite reliability (CR), and average variance extracted (AVE), and criterion-related validity was evaluated using the 5-item World Health Organization Well-Being Index (WHO-5) as an external criterion. Internal consistency was estimated using Cronbach's α. Item-level performance was examined using item response theory under the graded response model.

The Chinese-language WEMWBS showed excellent internal consistency, with Cronbach's α = 0.961. The modified one-factor confirmatory factor model showed acceptable fit on most indices, with χ²/df = 2.68, CFI = 0.955, TLI = 0.944, RMSEA = 0.091, and SRMR = 0.038. Criterion-related validity was supported by a strong positive correlation with the WHO-5 (r = 0.746). Item response theory analyses indicated generally satisfactory item discrimination and ordered threshold parameters.

The Chinese-language WEMWBS demonstrated satisfactory psychometric properties in patients with heart failure or myocardial infarction. These findings support its potential use as a patient-reported outcome measure for assessing positive mental well-being in this population. Longitudinal and intervention studies are needed to evaluate its responsiveness, predictive validity, and clinical utility in cardiovascular care.

This study aimed to establish an evaluation system for social support in the field of adolescent physical health promotion and conduct empirical research, so as to provide a theoretical basis for optimizing the social support environment for adolescents' physical activity.

This study employed the Delphi method and the Analytic Hierarchy Process (AHP) to establish the evaluation index system. Subsequently, an empirical application was conducted from March to July 2025, involving 940 participants across six regions in Hunan Province. The Fuzzy Comprehensive Evaluation (FCE) method was utilized to analyze the data.

The social support evaluation system for adolescent physical health promotion consists of 4 primary indicators (government support, school support, family support, and community support), 19 secondary indicators, and 54 tertiary indicators. Among the primary indicator weights, government support had the largest weight (0.3764), followed by school support (0.2885), family support (0.2442), and community support (0.0909). For social support of adolescent physical health promotion in Hunan Province, government support scored the highest (87.56), reaching a "good" level; school support (80.82) and family support (75.40) were also rated as "good"; and community support had the lowest score (60.35).

This study underscores the significant role of social support in adolescent physical health promotion. Relatively stable social support for adolescent physical health promotion mainly includes four dimensions: government, school, family, and community. Overall, the level of social support for adolescent physical health promotion in Hunan Province is relatively positive, but structural imbalances and other shortcomings still exist. Future efforts should focus on four key stakeholders, government responsibility: bridging the gap between policy intent and implementation, school implementation: overcoming academic pressure and resource constraints, family participation: reshaping parental perceptions and health literacy, and community extension: revitalizing grassroots support systems, so as to promote the comprehensive physical and mental development of adolescents.

The Ambivalence Model of Suicidality (ABS) posits that suicidal experiences are often accompanied by internal conflicts between the desire to live and the urge to die. The model further conceptualizes the suicidal process as consisting of three phases: the uncertainty phase, the transition phase, and the action phase. This qualitative study explores the experiences of Iranian suicide attempters through the lens of the ABS to assess its cross-cultural validity and clinical relevance.

Semi-structured interviews with 15 individuals at Qods Psychiatric Hospital in Sanandaj, Iran, who had recently attempted suicide were conducted. The interviews examined emotional states, internal conflicts, external influences, and decision-making processes aiming to test whether the narratives corresponded to the three ABS phases. A deductive qualitative content analysis was applied: data were transcribed verbatim and coded according to predefined categories (Ambivalence, Transition, Action). Coding was conducted by one author and reviewed by a second author to ensure consistency with the theoretical framework. Representative quotations were extracted to illustrate alignment with the model.

Evidence for all three phases of the ABS was found. Participants' narratives reflected each of the model's predefined phases. Ambivalence prior to the suicide attempt was reported in 13 interviews, often accompanied by exhaustion. The transition phase frequently involved a sudden shift into acute suicidality, with some participants describing dissociation. Ambivalence often persisted into the action phase.

Findings support the applicability of the ABS in the Iranian context, highlighting ambivalence as a fluctuating yet persistent state throughout the suicidal process and across cultures. Incorporating the ABS into clinical practice might enhance therapeutic approaches, supporting suicide prevention efforts.

Translating the Self-Expression and Emotion Regulation in Art Therapy Scale (SERATS) into Chinese and adapting it for use by Chinese university students majoring in art and design.

After translating the SERATS into Chinese, we adapted it to the Self-Expression and Emotion Regulation in Art Making Scale (SERAMS). A total of 209 university students majoring in art and design were recruited to examine the reliability and validity of the scores derived from the SERAMS; of these participants, 121 were retested 2 weeks later. Another 200 university students majoring in art and design were selected to perform Confirmatory Factor Analysis (CFA).

The SERAMS is unidimensional and consists of nine items. The explained variance of SERAMS is 51.124%. CFA validated that the one-factor model fit with the data of SERAMS. Standardized factor loadings ranged between 0.688 and 0.733. The Cronbach's alpha coefficient of SERAMS was 0.880. Correlation analysis was performed between SERAMS and The General Self-Efficacy Scale (GSES) to calculate the criterion-related validity (r = 0.571 p < 0.001). The Pearson correlation coefficient for SERAMS' test-retest reliability was r = 0.889 (p < 0.001). SERAMS's split-half reliability was 0.875 (Spearman-Brown coefficient).

SERAMS has relatively good reliability and validity. It can be used to assess the self-expression and emotion regulation abilities of Chinese university students majoring in art and design.

The transition to the first clinical placement is a psychologically demanding phase for nursing students, requiring adaptation to patient care responsibilities, academic expectations, and unfamiliar clinical settings. Stress during this period may be influenced by academic, clinical, environmental, and relational stressors, which can affect students' psychological well-being and coping behaviors.

This study aimed to assess the levels and sources of perceived stress and examine the relationship between coping behaviors and environmental-relational stressors among first-year nursing students during their initial clinical placement.

Design: Cross-sectional descriptive correlational study. A total of 467 first-year undergraduate nursing students undergoing initial clinical training in seven governmental hospitals participated. Data were collected using the Perceived Stress Scale for Nursing Students and the Coping Behavioral Inventory. The Perceived Stress Scale included domains related to the clinical environment and interactions with teaching and nursing staff, which were used to explore perceived environmental and relational stressors. Descriptive statistics, Pearson correlations, and multiple linear regression were used to examine associations between stress domains and coping behaviors.

Students reported high overall perceived stress (M = 62.99, SD = 9.76). The most prominent stressors were practical assignments and workload, patient care, examinations of personal competence, and environmental and staff-related factors, while stress related to lack of professional knowledge/skills and daily life was comparatively lower. Regarding coping behaviors, problem-solving and optimistic coping showed significant negative associations with total perceived stress (r = -0.75 and r = -0.36, respectively; p < 0.001) and were significant negative predictors in regression analysis (β = -0.76 and β = -0.32; p < 0.001).

First-year nursing students experienced high stress during initial clinical placement, mainly related to workload, patient care, evaluation, and environmental factors. Coping strategies showed associations with stress levels, where problem-solving and optimism were linked to lower perceived stress, while avoidance and transference showed weaker associations. These findings highlight the potential importance of structured orientation, mentorship, stress-management support, and supportive clinical training conditions during early clinical exposure.