Despite recent declines in overdose deaths in Maryland, Baltimore County, and the nation, families who have lost loved ones to overdose remain an underutilized resource in shaping overdose response efforts. To better understand their experiences and inform overdose prevention strategies, Baltimore County Department of Health (BCDH) conducted interviews with family members or close acquaintances who lost a loved one to overdose.

Potential participants were identified through medical examiner records and invited via personalized letters. After screening for knowledge of confidential information pertaining to cause of death, 32 family members /close acquaintances voluntarily participated from 2022 to 2024. A licensed clinical social worker conducted one-on-one interviews (60-90 min in length). Interviews focused on family members' experiences prior to the overdose, the overdose events themselves, including use of naloxone, interactions with medical and treatment systems, and recommendations. Interviews were manually coded and analyzed by four qualitative researchers using thematic analysis guided by Grounded Theory.

Most respondents were parents (72%) of the decedents, followed by partners (16%), siblings, and former partners (6% each). Decedents were predominantly male (81%), White (78%), non-Hispanic (97%), with an average age of 49. Themes were organized into three domains: (1) circumstances and stressors leading up to the overdose, (2) non-fatal and fatal overdose events, and (3) reflections and system recommendations. In Domain 1, families described marked changes in their loved one's behavior as drug use escalated, fractured relationships, emotional exhaustion, and the struggle to balance support with tough love. Domain 2 revealed experiences with multiple non-fatal overdoses, limited use of naloxone and mixed experiences with medical systems. Domain 3 highlighted calls for financial and navigational support for treatment, better integration of mental health and substance use, high-quality treatment, greater information about overdose circumstances, and more family guidance about addiction and supporting someone with substance use dependency.

Families face profound emotional and systems challenges. They often witness multiple non-fatal overdoses, often at home with limited use of naloxone. Findings suggest the need for family-centered naloxone education programs, greater awareness of treatment options, and family support programs to position families as key partners in overdose prevention and response.

Depression affects nearly half of patients with heart failure (HF), which is associated with increased morbidity and reduced health-related quality of life (HRQoL). This secondary per-protocol analysis of a previously published randomized trial evaluated the behavioral activation (BA) versus antidepressant medication (MEDS) among patients with depression and HF who adhered to study interventions.

This analysis is based on a pragmatic randomized comparative-effectiveness trial conducted from 2018 to 2022, with a 1-year follow-up. 416 participants diagnosed with HF and a DSM-5 depressive disorder were randomized to BA or MEDS, and the current analysis examined outcomes according to treatment adherence.

The primary outcome was depressive symptom severity (PHQ-9) at 6 months, and the secondary outcomes were physical and mental HRQoL (SF-12v2-PC and SF-12v2-MC, respectively) and HF-specific HRQoL (Kansas City Cardiomyopathy Questionnaire; KCCQ) overall and clinical scores (KCCQ-OS and KCCQ-CS), at 3, 6, and 12 months. High adherence was defined as completion of >75-100% of intervention components. Overall adherence rates were similar between BA and MEDS. At 6 months, among patients with >75-100% adherence who followed treatment as directed in both arms, BA was associated with higher Mental HRQoL (SF-12v2-MC: 5.22; 95% CI: 0.72 to 9.72; p = 0.023) and higher HF-specific HRQoL (KCCQ-OS: 16.08; 95% CI: 7.20 to 24.97; p < 0.001); KCCQ-CS: 16.04; 95%CI: 7.05 to 25.02; p < 0.001) compared to MEDS. There were no significant differences in depressive symptoms or physical HRQoL at 6 months.

Both BA and MEDS were equally effective treatments for depression in HF. However, among highly adherent patients, BA was associated with greater improvements in mental and HF-specific HRQoL than MEDS.

The study was funded by PCORI Award Number: 2017C2-7716.

Scurvy is a nutritional deficiency disorder caused by sustained vitamin C depletion and is historically associated with dietary deprivation.

To review published cases of scurvy co-occurring with psychotic-spectrum disorders, characterize the recurrent illness-related contexts linked to low ascorbate intake, and summarize the clinical features relevant to recognition in consultation-liaison settings.

We searched four databases for reports of scurvy with a psychotic-spectrum diagnosis, from inception to May, 2025.

Eighteen reports describing nineteen patients met the criteria. Patients were typically middle-aged (median age, 54.0 years, [IQR 42-64]) and predominantly male (n = 13/19). Across the descriptions, mental state and functional narratives repeatedly converged in two contexts that plausibly reduced vitamin C intake: (i) psychosis that directly constrained eating (e.g., delusional contamination or rigid rules restricting fresh foods), and (ii) negative symptoms associated with self-neglect, impaired meal preparation, and irregular intake. Diets were often severely monotonous and lacked fresh produce. Psychiatric or behavioral deterioration was the presenting complaint in 5/19 patients (26%). Vitamin C repletion was followed by clinical improvement within days to weeks, mainly in the physical manifestations of scurvy; one patient died from refeeding syndrome. However, smoking status was rarely reported.

These case descriptions are consistent with a conceptual framework that suggests two potential pathways linking psychotic-spectrum disorders to vitamin C deficiency: psychosis-driven restrictive intake and executive-dysfunction mediated self-neglect. Clinicians should consider vitamin C deficiency when compatible mucocutaneous, musculoskeletal, or hematological features are accompanied by impaired self-care or marked dietary monotony.

Early intervention in psychosis has improved symptomatic outcomes, yet little is known about how early metacognitive change relates to long-term identity reconstruction and durable recovery. This study examined five-year quantitative and narrative outcomes of adolescents with first-episode psychosis (FEP) or at-risk mental states (ARMS) treated with Recovery-Focused Metacognitive Interpersonal Therapy (MIT-FEP).

Twenty-three adolescents participated in the original naturalistic cohort study; 21 completed treatment and 19 were reassessed five years later. Quantitative measures included subjective recovery, symptom severity, metacognitive functioning, psychosocial performance, service use, and hospitalizations. A qualitative thematic analysis of follow-up narrative interviews explored identity integration, agency, and autobiographical meaning-making.

Improvements in metacognition, symptoms, and recovery were sustained or enhanced at five years. Seventy-nine percent met remission criteria, 63% achieved functional recovery, and 58% met integrated recovery criteria, defined as the concurrent presence of symptomatic remission, functional recovery, and subjective recovery. Thematic analysis identified four core processes: (1) reconstruction of agency, (2) integration of the psychotic episode into a coherent life narrative, (3) transition from illness-centred to developmental identity, and (4) future orientation and meaning-making. Narrative coherence and future orientation were more evident among participants achieving integrated recovery.

Findings suggest that early metacognitive intervention was associated with durable recovery trajectories extending beyond symptom reduction to include identity reconstruction and reduced service dependency. Metacognition may represent a developmental process associated with the maintenance of recovery and sustained psychosocial integration following early psychosis.

There is increasing research and applied clinical interest in self-compassion as a protective factor that may foster positive emotional adaptations to psychosis. The Self-Compassion Scale - Short Form (SCS-SF) is a popular and economical measure of self-compassion, but its psychometric properties are not yet validated in populations experiencing psychotic disorders.

The factorial validity, reliability, convergent validity, and criterion validity of the SCS-SF were evaluated in young adults with early psychosis (N = 170). Confirmatory factor analysis was utilized to compare the fit of six a priori structures of the SCS-SF. Additional post-hoc exploratory factor analyses were conducted. Structural equation modeling evaluated the convergent and criterion validity of the best-fitting structure of the SCS-SF with theoretically and clinically relevant outcomes.

All a priori structures exhibited inadequate fit, with some producing serious misspecification. Additional exploratory modeling indicated a two-factor model, which was retained as the preferred factor structure and used to develop an alternate, reduced-item model. The composite reliability of these factors was acceptable. A factor representing uncompassionate self-responding was associated with an array of affective and psychotic symptoms, whereas a compassionate self-responding factor was weakly or inconsistently related to fewer of these.

Findings provisionally support a two-factor structure of the SCS-SF in psychosis, but its factorial validity remains uncertain. For psychosis researchers using the SCS-SF, scoring according to the two-factor approach rather than a total score may be important for deriving an accurate understanding of the effects of self-compassion on outcomes in psychosis.

Women identified with psychosocial risk factors are at higher risk of interventions during labour and birth and adverse maternal outcomes. Midwifery Continuity of Care (MCoC) reduces interventions and improves maternal outcomes among low-risk women; however, evidence on MCoC's impact among women with psychosocial risk factors is limited. This study aimed to investigate whether an MCoC model targeting women with psychosocial risk factors improved maternal outcomes in Sweden.

We conducted a retrospective cohort study using data from the Swedish Pregnancy Register. The cohort included 14 956 women with psychosocial risk factors such as mental health conditions, fear of birth requiring counselling, foreign-born status, need for an interpreter, single household, unemployment, or low educational attainment, who received either MCoC or standard care. All women gave birth at a Swedish university hospital between 2019 and 2024. Modified Poisson regression was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals.

Compared with standard care, MCoC was associated with an increased likelihood of normal vaginal birth (aRR 1.09; 95% CI 1.06-1.13) and a reduced overall risk of caesarean section (aRR 0.71; 95% CI 0.63-0.80), particularly caesarean section on maternal request (aRR 0.24; 95% CI 0.15-0.40). MCoC was also associated with reduced risks of obstetric interventions including labour induction, oxytocin augmentation, epidural/spinal analgesia and episiotomy.

Among women with psychosocial risk factors, MCoC was associated with reduced use of obstetric interventions and improved maternal outcomes, without evidence of increased risk of adverse maternal outcomes.

Aneurysmal subarachnoid haemorrhage (aSAH) is a major cause of premature death and disability. Although evidence-based guidelines exist, implementation is inconsistent and variation in care persists. Ischaemic stroke registries have improved guideline-concordant care, and several reviews have described their variables, coverage, governance and resource requirements. However, there has been no previous review of national aSAH registries.

To systematically identify and describe aSAH registries with respect to governance, case identification, data collection and general characteristics.

We searched MEDLINE (Ovid) for English-language studies published from inception to 1st April 2026. Eligible registries included unselected national cohorts of aSAH patients with ≥1 year of prospective data collection. Two reviewers independently screened titles, abstracts and full-texts. Data were extracted from peer-reviewed publications, registry websites or reports.

Eleven registries were identified, established between 1994-2009. Only one was a dedicated aSAH registry and, of the screened stroke registries, ten included aSAH patients. Four mandated hospital participation, and 81.8% employed no-consent or opt-out models. Governance, case identification and data collection varied substantially, with limited standardisation of consent and data entry. While most captured core inpatient variables, only 36.4% included sufficient detail to derive aSAH severity scores or aneurysm characteristics. Most registries were government led, with variable coverage, quality control and feedback mechanisms, typically focused on ischaemic stroke rather than aSAH-specific indicators.

Few stroke registries include aSAH patients, and most are not optimised to capture disease-specific variables. International harmonisation of core aSAH data variables and development of dedicated or nested registry modules is likely to improve global aSAH care.

Ketamine and esketamine have reemerged as promising interventions for treatment-resistant depression (TRD), yet debate persists regarding the clinical relevance of acute dissociative experiences. This secondary exploratory analysis aimed to examine whether dissociative experiences induced by subcutaneous esketamine differed according to antidepressant response and were associated with depressive symptoms in patients with TRD.

Patients received up to eight weekly subcutaneous doses of esketamine. Dissociation was assessed using the Clinician-Administered Dissociative States Scale (CADSS), and depressive symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory-II (BDI-II). Responders were defined as patients who achieved a ≥50% reduction in MADRS scores from baseline to the end of treatment, whereas participants who did not meet this criterion were classified as non-responders.

Of 30 patients eligible for inclusion, 23 were included in the final analysis (mean age, 34.3 years; 65.2% female). Dissociation levels remained stable across treatment sessions. Responders exhibited significantly higher CADSS total scores (p = 0.024) and derealization scores (p = 0.011) compared with non-responders across the treatment period. There were no significant differences in depersonalization or amnesia scores between responders and non-responders (p = 0.056 and p = 0.089, respectively).

These exploratory findings suggest that dissociative experiences, particularly derealization, may represent clinically relevant to antidepressant outcomes following subcutaneous esketamine treatment in TRD, although further prospective studies with larger samples and dose-controlled designs are needed before their clinical utility can be established.

A 49-year-old man presented with confusion, hallucinations, and seizure-like episodes. Evaluation revealed severe anemia and knee imaging showed lead synovitis from a gunshot wound received 27 years previously. Substance-related causes initially complicated the clinical picture, but further testing identified a critically elevated blood lead level. The patient was treated with chelation therapy and surgery to remove a retained bullet fragment and inflamed, metal-stained synovial tissue. After treatment, his mental status normalized and blood lead levels steadily declined.

This case highlights that retained intra-articular bullets can cause severe lead poisoning decades later, requiring early recognition and combined medical/surgical management.