Bipolar disorder (BD) is a clinically heterogenous mental disorder with a diversity in clinical trajectories and treatment response. Twin studies have shown that BD is highly heritable, with estimates ranging from 60% to 90%. However, our understanding of this genetic component has yet to be translated into clinical interventions or prediction tools. In this review, we summarize findings from large-scale international collaborations, with the latest and largest study finding 298 genome-wide significant loci and 36 credible mapped genes associated with BD, alongside the first genes with an increased burden of rare genetic variants. We next highlight key biological insights from these findings, including widespread genetic overlap but distinct patterns of genetic correlation with other mental disorders and related traits; enrichment of gene expression within both brain-specific tissues and cell types and non-brain tissues, including pancreatic and large intestinal tissues; and the identification of novel drug targets and repurposing candidates, including calcium channel blockers. While these insights may take several years before they impact clinical practice, the potential for genetic advances to impact patient care through more accurate nosology and the development of clinically relevant prediction and stratification tools is more imminently achievable. We go on to summarize the most prominent methods for genetic prediction, including artificial intelligence-based methods, before discussing promising use-cases and key challenges to implementation. Looking to the future, cross-disciplinary collaboration, access to real-world data for robust validation, and pragmatic solutions that facilitate implementation across diverse healthcare systems will be crucial to achieving material advances in clinical care and improving outcomes for people with BD.

This investigation aimed to replicate phenotypes in pediatric complex regional pain syndrome (CRPS) previously identified in adult CRPS patients. The impact of an intensive pain therapeutic approach in pediatric CRPS was also evaluated.

Neurological examination data were obtained from two samples of children with CRPS (cohort #1; N = 24 and cohort #2; N = 14). The structure among CRPS signs was analyzed on pooled data from cohorts #1 and 2 using hierarchical clustering. A phenotype score was quantified for patients and then submitted to unsupervised k-means clustering. Patients in cohort #2 were enrolled in a 4-6-week treatment program consisting of psychological, physical, and occupational therapy. Questionnaires about pain and mental and physical health were evaluated at treatment admission and discharge.

A two-cluster structure of CRPS signs could be replicated in the pediatric population. Cluster #1 includes skin color, temperature, and edema resembling peripheral inflammation ("peripheral" phenotype). Cluster #2 grouped together motor disorders, minor injury, glove/stocking-like sensory deficits, and allodynia ("central" phenotype). K-means clustering also showed three phenotypes, "peripheral" (N = 12), "central" (N = 10), and "mixed" (N = 17), similar to adults. The impact of treatment was revealed for pain affect, pain behavior, psychological distress, depression, pain catastrophizing levels, as well as physical activity and strength (Cohen's d = [0.8-1.3]).

CRPS phenotypes reflecting major pathophysiological mechanisms of peripheral inflammation and central reorganization are identifiable in adult and pediatric patients, suggesting phenomenological features of the disease. An intensive interdisciplinary pain treatment approach was effective in reducing CRPS severity and restoring function in pediatric CRPS.

Sleep disturbance and quality of life have been widely studied; however, there is a lack of theory-based, nursing-specific tools that directly assess their relationship. This study aimed to develop a valid and reliable measurement tool based on Kolcaba's Comfort Theory.

Methodological study.

The study included 781 patients and followed standard procedures for scale development. The scale was rated on a 5-point Likert scale, and item scores were averaged to obtain overall scores. Data were collected using the Personal Information Form, the Pittsburgh Sleep Quality Index, the Visual Analog Scale (impact of sleep disturbance), the World Health Organization Quality of Life Scale, and the newly developed scale. Content validity, exploratory factor analysis, and confirmatory factor analysis were used to assess validity. Reliability was evaluated using Cronbach's alpha, McDonald's omega, and split-half reliability.

The final scale consists of 23 items and two sub-dimensions: Physical-Psycho-Spiritual and Environmental-Sociocultural. Mean scores range from 1 to 5, with higher scores indicating a greater negative impact of sleep disturbance on quality of life. These findings suggest that the scale may capture the multidimensional impact of sleep disturbance on quality of life. Reliability coefficients were 0.96 for both sub-dimensions and 0.98 for the overall scale. However, the confirmatory factor analysis results indicated an acceptable yet borderline model fit, particularly with respect to the RMSEA value, and therefore should be interpreted with caution.

The Effect of Sleep Disturbance on Quality of Life Scale may offer a theory-based approach to assessing how sleep disturbances relate to patients' quality of life. It may assist healthcare professionals in clinical assessment by helping to identify the multidimensional impact of sleep-related problems and could potentially contribute to clinical decision-making and care planning. The findings suggest that the scale demonstrates adequate psychometric properties and may be a useful tool for research, education, and clinical practice. In addition, criterion-related validity showed correlations ranging from weak to moderate levels, indicating partial support rather than strong evidence. These findings should therefore be interpreted with caution, as the observed correlations provide limited rather than conclusive evidence of criterion validity.

The scale appears to be a valid and reliable tool for assessing the impact of sleep disturbance on quality of life. The scale may provide a theory-based framework for assessing patient needs, which may support holistic assessment and individualized care.

Dietary changes are essential for managing metabolic dysfunction-associated steatotic liver disease (MASLD), yet patients often face barriers related to knowledge, skills, cost, time, and cultural fit.

The purpose of this paper is to report a process for culturally tailoring a dietary intervention and its application to create a calorie-restricted meal plan for Mexican and Central American patients with MASLD. Guided by the Theory of Planned Behavior and user-centered design, we produced a culturally tailored seven-day structured meal plan aligned with dietary guidelines for MASLD and weight loss.

We conducted a three-phase, mixed-methods process among Mexican/Central American patients with MASLD from a safety-net healthcare system in Houston, Texas (n = 25). Phase 1 characterized meal patterns and preferences through semi-structured interviews. Phase 2 integrated findings with clinical nutrition guidelines to develop structured meal plan prototypes at 1200-, 1500-, and 1800-calorie levels. Phase 3 tested usability through ecological momentary assessments and daily interviews.

Participants typically consumed home-cooked meals centered on animal protein, legumes and simple grains, with lunch and dinner preparation being most challenging. Recipe modifications focused on increasing fiber and reducing fat and refined carbohydrates. Usability testing showed that participants found the plans culturally aligned and practical, improving portion awareness and dietary self-efficacy.

This study offers a patient-centered process for culturally tailoring dietary interventions and its output, a calorie- restricted meal plan that shows preliminary feasibility and acceptability on user testing. Next steps (underway) are to evaluate the meal plan's larger-scale implementation and impact on dietary change and weight loss.

Help-seeking dilemmas are potential barriers to use of treatment, social interventions, and social support systems. While previously existing scales provided a means of assessing help-seeking intentions, a fundamental gap is their limitation to mental health cases or gender lines. Hence, Help-Seeking Dilemma Scale (HSDS) was developed for assessing help-seeking dilemmas regardless of mental health conditions or gender lines.

The study adopted cross-validation design with 660 participants across three samples. First sample comprised 15 participants (males = 7, females = 8) in an in-depth interview that facilitated the generation of HSDS items. Second sample comprised 446 participants (male = 49.6%, female = 50.0%, unspecified gender = .4%, mean age = 29 ± 11.31 years) randomly split into EFA (n = 227) and CFA (n = 219) subsamples. HSDS was cross-validated with Exploratory Factor Analysis (EFA) in the EFA subsample and Confirmatory Factor Analysis (CFA) in the CFA subsample. Third sample comprised 199 participants (male = 85%, female = 11.5%, unspecified gender = 3.5%, mean age = 31.29 ± 6.55 years) where predictive validity was tested. Data were collected using HSDS, General Help Seeking Questionnaire (GHSQ), Self-stigma of Seeking Help Scale (SSOSH) and Actual Help-Seeking Questionnaire.

EFA revealed sampling adequacy and data appropriateness for factorization [KMO = .910, χ²(231) = 2241.50, p < .0001] and extracted five dimensions, accounting for 62.4% of total variance. CFA confirmed the five-dimensional model of the EFA, with acceptable model fit indices: χ²(160) = 321.041, p < 0.001; CMNI/DF = 2.01; RMSEA = .07 (95% CI: .06 - .08). All HSDS dimensions showed convergent validity. Fornell-Larcker Criterion and Heterotrait-Monotrait (HTMT) ratio confirmed dimensional discriminant validity. Predictive validity showed that HSDS significantly predicted actual help seeking [OR = 1.19, p < 0.001]. Pearson's correlations confirmed discriminant validity between HSDS and SSOSH, r = .14, p < .01, and GHSQ, r = .05, p > .05. All dimensions demonstrated good internal consistency, with reliability score ranging from .79 to .88. Overall internal consistency for HSDS was .95.

HSDS is valid and reliable for assessing help-seeking dilemmas in academic and general populations and without limitation to any gender.

Changing trends in legal recreational cannabis markets necessitates the continuous monitoring of important market metrics such as price, potency, type, and availability of cannabis products which may influence consumer purchasing behavior. After initial legalization of recreational cannabis use in Canada in 2018 and expansion of the legal market in 2019, an increase in product types and decrease in prices were observed. The purpose of the present study was to provide an update on products on offer to cannabis consumers in Ontario, the largest Cannabis market in Canada, five years after initial federal legalization of non-medical cannabis use.

Data were obtained from the Ontario Cannabis Store (OCS) Website, the sole wholesaler and online market in Ontario between January and April 2024. Information on product type, prices, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) potency and plant type was extracted and products were grouped by OCS categories and sub-categories, and by route of administration (Inhaled, ingestible, topical and others).

A total of 1727 products were mapped, of which the majority available were inhaled products, sub-divided into smoking, vaping or concentrates (n = 1271). The majority of inhaled products were predominantly indica-dominant while most ingestible products (e.g. edibles) were mainly sativa-dominant. Most inhaled products were "very strong products", i.e., THC potency of 20% or greater (greater than 97%, 96% and 99% of all dried flower, vaping and concentrate products, respectively). All edibles were within the legally acceptable limit of 10 mg of THC per container. Average prices were lowest for dried flower products ($7.91/g) among inhaled products (pre-rolls: $9.65/g, 510 thread cartridges: $37.7/g, infused flower: $18.66/g). Compared to our previous study in 2022, which utilized data from the same website and similar extraction methods, the total number of products on the legal market declined, while the number of edible products (particularly gummies) and disposable vapes, increased. Prices of all flower products (p < 0.001), most abundant vapes (disposable vapes and thread cartridges: p < 0.001) and soft chews (p < 0.027) decreased in 2024 compared to 2022 at the 5% significance level. Conversely, THC potencies of products available generally increased (p < 0.05).

Given the trend of decreasing price and changes in products available, continuous monitoring of the cannabis market is vital. This is necessary to assess the consequences of legalization and inform legal amendments such as price control and potency limits that may curb potential negative consequences possible with the current market trend.

Cognitive behavioral therapy (CBT) is one of the most widely established treatments for mental disorders in children and adolescents and is empirically supported across a wide range of disorders, including evidence from routine care. However, evidence on long-term maintenance of effects in routine outpatient care is still limited, particularly across diagnostic groups. This study examines the long-term, cross-diagnostic effectiveness of CBT in children and adolescents treated under routine outpatient care conditions.

Analyses are based on pre-existing routine outcome monitoring data from 1225 patients (mean age = 14.00 years, SD = 3.24) receiving CBT, collected between 2017 and 2025. Symptoms were assessed using the parent- and patient-reported Strengths and Difficulties Questionnaire (SDQ) at pre-treatment, post-treatment and at 6-, 12- and 24-month follow-ups. Additional self-rated treatment-success ratings were collected at follow-up (covering expectations fulfilled, perceived helpfulness, problem recurrence and perceived change). Effectiveness was described using group means as well as clinical significance. Pre- to post- and pre- to follow-up changes were analysed using paired Wilcoxon signed-rank tests. Associations between follow-up SDQ scores and self-rated treatment success were examined using partial Spearman correlations controlling for baseline SDQ.

Across both parent- and patient-reported SDQ assessments, total difficulties and problem subscales showed significant improvements from pre- to post-treatment and from pre-treatment to all follow-up time points. Effect sizes were consistently moderate-to-large (r_rb = 0.59-0.77), with sustained effects up to 24 months. Higher follow-up SDQ difficulties were associated with lower self-rated treatment success across multiple follow-up ratings, with strongest associations observed for problem recurrence and change compared to before treatment. Sensitivity analyses restricted to participants in the clinical range at baseline (SDQ ≥ 17) yielded consistent results.

Routine outpatient CBT for children and adolescents was associated with meaningful symptom improvements that persisted up to two years after treatment. Clinically significant change analyses indicated that while many patients showed reliable improvement, a substantial proportion remained classified as unchanged according to conservative criteria. Subjective follow-up ratings were consistent with standardized symptom outcomes, supporting the perceived durability of treatment success under routine care conditions in a diagnostically heterogeneous sample.

Not applicable. This study is an observational analysis of routinely collected data. The analysis plan was preregistered at PsychArchives ( https://doi.org/10.23668/psycharchives.21444 ).

In Spain, induced abortions are covered by the public health system. In the region of Catalonia, under the scope of Primary Care, the Sexual and Reproductive Health Care Units (ASSIR) attend to women who choose to have a medical abortion (MA) up to 9.6 weeks of gestation.

To determine the perception of the quality of care received by women who have undergone a MA in the ASSIR.

Multicentre cross-sectional study, in collaboration with all of Catalonia's ASSIR units. At the follow-up visit after the MA, the women completed the SERVPERF (SERVice-PERFormance) Perceived Quality Satisfaction Scale, validated in Spanish, to evaluate the quality of care received in the dimensions of health professionals, administrative staff, organization, information, clinical aspects, impact of the process, and satisfaction.

Eight hundred and five (86.6%) women completed the SERVPERF MA questionnaire. The mean total SERVPERF score of participants' assessment of care was 96.68 (SD 15.6), with a maximum possible score of 130. The mean score per question across the entire scale was 3.72 (SD 0.6), with a maximum score of 5. The questions with the lowest scores were related to clinical aspects (pain, anxiety, bleeding), with a mean of 2.26 (SD 0.8), and the impact of the process (on life and family relationships), with a mean of 3.25 (SD 1). In contrast, satisfaction (I would use the service again or recommend it to a friend) obtained the highest mean score: 4.47 (0.8). Women who had previously had an abortion reported higher perceived quality (M = 98.54, SD = 14.52) than women without past abortions (M = 95.67, SD = 16.21), p = 0.013.

The overall satisfaction score falls within a favourable range. The clinical aspects of pain, anxiety, and bleeding scored the lowest but did not correlate with a decrease in user satisfaction; participants would return to the center and recommend it to others.

Primary care is often the first point of contact for adults with complex mental health difficulties, yet many experience persistent barriers to accessing timely and appropriate support. Despite policy commitments to integrated and equitable care, there remains a need to better understand how individuals make sense of distress and navigate services that may struggle to meet complex needs. This study aimed to better understand the experiences of adults with complex mental health difficulties as they access primary care services. It sought to further understand how they made sense of their difficulties accessing care and their psychological distress.

This study used a qualitative design with reflexive thematic analysis. Nineteen participants with complex mental health difficulties were interviewed using a semi-structured schedule. They were recruited via their GP practices.

Three themes were identified: participants' desire to understand why they felt the way they did, the mental health condition itself creating barriers to care, and the precarity of self-management and help. An overarching theme of "Contradictions" was evident across all three themes. "Contradictions" included professionals talking of connecting but then distancing, help being offered but never arriving, trauma being present but ignored, and diagnosis getting in the way of receiving care.

Overall, the study provided further evidence that those with complex mental health difficulties are currently underserved in the NHS. Novel insight into their health literacy questioned the assumptions that those with complex mental health difficulties lack understanding; rather, it provides evidence that services need to collaborate effectively with service users to enable better communication.

Social determinants of health (SDOH) are nonmedical factors that impact health outcomes and medication use. As national initiatives and value-based care models prioritize SDOH interventions, pharmacists are uniquely positioned to support these efforts. However, evidence describing pharmacist-led SDOH screening, particularly through collaborations between health-system and community pharmacists, remains limited.

To learn how community pharmacists address SDOH-related care gaps among patients with atrial fibrillation (AF) and how vertically integrated partnerships can strengthen these efforts through the Connect AF program.

Connect AF was developed through partnership among Community Pharmacy Enhanced Services Network USA (CPESN), UNC Health Pharmacy, Pfizer, and Blue Cross Blue Shield North Carolina. Pharmacists administered an adapted SDOH questionnaire to 75 AF patients receiving care at UNC Health and filling oral anticoagulants at five North Carolina CPESN pharmacies. Domains assessed included housing instability, transportation, mental health, food insecurity, community support, safety, and utilities. Pharmacists provided referrals, facilitated resource navigation, documented patient engagement, and completed pre- and post-program feasibility and acceptability surveys.

Connect AF represents a first-of-its-kind alignment between a health system, community pharmacies, a payer, and an industry partner to gain insights on pharmacist-driven SDOH strategies for AF patients.

Data were analyzed descriptively using frequencies and percentages.

Connect AF fostered a collaborative learning environment that enabled each partner to contribute insights, expertise, data, and resources aligned with their role. Mental health (28%), housing instability (20%), and transportation barriers (20%) were most prevalent. Though 16% of patients screened shared needs, most expressed uncertainty about engaging with referred resources (75%). All pharmacists reported strong confidence and intent to continue providing SDOH-related support.

Connect AF demonstrates how pharmacists can address SDOH-related care gaps and provides a scalable model for cross-sector collaboration to enhance patient care coordination.