Metabolic dysfunction-associated steatohepatitis (MASH) is associated with a substantial symptom burden. However, no validated symptom-focused patient-reported outcome (PRO) instrument exists for this population. We aimed to develop and validate the MASH Symptom Questionnaire.

We analyzed MASLD subjects from the Global NASH/MASH Registry (GNR) with clinical data and completed CLDQ-MASH instruments. For the new instrument development and preliminary validation, we used CLDQ-MASH items supplemented with symptom-related items from other generic instruments (development sample: n=2,066) and expert input. A list of 50 symptom-related items was identified. After removal of redundancy, 36 items were retained and evaluated using exploratory factor analysis. Standard pipeline for validation of a PRO instrument was applied. The instrument was validated using another independent validation sample from GNR (validation sample: n=2541).

In the development phase, 36 items were distributed in 8 symptom domains: Mental, Cognitive, Fatigue, Systemic, Abdominal, Health distress, Sleep Disturbance, and Peripheral symptoms domains. Seven of eight domains demonstrated Cronbach's alpha >0.80 (high internal consistency); the remaining Peripheral symptoms domain included diverse items. The domain scores significantly discriminated across histologic disease severity (early fibrosis vs. F2-F3 vs. cirrhosis), liver stiffness categories (<10 vs. 10-20 vs. >20 kPa) in both development and independent validation samples. The instrument discriminated well based on non-hepatic comorbidities (type 2 diabetes, hypertension, psychiatric, sleep, pruritus, clinically overt fatigue, GERD, other GI disorders). Similar strong validation properties were noted in the independent validation sample.

The 36-item, 8-domain CLDQ-MASH Symptom Questionnaire (CLDQ-MASH SQ) represents the first validated, disease-specific symptom questionnaire for patients with MASH showing good psychometric properties. With further external validation, the CLDQ-MASH-SQ has the potential to serve as a standardized tool in both clinical research and routine practice to comprehensively assess disease burden and treatment response.

Emotion regulation and memory control are indispensable for well-being, yet their interplay remains poorly understood. In this preregistered electroencephalogram (EEG) study, we investigated how emotion regulation influences the subsequent control of negative memories. Participants learned object-aversive scene pairings and were then instructed to either naturally watch or actively reappraise the aversive scenes. They subsequently completed an EEG-based Think/No-Think (TNT) task, where they either retrieved or suppressed the retrieval of aversive scenes in response to Think or No-Think object cues while reporting any intrusions they experienced. Different from our initial hypothesis, preregistered analyses showed that during retrieval suppression, reappraised memories were associated with larger centro-parietal P300 than watched scenes. Consistently, in the post-TNT recall test, participants recalled more details and reported lower negative emotions related to these reappraised scenes than the watched scenes. These results suggest that cognitive reappraisal may preserve the episodic content of negative memories while lessening their emotional impact during recall. This finding holds significant clinical potential, as it could enable individuals to retain valuable information from adverse experiences without being overwhelmed by distress. Additionally, it may help address reduced memory specificity in affective disorders, offering a promising avenue for therapeutic intervention.

This study aimed to compare written exposure therapy (WET) using the group therapy method for post-traumatic stress disorder (PTSD) in reserve combatants who participated in the October 7th War with other group therapies: psychoeducational group therapy, stress inoculation training (SIT), and cognitive processing treatment (CPT).

This retrospective observational cohort study analyzed the records of 133 Israeli army reservists who took part in the war and filled out questionnaires upon admission for evaluation at the Israel Defense Forces Combat Stress Reaction Unit (94.7% combatants, of whom 98.5% males; mean age = 29.03, SD = 6.28). The dependent variable was dropout. The independent variables included exposure to combat events and PTSD for DSM-5 (PCL-5) self-report questionnaires. Both dependent and independent variables were compared between different therapeutic approaches: WET, psychoeducational group therapy, SIT, and CPT.

Independent samples t-tests indicated that dropout was not significantly associated with age, PTSD symptom severity, or level of combat exposure. Cox proportional hazards regression revealed significantly higher treatment retention in the WET group-based interventions compared with other group-based treatments. Participants in -non-WET group therapies showed significantly increased dropout hazard (B = 1.70, SE = 0.79, Wald = 4.65, P = .031), with a hazard ratio of 5.49 (95% CI, 1.17-25.79).

Group-based WET was associated with higher treatment retention compared with other group-based therapies, highlighting substantial potential in ensuring therapeutic continuity and treatment engagement. However, it remains unclear if this translates into better clinical outcomes.

To investigate stroke survivors' preferences and preference heterogeneity regarding mental health services in China.

A cross-sectional study design was employed.

A discrete choice experiment was conducted to elicit preferences for mental health services among 322 stroke survivors recruited from three tertiary hospitals in Henan Province. Six key attributes were identified through literature review, qualitative interviews and expert consultation: service content, delivery method, group size, provider type, session duration and out-of-pocket expenses. Mixed logit and latent class models were used to analyse preferences and explore heterogeneity.

This study followed the STROBE checklist.

Patients showed a strong preference for less expensive services, smaller group sizes and shorter session durations. Services provided by clinical nurses and delivered face-to-face were also preferred, although delivery mode was less influential overall. Emotion regulation was the most favoured content type. Latent class analysis revealed three distinct preference groups: a general-oriented group, a face-to-face prioritized group (primarily older patients) and a personalization-focused group (primarily higher-income patients). Patient age, income level and prognosis were significant factors influencing preference heterogeneity.

Mental health service preferences among Chinese stroke survivors vary considerably. Out-of-pocket costs, group size and session length are key determinants of choice. Tailoring service delivery to reflect patient preferences, such as offering nurse-led, cost-effective and flexible interventions may enhance acceptance and adherence. Policymakers and healthcare administrators should integrate preference-based strategies into stroke care planning to improve psychological outcomes.

Stroke patients were involved as participants in this study for data collection.

Mental health service content, delivery method, group size, service providers, duration of each session and out-of-pocket expenses have an impact on mental health service preferences of stroke patients. Mental health services whose content is emotion regulation, face-to-face, small group (3-5 participants), provided by clinical nurses and with a single session lasting 15 to 30 min are more likely to be accepted by patients. There is heterogeneity in mental health services for stroke patients, and this study highlights the importance of tailored mental health services.

Sleep disturbances are prevalent among adolescents. This study aims to examine the associations between parental phubbing (PP), loneliness, and sleep quality (SQ), with a specific focus on investigating the mediating role of loneliness in these relationships. A cross-sectional survey was conducted among 1,079 students from two medical colleges in Chongqing, China. Data were collected on demographic characteristics, the Parental Phubbing Scale, the Simplified Loneliness Scale, and the Pittsburgh Sleep Quality Index (PSQI). Pearson correlation analysis was performed to assess the linear relationships between variables, while a structural equation model (SEM) was constructed. The bootstrap method was applied to evaluate the mediating effect of loneliness. The findings revealed that 80.72% of participants were classified as having poor SQ. PP showed a significant positive correlation with loneliness (r = 0.221, p < 0.001) and with the PSQI score (r = 0.199, p < 0.001). Loneliness also demonstrated a positive association with the PSQI score (r = 0.368, p < 0.001). Furthermore, loneliness was found to significantly mediate the relationship between PP and SQ (indirect effect: β = 0.131, 95% CI: 0.093-0.171, p < 0.001). PP was associated with poorer SQ directly and indirectly through heightened loneliness. These findings underscore the critical role of family behaviors in shaping adolescents' mental health and SQ, highlighting the importance of reducing PP and fostering healthier parent-child interactions.

Lacunar stroke can cause cognitive decline and dependency. The LACI-2 (Lacunar Intervention Trial-2) trial showed that 12 months of treatment with isosorbide-mononitrate (ISMN) or cilostazol improved these outcomes. We tested whether this effect was present at 6 months.

LACI-2 was a prospective randomized open-label blinded-end point 2×2-factorial phase-2b trial assessing feasibility, safety, and proof-of-concept of 1 year of ISMN (40-60 mg) or cilostazol (200 mg). Participants aged >30 years had clinical lacunar stroke, compatible neuroimaging, and capacity to consent. The primary clinical outcome was the composite of stroke, myocardial infarction, dependency (modified Rankin Scale score >2), cognitive impairment (Diagnostic and Statistical Manual version 5, 7-level >0) and death; key secondary outcomes included the composite components, mood and stroke impact scale. Global analysis of the stroke impact scale was analyzed using the Wei-Lachin test with result given as Mann-Whitney difference.

Baseline characteristics were balanced across 363 participants: median age 64 (56-72) years, 31% female, and median onset to randomization 79 (27-244) days. At 6 months, participants allocated to ISMN versus control had fewer composite events (adjusted odds ratio [OR], 0.74 [95% CI, 0.55-0.99]) and improved stroke impact (Mann-Whitney difference, -0.15 [95% CI -0.25 to -0.05]). Cilostazol versus control improved cognition (Diagnostic and Statistical Manual version 5, 7-level scale, adjusted common OR, 0.64 [95% CI, 0.41-0.99]). ISMN/cilostazol versus control improved cognition (Diagnostic and Statistical Manual version 5, 7-level adjusted common OR, 0.40 [95% CI, 0.21-0.78]), mood (Zung adjusted mean difference, -6.94 [95% CI, -12.25 to -1.64]) and global stroke impact (Mann-Whitney difference, -0.23 [95% CI, -0.37 to -0.09]).

A reduction in the composite outcome, cognitive impairment, dependency, and stroke impact was seen within 6 months of starting ISMN or cilostazol.

URL: www.isrctn.com; Unique Identifier: ISRCTN14911850.

Effective treatment and care of substance use disorders requires reliable and valid diagnosis. Their diagnosis in mental health services reportedly remains inconsistent despite their prevalence and associated harms.

This study examines routine substance use disorder diagnosis across public adult mental health services to identify patterns. Care recorded in the statewide electronic health record of 58,724 adults over 4 years was analysed. Substance use disorder diagnosis, specified and aggregated by substance class and clinical state, was compared across gender, age, substance class and diagnostic groups.

Substance use disorder was present in 34.4% of patients. Common specific substance classes were nicotine, cannabinoids, alcohol and stimulants (excluding cocaine). The most common class at 14.1% was multiple and other drug use. Of those with any substance use disorder, 45.3% had multiple and other drug use or other residual use disorders and 21.3% had substance-induced psychosis. People with schizophrenia had higher proportions of substance use disorders than the entire cohort.

Substance use disorder diagnostic practice lacks specificity and consistency with diagnostic classification guidance. Disorders requiring combined consideration of aetiology and comorbidity, including 'multiple and other drug use' disorders and substance-induced psychosis, may be over-diagnosed. Nicotine use disorder is likely under-diagnosed.

Improving diagnostic specificity is central to effectively treating substance use disorders. Non-specific substance use disorder diagnoses, including 'multiple and other drug' use, should be avoided unless necessary. Specific substances should be named. Consistent use of diagnostic classifications and ongoing diagnostic review are vital for diagnostic clarification and specific treatment.

The ketogenic diet (KD) is gaining increasing interest as a metabolic intervention for neuropsychiatric disorders, including mood disorders. However, its potential role in clinically relevant affective changes, such as hypomania or mania, remains insufficiently characterized.

We present the case of a woman with a previous history of major depressive episode with psychotic symptoms and a posterior history of recurrent episodes of mild depression, who never achieved complete symptom remission. In an effort to ameliorate her chronic depressive symptoms, the patient started a KD for approximately 6 months. Metabolic monitoring included daily capillary measurements of glucose and ketone levels, with calculation of the glucose-ketone index (GKI) to assess ketosis and dietary adherence. Anthropometric parameters and physiological variables were recorded longitudinally. Laboratory assessments were performed before, during, and after the intervention. Psychiatric outcomes were evaluated using clinical scales, including the YMRS, PANSS, CGI, GAF, WHODAS and OAS, allowing assessment of symptom severity and clinical evolution. Pharmacologic, dietary, substance-related, sleep-related, and psychosocial exposures were reconstructed across clinically relevant phases.

After KD initiation, the patient reported improved mood and vitality, increased energy, reduced need for sleep, slight euphoria, and increased goal-directed activity. This period was retrospectively interpreted as possible hypomania. Four months after KD initiation, in the context of ongoing venlafaxine treatment (112.5 mg/day), absence of mood-stabilizing treatment, psychosocial stressors, reduced sleep and increased alcohol intake, and possible dietary drift, she developed a manic episode with psychotic features requiring urgent psychiatric care and home hospitalization. Symptoms remitted after antipsychotic treatment, lithium initiation, venlafaxine dose reduction, and temporary KD interruption. After remission, the patient chose to restart a less intensive KD under close supervision.

This case describes hypomanic symptoms and subsequent mania temporally associated with KD in a patient taking venlafaxine with prior antidepressant-associated hypomanic symptoms and later diagnostic reclassification to bipolar I disorder. To our knowledge, it is the first report providing a longitudinal characterization of metabolic parameters in relation to the clinical course of mania. The case highlights the need to monitor mood, sleep, alcohol use, antidepressant exposure, dietary adherence, and ketosis when KD is considered in mood-disorder populations.

We report the first detailed immunological characterization of a DEGCAGS patient, showing that biallelic ZNF699 loss-of-function variants can cause syndromic combined immunodeficiency and that DNA methylation profiling improves diagnostic precision in selected inborn errors of immunity.