Explanatory frameworks for mental disorders influence stigmatisation and clinical attitudes. Mechanistic biological explanations often yield negative effects on prognostic optimism and empathy. Evolutionary framings might reduce stigma, but this has rarely been tested empirically.

To experimentally test whether a brief educational intervention presenting an evolutionary explanation of anxiety, compared with a genetic explanation, would influence clinicians' attitudes in directions consistent with anti-stigma goals.

In this pre-registered, multi-site, cluster-randomised trial, 171 practising mental health clinicians across the UK and Ireland were randomised by session to receive a 30 min educational presentation on either evolutionary or genetic explanations for anxiety. Pre- and post-session questionnaires assessed clinicians' optimism regarding patient recovery, perceived efficacy of psychosocial interventions, expected patient willingness to share diagnosis and seek help and perceived usefulness of the information. Data were analysed using Bayesian cumulative ordinal regression models.

In line with pre-registered hypotheses, clinicians rated evolutionary explanations as substantially more useful for patients (odds ratio 5.05, 95% credible interval [2.46, 10.28], latent standard deviation shift 1.07) and for clinicians (odds ratio 3.10, 95% credible interval [1.62, 5.81], latent standard deviation shift 0.76) compared with genetic explanations. Evolutionary explanations also resulted in higher anticipated public willingness to seek psychiatric help (odds ratio 1.79, 95% credible interval [0.93, 3.35]) and share a diagnosis (odds ratio 1.62, 95% credible interval [0.88, 2.97]); optimism about patient recovery (odds ratio 1.58, 95% credible interval [0.71, 3.46]); perceived effectiveness of psychosocial interventions (odds ratio 1.62, 95% credible interval [0.84, 3.10]); and belief in the functional usefulness of negative emotions (β = 0.25 s.d., 95% credible interval [0.01, 0.49]). These effects were driven by both positive pre-post effects of evolutionary education and negative pre-post effects of genetic education compared with pre-education baseline. Exploratory analysis showed further anti-stigma effects.

Framing anxiety through an evolutionary lens substantially improved clinicians' attitudes on various measures of stigmatisation compared with genetic explanations, and was rated as highly useful for both clinicians and patients.

Screening for psychiatric risk in youth at the population level is often constrained by resource limitations and lengthy assessment tools. This study aimed to develop a reduced, psychometrically robust subset of Child Behavior Checklist (CBCL) items to effectively predict transdiagnostic psychiatric morbidity in the youth population.

Data were drawn from a nationally representative sample of 72,109 Chinese youth aged 6-16 years. Initial item screening on the full sample employed unique variance analysis, item-rest correlation tests, and conceptual redundancy checks. A nested case-control subset (approximately 4,500 with diagnoses and 5,000 without) was used for feature selection. Recursive feature elimination with repeated cross-validation was then applied to the nested subset to derive three item sets (n = 35, 69, 98). These were psychometrically evaluated using exploratory graph analysis and confirmatory factor analysis in two age- and gender-stratified samples from the full dataset. Predictive performance was assessed using five machine learning algorithms, trained and tested on a 70/30 split of the nested case-control data.

The 35-item and 60-item subsets achieved high diagnostic accuracy (AUC = 0.88-0.89), with performance comparable to the best-performing larger subsets. Items captured transdiagnostic dimensions including Functional Somatic Symptoms, Neurodevelopmental Dysregulation, Affective-Social Withdrawal, Threat Sensitivity and Cognitive-Perceptual Disturbance, and Disinhibited-Irritable Externalising.

The reduced CBCL sets demonstrated strong diagnostic utility and psychometric soundness. This scalable tool supports transdiagnostic, data-driven screening of youth psychiatric risk at the population level.

This study aimed to investigate the effect of preoperative regular exercise on postoperative mental health in patients undergoing Type II incision surgery. Explore the correlations between preoperative exercise and postoperative mental health in this patient group.

A total of 480 patients who underwent Type II incision surgery at a tertiary Grade A hospital in Pingxiang from July 2024 to June 2025 were enrolled. Preoperative physical activity was assessed via the International Physical Activity Questionnaire (IPAQ) short form, and patients were divided into an exercise group (EH, n = 133) and a nonexercise group (NEH, n = 347) on the basis of the "sports population" criteria in China. Mental health was evaluated via the Hospital Anxiety and Depression Scale (HADS) and the 12-Item Short-Form Health Survey (SF-12) on the 14th postoperative day.

Compared with the NEH group, the EH group had significantly lower postoperative HADS-Anxiety (HADS-A) scores (5.3 ± 2.0 vs. 8.5 ± 3.3) and higher SF-12 Mental Component Summary (MCS, 49.1 ± 7.5 vs. 42.1 ± 8.3) and Physical Component Summary (PCS, 47.3 ± 7.1 vs. 42.8 ± 7.6). Correlation analysis revealed that preoperative regular exercise in the EH group was negatively associated with postoperative anxiety (r = -0.55) and positively associated with the SF-12 PCS (r = 0.72) and MCS (r = 0.60). No significant correlations were observed in the NEH group for anxiety or depression.

Preoperative regular exercise significantly alleviates postoperative anxiety and improves both physical and mental function in patients undergoing Type II incision surgery, with these effects remaining significant after adjusting for confounders. However, its effect on improving postoperative depression is not significant. Additionally, preoperative exercise is closely associated with better postoperative psychological status in the EH group, while the NEH group shows no significant correlations between preoperative activity and postoperative anxiety/depression, and weaker correlations with physical/mental function-suggesting that establishing preoperative exercise habits may be a key factor in promoting postoperative psychological recovery.

This study was aimed at exploring the prevalence of somatic symptom disorder (SSD) in patients with chronic cough and comparing SSD comorbid (SSD+) and non-comorbid (SSD-) groups, including sociodemographic, clinical, psychological, and neuroimaging characteristics.

A total of 463 patients with chronic cough were enrolled. The structured clinical interview from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was used for SSD diagnosis. Clinical features, cough-related assessment and psychological assessment were used to compare the SSD+ and SSD- groups, while functional magnetic resonance imaging (fMRI) was performed in 24 patients (12 SSD+ and 12 SSD-) for neuroimaging comparisons.

SSD was diagnosed in 13.8% (64/463) of all enrolled patients. The prevalence of SSD was greater in patients with refractory chronic cough (27.7%) than those with non-refractory chronic cough (7.8%). The SSD+ group had higher levels of capsaicin cough sensitivity (P = 0.016), anxiety (P < 0.001), and depression (P < 0.001), and lower cough-related quality of life scores (P < 0.001), than the SSD- group. Binary logistic stepwise regression indicated that higher anxiety level, female sex, lower cough-related quality of life, and more doctor visits were predictors of SSD diagnosis. Notably, SSD- patients demonstrated enhanced regional neural activity synchronization in the right cerebellum and mid-cingulate cortex, whereas SSD+ patients exhibited diminished spontaneous neural activity in the lingual gyrus (voxel P < 0.001, cluster P < 0.05, FWE corrected).

SSD was identified in 13.8% of chronic cough patients and in approximately 28% of those with refractory chronic cough. Comprehensive evaluation of psychological in chronic cough patients is essential for early identification and management of SSD comorbidity. Interdisciplinary collaboration, including psychosomatic medicine, may enhance diagnostic accuracy and treatment outcomes in this population.

This study was registered in the Chinese Clinical Trials Register (http://www.chictr.org.cn/) (ChiCTR2400079808). Registration date: January 12, 2024.

Maternal obesity affects approximately 16% of pregnancies worldwide and is a major concern for public health. This condition is associated with elevated risks of adverse outcomes, such as gestational diabetes, hypertensive disorders of pregnancy, and cardiovascular and metabolic disease (CVMD) during the life course. Our long-term experience with the (cost-)effective web-based Smarter Pregnancy coaching program is promising to mitigate these risks and improve lifestyle behaviours as well as maternal and neonatal health outcomes. Here our aim is to describe the rationale and study protocol for a randomised controlled trial (RCT) to investigate the clinical and cost-effectiveness, and implementation potential of Smarter Pregnancy Plus (SP+) from early pregnancy onwards in women with obesity.

The HYGEIA study is designed as a multicentre, two-armed RCT. A total of 930 women with a body mass index ≥30 kg/m² and a singleton pregnancy of ≤14 weeks gestation will be recruited and randomised 1:1 to the intervention (n=465) and control group (n=465). The intervention group will receive six months of digital lifestyle coaching via the SP+ application, supported by at least one video consultation. SP+ is an extended, co-designed and tailored app version for pregnant women with obesity based on the validated SP program. It provides evidence-based coaching on nutrition, physical activity, mental health, folic acid and vitamin D supplement use, and smoking and alcohol cessation. The control group will receive usual care. Data will be collected through validated questionnaires, electronic medical records, financial records, and qualitative stakeholder sessions, guided by the Non adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS)-framework. The primary outcome is the incidence of maternal CVMD during pregnancy, assessed using a composite measure that includes gestational diabetes, hypertensive disorders of pregnancy, and worsening of pre-existing hypertension or diabetes. Secondary outcomes include changes in lifestyle behaviours, maternal and neonatal outcomes, quality of life, and cost-effectiveness. Tertiary outcomes involve patient satisfaction, provider feasibility and a roadmap for nationwide implementation.

The HYGEIA study will provide evidence on the clinical impact, cost-effectiveness, and implementation potential of SP+ as a digital lifestyle intervention for pregnant women with obesity. If successful, SP+ could further enhance routine obstetric care and contribute to improving maternal and neonatal health while reducing healthcare costs.

Dutch Trial Registration number NL-OMON57196 (URL: https://onderzoekmetmensen.nl/nl/node/57196/pdf), date of registration 19-12-2024.

Fatigue is a common symptom in the general population, as well as in several somatic conditions. Despite this, no review has yet examined the occurrence of fatigue across common mental disorders (CMD) such as mood disorders, anxiety disorders, personality disorders, and trauma and stressor related disorders. The objective of the review was to examine the prevalence of fatigue in patients with CMD, how fatigue when fatigue occurs in these populations, and it's relationshop with other outcomes.

We searched in 2026 Medline, PsychInfo, and Embase for studies reporting on fatigue in CMD and conducted a manual search of the included references. Two reviewers independently selected papers and extracted data. Eligible studies were on patients with CMD without somatic illness, that employed a measure designed to assess fatigue. We conducted and reported the systematic review following the PRISMA statement. The evidence was synthesized according to whether it reports on the prevalence of fatigue, or provides data on the temporal occurrence of fatigue in the trajectory of the disorders.

We screened 7861 abstracts, and read full text on 393 papers and finally included 46 papers, of which 40 reported on prevalence. Most research concerned patients with mood disorders. Fatigue was found to be highly prevalent across CMD, with prevalences between 18% and 100%. Research suggests that fatigue can predict the onset of depression and that depression can predict the onset of fatigue.

Fatigue is highly prevalent across patients with CMD and can therefore be regarded as a transdiagnostic symptom. A host of research suggests that fatigue in depression and anxiety can be explained by biological symptoms such as low-grade inflammation. Limitations includes high heterogeneity in the assessment of fatigue across included studies, and few instruments were validated for this population.

The symptom of fatigue was found to be prevalent across samples of patients with CMD, which highlights it as a possible transdiagnostic treatment target.

Advancements in precision medicine, particularly the use of neuroimaging and neurophysiologic techniques, may improve diagnosis, prognosis, and treatment of mental health disorders. Recent efforts to develop large neuroimaging datasets have yielded promising results for identifying mental health biomarkers. This scoping review identifies and characterizes studies of neuroimaging and neurophysiologic techniques used to address a variety of mental health disorders.

We searched MEDLINE and Embase (January 2010-September 2023). Eligible studies examined neuroimaging and neurophysiologic techniques (e.g., magnetic resonance imaging [MRI] or electroencephalogram [EEG]) for diagnosis, prognosis, and/or treatment response for eligible mental health disorders. From eligible studies, we abstracted information on populations, clinical settings, imaging techniques, study designs, outcomes, and analytic approaches.

From 58,824 unique search results, we identified 441 eligible primary studies and 27 systematic reviews addressing mental health disorders. Most studies focused on depressive disorders (k = 320 primary studies [17 systematic reviews]); fewer examined bipolar disorders (k = 61 [3]), posttraumatic stress disorder (PTSD; k = 39 [2]), obsessive compulsive disorder (OCD; k = 26 [1]), anxiety disorders (k = 22 [3]), or substance use disorders (SUD; k = 25 [0]). Three-quarters of primary studies used MRI-based techniques and 20% employed EEG. Two-thirds of studies focused on diagnosis (nearly all cross-sectional); the remaining studies mostly addressed symptom response to various treatments, including antidepressants and psychotherapy. Most primary studies were small (N < 100; k = 263), and generally included y oung and middle-aged adults; only 5 focused on older adults (sample mean age ≥ 65). Studies were most commonly conducted in China (k = 181), the United States (k = 83), or Canada (k = 22).

Although many eligible studies evaluated MRI or EEG for diagnosis and/or treatment response for depressive disorders, most were small and cross-sectional. There was less existing evidence examining other neuroimaging techniques or focusing on other mental health disorders (PTSD, OCD, anxiety disorders, or SUD). Given these evidence gaps, it is likely premature to implement neuroimaging and neurophysiologic tests in clinical settings. To determine clinical utility, future research should use large samples in longitudinal designs and investigate a broader set of disorders.

https://doi.org/10.17605/OSF.IO/5PHG2 .

not applicable.

Home-based physical exercise is an accessible strategy to help maintain physical functioning in adults over 50, but mobility gains may be limited without direct supervision. By improving cognitive processes involved in motor control, cognitive training may help enhance the effectiveness of home-based physical exercise in preventing age-related decline in mobility. This study compares the effects of a six-month home-based physical exercise, with or without cognitive training, on gait speed and balance.

127 community-dwelling adults aged 50-87 years (mean 65.20 ± 7.93; 76% women) were randomly assigned to (1) home-based, remotely monitored physical exercise alone (n = 64; 72% women) or (2) combined with cognitive training (n = 63; 81% women) for six months. The primary outcome was the change from baseline in usual gait speed, measured by the 4-meter walking test. Secondary outcomes included fast gait speed, balance (one-leg stance test), and lower-limb strength (five-time sit-to-stand test), all of which were assessed via videoconference at 3 and 6 months. Changes in outcomes were analyzed using adjusted mixed linear models with intervention group, time (ΔT0-T3, ΔT0-T6), and their interaction as fixed effects.

Change in usual gait speed did not differ between groups. In contrast, the combined group showing greater improvements than the physical exercise alone group in fast gait speed (+ 0.07 m/s; F(1,199) = 6.24, p = 0.013, η²p ≃0.03) and one-leg balance test (+ 3.83 s; F(1,202) = 6.05, p = 0.015, η²p ≃0.03) in response to intervention. No significant group × time interaction was observed, indicating similar changes at 3 and 6 months.

Adding cognitive training to home-based physical exercise may improve fast gait speed and balance in adults aged 50 and above. These findings support the interplay between sensorimotor and cognitive functions in older adults and suggest that combined physical and cognitive interventions could help prevent age-related mobility decline.

COVEPIC was retrospectively registered on November 19, 2020.

NCT04635462. https://clinicaltrials.gov/ct2/show/record/NCT04635462?term=NCT04635462&draw=2&rank=1.

This study analyses the most common types of insomnia and comorbidities in patients referred to our sleep unit's neurology consultation, and how these patients are managed.

We conducted a retrospective, observational, descriptive study of consecutive patients diagnosed with insomnia at our hospital's sleep unit between January and December 2023, inclusive.

Of the 200 patients registered in 2023, 127 (63.5%) were diagnosed with insomnia. Of these, 64 were women (50.39%) and 63 were men (49.60%), with a mean age of 53.24 years (SD: 15.372). In our sample, the main aetiology or associated comorbidity of insomnia according to the American Academy of Sleep Medicine classification (insomnia associated with mental illness, medical illness, and other sleep disorders) was as follows: 77 patients (60.62%) with active mental disorder at the time of the consultation (anxiety, dysthymia, depression, hyperalertness/stress/rumination) and 30 patients with insomnia associated with a medical illness. The following sleep comorbidities were observed: periodic leg movements (n = 9), restless legs syndrome (n = 15), and obstructive sleep apnoea (n = 45). Of the 31 patients with insomnia associated with medical disorders, 16 also presented reactive anxiety/depression that contributed to the persistence or worsening of insomnia. Of the total 127 patients, 77 patients had insomnia associated with a mental condition, and 16 had insomnia secondary to both medical and mental conditions (73.22%).

Insomnia associated with mental conditions (depression, anxiety, dysthymia) is the most common type of insomnia. Its prevalence has increased since the COVID-19 pandemic, and now accounts for two-thirds of the patients assessed at the neurology consultations of sleep units. Idiopathic insomnia accounts for barely one-tenth of cases. Patients with chronic insomnia would benefit from initial assessment by mental health professionals, who are able to diagnose the most prevalent comorbidities and triggers, as well as other disorders that are frequently overlooked by other professionals. This approach would also improve the identification of patients eligible for cognitive-behavioral therapy, the first line of treatment for insomnia according to clinical guidelines, ultimately improving patient care and healthcare resource management.

Olfactory dysfunction is an early feature of schizophrenia, but its structural brain network basis remains unclear, especially in ultra-high risk (UHR) individuals.

We recruited 99 drug-naive first-episode schizophrenia patients (FES), 72 UHR individuals (followed for 2 years), and 69 healthy controls individuals (HC). Olfactory function was assessed by using the Odor Stick Identification Test for the Japanese (OSIT-J). Structural MRI data were processed to measure cortical volume and thickness across 8 brain networks. General linear models and partial correlation analyses were conducted. Mediation analysis assessed whether brain network alterations mediated the relationship between olfactory function and symptoms. Logistic regression assessed psychosis conversion in UHR.

Both FES and UHR groups exhibited reduced OSIT-J scores and decreased brain network volumes compared to that of the HC group (p_-FDR < 0.05), with the default mode network (DMN) and frontoparietal network (FPN) showing the strongest associations with olfactory performance. Mediation analysis revealed that DMN and FPN volumes mediated the relationship between olfactory impairment and clinical symptoms in both FES and UHR. Poorer OSIT-J scores predicted psychosis conversion in UHR (OR = 0.35, p = 0.009), with the combined OSIT-J and intracranial volume model achieving high predictive accuracy (AUC = 0.86).

Olfactory impairment is closely linked to structural alterations in DMN and FPN, which mediate its impact on symptoms. When combined with structural brain measures, the OSIT-J may contribute to risk assessment of UHR transition to schizophrenia.