Insomnia and anxiety are highly prevalent and often comorbid in older adults. Although cognitive behavioural therapy is the first-line treatment for insomnia, few interventions simultaneously address both conditions. Furthermore, access remains limited by provider availability and high costs. To address these gaps, we developed an online CBT programme for insomnia and anxiety (eCBT+). This randomised controlled trial aimed to assess the usability and acceptability of the eCBT+ programme and evaluate its efficacy in older adults with insomnia. Eighty older adults with insomnia were randomised to the eCBT+ intervention (n = 38) or a waitlist (WL) control condition (n = 42). Platform usability and programme acceptability were assessed post-intervention using the System Usability Scale (SUS) questionnaire and the extended Technology Acceptance Model questionnaire. Insomnia and anxiety symptoms were evaluated with the Insomnia Severity Index (ISI) and Geriatric Anxiety Inventory (GAI) respectively, along with sleep-diary-derived sleep efficiency, at baseline and follow-up. Linear mixed models with an intention-to-treat approach assessed the Group*Time interaction. The platform was considered user-friendly (SUS = 69.94%). Perceived ease of use, perceived usefulness and result demonstrability were the main contributors to acceptability. The eCBT+ group showed reduced ISI and GAI and increased sleep efficiency, from baseline to follow-up, compared to the WL group (Ps < .001). The eCBT+ programme was user-friendly and its use was acceptable in older adults with insomnia. The programme improved sleep efficiency and reduced insomnia and anxiety symptoms, demonstrating the efficacy of our eCBT+ intervention. Web-based tools offer a promising approach to promote sleep and mental health among older adults (https://www.isrctn.com/ISRCTN15338211).

Over the past decade, neuropsychopharmacology has shifted from stagnation to momentum, with first-in-class mechanisms and biomarker-enabled trials spanning psychiatry and neurology.

We narratively synthesized advances from 2013 to 2026 across central nervous system (CNS) discovery and development, including pivotal trials, regulatory actions, digital/real-world evidence, genetics, artificial intelligence (AI), and implementation/global-access themes that are endorsed by international societies.

Therapeutic gains include rapid-acting drugs for treatment-resistant depression (intranasal esketamine); psychedelic-assisted therapy for posttraumatic stress disorder and depression; neuroactive steroid γ-aminobutyric acid-A receptor positive allosteric modulators (brexanolone, zuranolone) for postpartum depression; non-dopaminergic muscarinic agonists (xanomeline-trospium) for schizophrenia; orexin receptor antagonists for insomnia; and anti-amyloid monoclonal antibodies (lecanemab, donanemab) for early Alzheimer's disease. Persistent barriers include high mid-/late-stage attrition that is driven by placebo effects, subjective endpoints, and preclinical-to-clinical gaps; regulatory and economic headwinds; and limited generalizability from tightly run trials. Emerging enablers include adaptive/platform designs, digital health technologies, patient-reported outcomes, and clinical outcome assessments, real-world evidence (RWE), AI/machine learning (ML), genetics for target de-risking and biomarker-guided stratification, and publicly accessible large CNS relevant biological datasets.

To convert momentum into durable progress, we recommend: (i) deeper academia-industry/stakeholder collaboration and sustained funding for high-risk/high-reward science from industry, governments and non-for profit foundations; (ii) modernized regulation (flexible evidentiary paths, novel endpoints, and clear guidance on adaptive/platform trials); (iii) data-driven development integrating RWE, AI/ML, and precision medicine; (iv) the adoption of Neuroscience-based Nomenclature (NbN); and (v) a global-access mandate with essential-medicine inclusion, equitable pricing/licensing, capacity building, tele-enabled mental health, and geographically diverse research. Aligning scientific innovation with implementation and equity can accelerate translation and ensure new treatments benefit patients worldwide.

To evaluate the Brief Digital Intervention Program, developed in response to pandemic-era disruptions in school mental health care and the need for flexible and scalable interventions with integrated measurement for students with mild-to-moderate difficulties. The program comprises four brief, digital interventions that teach transdiagnostic, evidence-based skills (relaxation, cognitive restructuring, problem solving, and practicing the opposite of unhelpful behavior), and includes an embedded progress monitoring tool for routinely measuring students' internalizing and externalizing difficulties and "top problems" session-by-session. Study goals were to: 1) examine the acceptability of the intervention; 2) describe barriers and facilitators to its use; and 3) examine pre-post changes in student-reported difficulties.

Data were examined from 53 school mental health professionals who implemented the intervention with 213 students (M_age = 13.41 years; 63.3% cisgender girls, 27.1% cisgender boys, 9.5% another gender) presenting for mild to moderate mental health concerns from 2021-2024.

Professionals and students reported high satisfaction with the intervention. Commonly reported barriers included difficulties with technical navigation and time for training; facilitators included ease of use/accessibility of the technical features and student engagement. Results indicated significant reductions in internalizing difficulties, β = -0.42, p < .001 [small-to-medium effect], externalizing difficulties, β = -0.15, p = -.04 [small effect], and top problem severity, β = -1.01, p < .001 [large effect], from pre- to post-intervention.

Findings provide preliminary support for the acceptability and potential benefits of the Brief Digital Intervention Program for school mental health care. Next steps include evaluation using a controlled, randomized design and testing sustainability.

Global adolescent-level food insecurity (AFI) and common mental disorders (CMD) represent a significant public health burden. While household-level food security is known to be associated with mental health disorders, there is a dearth of evidence regarding the specific association between AFI and CMDs in Ethiopia, particularly in the Harari Regional State.

A school-based cross-sectional study was conducted among 3,326 adolescents in the Harari Regional State, Eastern Ethiopia, utilizing a multistage sampling strategy stratified by locality and school type. Data were collected using validated scales adapted from previous studies, including the HFIAS for adolescent-level food insecurity, KIDSCREEN-10 for health-related quality of life, the Rosenberg Scale for self-esteem, and the SDQ-25 for CMDs. Data were collected using a structured questionnaire translated into Amharic and Afan Oromo and pre-tested for validity. A guided self-administration approach was employed by eight trained BSc nurses and psychiatric nurses. All data collectors and supervisors underwent rigorous training to ensure data quality. Questionnaires were subjected to daily checks for completeness during fieldwork, and double data entry was utilized for final validations and accuracy. Data were analysed using STATA version 16.1. Prior to analysis, data were screened for outliers, missing values, and normality. The structural equation model (SEM) demonstrated a good fit to the data (RMSEA = 0.03, CFI = 0.90, TLI = 0.89 and SRMR = 0.05), confirming the structural integrity of the model prior to the interpretation of path coefficients. We conducted SEM using maximum likelihood estimation after adjusting for relevant covariates.

The descriptive results revealed that 14.50% of adolescents experienced moderate-to-severe food insecurity, while the prevalence of CMDs was 22.93%. Several factors were significantly associated with the prevalence of CMDs. AFI was linked to a higher likelihood of CMDs (β = 0.20, P < 0.001), as were substance use (β = 0.14, P < 0.001) and frequent financial difficulties (β = 0.06, P < 0.001). Conversely, higher quality of life (β = -0.07, P < 0.001) and stronger self-esteem (β = -0.06, P < 0.001) were associated with a lower likelihood of CMD symptoms. Furthermore, urban residency emerged as a protective factor, showing a significant negative association with CMDs (β = -0.21, P < 0.001).

AFI significantly predicts the occurrence of CMDs. A relationship is further driven by poor quality of life, diminished self-esteem, substance use, and financial instability. The study highlights the need for tailored interventions to tackle these functional drivers, suggesting that addressing food insecurity and its associated psychosocial factors is essential to reduce adolescents' CMD burden.

Psychosis remains a significant global health challenge, with people in low- and middle-income countries (LMICs) like Malawi disproportionately impacted. Yet, little is known about community perspectives, treatment-seeking practices, and acceptable pathways for psychosis management. This study explored diverse community perspectives of psychosis to inform the development of a community-based psychosis detection and management system. This exploratory qualitative study was conducted in Malawi's Salima and Chiradzulu districts between October and December 2023. Seventy-six participants, including traditional healers, religious leaders, caregivers, and PWLE, were purposively sampled for 16 in-depth interviews (IDIs) and six focus group discussions (FGDs). Data were collected using semi-structured interviews, transcribed, and thematically analysed. The majority across all participants largely attributed psychosis to witchcraft, smoking cannabis, and alcohol use. Traditional healers and religious leaders were commonly the first points of care, and preferred over biomedical services. Participants recommended active community involvement, engagement of health surveillance assistants (HSAs), stronger partnerships between community leaders and health workers, and resource availability for an ideal community-based psychosis detection and management system. Cultural norms and practices strongly influence psychosis care pathways in Malawi, in the context of severe economic challenges which shape the provision of healthcare. Future interventions should prioritise culturally sensitive community outreach programs to improve psychosis management.

Menstrual stigma, characterized by negative beliefs, attitudes, and practices surrounding menstruation, often leads to the social exclusion and discrimination of menstruators. The intersection of menstrual stigma and period poverty, which is marked by limited access to menstrual hygiene products and safe sanitation has a profound impact on the mental health and well-being of adolescent girls, particularly in low- and middle-income countries. This study aimedto examine the associations between menstrual stigma and mental health (Mood and Feelings Questionnaire) among female adolescents aged 10-20 in primary schools in Panyijar County, South Sudan. Cross-sectional baseline data were analyzed from a school safety evaluation using unadjusted and adjusted linear regression models In unadjusted analyses, knowing whether female classmates had their period was significantly associated with poorer mental health (β = 1.75, p < 0.001). Feeling ashamed if boys knew about one's period was also associated with poorer mental health (β = 1.49, p = 0.05). In individually adjusted models, ajusting for demographic characteristics, feeling the need to hide one's period was associated with better mental health (β = -1.80, p = 0.02). In fully adjusted models, which included all stigma variables and demographic controls, hiding one's period remained significantly associated with mental health (β = -1.99, p = 0.04), while knowing when a classmate had their period showed a marginal association with poorer mental health (β = 0.88, p = 0.08). Disability was significantly associated with poorer mental health (β = 2.52, p < 0.01), while displacement showed a marginal association (β = 0.84, p = 0.06). No other demographic variables retained significance. These findings highlight the need for comprehensive strategies that address menstrual stigma and its impact on mental health, including interventions that challenge harmful social norms, promote safe latrine environments, and ensure access to hygiene products and menstrual education.

Managing chronic pain is challenging for primary care physicians (PCPs). Sixty percent do not feel confident in pain management skills, which negatively impacts patients. We developed a multidisciplinary electronic consult (eConsult) program that integrates primary care, psychiatry, and pharmacy to guide safe, evidence-based long-term opioid therapy (LTOT). Patients were referred by their care team or identified via chart review as being on LTOT. The E-consult team was comprised of two PCPs, one consult-liaison psychiatrist, and three pharmacists, as well as rotating trainees in the three specialties (internal medicine, psychiatry, and pharmacy). eConsults reviewed medical and psychiatric histories and treatments to recommend additional testing and evidence-based management. Follow-up chart reviews at 3, 6, and 12 months evaluated changes in oral morphine equivalents (OME) and follow-through on recommendations. There was a statistically significant reduction in OME for all populations at 12 months compared to baseline, as well as when psychiatric recommendations were followed versus not followed. eConsults are a unique approach to a growing population of patients with complex chronic pain that allow PCPs access to a multidisciplinary team with expertise.

Self-regulatory fatigue is an emerging concern within nursing education, with implications for professional competence, emotional resilience, and long-term career development. To assess the level of self-regulatory fatigue among nursing interns and explore its related influencing factors.

A total of 340 nursing interns participated in this survey. Data were collected from March to December 2024 using an online survey comprising a general information questionnaire, the Perceived Stress Scale (PSS), the Adolescent Mental Health Literacy Assessment Questionnaire (AMHLAQ), and the Psychological Detachment Scale. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple linear regression analyses were conducted.

Perceived stress (β = 0.47, p < 0.001), mental health literacy (β = -0.13, p = 0.008), psychological detachment (β = -0.10, p = 0.025), academic performance (β = 0.15, p < 0.001), length of clinical placement (β = -0.11, p = 0.016) and left-behind experience (β = -0.10, p = 0.032) were significant predictors of self-regulatory fatigue. The model explained 39.1% of the variance in self-regulatory fatigue.

Nursing interns showed a moderate level of self-regulatory fatigue. Three psychological factors, namely, perceived stress, mental health literacy, and psychological detachment, along with academic performance, clinical placement duration, and left-behind experience, were significantly associated factors of self-regulatory fatigue. These findings suggest that targeted strategies should be developed to mitigate interns' fatigue and promote their holistic health.

Robust empirical evidence supports the effectiveness of physical and cognitive training in preventing and delaying cognitive decline. Emerging research suggests distinct neurobiological mechanisms underpin the effects of these different training modalities. An unresolved question is whether the mechanisms through which these training modalities impart their effect interact synergistically to improve cognitive outcomes, rather than exerting additive effects, differ. In addition, past research has been inconsistent in adequately controlling for or documenting the dosage of physical and/or cognitive training. Consequently, the aim of this study is to assess the relative effectiveness of physical and cognitive training conducted in isolation or concurrently, whilst rigorously controlling and documenting the treatment parameters.

This study is a three-arm randomised controlled trial conducted over a 3-month period, comparing cognitive training, physical activity, and a combination of both interventions. Older cognitively healthy participants (n = 126) aged 60-75 years will be recruited from the community. The physical only training will require participants to cycle on a cycle ergometer at above 60% of their age-predicted heart rate maximum for 50 min with a 3-min warm-up and cool-down period. The cognitive only training will require participants to complete up to five different cognitive tasks selected from a set of eight on the BrainHQ platform during each 50-min training session. The concurrent cognitive and physical training will require participants to undertake both treatments at the same time. Primary outcomes, assessed pre- and post- intervention, will include speed of processing and episodic memory assessed with the NIH Toolbox, as well as general driving skills assessed on a driving simulator.

Findings will inform the design of interventions and population health advice aimed at mitigating cognitive decline. If a substantial synergetic effect is detected, it may lead to the use of more widespread concurrent physical and cognitive training and the potential development of methods to make concurrent training practical. Findings will also provide important clarification as to the relative benefit of the two modes of training.

Prospective registration with Australia and New Zealand Clinical Trial Registry (ACTRN12624001088538) on 10th September 2024 and World Health Organisation International Clinical Trials Registry (U1111-1280-3851).

Temporomandibular disorders (TMD), psychological distress, and sleep disturbances are common and frequently co-occur in children and adolescents. However, the patterns and nature of their interrelationships-including potential underlying mechanisms-remain systematically underexplored in this age group.

To synthesize the evidence on the associations among TMD, psychological distress, and sleep disturbances in children and adolescents, and to explore potential interacting mechanisms described in the literature.

We systematically searched PubMed, CNKI, Wanfang, Medline, CINAHL, Cochrane, Web of Science, and Scopus for observational studies between January 2010 and December 15, 2025, that investigated associations among TMD, sleep quality, and mental health in children and adolescents. We included studies reporting on at least two of the three conditions and assessed methodological quality using established critical appraisal tools.

We included 17 studies (16 cross-sectional, 1 case-control), which reported intricate associations among TMD, psychological distress, and sleep disturbances. Anxiety and depression were the most prevalent psychological comorbidities, while poor sleep quality and sleep bruxism were the most frequently reported sleep disturbances. These associations were particularly pronounced in painful TMD subtypes, and their strength was influenced by sex (stronger effects in females), age, and developmental context.

This systematic review summarizes consistent associations among TMD, psychological distress, and sleep disturbances in children and adolescents. The available evidence supports the hypothesis that psychological factors may be involved in the observed association between TMD and sleep disturbances, but this requires confirmation through longitudinal mediation analyses. Given the predominantly cross‑sectional design of the available studies, causal conclusions cannot be drawn. From a clinical perspective, an integrated, multidisciplinary approach addressing all three domains may be beneficial, and future longitudinal research is needed.

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD420251218752.

Not applicable.