Depressive disorders are associated with a high burden of disease; a substantial proportion of patients show insufficient response despite guideline-based pharmacotherapy and psychotherapy, particularly in treatment-resistant depression (TRD). Neuromodulation has become established as a fourth pillar in the treatment of depression and includes electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), transcranial electrical stimulation (tES), magnetic seizure therapy (MST), deep brain stimulation (DBS) and neurofeedback (NF). Despite partly well-established efficacy, these interventions remain insufficiently integrated into routine clinical care. The aim of this paper is to summarize the current evidence and to analyze key barriers to implementation.

Narrative review of clinical studies, meta-analyses, and care data on efficacy, safety and cognitive tolerability.

The strongest evidence for both acute and maintenance treatment of severe depressive disorders is for ECT; rTMS is effective and cognitively well tolerated and VNS can represent an additive long-term option in TRD. For tES, small and heterogeneous effects have been reported, MST and DBS remain experimental and for NF consistent evidence of efficacy is lacking. Key barriers include partly heterogeneous protocols, insufficient funding structures, particularly in the outpatient setting and the absence of standardized qualification requirements.

Neuromodulation should be systematically integrated into staged-care models. Standardized protocols and registry-based research are needed to enable the structured and sustainable implementation of neuromodulatory interventions in clinical care.

Maintaining best practice around surgical consent is a core competency, yet in caring for older patients, it can be particularly challenging to meet these standards. Our research question was: In the context of obtaining surgical consent for older people, what are the barriers to, and enablers of, best practice? A literature review was undertaken, using RAMESES (Realist And Meta-narrative Evidence Syntheses) methodology, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight studies were identified by searching PubMed, Embase, Medline and CINAHL databases, supplemented by reference list searches. Four major themes with subthemes emerged: 1. Complexities: (i) Factors affecting decision-making capacity; (ii) Patient Comprehension; (iii) The doctor-patient relationship and barriers to autonomy; (iv) Ethical issues at stake; 2. Gaps between theory and practice: (i) Lack of proper documentation; (ii) Patient resistance resulting in coercion and restraint; (iii) Proper practice in the emergency context; 3. Reasons for gaps between theory and practice: (i) Lack of knowledge and training: physician misconceptions; (ii) Guesstimates of cognition don't work; (4) Potential solutions: (i) Promoting patient autonomy; (ii) General communication strategies; (iii) Person-centred education step. Notwithstanding a limited yield, this review has identified several pitfalls and practical strategies for promoting human-rights and autonomy; avoiding coercion and restraint in this complex setting.

Universal well-being assessments in schools may support early identification of pupils needing mental health support. However, little is known about how privacy and confidentiality concerns influence pupils' acceptability of assessments and willingness to engage authentically. This study examined how hypothetical identification, where responses are linked to pupils and shared with key stakeholders, affects pupils' anticipated honesty and engagement, and whether known help-seeking barriers predict negative responses.

Cross-sectional data were collected from 12,377 primary (ages 8-10) and secondary pupils (ages 11-17) across 55 schools in England. Pupils reported whether their responses would change if identifiable and shared with school staff, parents/guardians, or external professionals. Responses indicating reduced honesty or likelihood of disengagement were coded as negative. Predictors were examined using mixed-effects logistic regression models, including demographics, school connectedness, and mental well-being.

Identification and data sharing influenced pupils' anticipated engagement, particularly in secondary schools. Identification by school staff elicited the highest proportion of negative responses in both phases, whereas external professionals elicited the fewest. Most primary pupils reported they would respond authentically, while a larger proportion of secondary pupils indicated they would respond less honestly or disengage when responses were identifiable and shared. Across primary and secondary samples, low well-being, low school connectedness, and being female were associated with greater likelihood of negative response.

Pupils' anticipated engagement with well-being assessments is shaped by who accesses their data, with marked developmental differences. Strengthening trust, privacy, and connectedness, and supporting pupils' autonomy, may improve the acceptability and response accuracy.

Supporting maternal mental health is a priority in circumpolar settings, where seasonality and constrained service availability can limit psychosocial support. This qualitative study explored pregnant women's and healthcare providers' experiences of a postpartum depression prevention programme and perspectives on integrating it into routine antenatal care in Arkhangelsk, Northwest Russia. Four focus group discussions with pregnant women (n = 17) and individual interviews with four healthcare providers were analysed using reflexive thematic analysis. Participants described the programme as providing trusting spaces for sharing, expert-led preparation for childbirth and the postpartum period, and brief individual follow-up after birth. Women reported greater confidence in identifying signs of vulnerability, articulating needs, and accessing support. Providers highlighted that these benefits depended on feasible scheduling, group formats, reusable materials, and coordinated delivery across professionals to avoid fragmentation. System-level factors (reach, retention, and cross-provider coordination) were seen as central for sustained uptake and routine integration. The findings suggest that the programme's contribution lies in the interaction between participant experiences of support and the organisational conditions needeed to sustain them in routine antenatal care. Preventive perinatal mental health programmes in circumpolar contexts can strengthen preparedness and help-seeking when designed for relational participation and supported by coordinated service structures.

Childhood-onset Obsessive-Compulsive Disorder (OCD) has been associated with an increased vulnerability to psychosis, yet no prospective studies have examined this risk in paediatric populations.

In this pilot prospective study, 59 adolescents with a primary diagnosis of OCD were assessed at baseline for psychotic vulnerability, measured through Cognitive-Perceptual basic symptoms (COPER) and the high-risk criterion Cognitive Disturbances (COGDIS), as well as for OCD severity and psychosocial functioning. The number of subjects who developed a first episode of psychosis (FEP) during the 18-month follow-up period was evaluated. Logistic regression and moderation analyses were performed.

During the follow-up period, 18.6% of participants presented with a FEP. These patients were older and displayed poorer psychosocial functioning compared with those who did not develop a FEP. Logistic regression identified higher COPER symptoms and lower psychosocial functioning as the only significant predictors of FEP. Although moderation effects were not statistically significant, exploratory simple slopes suggested that both COPER and COGDIS symptoms were more strongly associated with psychosis onset in adolescents with lower psychosocial functioning.

This study highlights a notable rate of progression to psychosis among adolescents with OCD over an 18-month period. Despite methodological limitations, our findings offer preliminary evidence that COPER symptoms and impaired psychosocial functioning are key risk factors in adolescents with OCD for progression to psychosis.

Chronic Kidney Disease-associated Pruritus is a chronic itching condition experienced by patients during and between dialysis sessions. The individualised nature of the condition makes prevalence and severity difficult to measure.

The study aimed to identify the prevalence of Chronic Kidney Disease-associated Pruritus amongst patients receiving dialysis in Ireland, characterise symptom burden, severity, and frequency, factors associated with worsening symptoms, and to examine patient experiences of itching.

A quantitative study with a qualitative free-text element was employed.

689 patients undergoing dialysis completed a national survey.

Patients undergoing haemodialysis and peritoneal dialysis completed the 5-D itch scale and a qualitative assessment of itching experiences. Regression analyses examined associations between domains of the 5-D itch scale, patient clinical characteristics and the occurrence of moderate-severe itching. Content analysis was used to report qualitative findings.

Sixty-two percent (85% haemodialysis; 15% peritoneal dialysis) experienced Chronic Kidney Disease-associated Pruritus; 66% reported moderate-severe itching, with body/trunk region most affected (73%); however, the scalp/face region was most associated with moderate-severe itching (OR = 2.08, 95% CI 1.11-3.870). Four themes were identified: (1) the physical impact of Chronic Kidney Disease-associated Pruritus; (2) the psychological burden of itching; (3) variability in treatment success; (4) itch resolving over time.

Two-thirds of Irish patients experience moderate-severe Chronic Kidney Disease-associated Pruritus; a prevalence rate higher than international estimates. This condition is psychologically distressing - impacting sleep, overall quality of life, and risk of infection. Patients require improved clinical attention and greater pratitioner education on management of this condition.

Understanding when and who is at greater risk of dropping out can help therapists and mental health professionals develop strategies to keep clients engaged, thereby improving the overall effectiveness of therapy. In the present study, we aimed to explore the hazard of dropout, both early and late in treatment, and evaluate the predictive power of both static (i.e., baseline client characteristics) and dynamic predictors (i.e., treatment process variables), in a sample of 97 clients treated with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Thirty-one clients (31.96%) discontinued treatment, with the highest dropout rate observed at the end of Session 4. Stratified Cox modelling showed a significant effect of younger age β 1 = - 1.706 , p = 0.031 , non-student status β 2 = - 1.715 , p = 0.031 and higher baseline anxiety severity β 3 = 1.806 , p = 0.022 , on the risk of dropping out until Session 4 (i.e., the early phase of treatment). Beyond Session 4, only lower depressive severity measured at intake began to significantly affect the risk of dropout β 8 = - 1.007 , p = 0.034 . Additionally, joint modelling (JM) of survival and longitudinal data for the early phase of treatment provided evidence of the predictive power of lower distress levels γ 01 = - 0.181 , p = 0.093 and lower therapeutic alliance quality γ 02 = - 0.137 , p = 0.05 on the clients' decision to discontinue treatment prematurely. After Session 4, no factor showed a significant association with dropout risk within the JM approach. The results suggest that early sessions are critical for the client's retention, and the JM approach is indispensable for studying psychotherapy dropout, especially in the context of endogenous time-varying predictors. Implications for clinical and research contexts are discussed.

Background Psychiatric EDs manage high volumes of patients who often face barriers to medication access, limited understanding of discharge instructions, and difficulty securing timely outpatient follow-up. Structured early outreach has shown promise in improving these transitions. This quality improvement initiative evaluated a 72-hour nurse-led telephone follow-up program for patients discharged from a psychiatric service within an ED. Methods  All patients discharged over the study period were eligible for a structured telephone call within 72 hours. The call assessed medication pickup, medication adherence, follow-up appointment status, transportation needs, and satisfaction with both emergency care and the follow-up call. Diagnoses were extracted from clinician documentation. Demographic characteristics and patient-reported needs were summarized. Outcomes included call reach rate, patient-reported understanding of discharge instructions, medication-related behaviors, and follow-up completion. Results  A total of 69 patients met the inclusion criteria, with a mean age of 35.3 years. The most common diagnoses were major depressive disorder with suicidal ideation, schizophrenia, and bipolar disorder. The nurse navigator successfully contacted 37.7% of discharged patients. Among reached patients, half reported taking their medications, and over two-thirds had a scheduled follow-up appointment. Transportation barriers were uncommon. Patient satisfaction with psychiatric emergency care averaged 4.45 on a five-point scale, and satisfaction with the follow-up call averaged 4.95. Patients commonly sought clarification regarding medications, follow-up appointments, and transportation resources. Conclusion Early nurse navigator-led telephone follow-up after discharge from psychiatric emergency care demonstrated strong patient engagement and high satisfaction. The calls created opportunities to reinforce discharge instructions, support medication use, and assist with follow-up planning. These findings suggest that early nurse-led contact can highlight actionable barriers and support safer care transitions following psychiatric emergency discharge.

Yoga has been studied as an effective alternative therapy for substance use disorders, demonstrating its ability to reduce stress and addictive behaviors while improving self-control and self-esteem. However, not everyone may be willing or able to engage in yoga for various reasons. Furthermore, there is a lack of systematic reviews and meta-analyses of the existing research on this topic. The objective is to explore the nonparticipation rate in yoga intervention randomized controlled trials related to addictive disorders, and to explore the reasons for nonparticipation in yoga trials related to addictive disorders. We searched Google Scholar, CENTRAL, and PubMed for peer-reviewed published RCTs that incorporated yoga interventions in any format of at least one session. Data were extracted using standard procedures, and the risk of bias was evaluated. Pooled analysis and sensitivity analysis were done. About 54% of potential participants were not included. The pooled effect size was 0.544 (95% confidence interval: 0.301-0.787), with an I² = 99.797. Key barriers included failure to meet inclusion criteria, such as medical conditions, mental health issues, and specific health conditions such as posttraumatic stress disorder, depression, and heart disease. Participant refusals and lack of interest in randomization or the study itself were common reasons for nonparticipation. Scheduling conflicts were also frequently reported as a significant obstacle. Two broad categories for noninclusion were meeting exclusion criteria, and not interested/declined to participate. Understanding reasons for noninclusion can lead to more efficient and effective recruitment efforts in future trials and also possibly guide the design of future studies to minimize dropout rates and ensure a representative sample.

University is a pivotal life-course transition in which academic, social and geographic changes intersect with heightened risk for mental disorders and maladaptive behaviors. Health Mode On (HMO) and its longitudinal expansion Health Mode On Plus (HMO+), funded by the Italian Ministry of University and Research (MUR) competitive PRO-BEN 1 and PRO-BEN 2 calls, couple harmonized surveillance with a stepped, integrated model of prevention and care aligned with the World Mental Health-International College Student (WMH-ICS) framework to address fragmentation of campus provision and unmet need.

HMO implements a cross-sectional, census-style online survey paired with the implementation of an integrated counseling pathway and a Virtual Academy for staff and student mentors. HMO+ adds 12-month re-contact, objective lifestyle sub-studies, and a strengthened shared digital platform that supports first-contact intake, triage, and orientation to the most appropriate service. Within this framework, students with an anxiety risk profile may be offered participation in an embedded two-arm randomized evaluation of digital cognitive-behavioral therapy (e-CBT) versus counseling-as-usual. The consortium spans five universities, four higher artistic and musical education (AFAM) institutes and one Scuola Superiore Universitaria, in coordination with University Sports Centres (CUS). Primary outcomes are 12-month and lifetime DSM-5 disorder status derived from validated WMH-ICS/CIDI-based modules (mood; anxiety; trauma- and stressor-related; obsessive-compulsive and related; eating; attention-deficit/hyperactivity; and substance use disorders), and safety outcomes (suicidal ideation, planning and non-suicidal self-injury). Secondary outcomes include psychological distress, role impairment, days-out-of-role, sleep, physical activity (accelerometry in subsamples), dietary habits, nicotine and cannabis use, behavioral addictions (e.g., gaming, gambling, internet addiction), social connectedness, academic engagement and service access. Analyses will estimate weighted prevalence and impairment with multilevel models; longitudinal change with mixed-effects models and GEE; and naturalistic program effects using difference-in-differences with propensity-score methods.

Ethics approvals will be obtained at the coordinating and partner institutions. GDPR-compliant governance and results' FAIR-oriented sharing are planned, alongside open-access publications, institutional dashboards and policy briefs.