Caregivers of patients with chronic diseases are unpaid providers, whose contributions to healthcare and patient outcomes are well recognized. We sought to obtain the perspectives of those who have supported a kidney transplant recipient with a failing or failed graft.

This qualitative study adopted an interpretive-descriptive methodology. Data collection entailed semistructured interviews that were analyzed thematically.

Twenty-three caregivers (spouses = 11, parents = 10, and siblings = 2) reported that graft loss did not introduce new roles or responsibilities. However, the caregiver burden intensified because of the following: supporting recipients' wellbeing (emotional support and attention to social needs); adapting to the new reality of graft loss (dietary management, home dialysis support, logistical coordination for medical appointments, and treatments); navigation of care (information tracking and communication and advocacy); and managing multiple roles and responsibilities (increased household and parental load and balancing employment and caregiving). Care gaps included more focus on the graft instead of the person (clinical prioritization of the graft and lack of attention to mental health and emotional aspects of graft loss); communication shortcomings; and inclusion of caregivers in patient care (not recognizing the value of caregiver input and lack of role definition). Recognition of emotional labor and support; educational resources tailored to the graft loss phase; training and tools to fulfill the role of caregivers; peer support; and social work were the desired resources.

Caregivers of kidney transplant recipients experience heightened burden with graft loss and reported feeling undervalued. We recommend strategies to better integrate, support, and educate these caregivers, as it may enhance both their well-being and the outcomes of recipients who experience graft loss.

Little is known about the optimal treatment for constipation in patients with schizophrenia or depression. Elobixibat is a laxative with a novel mechanism of action that inhibits the ileal bile acid transporter, acting as both an osmotic and a stimulant agent.

We conducted a prospective, multicenter, postmarketing surveillance study to assess the safety and effectiveness of elobixibat for patients with chronic constipation in Japan (jRCT1080223950). The surveillance period was between June 2018 and May 2022. Patients were observed from the date of initial administration of elobixibat to 55 days thereafter (4-week treatment groups) or to 419 days thereafter (52-week treatment groups). Safety outcomes included adverse drug reactions (ADRs). Effectiveness outcomes included defecation frequency, Bristol Stool Form Scale (BSFS) scores, and constipation-related symptoms.

In the safety analysis set, the 4-week treatment groups comprised 105 patients with schizophrenia and 129 with depression; the 52-week treatment groups included 43 patients with schizophrenia and 55 with depression. Approximately 85% to 95% of patients used antipsychotics, and 40% to 55% used anxiolytics or sedative-hypnotics. The proportions of patients who experienced ADRs were 4.76% in the 4-week treatment group and 2.33% in the 52-week treatment group of patients with schizophrenia, and 3.88% and 9.09% of patients with depression. Diarrhea was the most common ADR in each group. There were no serious ADRs. In the 4-week treatment groups, the mean defecation frequency per week at baseline was 3.3 among patients with schizophrenia and 3.0 among patients with depression, which increased to 5.3 and 4.9, respectively, at week 4. In the 52-week treatment groups, the mean defecation frequency per week at week 52 was higher than that at baseline. After treatment, the proportion of patients with an ideal BSFS score of 4 increased in all groups by week 2 and reached approximately 60% by week 52. All constipation-related symptoms also improved by week 2 in all groups.

Elobixibat improved chronic constipation with no new safety signal identified in patients with schizophrenia or depression and with available follow-up in real-world settings.

https://jrct.mhlw.go.jp/latest-detail/jRCT1080223950, identifier jRCT1080223950.

Some veterans are haunted by memories of action they have taken or betrayals they have experienced that violated deeply held moral beliefs; these experiences can lead to moral injury. We have developed a depth-oriented group psychotherapy for U.S. combat veterans, to address moral injury. Depth psychotherapy is an evidence-based form of psychoanalysis; the treatment we have developed is based on Relational psychoanalysis. The aim is for the group members to each develop an organized narrative about morally injurious events and their impact on their current lives to facilitate psychosocial recovery. The hypothesized change agents of this treatment are, in order of their use in the sessions: (1) warm-up team-building activities such as exercises from the improv and psychodrama/sociometry traditions; (2) reflective listening and speaking; (3) sharing moral injury event narratives with trusted others. The clinical model we have developed for treating moral injury emphasizes that veterans will be asked to describe, to the extent that they are able, the feelings, sensations, and fragmentary thoughts that are initially hard to articulate and sometimes difficult to recall. The goal of this article is to describe relevant depth psychology theory, its application to the moral injury context, the relevance of depth-oriented group psychotherapy for moral injury and, further, the depth-oriented group psychotherapy approach we have derived from these ideas.

Adolescent depression poses a major public health concern with substantial clinical and societal implications. Both internet-delivered cognitive behavioural therapy (ICBT) and internet-delivered psychodynamic therapy (IPDT) have shown efficacy, but questions remain regarding long-term efficacy and cost-effectiveness. The present study presents a 12-month follow-up and cost-comparison from a randomized controlled trial (RCT) comparing ICBT and IPDT for adolescent depression.

Participants were 272 adolescents aged 15-19 with a primary diagnosis of major depressive disorder. The primary outcome was depressive symptoms measured with the QIDS-A17-SR while the secondary outcome was anxiety symptoms measured with the GAD-7. Costs were assessed both by comparing costs of treatment and healthcare use 12-month post-treatment using the TIC-P.

Results were stable at the 12-month follow up compared to treatment endpoint, for both depressive and anxiety symptoms. There were no significant group differences at the 12-month follow-up. There were no differences in treatment costs or in costs for healthcare use one-year post-treatment.

This study suggests that treatment gains from IPDT and ICBT for adolescent depression remain stable during a 12-month follow-up period, with no differences between the treatments one-year post-treatment. Furthermore, it suggests comparable costs for the treatments. Interpretation of health-care use data was restricted due to the COVID-19 pandemic taking place during the follow-up period. This adds to the literature suggesting that ICBT and IPDT can be seen as viable alternatives for treating adolescent depression. More research into the long-term effects and cost-effectiveness is needed.

As Alzheimer's disease and related dementias (ADRD) progress, family caregivers may experience grief before the death of the person living with ADRD. This type of grief is commonly referred to as anticipatory grief, which can contribute to increased psychological distress (i.e., depressive and anxiety symptoms) and potentially affect caregivers' long-term mental health. This scoping review aimed to synthesize evidence on risk and resilience factors associated with anticipatory grief, its relationship with caregiver mental health, and psychosocial interventions targeting anticipatory grief among caregivers of people living with ADRD.

Guided by the Stress Process Model and the Grief-Stress Model, a literature search was conducted in PubMed, CINAHL, Embase, Scopus, Web of Science, and PsycINFO in May 2025.

Thirty articles met the inclusion criteria. Caregiver characteristics, such as being a spousal caregiver and greater caregiving involvement, were associated with higher levels of anticipatory grief. Caregiving-related stressors and relationship changes across the ADRD trajectory were consistently linked to anticipatory grief across studies, while psychosocial resources, such as adaptive coping and social support, were generally associated with lower levels of anticipatory grief. Anticipatory grief was consistently associated with depressive symptoms. Intervention studies were limited, but those focused on acceptance and preparedness showed potential for reducing anticipatory grief.

Anticipatory grief represents an important dimension of caregiver mental health that reflects ongoing loss. Conceptualizing anticipatory grief within caregiving stress frameworks highlights how vulnerability to distress may emerge from the interplay between caregiving stressors, relationship changes, and psychosocial resources. This conceptual framing may inform future research and palliative care interventions to support the well-being of family caregivers across the dementia trajectory.

Attention Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that impair functioning across multiple domains. While deficits in inhibitory control and processing speed are well-documented in ADHD, the precise neurocognitive mechanisms underlying these impairments and their specific relationships with ADHD symptom dimensions remain poorly understood. This study examined distinct profiles of processing speed and inhibitory control at the subcomponent level in 41 children with ADHD compared to 45 typically developing peers. Specifically, processing speed was dissociated into perceptual and verbal components, assessed via a visual recognition task (based on the theory of visual attention) and a rapid digit naming task, respectively. Inhibitory control was fractionated into response and interference inhibition, separately evaluated via go/no-go and flanker tasks. ADHD symptoms were assessed using the Swanson, Nolan, and Pelham rating scale IV. Results indicated that children with ADHD exhibited significantly lower verbal processing speed and impaired interference inhibition. Given significant correlations among these cognitive subcomponents and inattentive symptom, four mediation models were tested. Notably, only the model in which verbal processing speed mediated the relationship between interference inhibition and inattention was significant, suggesting that distinct cognitive deficits interact differentially to shape the clinical presentation of ADHD. These findings provide novel insights into the cognitive mechanisms underlying ADHD and have important implications for developing targeted cognitive interventions.

Social anxiety disorder (SAD) is a commonly occurring mental health condition characterized by excessive fear and anxiety in social situations. The disorder significantly impacts individuals' daily functioning and is often associated with a range of emotional and physiological symptoms. Understanding the neural basis of SAD is crucial for developing effective treatments.

This meta-analysis utilized anisotropic effect-size seed-based d mapping with permutation of subject images (SDM-PSI) to examine brain activity alterations in SAD patients. We systematically reviewed neuroimaging studies, focusing on resting-state functional magnetic resonance imaging (fMRI) data, and analyzed the reported regional brain activity alterations. Our search encompassed studies published up to July 31, 2024, and applied strict inclusion and exclusion criteria to ensure the reliability of the findings.

The analysis revealed increased functional activity in the left superior parietal gyrus, right cerebellum, and right supramarginal gyrus, along with decreased activity in the left insula and right supplementary motor area in SAD patients compared to healthy controls (HC). Meta-regression analysis indicated a negative correlation between left insula activity and age, and between right supplementary motor area activity and symptom severity.

The findings provide evidence for distinct neural signatures in SAD, emphasizing the pivotal role of key brain regions in the disorder's pathophysiology. These results contribute to the understanding of the neural correlates of SAD and may guide the development of therapeutic strategies in the future.

Psychiatric history is the strongest risk factor for postpartum depression (PPD). Obstetric complications, more prevalent among women with a psychiatric history, are also independent risk factors. However, the mechanisms linking these factors to PPD remain unclear. We examined whether obstetric complications mediate the association between psychiatric history and PPD.

This cohort study utilized Danish nationwide Edinburgh Postnatal Depression Scale (EPDS) screenings (2015-2021) linked with register data. Psychiatric history was defined as psychiatric diagnoses (ICD-10: F00-99) or filled psychotropic prescriptions (ATC: N05A, N05BE01, N06A, N06BA) from 1995 until conception. Complications were defined as a composite measure of complications occurring between conception and delivery. PPD symptoms were defined as a positive EPDS score (≥ 11), and PPD diagnosis was defined as a depression diagnosis (ICD-10: F32-33) or antidepressant prescription fill (ATC: N06A indicated for depression).

Of 170,218 mothers (163,326 in analyses), 23.9% had a psychiatric history. These mothers had higher levels of PPD symptoms (13.4% vs. 6.1%), PPD diagnosis (7.0% vs. 0.4%), and complications (34.1% vs. 28.5%) compared to those without. (A) Psychiatric history (PPD symptoms: OR = 2.32 [95% CI, 2.22; 2.41]; PPD diagnosis: OR = 5.09 [95% CI, 4.48; 5.79]) and complications (PPD symptoms: OR = 1.16 [95% CI, 1.11; 1.21]; PPD diagnosis: OR = 1.18 [95% CI, 1.04; 1.34]) were independently associated with PPD. (B) Psychiatric history did not modify the association between complications and PPD (PPD symptoms: OR = 1.20 [95% CI, 1.14; 1.26] vs. 1.09 [95% CI, 1.02; 1.17]; PPD diagnosis: OR = 1.22 [95% CI, 1.00; 1.49] vs. 1.15 [95% CI, 0.97; 1.36]). (C) Complications mediated only a small fraction of the association between psychiatric history and PPD (proportion mediated: PPD symptoms = 0.68% [95% CI, 0.50%; 1.00%], PPD diagnosis = 0.42% [95% CI, 0.14%; 0.79%]).

Psychiatric history and complications are independently associated with PPD, but complications explain only a negligible portion. These findings suggest that the link between psychiatric vulnerability and PPD is primarily driven by direct mechanisms rather than mediation through complications.

The objective of this registry-based cohort study was to evaluate longitudinal associations between disease activity measures and patient-reported outcomes (PROs) in GCA, and to assess whether specific PRO domains reflect clinically active disease.

Among all GCA patients registered in NorVas up to 12 December 2024, we selected patients who: 1) fulfilled the ACR 1990 classification criteria for GCA, 2) had two PROs recorded at least once, and 3) were included in NorVas at the time of diagnosis. HRQoL was assessed by RAND-12, using the physical (PCS) and mental composite scores (MCS) as outcomes. Visual analogue scales were used to assess pain, fatigue, and global disease assessment. The association between the PROs and disease activity were evaluated using linear mixed effects models. We assessed the PROs over time and the difference in PROs between active and inactive disease.

We included 256 patients in the study with a median of 3 observations each, and a total of 1003 observations. All examined PROs showed a significant difference between active and inactive disease at baseline. Statistically and clinically significant differences were retained during follow-up for RAND-12-PCS (11.19 [5.67, 16.71]), pain (-12.64 [-18.58, -6.70]) and global assessment (-9.92 [-15.48, -4.35]).

Our study demonstrates a consistent association between PROs and disease activity in GCA, most pronounced for the physical component of HRQoL, pain and global assessment. Patients with active disease showed statistically and clinically significant differences in PRO scores compared with those in remission, both at baseline and throughout follow‑up. While no single PRO domain can replace formal disease activity assessment, patterns across pain, fatigue and patient global measures may signal active disease and warrant clinical reassessment. Taken together, these findings indicate that selected combinations of PROs may serve as a useful adjunct in the monitoring of GCA.

Despite the established clinical effectiveness of electroconvulsive therapy (ECT) in the treatment of bipolar depression, its acceptance is limited by concerns over cognitive adverse effects. Magnetic seizure therapy (MST) has shown promise in treating patients with depression, with fewer cognitive adverse effects. The aim of this pilot study was to assess the clinical efficacy and cognitive adverse effects of MST compared to right unilateral ultrabrief-pulse (RUL-UB) ECT in patients with bipolar depression.

In this double-blind, randomized, parallel-group pilot clinical trial, participants with bipolar depression received either RUL-UB ECT or MST until they achieved remission, dropped out, or received a maximum of 21 treatments. The primary outcomes were 1) clinical remission as assessed with the 24-item Hamilton Rating Scale for Depression and 2) cognitive adverse effects as assessed with the Autobiographical Memory Test (AMT).

Of 55 participants who were randomized, 45 received an adequate trial of treatment, of whom 6/20 (30%) in the ECT group and 5/25 (20%) in the MST group achieved remission. Clinically important worsening in autobiographical memory (≥25% decline in AMT score) occurred in 6/27 (22.2%) participants in the ECT group and 2/28 (7.1%) in the MST group. Secondary clinical outcomes were similar in both groups.

This pilot study demonstrated similar effects on depression symptoms between MST and ECT. MST appeared to have resulted in less worsening of autobiographical memory and was better tolerated, suggesting that it may be a safe clinical application to treat bipolar depression. Given the relatively small sample size of this pilot study, these findings should be considered preliminary.