Depressive and anxiety symptoms frequently persist during stable phases of bipolar disorder (BD), yet their interconnected architecture remains unclear. This study examined the prevalence, clinical correlates, and network structure of these symptoms in patients with BD.

We evaluated 9455 clinically stable patients with BD in Hangzhou, China. Symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Multivariable logistic regression identified correlates, and a regularized Gaussian Graphical Model mapped symptom interactions, centralities, and bridge symptoms.

Screen-positive rates of depressive symptoms, anxiety symptoms, and their co-occurrence were 18.3%, 15.1%, and 12.1%, respectively, with a strong correlation between the two domains (r = 0.71, p < 0.01). Poor social relationships and sleep disturbances were consistently associated with higher symptom burden (ORs: 1.37-2.65). Network analysis revealed a prominent "concentration"-"motor" association (weight = 0.38). Centrality analysis identified "guilty," "uncontrollable worry," and "motor" as the most influential nodes. "Motor," "irritability," and "feeling afraid" served as critical bridge symptoms linking both domains. In the flow network, "suicidal ideation" was directly anchored by "guilty" (weight = 0.21) and "motor" symptoms (weight = 0.20). Three distinct symptom communities were identified, reflecting anxiety, cognitive-behavioral, and somatic-affective clusters.

Even during stable periods of BD, residual depressive and anxiety symptoms form a highly structured network. These findings suggest that clinical management should transcend aggregate scale scores to target key central and bridge features, specifically psychomotor alterations, guilt, and uncontrollable worry, to disrupt symptom reinforcement and mitigate suicide risk.

Cognitive symptoms represent a significant and persistent challenge in patients with treatment-resistant depression (TRD), substantially impacting their functional outcomes. Deep brain stimulation (DBS) targeting the subcallosal cingulate gyrus (SCG) has shown clinical efficacy. Nonetheless, its long-term effects on cognition remains insufficiently researched. This study systematically evaluates cognitive outcomes following SCG-DBS over an extended follow-up period.

This retrospective, exploratory secondary analysis used longitudinal data from 12 TRD patients treated with SCG-DBS without a control group. Cognitive and clinical assessments were conducted pre-surgery and at long-term follow-up. Potential changes were examined using the Wilcoxon signed-rank test and its corresponding effect size (r), while Reliable Change Indices (RCIs) were applied to evaluate the statistical reliability of intra-subject cognitive changes. Spearman correlations explored associations between cognitive outcomes with clinical and functional ones.

After a median follow-up of 5 years following SCG-DBS, TRD patients showed statistically significant improvements in immediate and delayed verbal memory (Wilcoxon's z = -2.28, p = .023, r = 0.66; Wilcoxon's z = -2.83, p = .005, r = 0.82, respectively), both reflecting large effect sizes. RCIs indicated reliable improvement in immediate (41.7% of patients) and in delayed (75%) verbal memory. Changes in verbal memory were not significantly correlated with clinical or functional improvements.

These findings support the cognitive safety and benefits of SCG-DBS in individuals with TRD, particularly in verbal memory. However, further research is required to investigate the broader functional effects of SCG-DBS beyond the improvement of core clinical symptoms.

Patient-reported outcomes are essential for monitoring recovery after traumatic brain injury (TBI), yet commonly used instruments differ in scope. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is symptom-specific, whereas Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health is a generic measure of physical and mental health. The degree to which these tools provide overlapping versus non-interchangeable information in outpatient TBI care is unclear.

We conducted a retrospective observational study at a Level I academic trauma center (June 2018-February 2025). Adults (≥18 years) evaluated for TBI who completed paired RPQ and PROMIS Global Health assessments within ±3 days were included (one paired assessment per patient). Clinical and injury variables were abstracted from the electronic medical record and REDCap; head CT was classified as positive versus negative based on neuroradiology report, and polytrauma was defined as non-neurosurgical injuries requiring additional service management. Associations between PROMIS domains (physical, mental, total; higher scores indicating better health) and RPQ burden (RPQ-3, RPQ-13, total; higher scores indicating greater symptom burden) were assessed using Spearman correlation. Agreement was evaluated using two-way random-effects intraclass correlation coefficients (ICC; absolute agreement), Bland-Altman analysis after linear transformation to a 0-100 scale with standardized directionality, and kappa for selected construct-matched item pairs.

Of 372 screened patients, 216 met inclusion criteria. Median age was 58 years (IQR 39-73); 67% were male; 84% had mild TBI by admission Glasgow Coma Scale; 51% had polytrauma. PROMIS domains showed consistent inverse correlations with RPQ burden (ρ -0.41 to -0.68; all p < 0.001), strongest for PROMIS total versus RPQ-13 (ρ = -0.68) and RPQ total (ρ = -0.67). Despite these associations, patient-level agreement was poor: ICCs were negative across PROMIS-RPQ pairings (ICC -0.04 to -0.49) and Bland-Altman limits of agreement were wide. Construct-matched item agreement was moderate to substantial (κ 0.46-0.64), highest for combined affect ("angry and sad") (κ = 0.64).

PROMIS and RPQ are associated at the group level but demonstrate poor agreement and should not be used interchangeably for individual outpatient TBI monitoring. Findings support combined use of global and symptom-specific instruments across care settings.

Background: Military sexual trauma (MST) disproportionately impacts women veterans globally. UK research highlights that these in-service experiences may contribute to unique mental and physical health needs. Yet, service providers are often perceived to be unaware of and unable to meet these needs.Objective: To evaluate a national training programme that synthesised evidence to support UK women veterans. Situated within a wider knowledge mobilization (KMb) initiative and guided by the Knowledge-to-Action (KTA) framework, a three-part programme was developed for different professional audiences to enhance understanding of and support for women veterans.Method: Co-produced and grounded in KMb theory. Course 1 aimed to enhance knowledge of women veterans' health needs. Course 2 targeted healthcare professionals and veteran specialist providers, exploring evidence-based considerations for promoting service engagement. Course 3 aimed to increase UK clinical capacity in the best-evidenced treatment for post-traumatic stress disorder associated with MST in women veterans, through training mental health professionals in cognitive processing therapy (CPT). Mixed-methods data were collected from all programme attendees. CPT attendees completed pre- and 3-month post-training measures; quantitative data were analysed using a Wilcoxon signed-rank test and qualitative data using manifest content analysis.Results: Course 1 was completed by 526 individuals, 363 completed Course 2, and 98 completed Course 3. Course 3 attendees were split across two cohorts (n = 57; n = 41). Compared with pre-training, 3-month post-training self-efficacy in delivering CPT across cohort one increased significantly (p < .001, r = 0.915). Content analysis identified three themes: (1) Clinician confidence delivering CPT; (2) Clinicians' perceptions of CPT; and (3) CPT in a service system.Conclusions: The education programme addressed gaps in UK service provider knowledge and increased CPT clinical capacity. The wider KMb initiative demonstrates how research can be translated into impact for military populations and highlights the value of co-produced KMb approaches.

Eating attitude can be defined as beliefs, thoughts, feelings, behaviour and relationship with food. It can impact a person's food choices and health status. A deviant eating attitude is a maladaptive pattern of thoughts and behaviours related to food consumption, which can include periods of inconsistent eating, ranging from overeating to undereating, dietary restriction, emotional eating and preoccupation with food and body weight. These concerns may be visible in the form of emotional dysregulation, anxiety, depression, low self-esteem and interpersonal difficulties. The deviant eating attitude can lead to psychological distress, as individuals may use restrictive eating patterns to cope with overwhelming emotions and life stresses, further deteriorating their overall mental health. Dialectical behaviour therapy (DBT) plays a key role in addressing this vicious cycle by targeting the core emotional and behavioural patterns which maintain disturbed eating disorder. DBT reduces the shame and self-stigma that affect the eating cycle and fosters genuine engagement with the therapeutic process. Through DBT, an individual can learn about mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. It facilitates individuals to recognise and manage uncomfortable emotions without resorting to dysfunctional eating patterns.

The study aimed to explore the therapeutic effect of DBT on deviant eating attitude, along with mental health in adolescents.

A single case report method was used in the current study. The tools used in the study were case history, Mental Status Examination, Eating Attitudes Test-26, developed by David M. Garner, and Mental Health Inventory, developed by A. K. Srivastava. A total number of 14 sessions of DBT were given, and the pre- and post-therapy assessments were conducted. A case of a 15-year-old female presented with the chief complaints of concerns with her weight and physical looks, high consumption of junk food, disturbed sleep routine, disturbed interpersonal relationship, anger outburst, low self-esteem, irritability and reduced academic performance since the last 2 years, which increased significantly in the last 6 months.

The pre- and post-assessments were conducted, and they indicated relief in the symptoms reported by the client. She reported improved focus and increased motivation for academic goals. She also reported improved social relationships with improved mood and regulated sleep than before. She reported a reduction in the consumption of junk food. Her interpersonal skills improved significantly, allowing her to express her thoughts and feelings more effectively.

Findings support DBT as an effective mode of intervention that targets deviant eating attitudes and improves mental health by strengthening emotion regulation, increasing distress tolerance, and improves interpersonal skills.

War profoundly affects the well-being of civilian populations and shapes subsequent mental health outcomes. This study aimed to investigate the effects of continuous traumatic stress (CTS) and coping efficacy on mental health outcomes among adults in Ukraine amid ongoing warfare over time. We examined how changes in CTS responses, coping efficacy, and stressful life events predicted posttraumatic stress disorder (PTSD) symptoms and broad mental health outcomes (depression, anxiety, insomnia, well-being). Participants were 157 adults who experienced war-related stress and completed two online surveys approximately 12 months apart. Moderately small but significant symptom reductions were observed, ds = 0.18-0.32, ps = .005-.026. Structural equation models analyzing the associations between initial status and changes in CTS, coping efficacy, and stressful life events and Time 2 PTSD symptoms and broad mental health outcomes explained most of the variance in PTSD symptoms and broad mental health outcomes, R² = .84‒.85. Higher initial severity and worsening CTS responses over time predicted higher PTSD symptom severity, standardized estimate (Est_std) = 0.29‒0.32, ps = .001‒.006, and poorer broad mental health outcomes, Est_std = 0.25‒0.28, ps = .001‒.016. Increased stressful life event exposure was linked to worse broad mental health outcomes, Est_std = 0.16, p = .001. Improvements in coping efficacy predicted superior broad mental health outcomes, Est_std = -0.43, p < .001. Assessing and addressing the impact of CTS, considering the toll of stressful life events, and enhancing coping efficacy may help to optimize service delivery in ongoing war environments.

This study examined the interactive relationships among health literacy, psychological resilience, and fear of progression (FoP) in patients with chronic heart failure and their caregivers.

A total of 300 dyads were recruited. The Actor - Partner Interdependence Mediation Model was used to analyze actor, partner, and mediation effects.

For both patients and caregivers, health literacy and psychological resilience negatively predicted individual FoP. Caregivers' health literacy positively predicted their psychological resilience, while no such association was found in patients. Psychological resilience mediated the health literacy-FoP association in both groups. Patients' health literacy could indirectly alleviate caregivers' FoP via caregivers' psychological resilience.

FoP in chronic heart failure is a dyadic psychological phenomenon. Interventions should target both patients and their caregivers to reduce fear of disease progression and improve family mental health.Clinical Implications: Dyad-based interventions that enhance health literacy and psychological resilience in both patients and caregivers may effectively alleviate FoP and promote overall family well-being.

Animal models demonstrated that pharmacologically-induced lesioning of the locus coeruleus (LC), the brain's primary source of norepinephrine, triggered astrocyte reactivity, exacerbating Alzheimer's disease (AD) pathology and cognitive deficits. We examined whether astrocyte reactivity modulates the relationship between LC dysfunction, tau pathology, and cognitive decline in humans.

We combined ultra-high-field LC functional imaging during an affective task with plasma biomarkers of glial fibrillary acidic protein (GFAP) and hyperphosphorylated tau (p-tau), and longitudinal cognitive data from 78 asymptomatic individuals. Associations between LC activity and norepinephrine transporter-enriched LC functional connectivity (LCFC) with p-tau, GFAP, and cognitive decline were examined.

Lower LC activity and LCFC were related to elevated plasma p-tau₂₁₇, particularly at elevated GFAP. Lower LC FC was also associated with cognitive decline in individuals with elevated plasma p-tau₂₁₇ and GFAP.

LC-norepinephrine system dysfunction may contribute to emerging tau pathology and cognitive decline, with astrocytes playing a critical gating role.

Despite extensive characterisation of immune responses across peripheral organs, the immunological landscape of the central nervous system (CNS) remains incompletely defined. Among the resident immune cell populations in the brain, mast cells and microglia have emerged as key modulators not only of neuroinflammatory processes but also of fundamental homeostatic functions, including regulation of sleep, affective states, and energy balance. These cells engage in complex bidirectional communication, mediated in part by the biogenic amine histamine. Although histamine was first identified over a century ago, its multifaceted roles in CNS homeostasis, immune surveillance, and neuropathophysiology remain poorly delineated. This review examines the biosynthesis, receptor-mediated signalling, and functional consequences of histaminergic activity within the brain, with a particular focus on microglial dynamics. We discuss crosstalk between mast cells and microglia via histamine signalling pathways, and the potential implications of this interaction in the etiology of neurodevelopmental disorders. Furthermore, we evaluate the emerging evidence on the capacity of centrally acting antihistamines, especially those capable of penetrating the blood-brain barrier, to modulate microglial phenotypes. Collectively, these insights underscore the urgent need for deeper mechanistic studies to elucidate histamine's role in CNS immunophysiology.

Anxiety disorders in older adults are commonly underdiagnosed and undertreated, especially among minority ethnic groups. This UK-based multicultural qualitative study explored beliefs about anxiety among White British, South Asian, African and Caribbean older adults who self-reported anxiety, and examined the applicability of Leventhal's Common-Sense Model.

Individual interviews were conducted with 52 older adults self-reporting current or past anxiety. Data were managed and analysed using the Framework Method. Professional interpreters facilitated interviews with non-English speakers.

The study included 27 participants with distressing anxiety and 25 with non-distressing anxiety. Participants' accounts revealed a fragmented understanding of anxiety. Beliefs varied within and across cultural groups, shaped by the interaction between culture, participants' salient identities, degree of distress and prior contact with mental health services. Despite this variability, participants' beliefs broadly mapped onto Leventhal's Model, supporting its applicability. Inductive analysis identified two new dimensions: aggravating factors and protective factors.

Older adults' understanding of anxiety is often fragmented. Broad cultural classifications risk obscuring within-group diversity. Cross-cultural research should adopt nuanced approaches to provide meaningful, person-centred insights into people's perceptions of illness. While applying Leventhal's Model provided new insights, further theoretical refinement may be needed to capture dimensions extending beyond the model.