Charles Bonnet syndrome (CBS) is a condition that can cause people with vision loss to see things that are not actually present, such as patterns, objects, animals, or people. Although these experiences are usually not a sign of mental illness, many individuals feel worried, confused, or reluctant to discuss their symptoms with healthcare professionals. A recent study in Therapeutic Advances in Ophthalmology showed that an educational podcast helped people with CBS better understand their condition and reduced some of the emotional distress associated with hallucinations. This finding highlights the value of simple, accessible educational tools in supporting patients. In our letter, we suggest that educational podcasts should be viewed as the first step in a broader support strategy. Education can help patients feel reassured, but it should be combined with routine screening, opportunities to discuss symptoms with healthcare providers, and clear pathways for referral when additional support is needed. We also emphasize the importance of making educational resources available in different languages and formats so they can reach people with varying levels of digital access and health literacy. By combining patient education with structured clinical support, healthcare systems may improve awareness of CBS, reduce stigma, encourage earlier disclosure of symptoms, and enhance quality of life for people living with this often-overlooked condition. Our goal is to promote practical, equitable, and patient-centred approaches that can be adopted in eye care services worldwide.

Starfruit (Averrhoa carambola) contains a potent neurotoxin, caramboxin, which can induce severe and often fatal encephalopathy in patients with impaired renal function. The diagnosis is frequently challenging due to nonspecific initial symptoms that can mimic other common complications in the end-stage renal disease (ESRD) population. A 63-year-old female patient with ESRD on maintenance hemodialysis presented with intractable hiccups, emesis, and chest pain. Her hospital course was immediately complicated by a hypertensive emergency and an elevated troponin level. Other labs were significant for hyperkalemia (potassium 5.7 mEq/L) and high-anion-gap metabolic acidosis. Following a hemodialysis session, she developed a severe, fluctuating encephalopathy. In view of a sudden decline in mental status, the patient underwent a CT head and an MRI head, which were negative for acute findings. The diagnostic workup was confounded by multiple concurrent issues, including lumbar puncture results suggesting meningitis, seizure-like activity requiring antiepileptic drugs, and an electroencephalogram (EEG) suggestive of toxic-metabolic encephalopathy. Furthermore, the patient developed new-onset atrial fibrillation. On the fifth day of admission, a detailed over-the-counter and dietary history obtained from the family revealed a significant starfruit ingestion two days prior to symptom onset. With the diagnosis of starfruit intoxication established, management was refocused on intensive hemodialysis. The patient's mental status gradually improved with increased frequency of renal replacement therapy as the toxin was cleared and confounding medications were withdrawn. This case illustrates how the classic presentation of starfruit neurotoxicity can be obscured by a complex clinical picture. It underscores that a high index of suspicion and a persistent, detailed dietary history are critical for a timely diagnosis and management of unexplained encephalopathy in all ESRD patients.

Adolescent non-suicidal self-injury (NSSI) is a growing public health concern. Adherence to 24-h movement guidelines yields notable health benefits, yet no studies have explored its association with adolescent NSSI. This study examined this association, alongside the moderating effect of sex and mediating role of psychological health (PH).

A total of 4,205 adolescents from five central Chinese cities were recruited. Self-reported questionnaires assessed sociodemographic characteristics, moderate-to-vigorous physical activity (MVPA), screen time, sleep duration, NSSI, and PH. Logistic regression analyzed associations between 24-h movement guideline adherence and NSSI; sex moderation was tested via interaction terms, and PH mediation via the PROCESS macro.

NSSI prevalence was 35.29%, while only 1.28% adhered to all three guidelines. Compared with adherence to none, meeting more guidelines was associated with progressively lower NSSI odds [1 vs 0: OR = 0.72, 95% CI (0.62, 0.83); 2 vs. 0: OR = 0.44, 95% CI (0.36, 0.54); 3 vs. 0: OR = 0.31, 95% CI (0.15, 0.65)]. However, adherence to three guidelines did not significantly further reduce risk vs. two [OR = 0.72, 95% CI (0.34, 1.49)]. Among equivalent adherence levels, combinations including the sleep guideline were associated with lower NSSI than those without (p < 0.05). Isolated MVPA guideline adherence showed no association with NSSI [OR = 1.15, 95% CI (0.74, 1.80)]. Sex significantly moderated the association for two guidelines and the "screen + sleep" combination (p < 0.05), with stronger negative associations in girls. PH significantly mediated the relationship.

Promoting adherence to 24-h movement guidelines, particularly the sleep guideline, may help manage adolescent NSSI risks, with emphasis on PH promotion and attention to sex differences.

The uptake of Family Interventions for psychosis (FIp) in routine settings has been limited across high-, middle-, and low-income countries due to geographic, systemic, and socioeconomic barriers. Psychosis REACH is a FIp that addresses these barriers by using a direct-to-family model co-facilitated by licensed mental health practitioners with expertise in Cognitive Behavioral Therapy for psychosis and family members with lived experience. While prior delivery relied on in-person training, this approach does not adequately address structural access challenges. The aim of this investigation was to evaluate caregiver outcomes of a hybrid asynchronous-synchronous version of Psychosis REACH consisting of (a) an online course, (b) a live virtual skills workshop, and (c) follow-along skills coaching from a trained family peer (Psychosis REACH Family Ambassador; pRFA).

Psychosis REACH was delivered via a hybrid digital format to 275 caregivers of individuals with psychosis, the majority of whom were parents (61.2%). We evaluated feasibility, acceptability, and participant characteristics, along with outcomes including depression, anxiety, caregiver burden, expressed emotion, attitudes toward psychosis, and self-perceived CBT skillfulness at post-training and 4-month follow-up.

Both asynchronous and synchronous components were rated as highly feasible and acceptable. Nearly all participants completed the online course; 85% went on to complete the virtual workshop, of which 66.7% endorsed intention to follow-up with a pRFA. Participants demonstrated significant improvements across multiple domains, including reduced psychiatric symptoms, caregiver burden, stigmatizing attitudes, and expressed emotion, along with increased confidence in CBT-informed skills.

Findings suggest that this hybrid digital training is both acceptable and feasible, offering a promising approach for disseminating evidence-based family support in psychosis. Clinical and educational outcomes were comparable to in-person delivery, underscoring its potential to reduce access barriers for some caregivers. Future research should prioritize randomized trials and active engagement of diverse and underserved families.

In recent years, there has been increased public concern surrounding the mental health of young people in Barbados. A significant challenge for young people experiencing mental health conditions is stigma, which is a key barrier to help-seeking. This study aimed to explore how young Barbadians with mental health conditions experience and respond to mental health stigma and help-seeking. Qualitative semi-structured interviews were conducted in 2022 with 28 Barbadians aged 18-24 years who reported being diagnosed with a mental health condition, or self-identifying as having experienced mental health challenges. The data were analysed through reflexive thematic analysis. The findings highlighted the importance of culture in how mental health is perceived, and the role of anticipated and experienced stigma deterring help-seeking. Social networks acted as both facilitators and barriers to stigma and help-seeking, and mixed experiences and opinions of formal services raised concerns regarding the quality of care and accessibility. These findings highlight the need for locally informed, culturally relevant strategies and interventions to address and reduce stigma, facilitate help-seeking and improve care outcomes within the community in Barbados.

Adolescent marriage and early childbearing remain common in rural Pakistan, yet few interventions support young couples transitioning into parenthood. This study explores the perceived impact and implementation of preparing for parenthood (PPP), a life skills intervention designed for married adolescents and their families. A qualitative design explored participants' and delivery agents' experiences of PPP. Data were collected through 12 in-depth interviews and 4 focus group discussions with married adolescent women, spouses, family members and programme trainers. Thematic analysis was used. PPP was perceived as relevant, acceptable and empowering. Participants reported improved core life skills; communication, emotional regulation, problem-solving and decision-making that enhanced their confidence and preparedness for parenting. Home-based delivery by trusted female trainers and recruitment via community health workers supported engagement in mobility-restrictive, patriarchal settings. Challenges included limited male participation, family gatekeeping and the burden of domestic work. Participants suggested adaptations such as mobile content, male facilitators and media-based delivery to overcome these barriers. This study highlights the value of life skills interventions in equipping married adolescent women with socioemotional competencies necessary for effective parenting. Home-based, culturally grounded models paired with flexible, gender-sensitive approaches can foster empowerment and improve outcomes in low-resource, gender-restrictive settings.

Mental and behavioural health (MBH)-related visits account for a substantial portion of emergency department (ED) care. EDs have increasingly adopted technological interventions to support MBH patients and staff. This review examined ED-based technological interventions and their impact on patient safety and quality of care for MBH populations. An initial search on six databases led to identification of 37,432 articles and final selection of 34 peer-reviewed articles on technology interventions. Key findings indicate that screening interventions effectively identify underlying drug and alcohol use, depression, and suicidal ideation in patients presenting to the ED with non-psychiatric complaints; remote psychiatry consultations improve access to mental health care; crisis management intervention programs are well-accepted by patients while waiting in the ED; and documentation interventions enhance communication with providers, and LLMs show strong potential in identifying psychiatric indicators. This review delineates key implications, implementation challenges, and future research directions for ED MBH care delivery.

The relationship between retirement and mental health remains unclear, with mixed evidence likely driven by methodological challenges and heterogeneity across population subgroups. This study explores the relationship between retirement, time since retirement and mental health, focusing on differences between those living alone and cohabiting.

We used data from 10,698 participants (48,815 observations) in the Survey of Health, Ageing and Retirement in Europe, waves 1-8, spanning 20 countries and 16 years. Participants were included if they were employed at baseline and retired during follow-up. We applied a triangulated approach using (1) multilevel linear spline models to examine trajectories and (2) fixed-effects instrumental variable analyses (IV) using statutory retirement age as an instrument to establish causal effects. The outcome was depressive symptoms measured using the EURO-D scale (higher scores indicate more depressive symptoms).

Multilevel spline models showed minimal change in depressive symptoms before retirement. At retirement, a small decline in EURO-D scores was indicated (-0.07 points per year [95% CI: -0.13 to -0.0003]), followed by an increase starting two years post-retirement (0.09 per year, 95% CI: 0.02 to 0.16). IV analyses showed that retirement was associated with fewer depressive symptoms (-0.26, 95% CI: -0.45 to -0.07). Individuals living alone reported higher depressive symptoms, but cohabitation status did not moderate the relationship between retirement and mental health.

Retirement is associated with a short-term reduction in depressive symptoms, but the effect diminishes over time. While individuals living alone consistently report higher depressive symptoms, cohabitation status does not moderate the retirement-mental health relationship.

Schizophrenia is a chronic psychiatric disorder that significantly affects individuals' mental health. Sustained personal recovery in schizophrenia is a multidimensional process that extends beyond symptom reduction and may be significantly influenced by psychological resources and cognitive appraisals. While self-compassion and metacognitive beliefs are known to affect mental health outcomes independently, their interacting roles in predicting personal recovery remain unclear.

This study examined the mediating role of metacognitive beliefs in the relationship between self-compassion and recovery among individuals diagnosed with schizophrenia.

A cross-sectional correlational design was used. A purposive sample of 150 clinically stable adults diagnosed with schizophrenia (DSM-5 criteria) was recruited from psychiatric outpatient clinics at Helwan University Hospitals, Egypt, between April and September 2024. Data were collected through structured face-to-face interviews using the Arabic versions of the Metacognition Questionnaire-30, the Self-Compassion Scale-Short Form, and the Recovery Assessment Scale-Domains and Stages.

Bivariate analyses revealed a significant positive correlation between self-compassion and personal recovery (r = 0.374, p < 0.001). While total metacognitive belief scores correlated positively with recovery (r = 0.346, p < 0.001), subscale analysis indicated this was driven primarily by the Cognitive Self-Consciousness subscale (r = 0.598, p < 0.001). The association between self-compassion and total metacognitive beliefs was non-significant (r = 0.084, p = 0.304). Consequently, mediation analysis demonstrated that self-compassion showed a significant direct association with recovery (B = 0.5726, p < 0.001); however, the indirect pathway through metacognitive beliefs was not significant (B = 0.0442, 95% Bootstrap CI [-0.045, 0.147]).

Metacognitive beliefs were not found to mediate the association between self-compassion and recovery; instead, self-compassion was independently associated with multidimensional recovery. Clinically, these findings support the integration of self-compassion training into long-term schizophrenia treatment plans. Future longitudinal and intervention-based studies are warranted to clarify the temporal dynamics of these relationships.

Prenatal exposure to alcohol (PAE) and/or tobacco (PTE) may impact neurobiological and cognitive development years after such exposures have occurred. While such effects on cortical gray matter and cognition are widely researched, there is less research on the effects of PAE and PTE on white-matter development and cognition, particularly in non-clinical, community samples.

We analyzed white-matter microstructure and its cognitive correlates in four hundred and sixty five 8-12-year-olds in the urban Cape Town region of South Africa: 192 were prenatally exposed to alcohol and tobacco (PAE + PTE), 73 to tobacco only (PTE), 102 to alcohol only (PAE), and 98 to neither tobacco nor alcohol (CON). White-matter microstructure was quantified via neurite orientation and dendrite dispersion imaging (NODDI). The outcome variables were fractional anisotropy (FA), the neurite density index (NDI), and neurite orientation dispersion index (ODI) for 52 white-matter tracts. Cognition was measured using the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V).

PAE (but not PTE) was associated with NDI in 35 of 52 white-matter tracts analyzed. There were no false-discovery-rate (FDR) corrected main effects of PAE or PTE on FA or ODI. For 17 of the 35 tracts affected by PAE, the corresponding NDIs were positively associated with scores on the WISC-V Processing Speed Index.

Our previous research of neuroanatomical structure in this cohort suggested that there are stronger effects of PTE on cortical gray matter. In contrast, the present data suggest that PAE may have stronger associations with white-matter microstructure, with such effects potentially manifesting as downstream deficits in processing speed.