Dispositional optimism is associated with a lower risk of depression. Optimism may protect against depression by conferring resilience to stressful life events. This study aimed to investigate the effects of dispositional optimism, and the related trait of dispositional pessimism, on the relationship between stressors and depression in older adults.

This prospective cohort study used data from the ASPREE Longitudinal Study of Older Persons. Participants were aged ≥70 years and without known cardiovascular disease, dementia, independence-limiting physical disability and depression. Optimism and pessimism were measured using the Life Orientation Test-Revised. Incident depression was defined as a score ≥ 8 on the 10-item Center for Epidemiological Studies Depression Scale. The experience of 10 different types of stressors was assessed.

10,791 participants were followed for a median (IQR) period of 3.5 (2.8-5.0) years. After adjusting for sociodemographic, lifestyle and medical factors and genetic predisposition to depression (using a polygenic score), optimism was associated with a lower risk of depression (HR, 0.92; 95% CI 0.90-0.93). Pessimism (HR, 1.07; 95% CI 1.06-1.08) and stressful life events (HR, 1.17; 95% CI 1.14-1.21) were associated with a higher depression risk. Neither optimism nor pessimism was associated with differences in the strength of the relationship between stressors and depression (p ≥ 0.499).

Optimism was associated with a lower risk of late-life depression. However, it was not associated with lower vulnerability to the depressogenic effects of stressful life events. These findings raise questions regarding whether optimism confers resilience to stressors in older adults.

Suicidal ideation (SI) and suicide attempt (SA) are both influenced by genetic, behavioral, and environmental factors. Alcohol use disorder (AUD) and adverse childhood experiences (ACEs) may mediate or moderate the effects of genetic liability for suicidality.

Using data from 10,275 participants (43.8% female; 47.2% African-like genetic ancestry [AFR], 52.8% European-like genetic ancestry [EUR]), we tested whether polygenic scores (PGS) for SI and SA predicted lifetime suicidality outcomes. We evaluated whether AUD partially accounted for these associations and ACEs moderated the direct and indirect associations.

The SA PGS was significantly associated with SA (AFR: b = 0.36, SE = 0.01; EUR: b = 0.17, SE = 0.01; both ps < 2e-16), but the SI PGS was not associated with SI (p > 0.55). AUD statistically mediated the association between the SA PGS and SA, accounting for approximately 2% of the total association in AFR individuals and 10% in EUR individuals (both ps < 2e-16). Notably, the proportion of the association that was accounted for by AUD decreased as ACEs exposure increased, from 4.30% to 0.54% in AFR individuals and from 13.31% to 3.44% in EUR individuals. In contrast, there was only very modest mediation and no moderated mediation for SI.

Particularly among individuals with lower ACEs exposure, AUD accounted for a meaningful proportion of the association between genetic liability to SA and lifetime SA. These findings highlight different correlates across suicidality phenotypes and suggest potential clinical relevance for AUD in the association between genetic liability and SA.

The p factor reflects general liability for psychopathology. Few studies have examined the p factor in youth with chronic physical illness (CPI), and none have modelled its association with health-related quality of life (HRQL).

This study examined associations between the p factor and 48-month HRQL in youth with CPI, and whether age or sex moderate these associations.

Children and adolescents aged 2-16 years with CPI were recruited from outpatient clinics at a pediatric hospital (N = 263) and followed for 48 months (N = 202). The p factor was derived from the parent-reported Emotional Behavioural Scales. HRQL was measured using the parent-reported KIDSCREEN-27 across five domains. Multiple regression was used to estimate associations between p scores and 48-month HRQL, stratified by age (2-9 years vs. 10-16 years) and sex (female vs. male). Moderation was tested using the method of variance estimates recovery.

Among children, higher p scores were associated with lower psychological well-being (β = -0.17, p = 0.016), social support & peers (β = -0.26, p = 0.003), and school environment (β = -0.24, p = 0.002). For adolescents, the association was significant only for school environment (β = -0.21, p = 0.011). Among males, p scores were associated with lower autonomy & parent relations (β = -0.17, p = 0.028) and school environment (β = -0.17, p = 0.012); whereas for females, associations were significant for social support & peers (β = -0.20, p = 0.015) and school environment (β = -0.21, p = 0.007). There was no evidence for a moderating effect of youth age or sex.

The p factor is inversely associated with HRQL in youth with CPI and may be useful in identifying at-risk individuals in clinical settings.

The interest in microdosing psychedelics continues to grow within academic and recreational contexts. However, microdosing practices have changed over time, and warrants examination of use patterns within a large, global sample of consumers.

The Global Psychedelic Survey 2025 (GPS 2025) was an online, anonymous, cross-sectional survey conducted from May 1-23, 2025. The survey was available in 19 languages and inquired about a wide range of topics surrounding psychedelic use. This manuscript focuses on the primary outcomes for the microdosing component of the survey, examining the substances consumed, dosing regimens employed, reasons for use, as well as the typical 'set and setting' while microdosing.

In this sample, 5399 participants reported microdosing during their lifetime, of whom 69.8% (n = 3768) used a microdose within the past year. Psilocybin was the most commonly microdosed substance (n = 4377; 81.1%, 95% CI: 80.0%-82.1%), followed by LSD (n = 2136; 39.6%, 95% CI: 38.3%-40.9%). This was consistent across global regions. The 'Fadiman protocol' (i.e. one day on, two days off) was the most reported dosing regimen among regular microdosers (n = 1203; 24.3%, 95% CI: 23.1%-25.6%). While microdosing, respondents reported often spending time in nature (n = 3087; 58.9%), focusing inwards (n = 2977; 56.8%), or spending leisure time (n = 2253; 43%), demonstrating preliminary evidence supporting the integration of set and setting in the context of microdosing.

This study provides a snapshot of psychedelic microdosing practices using the largest psychedelic-specific global survey to date. These findings highlight real-world practices that can guide both clinical study designs and inform harm-reduction practices in naturalistic settings.

Formal thought disorder (FTD) is a key determinant of social functioning in schizophrenia. However, existing syntheses have not differentiated positive versus negative FTD dimensions, which have distinct trajectories, mechanisms, and treatment implications. We examined the differential associations of positive and negative FTD with social functioning.

A comprehensive systematic review with stricter inclusion criteria to update prior meta-analyses, searching Scopus and PubMed for publications up to 31 January 2026. Bayesian random-effects meta-analyses were performed separately for negative FTD (k = 7 studies, N = 1226) and positive FTD (k = 24, N = 4072). Bias was assessed using a modified Newcastle-Ottawa Scale. Robust Bayesian methods assessed publication bias. Protocol pre-registered with OSF: 10.17605/OSF.IO/WMT3X.

Both dimensions showed negative associations with social functioning. Positive FTD demonstrated a robust pooled effect (r = -0.31, 95% CrI: -0.40 to -0.20) with extreme evidence (BF₁₀ > 100, posterior probability ~100%). Negative FTD showed a smaller effect (r = -0.21, 95% CrI: -0.38 to 0.000) with moderate evidence (BF₁₀ = 7.97, posterior probability = 88.9%). Positive FTD accounts for more variance in functioning than negative FTD, but this difference is not robust due to paucity of negative FTD studies. High heterogeneity (I² > 76%), unexplained by known moderators, indicates substantial variation across study settings.

Both FTD dimensions link to poorer social functioning, with stronger evidence for positive FTD due to more studies and larger samples. Positive FTD may affect social functioning by disrupting communicative competence, highlighting a need for interventions targeting communication deficits.

We aimed to estimate the cost-effectiveness of the patient-centered special care unit for behavioral and psychological symptoms of dementia (SCU-B) in the Respectful Caring for the Agitated Elderly (RECage) study.

A health-economic evaluation was performed alongside a controlled European multicenter three-year longitudinal cohort study enrolling 508 participants in a non-SCU-B cohort and SCU-B cohort. Health service resource use, costs, quality-adjusted life years (QALYs), and incremental cost per QALY gained were assessed.

Total QALYs were lower (-0.13; bootstrap-interval -0.23 to -0.02) and total costs were higher (€24,960; bootstrap-interval 14,870 to 35,090) in the SCU-B cohort. Base case and sensitivity analyses indicated the SCU-B was likely not cost-effective.

Widespread implementation as well as disinvestment of SCU-B cannot be recommended, given the uncertainty of the study results. We recommend a randomized study stratified by (local/county) region for conclusive evidence.

Systematic collection of social determinants of health (SDoH) data remains inconsistent across health care settings, despite its critical impact on patient outcomes. Large language model-powered chatbots offer promise for scalable SDoH data collection, but rigorous, feasible evaluation methods for patient-facing applications are lacking.

This study aimed to describe an efficient, iterative, multidisciplinary approach for developing and evaluating a patient-facing SDoH chatbot using synthetic data and case simulation, with the goal of optimizing both chatbot performance and the evaluation rubric prior to clinical deployment.

A 10-criterion evaluation rubric was adapted from established health care AI frameworks and applied to 27 synthetic clinical scenarios representing diverse SDoH profiles. Scenarios were role-played by a licensed clinical social worker, and chatbot-patient interactions were rated by 3 members of the research team that were multidisciplinary experts: a social worker, a nurse practitioner, and a physician. Quantitative analysis used percent agreement and Fleiss κ to characterize chatbot performance and rater consensus, with percent agreement selected due to the high prevalence of ceiling effects in several domains. Qualitative analysis synthesized rater feedback to guide iterative refinement of both chatbot prompts and rubric domains.

Across 27 simulated cases, the chatbot received high proportions of positive ratings for accurate interpretation (agreement=0.98%, 95% CI 0.91-0.99), communication quality, and cultural sensitivity (agreement=0.99%, 95% CI 0.93-1.00), and appropriately adaptive questioning (agreement=0.99%, 95% CI 0.93-1.00). Lower performance was observed in domain focus and completeness (agreement=0.51%, 95% CI 0.40-0.61), completeness of data capture (agreement=0.59%, 95% CI 0.48-0.69; Fleiss κ=0.18), and safety (agreement=0.69%, 95% CI 0.58-0.78; Fleiss κ=-0.04), prompting targeted adaptations. Qualitative feedback highlighted the importance of distinguishing screening from clinical interviewing capabilities and informed the refinement of the rubric, including clarifying the definition of safety to focus on recognition of physical and mental health emergencies.

This study describes a formative feasibility approach for iterative refinement of a patient-facing SDoH chatbot and its evaluation rubric using synthetic case simulation. Future work will include independent external raters, patient stakeholders, repeated scenario testing, and prospective clinical evaluation.

Emergency medicine has experienced growth as a research discipline, with psychiatric emergencies representing an area of expansion. The increasing volume of psychiatric presentations to emergency departments necessitates analysis of scientific output in this domain. This study examines publication trends, geographic distribution, and thematic priorities in psychiatric emergency medicine research over the past decade.

We conducted a bibliometric analysis of articles published between January 2014 and December 2023. Data were extracted from the Web of Science Core Collection database using the search terms "Emergency Medicine" AND "Psychiatry." Analysis included publication trends, geographic distribution, journal metrics according to Bradford Law, keyword frequency analysis, and thematic mapping. Statistical analyses employed IBM SPSS Statistics 25 and bibliometric software.

The analysis identified 862 publications authored by 5111 individuals from 67 countries. Annual publication volume increased from 52 articles in 2014 to 126 articles in 2023. The United States contributed 488 publications (56.7%), followed by Turkey (46 publications, 5.3%), Canada (44, 5.1%), Australia (40, 4.7%), and Iran (33, 3.8%). Four core journals accounted for 37.0% of publications: American Journal of Emergency Medicine (117 articles), Pediatric Emergency Care (75), Academic Emergency Medicine (66), and Journal of Emergency Medicine (61). Mean citation rate was 11.5 per article. Keyword analysis identified 6 primary research themes: pediatric psychiatric emergencies, substance use, suicide and self-harm, consultation models, emergency department management, and geriatric psychiatric emergencies. Temporal analysis revealed increased research focus on vulnerable populations including children and older adults after 2017.

Psychiatric emergency medicine research demonstrated consistent growth over the decade studied. Publication output was concentrated geographically, with limited international collaboration. Research priorities evolved toward pediatric and geriatric populations. Findings provide insight into current research landscape and may inform future research directions and resource allocation in psychiatric emergency care.

Background: Estimating the association between childhood emotional maltreatment (CEM) and trauma-related outcomes is important for prevention and intervention.Objective: We synthesised the evidence by differentiating between emotional abuse and emotional neglect, examining post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) and exploring moderators and mediators.Method: Following PRISMA guidelines, seven databases were searched up to 19/03/2026 (PROSPERO-CRD42024598358) for studies on the association between CEM and PTSD/CPTSD. Study quality was assessed using an adapted Newcastle-Ottawa Scale (NOS), and certainty of evidence was evaluated using the GRADE framework.Results: Of 11,479 records, 62 were included in the review, of which 57 studies provided 132 effect sizes for a random-effects multilevel meta-analysis (N = 323,776). Study quality was overall fair (Mean NOS = 5.8). A positive association between CEM and PTSD/CPTSD (k = 132, r = .27, 95% CI [.23, .30]) 95% PI [-.04, .53] with substantial heterogeneity (I² = 86.5%). Higher estimates were identified for emotional abuse (k = 71, r = .29, 95% CI [.25, .33]) compared to emotional neglect (k = 55, r = .24, 95% CI [.19, .28]). Effect sizes were similar for CPTSD (k = 29, r = .29, 95% CI [.24, .35]) and PTSD (k = 103, r = .26, 95% CI [.22, .30]). No differences were observed by sex, age, or population type (clinical vs. non-clinical). However, higher estimates were identified in high-income settings and more developed contexts. Narrative synthesis identified cognitive, affective, physiological and interpersonal mechanisms as potential mediators. The certainty of the evidence was generally low. Limitations include the predominance of cross-sectional designs, reliance on self-report measures of CEM and variability across outcome measures.Conclusions: These findings underscore the importance of CEM in trauma-related symptomatology and support the need for its systematic assessment in clinical and research settings, particularly by highlighting differences between emotional abuse and emotional neglect.

In the US, deep brain stimulation (DBS) is accessible to pediatric patients with dystonia who are 7 years of age and older through an FDA Humanitarian Device Exemption (HDE). The aim of this study was to assess the safety, feasibility, and outcomes of DBS for dystonia in children younger than 7 years of age who are excluded from the FDA HDE.

Data were collected (February 2015-December 2025) through The Child & Youth Comprehensive Longitudinal Database for DBS, which is a prospective registry of pediatric DBS from 5 tertiary pediatric hospitals in North America. Participants younger than 7 years of age who underwent DBS targeting the globus pallidus internus for the treatment of dystonia were included. Demographics, operative details, and postoperative outcomes and complications were analyzed.

Twelve children underwent 14 DBS-related surgeries, with a mean follow-up duration of 2.66 years (range 0.50-10.85 years). The mean age at the time of surgery was 4.72 years (range 2.96-6.83 years), and the mean weight was 16.5 kg (range 9.3-30.8 kg). Half of the children had prior ICU admissions for status dystonicus, and 9 DBS surgeries (64.3%) were performed urgently. Three children had transgression of stereotactic frame pins beyond the inner table of the skull, while 4 other children had wound complications requiring surgical intervention. No patients experienced neurological sequelae, and those requiring explantation of infected hardware were reimplanted successfully once the infections were treated. Overall, there was a mean reduction of 40.1% in the Burke-Fahn-Marsden movement subscale at 6 months postoperatively (p < 0.05), which persisted to 12 months. Three children died due to underlying conditions > 6 months from their respective surgeries.

DBS had demonstrable benefits in children younger than 7 years of age with severe refractory dystonia, albeit with higher surgical risks compared with older children. Further research is warranted to better inform treatment decisions and regulatory oversight.