Encephalitis is difficult to diagnose and manage, posing a challenge to clinicians. Since the last European guidelines were published in 2010, novel causes have emerged, diagnostic processes have evolved and treatments assessed which need to be reflected in updated guidelines.

We aimed to produce recommendations for the diagnosis and management of infectious encephalitis in adults based on current evidence to equip clinicians to improve patient outcomes.

These guidelines were developed jointly with the support of two European specialist medical organisations. Clinical questions were prioritised and formulated in PICO format. A systematic literature search was conducted for each question, and the quality of evidence was assessed using standardised tools. Recommendations were developed according to the GRADE approach. Where only indirect evidence was available, a good practice statement was made.

Sixteen questions were considered, with two recommendations reached: for initiation of intravenous aciclovir as soon as possible upon suspicion of encephalitis and against replacing pathogen-specific polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) with multiplex CSF PCR panels for diagnosis of adult patients with suspected infectious encephalitis. For adults with proven HSV encephalitis, we were unable to recommend for or against the use of corticosteroids. A further 13 good practice statements regarding when to clinically suspect infectious encephalitis, microbiological investigations, additional investigations, treatment, and ongoing care and rehabilitation were agreed.

Given the clinical severity and public health importance of this condition, the paucity of high-quality evidence is striking. Transnational, large-scale research in infective encephalitis is encouraged.

Parkinson's disease (PD) is a systemic disorder linked to gut dysbiosis, yet key microbiota-regulated metabolites remain unclear. Here, we observe elevated taurochenodeoxycholic acid (TCDCA) in patients with PD that correlates with disease severity. Reduced bile salt hydrolase (BSH) gene abundance correlates inversely with circulating TCDCA, consistent with altered bile acid deconjugation. Exogenous TCDCA correlates with aggravated motor and gastrointestinal deficits, impaired blood-brain barrier (BBB) integrity, and accelerated dopaminergic neurodegeneration in a PD mouse model. Mechanistically, TCDCA links to TGR5 signaling activation in vascular smooth muscle cells (VSMCs), alongside PKCα-dependent mitochondrial apoptosis and BBB disruption. VSMC-specific Tgr5 deletion coincides with neurovascular protection. Supplementation with a BSH-high Lactobacillus reuteri strain reduces TCDCA concentrations, improves gut and BBB integrity, mitigates inflammation, and alleviates PD-like phenotypes in a BSH-dependent manner. These data support a gut-BBB-brain axis linked to PD, identifying TCDCA as a candidate pathological marker.

Child maltreatment is a major public health concern associated with a wide range of adverse mental health and behavioral outcomes in adolescence.

To identify latent profiles of childhood maltreatment in a community sample of adolescents in Spain and to examine whether these profiles differ across theoretically relevant emotional, behavioral, interpersonal, and clinical outcomes. As a secondary aim, the study explored whether maltreatment profile membership was associated with the severity of suicidal behavior and non-suicidal self-injury.

A total of 1526 adolescents (54.3% girls; mean age = 13.8 years, SD = 1.27) from secondary schools in Madrid completed standardized self-report measures of maltreatment, psychopathology, and risk behaviors.

A cross-sectional survey was conducted. Latent profile analysis based on Childhood Trauma Questionnaire subscales was used to identify maltreatment profiles. Differences between latent profiles were examined using t-tests and chi-square analyses. Ordinal logistic regression models were used to examine factors associated with suicidal behavior and non-suicidal self-injury (NSSI) severity.

Two profiles were identified: a High Maltreatment Exposure Profile (7.5%) and a Low Exposure Profile (92.5%). Compared to the low-exposure group, adolescents in the high-exposure profile-who were more likely to be girls- showed significantly higher levels of depressive symptoms, suicidal ideation and attempts, repeated NSSI, impulsivity, and emotion dysregulation, as well as greater alcohol use, more problematic gaming, and lower perceived social support. Regression analyses indicated that maltreatment profile, depressive symptoms, and emotion dysregulation were significantly associated with suicidal behavior and NSSI severity.

Distinct maltreatment profiles were associated with differential clinical severity. Adolescents in the high maltreatment exposure profile, particularly girls, showed a more severe concurrent pattern across emotional, behavioral, and interpersonal domains. A person-centered characterization of maltreatment exposure may help clarify heterogeneity in adolescent psychosocial risk, particularly regarding emotion dysregulation, suicidal behavior, and NSSI.

Disclosure of childhood sexual abuse (CSA) is often assumed to be beneficial. However, prospective research examining outcomes associated with disclosure remains scarce, limiting evidence-based guidance for adults considering disclosure.

The primary aim was to examine changes in posttraumatic stress disorder (PTSD) symptoms following first-time disclosure of CSA to personal contacts and to test whether perceived supportiveness of confidants' responses moderated these changes. The secondary aim was to explore characteristics of CSA disclosure.

Forty adults with a history of CSA who had not previously disclosed the abuse to personal contacts completed two assessments, at baseline and at follow-up six months later. Participants who disclosed their CSA to a personal contact during the follow-up period were classified as disclosers, whereas those who did not were classified as non-disclosers.

During the follow-up period, 60% (n = 24) disclosed for the first time to personal contacts, after on average 31.5 years (SD = 16.2), most often to friends (47%). Disclosers showed a clinically relevant, greater reduction in PTSD symptoms than non-disclosers. Perceived supportiveness of confidants' responses was moderate to high but did not significantly moderate changes in PTSD symptoms.

First-time disclosure of CSA in adulthood to personal contacts was associated with a clinically relevant reduction in PTSD symptoms. Nevertheless, individual differences in symptom change indicate that outcomes following disclosure vary. Guidance should therefore move beyond the question of whether to disclose and consider when, under what circumstances, and for whom disclosure may be beneficial.

Delayed responses after cerebrospinal fluid (CSF) removal and changes observed in daily life may be missed by same-day clinic-based testing. We evaluated an outpatient CSF tap-test pathway combining quantitative testing with a 1-week patient and caregiver assessment in older patients with suspected normal pressure hydrocephalus (NPH).

We retrospectively reviewed all 22 consecutive patients who entered the pathway at two hospitals from January 2024 through December 2025. After removal of 30-50 mL of CSF, Timed Up and Go (TUG) and Mini-Mental State Examination (MMSE) assessments were performed when feasible approximately 1 h later and at 1 week. At the 1-week visit, patients and/or accompanying family members were interviewed face to face about changes in daily activities.

All patients completed testing without admission. Quantitative improvement occurred in 10 patients, clinician-documented improvement in 13, and patient- or caregiver-reported improvement in 13. The integrated clinical response was positive in 18 patients; 5 had improvement reported only by the patient or caregiver. One transient orthostatic headache occurred. No emergency department visit, unplanned hospitalization, or serious tap-test-related adverse event occurred through 1 week. Twelve patients underwent shunt surgery, and 11 had gait improvement at 3 months.

This outpatient pathway was feasible at the participating hospitals. Delayed patient and caregiver assessment identified changes not captured by clinician documentation in some patients and may complement quantitative testing. Prospective studies should use standardized reported-outcome measures and predefined assessment schedules.

Obsessive-compulsive disorder (OCD) commonly begins during adolescence, yet its neurobiological basis remains unclear. Beyond the classical cortico-striatal framework, the cerebellum has been implicated in cognitive, affective, and motor regulation, relevant to OCD. However, it is unknown whether adolescent OCD involves abnormal dynamic coordination of large-scale cerebellar networks.

Thirty-eight adolescents with OCD and 29 matched controls underwent dynamic functional network connectivity (dFNC) analysis of cerebellar networks using a sliding-window approach and k-means clustering. Connectivity states, temporal properties, and the standard deviation of dFNC across sliding windows were quantified and examined in relation to clinical symptoms through exploratory partial correlation analyses.

Compared to healthy controls, adolescents with OCD showed fewer state transitions, indicating reduced network flexibility. They also exhibited lower dFNC variability in networks, including dorsal attention network (DAN)-visual network (VN), DAN-salience network, default mode network (DMN)-VN, and DMN-somatomotor dorsal network connections. Exploratory partial correlation analysis revealed that DAN-VN dFNC variability was negatively correlated with OCI-CV neutralizing scores, whereas DMN-VN dFNC variability was positively correlated with CDI negative mood scores, and CDI total scores.

Adolescent OCD shows reduced intra-cerebellar dynamic connectivity flexibility and variability associated with obsessive-compulsive and depressive symptoms, suggesting impaired cerebellar reconfiguration.

Although 40%-60% of patients with schizophrenia achieve symptomatic remission, residual symptoms often persist. Negative symptoms are associated with poorer functioning and quality of life. Determinants of residual symptom severity in remitted first-episode psychosis remain insufficiently understood, and identifying these factors may inform interventions to reduce burden.

We conducted a cross-sectional analysis using data from HAMLETT, a multicentre randomised controlled trial of remitted first-episode psychosis patients. The primary measure was the Positive and Negative Syndrome Scale (PANSS). Additional measures were the negative PANSS subscale and Global Assessment of Functioning (GAF). Associations with clinical and demographic characteristics were examined using linear regression analyses.

368 participants (70% male, 30% female) were analysed. Mean (SD) total PANSS, negative PANSS subscale, and GAF scores were 44.9 (10.2), 12.2 (4.2), and 64.7 (12.0), respectively. Only socioeconomic status (SES) was significantly associated with clinical measures: higher SES was associated with lower total PANSS (B = -0.077, 95% CI [-0.107, -0.047], p < .001), lower negative PANSS subscale (B = -0.137, 95% CI [-0.183, -0.090], p < .001), and higher GAF (B = 4.57, 95% CI [2.89, 6.24], p < .001). No other significant associations were observed.

Within a remitted first-episode psychosis population, we found that a lower socioeconomic status was associated with more residual symptoms and poorer functioning. This finding underscores the importance of addressing social determinants of health in early psychosis care, even after symptomatic remission. Future longitudinal research should test whether addressing socioeconomic needs improves outcomes in remitted first-episode psychosis.

Fatigue is a frequent and disabling symptom across many physical and mental health conditions. Despite similar phenomenology, research has largely focused on single conditions using heterogeneous assessments, limiting cross-condition comparability. This study examines fatigue-related symptom burden across diverse clinical conditions within a shared framework.

In this multicenter cross-sectional study, adult outpatients (18-65 years) were recruited at five German university hospitals into seven cohorts: chronic primary pain, multiple sclerosis, cancer, chronic renal failure, inflammatory bowel disease, post-COVID condition, and chronic fatigue syndrome. Fatigue was assessed using established self-report measures, including the Fatigue Severity Scale and the Chalder Fatigue Scale, alongside mental health measures. Group differences were analyzed using ANOVA and chi-square tests with adjusted post hoc comparisons.

A total of 538 patients were included. Fatigue burden varied substantially across cohorts, with a largely consistent pattern across assessment instruments. Despite significant overall between-cohort differences, the post-COVID (n = 91), chronic primary pain (n = 110), and cancer (n = 124) cohorts showed comparable fatigue levels across several assessment instruments. Multiple sclerosis (n = 63) showed intermediate levels, whereas inflammatory bowel disease (n = 95) consistently showed the lowest fatigue burden. Due to the small sample size, chronic renal failure (n = 30) and chronic fatigue syndrome (n = 25) were analyzed descriptively. Across cohorts, fatigue and most psychological and somatic symptom measures were elevated relative to population reference values.

Using a harmonized assessment framework across seven diagnostic cohorts, this study demonstrates meaningful differences in fatigue burden, with convergent patterns across instruments. The findings provide a reference for contextualizing fatigue severity across conditions and support future hypothesis-driven and mechanistic analyses.

Parental beliefs about infant sleep shape caregiving practices, infant development, and parental wellbeing. The Views oN Infant Sleep (VNIS) questionnaire was designed to assess these beliefs across three domains: Closeness, Independence, and Night-Waking. This study aimed to validate the questionnaire for the first time in an Australian context, in a sample of 111 pregnant women.

Women completed an anonymous online questionnaire containing the 12-item VNIS. Confirmatory factor analysis was conducted in MPlus, using a weighted least squares estimator to evaluate the proposed three-factor structure.

Findings provided partial support for the three-factor model. Incremental and residual fit indices were strong (comparative fit index = 0.97; Tucker-Lewis index = 0.96; weighted root mean square residual = 0.76) and the chi-square to degrees-of-freedom ratio indicated acceptable fit (1.75). Global fit was borderline (root mean square error of approximation = 0.08, 90% confidence interval = 0.05-0.11). All items loaded significantly onto their intended factors, however item performance varied. Independence items showed consistently strong loadings, while Closeness items ranged from moderate to strong with one weaker indicator. Night-Waking items were more variable, including one item below acceptable thresholds. Inter-factor correlations were strong (r = 0.58-0.71), indicating substantial coherence and limited distinctiveness between components.

The VNIS questionnaire captures multidimensional parental beliefs about infant sleep but requires refinement to strengthen reliability and discriminant validity. Further cross-cultural and longitudinal research is needed to support its broader applicability in diverse clinical and research contexts including to fathers and non-birthing partners.

Postoperative delirium affects up to 50% of older adults with cognitive impairment, yet preoperative identification of at-risk patients remains limited. Artificial intelligence methods, such as natural language processing, can extract cognitive impairment signals from electronic health records and enable targeted clinical decision support interventions to promote adherence to perioperative best practices and reduce postoperative delirium. We aimed to evaluate the effectiveness of an artificial intelligence-driven non-interruptive clinical decision support intervention in reducing postoperative delirium by promoting adherence to best practices among anesthesia teams caring for surgical patients with cognitive impairment.

We conducted a pragmatic randomized controlled trial embedded within routine clinical care at The Mount Sinai Hospital in New York City from June 20, 2023, to August 31, 2024, including patients with preoperative cognitive impairment identified immediately before surgery using a validated natural language processing algorithm, Mini-Mental State Examination scores, or diagnostic codes. Patients were randomized to an artificial intelligence-driven non-interruptive clinical decision support intervention within the electronic health record to promote adherence to best practices among anesthesia teams or routine perioperative care. The primary outcome was postoperative delirium, assessed with the 4 A's Test within seven days postoperatively. Secondary outcomes were adherence to 12 perioperative best practices. We used chi-square tests for primary and secondary outcome analyses.

Overall, 7294 patients were identified as having cognitive impairment immediately before surgery and were randomized to the intervention (n = 3624) or control (n = 3670) group. In total, 1255/7294 (17.2%) patients had documented postoperative delirium assessments, of whom 426/1255 (34%) developed this condition. Between intervention and control groups, there were no statistically significant differences in POD incidence (225/641, 35.1% vs 201/614, 32.7%, P = .37) or best practice adherence (all P > .05).

In this pragmatic randomized controlled trial, less than 20% of the sample had documented delirium assessments due to variability in routine POD screening practices, limiting our ability to conclude that artificial intelligence-driven clinical decision support was not effective in preventing postoperative delirium. However, based on our secondary outcome analyses, the intervention did not significantly change best practice adherence. Further work is needed to determine the best way to use these tools effectively.