Suicide has been linked to distinct impairments in emotional face processing. This magnetoencephalography (MEG) study used a multimodal design to address how cortisol dysregulation, often reported in individuals with suicidal thoughts and behaviors, affects emotional face processing.

The electrophysiological correlates of emotional face processing were investigated in 118 adults with varying suicide risk. Tonic cortisol levels and their moderating effects on face processing were analyzed. Participants performed an emotional evaluation task during MEG to categorize face stimuli. MEG data were source-localized in the gamma (30-58 Hz) frequency, and dynamic causal modeling (DCM) examined effective connectivity between regions implicated in face processing.

Individuals with a past suicide attempt (>1 year) showed blunted cortisol. Distinct gamma oscillation patterns emerged based on risk: at-risk groups showed higher gamma power in early visual cortex (EV) but lower power in superior frontal gyrus. Cortisol moderated EV gamma power in those with a recent suicide crisis, with higher EV gamma linked to lower cortisol levels. DCM revealed that at-risk groups exhibited increased effective connectivity from EV to amygdala (AMYG) during face processing.

A recent suicide crisis was characterized by disengaged higher-order processing of emotional faces despite heightened early sensory processing, which was moderated by tonic cortisol levels. Enhanced feedforward prediction errors from EV to AMYG suggest impaired top-down control in at-risk individuals.

Altered neural and hormonal responses to emotional cues highlight the potential for cortisol dysregulation and impaired top-down processing to serve as biomarkers of suicide risk. Incorporating these methods could eventually complement existing clinical suicide risk assessments, pointing to stress regulation or attentional retraining as practical adjuncts to suicide prevention.

This study aims to estimate the prevalence and assess the clinical impact of ADHD in patients with severe borderline personality disorder (BPD) treated in a specialized unit.

Cross-sectional study of a sample of 145 patients diagnosed with BPD according to DSM-5 criteria, consecutively referred by outpatient psychiatrists to a Personality Disorders Unit. ADHD symptoms were assessed using the self-reported long version of the Conners Adult ADHD Rating Scale (CAARS-S:L). Groups were compared based on ADHD presence. Hypothesis testing was performed and variables with statistically significant differences were further analyzed using linear correlation and simple linear regression analyses.

Of the 145 BPD patients, 88 (60.7%) scored above 70 on the CAARS S:L. The BPD-ADHD group showed significantly greater anxiety, depression, impulsivity, poorer global functioning, and more severe BPD symptoms. Among ADHD domains, inattention is the one that best predicts the clinical severity of BPD.

The coexistence of BPD and ADHD is associated with greater clinical severity and poorer overall functioning. Inattention, in particular, emerges as a key factor explaining BPD symptom variability.

These findings emphasize the importance of systematically screening for ADHD symptoms in patients with severe BPD. Recognizing and addressing this comorbidity may allow clinicians to design more comprehensive treatment strategies, reduce clinical severity, and improve functional outcomes.

Parkinson's disease (PD) is a degenerative condition of the nervous system that is primarily characterized by a gradual decline of motor function. For patients with suboptimal response to medical treatment, deep brain stimulation (DBS) is a well-recognized surgical approach. This systematic review evaluates the performance of machine learning (ML) models in classifying patients or symptoms or to predict postoperative outcomes following DBS in PD.

PubMed, Scopus, Cochrane, Embase, and Web of Science were searched in accordance with PRISMA through December 31, 2024. We included original human studies of DBS-treated PD in which ML used clinical (non-imaging) features to classify patients or symptoms, or to predict postoperative outcomes. Cohort, cross-sectional, and case-series designs were eligible. Imaging-based prediction studies were excluded.

From 961 records, eight studies (n=555 patients) met the inclusion criteria. Three studies performed preoperative-to-postoperative outcome prediction, and five focused on symptom or patient classification. Targets included motor severity, speech outcomes, and gait-related measures. The Support Vector Machine (SVM) was the most frequently applied ML model, followed by the k-nearest neighbor, which was used in three studies. Commonly used assessment tools included the Mini-Mental State Examination (MMSE), the Hoehn and Yahr Scale, and the Unified Parkinson's Disease Rating Scale (UPDRS).

This review highlights early but exploratory application of ML for patients' or symptoms classification and predicting clinical outcomes and adverse events following DBS using preoperative clinical data. However, the current evidence is sparse, single-center, and methodologically heterogeneous, with limited external validation. Therefore, clinical translation remains premature.

Illiterate older adults are at heightened risk for mild cognitive impairment (MCI) and subsequent dementia, yet few cognitive rehabilitation interventions are tailored for this vulnerable group.We aimed to evaluate the feasibility and effectiveness of the Cognitive Intervention with-Movement-Rhythm-Game-Hobby (CIMORGH) cognitive rehabilitation package illiterate Iranian older adults with MCI. In a nonrandomized clinical trial, 30 illiterate older adults with MCI were assigned to an intervention group (n = 15; CIMORGH package, 24 sessions over 12 weeks) or a control group (n = 15; no intervention). Outcomes were assessed at baseline and one month post-intervention using the Mini-Mental State Examination (MMSE), LEIPAD Quality of Life Questionnaire, and Geriatric Depression Scale (GDS-15). Compared to controls, the intervention group showed significantly greater improvements in global cognition (MMSE change, Cohen's d = 2.43; 95% CI: 1.40 to 3.44), quality of life (LEIPAD change, Cohen's d = 1.09; 95% CI: 0.40 to 1.76), and depressive symptoms (GDS change, Cohen's d = 2.07; 95% CI: 1.13 to 2.98). The intervention was well-tolerated, with high adherence and no reported adverse events.The CIMORGH package is feasible and highly effective in improving cognition, quality of life, and mood among illiterate older adults with MCI, with large between-group effect sizes.

This study aims to evaluate the impact of combinatorial pharmacogenomic (CPGx)-guided treatment (CPGT) on medication patterns, symptom remission and hospital stay in patients with schizophrenia.

This retrospective study included schizophrenia patients hospitalized at Shandong Mental Health Center from 2019 to 2022 who underwent self-paid CPGx testing. Based on the temporal sequence of CPGx testing relative to hospitalization, their hospitalizations were classified into the CPGT and the treatment-as-usual (TAU) group. The χ² and Kruskal-Wallis tests were used to compare the antipsychotics use rate and dosage between the two groups, respectively, and the generalized estimating equation was used to evaluate the effect of CPGx on the percentage change in the Positive and Negative Syndrome Scale (PANSS) score, response and hospital stay.

This study included 895 hospitalization records from 494 patients with schizophrenia, with 331 in the CPGT and 564 in the TAU. CPGT added genotype-related prescriptions such as amisulpride, aripiprazole, risperidone and clozapine in the superior genotype subgroup (P < 0.05), reduced the dosage of risperidone in the slow metabolism subgroup, and increased the doses of clozapine, risperidone, quetiapine and olanzapine in the fast metabolism subgroup (P < 0.05). Compared with TAU, CPGT was associated with a higher percentage change in PANSS score during hospitalization (β = 6.79, 95% CI: 3.26-10.33) and a higher response rate (OR = 1.62; 95% CI, 1.21-2.16). Additionally, the hospital stay in the CPGT group was reduced by 4.80 (95% CI, 1.92-7.68) days.

Our findings demonstrate that CPGx significantly improves treatment outcomes in hospitalized patients with schizophrenia, supporting that CPGx can guide treatment.

Domestic violence and abuse (DVA) has long-lasting consequences on the physical, mental, emotional and psychological health of adults, children and young people affected by it. Recognising and responding to DVA in healthcare services is both a professional duty and a public health priority. Evidence-based guidance and frameworks outline how healthcare professionals including nurses should act when working with people affected by, or at risk of, DVA. In this article, the authors present a whole-systems public health leadership approach for strengthening nurses' recognition of DVA and their response to it. The authors describe frameworks, tools and resources that nurse managers and leaders can implement to support nurses in their safeguarding role. They stress the importance of embedding enquiry about DVA in routine care; implementing frameworks for training and clinical use; providing staff with training and clinical supervision; multi-agency partnership working; and continuous service evaluation and data monitoring.

This study aims to investigate the association between the perceived functional impact of hearing loss, assessed using the evaluation of the impact of hearing loss in adults (Évaluation du Retentissement de la Surdité chez l'Adulte; ERSA), and depressive symptoms quantified by the Beck Depression Inventory (BDI) in adults with hearing impairment.

This cross-sectional study comprised adult individuals exhibiting hearing loss of at least 25 dB in 1 ear for a minimum period of 6 months. The ERSA scale assessed hearing-related quality of life (QOL) in functional and psychosocial domains, whereas depression symptoms were measured using the BDI. Demographic and clinical attributes were documented. Correlations between ERSA scores and BDI scores were analyzed in various aspects.

A total of 103 adults with hearing loss were included in this study. Higher BDI scores were significantly correlated with lower ERSA scores in the QOL, personal life, and social life domains. Strong negative correlations were observed between BDI scores and ERSA total scores (ERSA 150 and ERSA 200). Participants exhibiting more severe, bilateral, and mixed-type hearing loss showed higher depressive symptom scores and lower ERSA outcomes. Hearing aid users exhibited higher BDI scores and lower ERSA scores compared with non-users. A higher socioeconomic status correlated with reduced depression symptoms and improved hearing-related QOL.

The perceived functional and psychosocial impact of hearing loss, as evaluated by ERSA, is strongly associated with the severity of depressive symptoms measured by the BDI. These findings highlight the necessity of incorporating patient-reported outcome measures and mental health screening into routine audiological assessment. A multidisciplinary, patient-centered approach addressing both auditory and psychological requirements may improve overall outcomes in adults with hearing loss.

Acute symptomatic seizures (ASS), a frequent complication of meningitis, are potentially life-threatening and are a predictor of epilepsy if not managed appropriately. The optimal duration of anti-seizure medicines (ASM) in these patients remains unclear. This systematic review evaluates the evidence for earlier versus later cessation of ASM in patients with meningitis who experience ASS.

A comprehensive literature search was conducted across Medline via OVID, Embase via OVID, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov. Eligible studies included randomized controlled trials and cohort studies that compared ASM cessation within 3 months of initiation of treatment to cessation beyond 3 months. Pooled estimates for outcomes including epilepsy development, seizure recurrence, and adverse events were calculated using random-effects meta-analysis. The certainty of evidence was assessed using the GRADE methodology.

Out of 4283 records screened for eligibility, none were found to provide direct evidence in people with meningitis. Two studies on people with encephalitis were included in the meta-analysis as indirect evidence. A randomized controlled trial (RCT) compared 4 weeks versus 12 weeks of ASM in children with acute encephalitis syndrome, while a cohort study investigated ASM duration in adults, including a subset with bacterial meningitis. Both studies found no significant difference in seizure recurrence between earlier and later cessation groups. The pooled risk ratio for seizure recurrence was 1.14 (95% CI, 0.26-5.01). The certainty of the evidence was very low due to indirectness and imprecision. Indirect evidence from other causes of ASS was inconclusive with regard to the duration of ASM.

The available evidence is inconclusive with regard to the difference between early and late ASM cessation in reducing seizure recurrence. Due to very low certainty of evidence, individualized clinical judgment remains crucial. Further research, specifically targeting bacterial meningitis, is needed to clarify optimal ASM duration in this population.

Care for common mental disorders relies on primary care, where they often remain undiagnosed and untreated. The collaborative care model (CoCM) is a team-based approach involving care managers (CMs) who work alongside general practitioners and remote psychiatrists to provide evidence-based mental healthcare. Between 2021 and 2023, a pilot study implemented the CoCM for the first time in France in four primary care practices with nurses with previous professional experience in psychiatry acting as the CMs. As part of the implementation research of this pilot, we analyzed the fidelity of the CM intervention to the original CoCM. We examined CM process of care metrics and explored their association with initial symptom severity and patient outcomes - an aspect rarely addressed in previous international implementation research on the CoCM.

Using electronic medical records, we calculated several fidelity measures for CM intervention, including early intervention (time to first intervention), intensity of care (number of visits and intervention duration) and evidence-based care (type of care provided). We also examined potential variations according to initial symptom severity, in line with a stepped-care approach. Patient outcomes, particularly depression response and remission, were analyzed according to initial symptom severity and fidelity measures.

A total of 235 patients were included in the study. Overall, the care provided by CMs aligned with the original CoCM, in terms of early intervention, intensive care, and type of evidence-based care delivered. It was also adjusted according to patients' initial symptom severity, in particular for early intervention, in line with a stepped-care approach. Higher fidelity of the CM intervention to the CoCM - especially shorter time to treatment initiation and number of visits - was associated with better patient outcomes.

The CoCM shows promise for improving the treatment of common mental disorders in French primary care within a stepped-care framework. Its extension will require ensuring high fidelity of the CM intervention to the model in real-world settings, as it appears crucial for achieving optimal patient outcomes. These findings also provide useful lessons for other countries implementing the CoCM.

Not applicable.