Brain oscillations are rapidly fluctuating neural activity carried out by large ensembles of neurons. The responsiveness of the brain to external stimuli and the plasticity induced by external stimulation depend strongly on these oscillatory brain states. Here we detail step-by-step instructions for stimulating the brain by tracking human brain activity via the real-time analysis of brain signals recorded by electroencephalography (EEG) and reconstructed in source space, and timing the application of noninvasive transcranial magnetic stimulation (TMS) in synchronization with oscillatory brain states. Real-time EEG-TMS enables the millisecond-precise timing of TMS pulses relative to target oscillatory brain states, such as the phase of an ongoing oscillation. Initial evidence indicates that oscillatory brain state-dependent EEG-TMS is more effective in inducing long-term plasticity than conventional TMS uncoupled to instantaneous oscillatory brain state. This opens the possibility of personalizing therapeutic brain stimulation by coupling it to specific physiological or pathological brain states. In the procedure, we cover brain MRI and image segmentation for anatomical modeling and accurate source reconstruction of the EEG signals, EEG recording without TMS to validate the origin of the oscillation of interest and to determine its phase targeting accuracy, and the main experiment of oscillatory brain state-dependent real-time EEG-TMS to achieve the desired neuroplastic effect. A moderate level of computer science expertise, standard MRI and TMS neuronavigation equipment and TMS-compatible EEG with an accessible online output copy suffice to perform the protocol. The protocol requires ~10 h to complete.

Brain functional alterations associated with overall cognitive impairments and specific cognitive domains defined by MATRICS Consensus Cognitive Battery (MCCB) and the similarities among them remain unclear in schizophrenia. Comprehensive literature review and meta-analyses of cognitive task fMRI studies were conducted to identify whole-brain differences between schizophrenia patients and healthy controls, and subgroup analyses were also conducted for each MCCB domain. Identified brain regions were mapped onto canonical brain networks. The similarity analyses between network dysfunction obtained for paired subgroup analyses with and without each MCCB domain, and between each MCCB domain and primary analysis, were calculated after controlling for sample size. Meta-regression analyses were conducted between brain alterations and demographic and clinical characteristics. The present meta-analysis encompassed 232 datasets with 5229 schizophrenia patients and 6132 healthy controls. In primary analysis, schizophrenia patients showed significant brain dysfunctions mainly within default mode and subcortical networks. Distinct brain dysfunctions for each MCCB domain were also identified. Sample size-weighted similarity analyses revealed that network alterations associated with working memory deficits, among the seven, showed the greatest convergence with brain changes identified in subgroup analysis without this domain and primary analysis (sample size-weighted Dice coefficients = 0.24 and 0.51). Significant correlations were identified between significant brain alterations and negative symptoms and years of education. Aberrant activations in default mode and subcortical networks in working memory domain showed higher similarity than those observed in the other six cognitive domains, indicating functional integration of working memory and functional specialization of remaining cognitive domains in schizophrenia.

Alcohol use disorder (AUD) is a chronic condition with a staggering global burden and yet limited pharmacological treatments. Convergent evidence implicates the endocannabinoid system (ECS) as a potential therapeutic target due to its broad regulatory role across reward, stress, and affective processes. We conducted a systematic review and meta-analysis of 63 preclinical and human studies evaluating ECS modulators for AUD. Preclinical studies were synthesized by mechanism of action, and meta-analyses were conducted for cannabinoid receptor (CB-1R) antagonists and inverse agonists, CB-1R agonists, and cannabidiol (CBD). Human studies were narratively synthesized due to methodological heterogeneity. Preclinical data meta-analyses demonstrated that CB-1R inverse agonists (SMD = -1.21) and CBD (SMD = -0.70) reduced alcohol intake, while CB-1R agonists increased consumption (SMD = +0.66). Dose-response analyses identified non-linear effects for CB-1R inverse agonists and CBD. In contrast, human studies showed inconsistent and generally null effects, with limited studies examining newer ECS modulators beyond rimonabant or CBD. While preclinical evidence supports ECS modulation, particularly CB-1R antagonism and CBD, as promising strategies for reducing alcohol use behaviors, clinical translation has been limited by safety concerns, methodological inconsistencies, and under-investigation of novel compounds. Mechanistically informed trials of novel compounds, including next-generation CB-1R antagonists and CBD, are needed to bridge this translational gap and yield new treatments for AUD.

Eviction is a significant yet understudied social determinants of health (SDoH), linked to housing instability, unemployment, and mental health. While eviction appears in unstructured electronic health records (EHRs), it is rarely coded in structured fields, limiting downstream applications. We introduce SynthEHR-Eviction, a scalable pipeline that adapts and integrates human-in-the-loop annotation, automated prompt optimization (APO), and reasoning-augmented fine-tuning for low-resource eviction-related SDoH extraction from clinical notes. Using this pipeline, we created a large public eviction-related SDoH dataset to date, comprising 14 fine-grained categories. Fine-tuned LLMs (e.g., Qwen2.5, LLaMA3) trained on SynthEHR-Eviction achieved Macro-F1 scores of 88.8% (eviction) and 90.3% (other SDoH) on human validated data, outperforming GPT-4o-APO (87.8%, 87.3%), GPT-4o-mini-APO (69.1%, 78.1%), and BioBERT (60.7%, 68.3%), while enabling cost-effective deployment across various model sizes. The pipeline reduces annotation effort by over 80%, accelerates dataset creation, enables scalable eviction detection, and generalizes to other information extraction tasks.

Federated learning (FL) and travelling model (TM) allow privacy-preserving model training across sites without sharing patient-sensitive data. While both approaches have shown success, they face unique challenges related to distribution shifts between sites. To address this, we propose FedTM, a hybrid framework combining the strengths of FL and TM. FedTM begins with FL warmup training at sites with larger datasets, followed by sequential refinement through TM across all sites. We evaluated FedTM for Parkinson's disease classification using 1817 brain scans from 83 international sites. Model performance, misclassification disparities, and communication costs were computed and compared to standard FL and TM approaches. Our results reveal that FedTM improves AUROC from 77 ± 0.01% to 82 ± 0.01%, reduces misclassification disparities from 34 ± 0.01% to 26 ± 0.01%, and decreases training load for smaller sites from 22 to 12 cycles. These advancements mark an important step toward promoting global healthcare equity and advancing responsible AI development.

The rapid expansion of psychedelic research has opened significant pathways of opportunity in treating mental health disorders. Participants in recent clinical trials consistently report mystical-type experiences during dosing sessions, and some scholars posit that such experiences themselves help mediate clinical improvements in depression, PTSD, anxiety, and substance use disorders. These reports are in keeping with the historical reality that the use of psychedelic substances and plant medicine has been tied to spiritual experience and shamanic ceremonial practice. Professional clinical chaplains are trained and experienced in providing spiritual and emotional support for people encountering illness, life change, and trauma. They regularly assist participants who seek to make meaning of their experiences in the context of their own beliefs and spirituality. This article argues that as subject matter experts in spirituality and health, chaplains are an asset to psychedelic assisted therapies and should be utilized in research trials and clinical practice, especially given a relative lack of training in spirituality and religion among interprofessional practitioners. We offer this set of competencies for chaplains to provide high quality, safe, and ethical care in the context of psychedelic medicines. These competencies include spiritual and religious care, spiritual inquiry, empathic presence, ethical engagement, and advocacy. We recognize that chaplains will need to pursue specialized education and supervised experience beyond their standard professional requirements, and pathways of personal preparation are discussed. The presence of qualified chaplains will help ensure that participants navigate non-ordinary states of consciousness with safety, sensitivity, and insight regarding improvement and growth.

With the rapid development of modern society, occupational populations commonly face work states characterized by high mental workload (HMW). HMW can rapidly mobilize and deplete an individual's cognitive resources within a short timeframe. As attention constitutes a fundamental cognitive quality, it is inevitably impacted by HMW, leading to issues such as impaired attentional function and decreased task performance. This study aimed to investigate the characteristics of alterations in attention network under HMW. Participants were recruited from a medical university using convenience sampling. The 1-back Stroop (BS) cognitive task was employed to induce an HMW state. The Attention Network Test-Revised (ANT-R) was completed before and after the induction of the HMW to assess attention network behavior. Eye tracking was assessed using an eye tracker, and subjective assessment was conducted using a visual analog scale (VAS). Statistical analysis was performed using a paired t-test or Wilcoxon signed-rank test. Subjective VAS ratings showed significant increases in mental fatigue (MF), mental effort (ME), mental stress (MS), boredom, and mind wandering (MW) following HMW induction compared to baseline. Behavioral results showed that, compared with before HMW state induction, there were significant differences in alert (sustained attention for maintaining arousal), moving+engaging (selective attention for adjusting and focusing on valid stimuli), flanker conflict (directional conflict between target stimuli and surrounding distracting stimuli) and location conflict (directional conflict between target stimuli and stimulus locations) changes. Alert efficiency values decreased significantly, while moving+engaging, flanker and location conflict values increased significantly. No significant differences were observed in the number of correct trials. Eye tracking results showed that, compared with the state before HMW induction, there were significant differences in average saccade duration and blink count, with a notable increase in both. The ANT-R demonstrates utility both as an experimental paradigm for assessing attention networks and as a behavioral indicator for evaluating HMW. Under the HMW state, significant changes were observed in a subset of behavioral, subjective rating scale, and eye-tracking indicators related to the attention network. This study validated the effectiveness of the BS cognitive task paradigm in inducing the HMW and provided new experimental evidence for revealing the characteristics of attention network changes in the HMW, laying the foundation for the development of assessment and intervention strategies.

Screening for mental health symptoms is crucial in people with chronic conditions, including individuals with HIV, and recommended indeed by Guidelines. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) are validated tools used and endorsed by guidelines to screen for anxiety and depression symptoms. This study aimed to evaluate the prevalence and risk factors for anxiety and depression symptoms and quality of life (QoL) assessment in a cohort living with HIV in an HIV service in Northern Italy.

We performed a cross-sectional analysis in adult people with HIV who completed the screening with the GAD-7 and PHQ-9 questionnaires, along with a QoL assessment using the Visual Analogue Scale (VAS). People with known mental health disorders, dementia, cognitive impairment, or who were unable to complete the questionnaires were excluded. Moderate-to-severe anxiety and depression symptoms were defined according to standard cut-offs of the GAD-7 (≥10) and PHQ-9 (≥10), respectively. A QoL score ≥ 60 was considered indicative of good well-being. Descriptive statistics and logistic regression analyses were conducted to investigate the associations between mental health symptoms and demographics, clinical and behavioural factors.

One thousand four hundred and forty-nine people with HIV, were included. Moderate-to-severe anxiety was identified in 14.4% (9.7% moderate, 4.7% severe), and moderate-to-severe depression in 11.9% (8.7% moderate, 3.2% severe). Suicidal ideation over the last 2 weeks was reported in 5.1% of participants, who were referred for immediate psychiatric counselling. In multivariate models, female gender was significantly associated with moderate-to-severe anxiety (aOR: 1.59, 95% CI: 1.09-2.31, p = 0.014), whereas Black African ethnicity was a protective factor (aOR: 0.39, 95% CI: 0.17-0.82, p = 0.020). Female gender also emerged as a significant risk factor for moderate-to-severe depression (aOR: 1.74, 95% CI: 1.16-2.59; p = 0.006). 1235 (85.2%) participants self-reported having a good quality of life.

Our findings underscore that people with HIV face a substantial burden of anxiety and depression symptoms. Women with HIV appear to be particularly vulnerable to both conditions, whereas Black African ethnicity appears to confer resilience against anxiety. These results highlight the requirement to integrate routine mental health screening into HIV care and tailor-specific interventions to gender and cultural contexts.

This study aimed to evaluate the cumulative benefits of Food and Drug Administration (FDA)-approved monoclonal antibodies (mABs), administered at FDA-approved dosing regimens in slowing cognitive decline compared with placebo and acetylcholinesterase inhibitor (AChEI), and the dynamic relationships between cognitive decline, amyloid reduction and whole brain volume (WBV) changes in mAB treatment.

Five major databases were systematically searched for double-blinded randomised controlled trials of patients with mild cognitive impairment due to Alzheimer's disease (AD) or mild AD treated with mAB or AChEI for at least 6 months. The primary outcomes were the change in cognitive function measured by Alzheimer's Disease Assessment Scale-cognitive subscale 14-Item (ADAS-Cog) and Clinical Dementia Rating Scale-Sum of Boxes (CDR-SOB). The secondary outcomes included amyloid burden and WBV changes.

There were 6479 participants across seven mAB trials, and 4993 participants in nine AChEI trials. Compared with placebo, the pooled percentage of cognitive slowing was 27.6% (95% CI 24.6% to 30.9%), and the pooled progression delay was 5.52 months over 19.5 months (1.40 to 9.65) on CDR-SOB in patients treated with mABs. For cognitive trajectories on ADAS-Cog, mAB progressively attenuated cognitive decline, whereas AChEI exhibited a smaller effect with large uncertainty and eventually provided no benefits. Additionally, the rates of cognitive decline and amyloid reduction stabilised over time, while WBV initially showed a rapid decline but progressively slowed. Finally, WBV decline was not associated with worsening cognitive function. Instead, a 1 cm³ reduction in WBV was linked to a 0.0975-point reduction in CDR-SOB (0.0614 to 0.1336).

In prodromal to mild AD, mAB therapy provided greater cumulative cognitive benefits than placebo and AChEI, and WBV reduction may reflect a treatment-related process rather than a detrimental sequela.

CRD42024628107.

Psychiatrists who treat mental disorders in pregnancy must navigate the risks associated with prescribing medication to pregnant and breastfeeding people alongside the risks associated with untreated mental illness. This article examines how U.S. courts have engaged with this complex landscape when tasked with evaluating allegations of clinician and pharmaceutical negligence in cases involving pharmacological management of perinatal mental health disorders (PMHDs). We begin first with a review of the legal theories that form the basis of negligence lawsuits related to PMHDs. We then explore cases of both pharmaceutical negligence (which are usually pursued under product liability claims) and professional negligence (i.e., malpractice), distinguishing how the courts' interpretation of liability has varied for errors of omission and errors of commission. We then provide an analysis of relevant themes in this area of case law with the goal of informing expert witnesses of considerations when called to opine upon questions related to negligence in the treatment of PMHDs.