Schizophrenia is associated with substantial disability, persistent symptoms, and significant unmet treatment needs. The ketogenic diet has emerged as a metabolic intervention of growing interest for serious mental illness. This study reports quantitative and qualitative findings from a large international Change.org petition advocating for the resumption of a halted randomized blinded inpatient study investigating a ketogenic diet intervention for individuals with schizophrenia. The petition received 21,637 signatures and 1,105 comments from individuals across 151 countries. Participant comments were analyzed using top-down theme consensus coding and Latent Dirichlet Allocation (LDA) topic modeling. Results revealed widespread interest in nutritional and metabolic approaches to mental health, concerns regarding the limitations of current treatment options, and support for further investigation of ketogenic interventions in schizophrenia. Many petitioners described personal or observed experiences with ketogenic diets and emphasized the need for additional research. As this was a self-selected advocacy-driven sample, findings may overrepresent individuals supportive of ketogenic diet research and are not representative of the broader population. These findings provide insight into the perspectives and experiences of petitioners and highlight interest in expanding research on novel treatment approaches for schizophrenia, such as ketogenic dietary interventions.

Digitized imaging of the spatial distribution of a targeted metal over a given area converts a continuous spectrum of data into a set of discrete pixels of intensities that ideally correlate strongly with the areal density map. This should be independent of the metal imaging modality, allowing semiquantitative analysis. In practice, correlation strength may vary between data sets obtained by different modalities. One enduring problem for all modalities is selecting a cutoff threshold intensity appropriately distinguishing the true signal from background noise. This may entail subjective choices between "conservative" thresholds prioritizing specificity over sensitivity (i.e., true positives despite possible false negatives) and "discovery-driven" thresholds prioritizing identification of putative effects for subsequent validation (i.e., true negatives despite possible false positives). Computerized data processing may help make this more objective by comparing outcomes for the set of all possible threshold values, termed cumulative threshold analysis. We address pitfalls in performing valid cumulative threshold analysis using ImageJ/Fiji for relative quantification of brain iron in mice with normal or genetically elevated iron, assessed by classical histochemistry or synchrotron X-ray fluorescence. In addition to pitfalls in choosing settings for generating analysis histograms, these include data loss with conversion between bit depths and selecting both appropriate X-axis directionality and image display range minima and maxima for analyzing multiple images. If these factors are handled appropriately, cumulative thresholding provides a powerful approach for more objective analysis of biometal imaging. This has important applications for metal imaging in research and clinical settings.

Positive mental well-being is increasingly recognized as an important component of cardiovascular care, particularly among patients with heart failure or myocardial infarction. However, validated Chinese-language instruments for assessing positive mental well-being in this population remain limited.

This study evaluated the psychometric properties of the Chinese-language 14-item Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in patients with heart failure or myocardial infarction.

In this cross-sectional validation study, 392 patients with heart failure or myocardial infarction completed the Chinese-language WEMWBS. Construct validity was examined using exploratory and confirmatory factor analyses. Convergent validity was assessed using factor loadings, composite reliability (CR), and average variance extracted (AVE), and criterion-related validity was evaluated using the 5-item World Health Organization Well-Being Index (WHO-5) as an external criterion. Internal consistency was estimated using Cronbach's α. Item-level performance was examined using item response theory under the graded response model.

The Chinese-language WEMWBS showed excellent internal consistency, with Cronbach's α = 0.961. The modified one-factor confirmatory factor model showed acceptable fit on most indices, with χ²/df = 2.68, CFI = 0.955, TLI = 0.944, RMSEA = 0.091, and SRMR = 0.038. Criterion-related validity was supported by a strong positive correlation with the WHO-5 (r = 0.746). Item response theory analyses indicated generally satisfactory item discrimination and ordered threshold parameters.

The Chinese-language WEMWBS demonstrated satisfactory psychometric properties in patients with heart failure or myocardial infarction. These findings support its potential use as a patient-reported outcome measure for assessing positive mental well-being in this population. Longitudinal and intervention studies are needed to evaluate its responsiveness, predictive validity, and clinical utility in cardiovascular care.

This study aimed to establish an evaluation system for social support in the field of adolescent physical health promotion and conduct empirical research, so as to provide a theoretical basis for optimizing the social support environment for adolescents' physical activity.

This study employed the Delphi method and the Analytic Hierarchy Process (AHP) to establish the evaluation index system. Subsequently, an empirical application was conducted from March to July 2025, involving 940 participants across six regions in Hunan Province. The Fuzzy Comprehensive Evaluation (FCE) method was utilized to analyze the data.

The social support evaluation system for adolescent physical health promotion consists of 4 primary indicators (government support, school support, family support, and community support), 19 secondary indicators, and 54 tertiary indicators. Among the primary indicator weights, government support had the largest weight (0.3764), followed by school support (0.2885), family support (0.2442), and community support (0.0909). For social support of adolescent physical health promotion in Hunan Province, government support scored the highest (87.56), reaching a "good" level; school support (80.82) and family support (75.40) were also rated as "good"; and community support had the lowest score (60.35).

This study underscores the significant role of social support in adolescent physical health promotion. Relatively stable social support for adolescent physical health promotion mainly includes four dimensions: government, school, family, and community. Overall, the level of social support for adolescent physical health promotion in Hunan Province is relatively positive, but structural imbalances and other shortcomings still exist. Future efforts should focus on four key stakeholders, government responsibility: bridging the gap between policy intent and implementation, school implementation: overcoming academic pressure and resource constraints, family participation: reshaping parental perceptions and health literacy, and community extension: revitalizing grassroots support systems, so as to promote the comprehensive physical and mental development of adolescents.

The Ambivalence Model of Suicidality (ABS) posits that suicidal experiences are often accompanied by internal conflicts between the desire to live and the urge to die. The model further conceptualizes the suicidal process as consisting of three phases: the uncertainty phase, the transition phase, and the action phase. This qualitative study explores the experiences of Iranian suicide attempters through the lens of the ABS to assess its cross-cultural validity and clinical relevance.

Semi-structured interviews with 15 individuals at Qods Psychiatric Hospital in Sanandaj, Iran, who had recently attempted suicide were conducted. The interviews examined emotional states, internal conflicts, external influences, and decision-making processes aiming to test whether the narratives corresponded to the three ABS phases. A deductive qualitative content analysis was applied: data were transcribed verbatim and coded according to predefined categories (Ambivalence, Transition, Action). Coding was conducted by one author and reviewed by a second author to ensure consistency with the theoretical framework. Representative quotations were extracted to illustrate alignment with the model.

Evidence for all three phases of the ABS was found. Participants' narratives reflected each of the model's predefined phases. Ambivalence prior to the suicide attempt was reported in 13 interviews, often accompanied by exhaustion. The transition phase frequently involved a sudden shift into acute suicidality, with some participants describing dissociation. Ambivalence often persisted into the action phase.

Findings support the applicability of the ABS in the Iranian context, highlighting ambivalence as a fluctuating yet persistent state throughout the suicidal process and across cultures. Incorporating the ABS into clinical practice might enhance therapeutic approaches, supporting suicide prevention efforts.

Translating the Self-Expression and Emotion Regulation in Art Therapy Scale (SERATS) into Chinese and adapting it for use by Chinese university students majoring in art and design.

After translating the SERATS into Chinese, we adapted it to the Self-Expression and Emotion Regulation in Art Making Scale (SERAMS). A total of 209 university students majoring in art and design were recruited to examine the reliability and validity of the scores derived from the SERAMS; of these participants, 121 were retested 2 weeks later. Another 200 university students majoring in art and design were selected to perform Confirmatory Factor Analysis (CFA).

The SERAMS is unidimensional and consists of nine items. The explained variance of SERAMS is 51.124%. CFA validated that the one-factor model fit with the data of SERAMS. Standardized factor loadings ranged between 0.688 and 0.733. The Cronbach's alpha coefficient of SERAMS was 0.880. Correlation analysis was performed between SERAMS and The General Self-Efficacy Scale (GSES) to calculate the criterion-related validity (r = 0.571 p < 0.001). The Pearson correlation coefficient for SERAMS' test-retest reliability was r = 0.889 (p < 0.001). SERAMS's split-half reliability was 0.875 (Spearman-Brown coefficient).

SERAMS has relatively good reliability and validity. It can be used to assess the self-expression and emotion regulation abilities of Chinese university students majoring in art and design.

The transition to the first clinical placement is a psychologically demanding phase for nursing students, requiring adaptation to patient care responsibilities, academic expectations, and unfamiliar clinical settings. Stress during this period may be influenced by academic, clinical, environmental, and relational stressors, which can affect students' psychological well-being and coping behaviors.

This study aimed to assess the levels and sources of perceived stress and examine the relationship between coping behaviors and environmental-relational stressors among first-year nursing students during their initial clinical placement.

Design: Cross-sectional descriptive correlational study. A total of 467 first-year undergraduate nursing students undergoing initial clinical training in seven governmental hospitals participated. Data were collected using the Perceived Stress Scale for Nursing Students and the Coping Behavioral Inventory. The Perceived Stress Scale included domains related to the clinical environment and interactions with teaching and nursing staff, which were used to explore perceived environmental and relational stressors. Descriptive statistics, Pearson correlations, and multiple linear regression were used to examine associations between stress domains and coping behaviors.

Students reported high overall perceived stress (M = 62.99, SD = 9.76). The most prominent stressors were practical assignments and workload, patient care, examinations of personal competence, and environmental and staff-related factors, while stress related to lack of professional knowledge/skills and daily life was comparatively lower. Regarding coping behaviors, problem-solving and optimistic coping showed significant negative associations with total perceived stress (r = -0.75 and r = -0.36, respectively; p < 0.001) and were significant negative predictors in regression analysis (β = -0.76 and β = -0.32; p < 0.001).

First-year nursing students experienced high stress during initial clinical placement, mainly related to workload, patient care, evaluation, and environmental factors. Coping strategies showed associations with stress levels, where problem-solving and optimism were linked to lower perceived stress, while avoidance and transference showed weaker associations. These findings highlight the potential importance of structured orientation, mentorship, stress-management support, and supportive clinical training conditions during early clinical exposure.

CSA is associated with post-traumatic stress disorder (PTSD), dissociation, emotion-regulation difficulties and psychopathology. Trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are evidence-based interventions, but their sequential delivery in online groups for women with CSA-related complex trauma remains underexplored.

To examine feasibility and preliminary clinical outcomes of a 16-session online group intervention combining TF-CBT and EMDR Group Traumatic Episode Protocol (G-TEP), and to explore differences by sequence (EMDR → CBT vs. CBT → EMDR).

Of 31 eligible participants, nine adult women (Mean age = 39.42 years, SD = 10.23) completed both phases and assessment (EMDR → CBT: n = 5; CBT → EMDR: n = 4). Assessments at baseline (T1), T2, and T3 included PTSD (EGS-R), dissociation (DES), psychopathology (SCL-90-R), emotion regulation (DERS), self-esteem (RSES), life satisfaction (SWLS), and treatment satisfaction (CRES-4). Non-parametric tests and effect sizes were used. An illustrative case was included.

The intervention showed descriptive improvements across domains, including PTSD symptoms, dissociation, and psychopathology, with improved self-esteem and life satisfaction. However, most statistical tests were non-significant, consistent with the exploratory nature of the small sample. Effect sizes indicated variability across sequences: EMDR → CBT showed larger effects in phobic anxiety and self-esteem, whereas CBT → EMDR showed larger effects in dissociation. Findings indicate exploratory sequence-related patterns rather than definitive treatment effects.

Sequential online delivery of TF-CBT and EMDR G-TEP appears feasible among completers, although substantial attrition limits feasibility. Findings are preliminary and require confirmation in future controlled studies.

3q29 deletion syndrome is a rare genomic disorder characterized by a broad spectrum of neurodevelopmental and psychiatric manifestations, including developmental delay (DD), intellectual disability (ID), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and a markedly increased lifetime risk of psychosis and schizophrenia.

We describe a 17-year-old female adolescent with severe congenital heart disease and longstanding neurodevelopmental impairment who developed early-onset recurrent psychotic symptoms. Chromosomal microarray analysis identified a de novo heterozygous 1.6 Mb deletion at the 3q29 locus. The emergence of psychotic symptoms served as the pivotal clinical trigger for genetic investigation in the absence of distinctive dysmorphic findings. Combination therapy with lurasidone and olanzapine led to sustained clinical stabilization over a one-year follow-up period, allowing gradual dose adjustment and functional reintegration through adapted educational and recreational activities.

Early-onset psychotic symptoms in adolescents with neurodevelopmental comorbidities may represent a critical clinical indicator of underlying pathogenic copy number variants, including 3q29 deletion syndrome, even in the absence of highly recognizable dysmorphic features. Increased clinical awareness may facilitate consideration of early genetic testing in this clinical profile to support precision-informed diagnostic evaluation, treatment planning and multidisciplinary management.

Large language models have evolved from laboratory demonstrations into mass-market companion-style conversational agents that many users treat as social partners. As these systems produce increasingly human-like conversational behavior, users may attribute mind, form affective bonds, disclose sensitive information, and rely on agents for emotional support, creating both potential benefits and psychosocial risks.

We conducted a PRISMA-ScR-informed scoping review of socioaffective human-artificial intelligence interaction research published or posted from 2016 to 15 January 2026. Eligible sources addressed companion-style conversational agents and adjacent therapeutic, assistant-first, or governance sources. Evidence was stratified by system type and calibrated as stronger empirical support, moderate support, preliminary support, or proposed/normative synthesis.

The final evidence map included 58 sources. We synthesized mechanisms that make agents feel social, including anthropomorphism, social presence, mind perception, self-disclosure, parasocial attachment, and socioaffective alignment. Therapeutic chatbot studies provided the strongest evidence for short-term symptom reduction in selected contexts, whereas evidence for sustained loneliness reduction in open-domain companion systems remained emerging. Reported and hypothesized risks included dependency-like use, displacement of human interaction, maladaptive validation or sycophancy, persuasive manipulation, privacy harms, and risks to minors or vulnerable users.

We propose an integrative pathway linking model capabilities and product design cues to relational outcomes and outline a companion-specific relational safety stack as a synthesis-based evaluation agenda rather than a validated regulatory or clinical standard. The review identifies measurement priorities for evaluating companion agents and governance priorities for managing psychosocial impact as these systems scale.