Early Intervention for Psychosis Services (EIPS) enhance outcomes for individuals experiencing their first episode of psychosis (FEP). However, in low-resource settings, there is limited knowledge about i) the pathways patients take to access EIPS, ii) the proportion and factors associated with acceptance of referral to EIPS, and iii) if different pathways to EIPS services affect clinical outcomes. Uganda's first EIPS, the Specialised Treatment Early in Psychosis Service at Makerere University Hospital (STEP_MaKH), presents a unique opportunity to explore these important questions.

We aimed to examine the pathways to EIPS, the factors associated with referral to specialised psychosis care and the impact of initial treatment-seeking behaviour on long-term symptom remission and quality of life.

We conducted a multiple-method study. Pathways to care were assessed retrospectively using the WHO Encounter Form among adults with FEP eligible for referral to STEP_MaKH. Among those who completed referral and enrolled in STEP_MaKH. Symptom severity and quality of life were followed prospectively for 12 months. Modified Poisson regression identified predictors of referral completion. Kaplan-Meier methods and Cox proportional hazards models examined time to symptom remission and time to achieving a good quality of life.

Of the 187 adults with first-episode psychosis eligible for referral to STEP_MaKH, Native/religious healers (n = 86) were the predominant first point of contact. Only 56 (29.9%) accepted referral to STEP_MaKH. Participants referred from Mulago National Referral Hospital more likely to enrol than those referred from Butabika (RR = 4.7; 95% CI: 2.90-7.87). Longer delays from first treatment contact were associated with reduced likelihood of reaching STEP_MaKH (RR = 0.99 per month; p = 0.041). After enrolment, symptoms improved rapidly with 60% achieving PANSS remission by Month 1, and fewer than 10% remained non-remitted by Months 2-3. In adjusted Cox models, participants initially seen by mental health workers achieved remission more quickly than those initially seen by non-medical personnel (HR = 1.48; 95% CI: 1.05-2.10). Older age was associated with slower remission (HR = 0.94; p = 0.023). Quality of life improved over the follow-up period, with earlier attainment of good quality of life among those initially managed by mental health workers.

Pathways to care for FEP in Uganda are complex and culturally mediated, with substantial attrition before specialised early psychosis care is reached. Referral completion is strongly shaped by referral site and by delays in the care pathway. Once in specialised care, clinical outcomes improve rapidly, and initial contact with mental health workers is associated with faster symptom remission and earlier gains in quality of life. Strengthening referral systems, reducing pathway delays, and developing collaborative detection-and-referral links with community and frontline providers are key priorities for optimising early psychosis outcomes in low-resource settings.

Comprehensive brain health is increasingly being recognized as critically important worldwide and incorporates elements of neurological and psychiatric health. This evolution in the view of cerebral wellbeing considers the many factors that can affect brain health and the interconnectedness of conditions affecting this organ. Such interplay between neurological and depressive diseases is highlighted by observations that these conditions share underlying pathophysiology and frequently co-occur in the same patient. A review of the literature on depression in post-stroke, Parkinson's disease, multiple sclerosis, and migraine, confirmed the high prevalence of depression in patients with neurological diseases, with approximately one third of patients with neurological diseases having depression. The search results also highlighted the importance of early detection of depression, and that appropriate treatment may substantially improve outcomes of both the depression and the neurological disease. However, there was a disparity in the amount of literature on depression in the different neurological diseases, with only three of the 80 retrieved articles discussing migraine and depression. Information on multidisciplinary care was also limited. Unmet needs with respect to management of depression in patients with neurological diseases include effective screening processes that can differentiate between overlapping symptoms. There is also a lack of clear, evidence-based treatment guidelines. Based on our clinical experience, we provide recommendations for best practice management of depression in patients with neurological diseases, including structured patient interviews to aid with diagnosis of depression, involvement of patient families and friends where relevant, multidisciplinary care that incorporates personalized treatment based on the specific symptoms, co-medications and needs of the patient, and continued follow up and monitoring. Antidepressant options are available with different mechanisms of action and adverse event profiles. Overall, evidence indicates that depression in neurological disorders is underdiagnosed and undertreated. We suggest that structured screening and tailored, multidisciplinary care can improve outcomes.

Depression is highly prevalent among patients undergoing hemodialysis in Arab countries, adversely affecting quality of life, treatment adherence, and clinical outcomes. Despite its significance, mental health issues remain underdiagnosed and undertreated due to cultural stigma, limited healthcare integration, and resource constraints.

This systematic review aims to evaluate the prevalence, key predictors, and management challenges of depression among hemodialysis patients in Arab countries.

Following PRISMA guidelines, comprehensive searches of multiple databases were conducted for studies published from 2010 to June 2025. Inclusion criteria encompassed original quantitative, qualitative, and mixed-methods research focusing on depression in dialysis patients across Arab nations. Data extraction and quality assessment used standard tools, with a narrative synthesis employed to integrate findings due to heterogeneity.

Analysis of 59 studies revealed a high prevalence of depression, averaging 55.6%, with rates ranging from 18% to 86.9%. Key predictors include female gender, older age, longer dialysis duration, low socioeconomic status, and comorbidities. Cultural stigma, lack of integrated mental health services, and limited provider training pose significant management barriers.

The findings underscore the substantial mental health burden among dialysis patients, exacerbated by socio-cultural factors unique to the region. Addressing these challenges requires culturally sensitive screening, integrated psychosocial support, and healthcare system reforms to improve early diagnosis and treatment.

Depression among hemodialysis patients in Arab countries is a critical public health issue, necessitating multidisciplinary, culturally tailored strategies to enhance mental health care, improve adherence, and elevate overall patient outcomes.

This study assessed the association between self-reported psychiatric diseases and the number of present teeth in older adults.

It was included 569 older adults selected using a probabilistic per cluster sampling strategy. Structured questionnaire was applied, and an oral health examination was performed. Self-reported psychiatric diseases were defined as the primary exposure, while the number of present teeth was the outcome. Adjusted analyses were performed using Poisson regression with robust variance (α < 0.05).

The prevalence of self-reported psychiatric disease was 16.5% (n = 94; 95% confidence interval [95% CI]: 13.5%-19.6%). In the final adjusted model, lower number of present teeth was associated with self-reported psychiatric diseases (rate ratio [RR]:0.69; 95% CI:0.51-0.94). Women (RR:0.72; 95% CI:0.61-0.84), those without access to the dentist (RR:0.54; 95% CI:0.45-0.65), and of higher age (RR:0.96; 95% CI:0.94-0.97) also presented lower number of present teeth when compared to their counterparts. Those with medium level of education presented higher number of teeth (RR:1.68; 95% CI: 1.43-1.98).

Older adults with self-reported psychiatric diseases, females, and those without dental access exhibited higher rates of tooth loss. Public policies should aim to integrate mental and oral health, ensuring equitable access to dental care for these most vulnerable groups.

Patients with disorders of consciousness (DoC) resulting from severe traumatic brain injury (TBI) may recover consciousness and independence years later. There is a prevailing belief that recovery, when limited to the restoration of independence in activities of daily living, will be accompanied by poor self-reported quality of life (QOL) and psychological health. This perception may influence early clinical decision-making related to the provision of life-sustaining treatment and access to specialized rehabilitation. In this observational study, we utilized data from the multisite TBI Model Systems (TBIMS) to evaluate the outcomes of QOL (Satisfaction With Life Scale [SWLS]), anxiety (Generalized Anxiety Disorder-7 Scale [GAD-7]), and depression (Patient Health Questionnaire-9 [PHQ-9]) in participants who were admitted to inpatient rehabilitation with DoC and recovered the ability to provide self-report on these measures by 1 year post-TBI. Among 887 TBIMS participants admitted to inpatient rehabilitation with DoC (defined as the absence of command-following; 74% male; mean [standard deviation, SD] age = 36.82 [17.87] years; days post-injury on rehabilitation admission = 33.63 [22.51]), 50% regained the capacity to respond to questions on self-report measures at the 1-year follow-up time point. The mean (SD) total scores were as follows: SWLS = 20.38 (7.81), GAD-7 = 4.00 (5.66), and PHQ-9 = 5.22 (5.04). A minority of patients endorsed dissatisfaction (15%) or extreme dissatisfaction (9%) with life, and similarly, only 14% and 16%, respectively, reported anxiety and depression symptoms above the clinical cutoff points. The results were similar at the 2- and 5-year follow-up time points. In summary, at the group level, QOL and psychological health in persons who recover from DoC are similar to those of individuals with less severe brain injuries and to the general population. These findings challenge the assumption that recovery from DoC is associated with poor QOL and psychological health. Clinicians should be aware that patients with a broad range of residual disability after DoC are unlikely to report dissatisfaction with life or have significant anxiety and depression up to 5 years post-TBI.

Bipolar disorder (BD) is a clinically heterogenous mental disorder with a diversity in clinical trajectories and treatment response. Twin studies have shown that BD is highly heritable, with estimates ranging from 60% to 90%. However, our understanding of this genetic component has yet to be translated into clinical interventions or prediction tools. In this review, we summarize findings from large-scale international collaborations, with the latest and largest study finding 298 genome-wide significant loci and 36 credible mapped genes associated with BD, alongside the first genes with an increased burden of rare genetic variants. We next highlight key biological insights from these findings, including widespread genetic overlap but distinct patterns of genetic correlation with other mental disorders and related traits; enrichment of gene expression within both brain-specific tissues and cell types and non-brain tissues, including pancreatic and large intestinal tissues; and the identification of novel drug targets and repurposing candidates, including calcium channel blockers. While these insights may take several years before they impact clinical practice, the potential for genetic advances to impact patient care through more accurate nosology and the development of clinically relevant prediction and stratification tools is more imminently achievable. We go on to summarize the most prominent methods for genetic prediction, including artificial intelligence-based methods, before discussing promising use-cases and key challenges to implementation. Looking to the future, cross-disciplinary collaboration, access to real-world data for robust validation, and pragmatic solutions that facilitate implementation across diverse healthcare systems will be crucial to achieving material advances in clinical care and improving outcomes for people with BD.

This investigation aimed to replicate phenotypes in pediatric complex regional pain syndrome (CRPS) previously identified in adult CRPS patients. The impact of an intensive pain therapeutic approach in pediatric CRPS was also evaluated.

Neurological examination data were obtained from two samples of children with CRPS (cohort #1; N = 24 and cohort #2; N = 14). The structure among CRPS signs was analyzed on pooled data from cohorts #1 and 2 using hierarchical clustering. A phenotype score was quantified for patients and then submitted to unsupervised k-means clustering. Patients in cohort #2 were enrolled in a 4-6-week treatment program consisting of psychological, physical, and occupational therapy. Questionnaires about pain and mental and physical health were evaluated at treatment admission and discharge.

A two-cluster structure of CRPS signs could be replicated in the pediatric population. Cluster #1 includes skin color, temperature, and edema resembling peripheral inflammation ("peripheral" phenotype). Cluster #2 grouped together motor disorders, minor injury, glove/stocking-like sensory deficits, and allodynia ("central" phenotype). K-means clustering also showed three phenotypes, "peripheral" (N = 12), "central" (N = 10), and "mixed" (N = 17), similar to adults. The impact of treatment was revealed for pain affect, pain behavior, psychological distress, depression, pain catastrophizing levels, as well as physical activity and strength (Cohen's d = [0.8-1.3]).

CRPS phenotypes reflecting major pathophysiological mechanisms of peripheral inflammation and central reorganization are identifiable in adult and pediatric patients, suggesting phenomenological features of the disease. An intensive interdisciplinary pain treatment approach was effective in reducing CRPS severity and restoring function in pediatric CRPS.

Sleep disturbance and quality of life have been widely studied; however, there is a lack of theory-based, nursing-specific tools that directly assess their relationship. This study aimed to develop a valid and reliable measurement tool based on Kolcaba's Comfort Theory.

Methodological study.

The study included 781 patients and followed standard procedures for scale development. The scale was rated on a 5-point Likert scale, and item scores were averaged to obtain overall scores. Data were collected using the Personal Information Form, the Pittsburgh Sleep Quality Index, the Visual Analog Scale (impact of sleep disturbance), the World Health Organization Quality of Life Scale, and the newly developed scale. Content validity, exploratory factor analysis, and confirmatory factor analysis were used to assess validity. Reliability was evaluated using Cronbach's alpha, McDonald's omega, and split-half reliability.

The final scale consists of 23 items and two sub-dimensions: Physical-Psycho-Spiritual and Environmental-Sociocultural. Mean scores range from 1 to 5, with higher scores indicating a greater negative impact of sleep disturbance on quality of life. These findings suggest that the scale may capture the multidimensional impact of sleep disturbance on quality of life. Reliability coefficients were 0.96 for both sub-dimensions and 0.98 for the overall scale. However, the confirmatory factor analysis results indicated an acceptable yet borderline model fit, particularly with respect to the RMSEA value, and therefore should be interpreted with caution.

The Effect of Sleep Disturbance on Quality of Life Scale may offer a theory-based approach to assessing how sleep disturbances relate to patients' quality of life. It may assist healthcare professionals in clinical assessment by helping to identify the multidimensional impact of sleep-related problems and could potentially contribute to clinical decision-making and care planning. The findings suggest that the scale demonstrates adequate psychometric properties and may be a useful tool for research, education, and clinical practice. In addition, criterion-related validity showed correlations ranging from weak to moderate levels, indicating partial support rather than strong evidence. These findings should therefore be interpreted with caution, as the observed correlations provide limited rather than conclusive evidence of criterion validity.

The scale appears to be a valid and reliable tool for assessing the impact of sleep disturbance on quality of life. The scale may provide a theory-based framework for assessing patient needs, which may support holistic assessment and individualized care.

Dietary changes are essential for managing metabolic dysfunction-associated steatotic liver disease (MASLD), yet patients often face barriers related to knowledge, skills, cost, time, and cultural fit.

The purpose of this paper is to report a process for culturally tailoring a dietary intervention and its application to create a calorie-restricted meal plan for Mexican and Central American patients with MASLD. Guided by the Theory of Planned Behavior and user-centered design, we produced a culturally tailored seven-day structured meal plan aligned with dietary guidelines for MASLD and weight loss.

We conducted a three-phase, mixed-methods process among Mexican/Central American patients with MASLD from a safety-net healthcare system in Houston, Texas (n = 25). Phase 1 characterized meal patterns and preferences through semi-structured interviews. Phase 2 integrated findings with clinical nutrition guidelines to develop structured meal plan prototypes at 1200-, 1500-, and 1800-calorie levels. Phase 3 tested usability through ecological momentary assessments and daily interviews.

Participants typically consumed home-cooked meals centered on animal protein, legumes and simple grains, with lunch and dinner preparation being most challenging. Recipe modifications focused on increasing fiber and reducing fat and refined carbohydrates. Usability testing showed that participants found the plans culturally aligned and practical, improving portion awareness and dietary self-efficacy.

This study offers a patient-centered process for culturally tailoring dietary interventions and its output, a calorie- restricted meal plan that shows preliminary feasibility and acceptability on user testing. Next steps (underway) are to evaluate the meal plan's larger-scale implementation and impact on dietary change and weight loss.

Help-seeking dilemmas are potential barriers to use of treatment, social interventions, and social support systems. While previously existing scales provided a means of assessing help-seeking intentions, a fundamental gap is their limitation to mental health cases or gender lines. Hence, Help-Seeking Dilemma Scale (HSDS) was developed for assessing help-seeking dilemmas regardless of mental health conditions or gender lines.

The study adopted cross-validation design with 660 participants across three samples. First sample comprised 15 participants (males = 7, females = 8) in an in-depth interview that facilitated the generation of HSDS items. Second sample comprised 446 participants (male = 49.6%, female = 50.0%, unspecified gender = .4%, mean age = 29 ± 11.31 years) randomly split into EFA (n = 227) and CFA (n = 219) subsamples. HSDS was cross-validated with Exploratory Factor Analysis (EFA) in the EFA subsample and Confirmatory Factor Analysis (CFA) in the CFA subsample. Third sample comprised 199 participants (male = 85%, female = 11.5%, unspecified gender = 3.5%, mean age = 31.29 ± 6.55 years) where predictive validity was tested. Data were collected using HSDS, General Help Seeking Questionnaire (GHSQ), Self-stigma of Seeking Help Scale (SSOSH) and Actual Help-Seeking Questionnaire.

EFA revealed sampling adequacy and data appropriateness for factorization [KMO = .910, χ²(231) = 2241.50, p < .0001] and extracted five dimensions, accounting for 62.4% of total variance. CFA confirmed the five-dimensional model of the EFA, with acceptable model fit indices: χ²(160) = 321.041, p < 0.001; CMNI/DF = 2.01; RMSEA = .07 (95% CI: .06 - .08). All HSDS dimensions showed convergent validity. Fornell-Larcker Criterion and Heterotrait-Monotrait (HTMT) ratio confirmed dimensional discriminant validity. Predictive validity showed that HSDS significantly predicted actual help seeking [OR = 1.19, p < 0.001]. Pearson's correlations confirmed discriminant validity between HSDS and SSOSH, r = .14, p < .01, and GHSQ, r = .05, p > .05. All dimensions demonstrated good internal consistency, with reliability score ranging from .79 to .88. Overall internal consistency for HSDS was .95.

HSDS is valid and reliable for assessing help-seeking dilemmas in academic and general populations and without limitation to any gender.