Substance use disorders (SUDs) pose significant mental health challenges due to their chronic nature, health implications, impact on quality of life, and variability of treatment response. This systematic review critically examines the application of machine learning (ML) algorithms in predicting and analyzing treatment outcomes in SUDs. Conducting a thorough search across PubMed, Embase, Scopus, and Web of Science, we identified 28 studies that met our inclusion criteria from an initial pool of 362 articles. The MI-CLAIM and CHARMS instruments were utilized for methodological quality and bias assessment. Reviewed studies encompass an array of SUDs, mainly opioids, cocaine, and alcohol use, predicting outcomes such as treatment adherence, relapse, and severity assessment. Our analysis reveals a significant potential of ML models in enhancing predictive accuracy and clinical decision-making in SUD treatment. However, we also identify critical gaps in methodological consistency, transparency, and external validation among the studies reviewed. Our review underscores the necessity for standardized protocols and best practices in applying ML within SUD while providing recommendations and guidelines for future research.

The online version contains supplementary material available at 10.1007/s11469-024-01403-z.

Preclinical and clinical evidence has implicated inflammation in the pathophysiology of depression. Abnormal cytokine levels in blood, cerebrospinal fluid, and post-mortem brain samples have been associated with depression. To our knowledge, however, a comprehensive analysis of cytokine protein levels in brain samples from patients with depression has yet to be conducted in major components of the limbic system such as the ventromedial prefrontal cortex (vmPFC). This region plays a crucial role in depression, impacting cognitive control, emotional regulation, and executive functions. In the current exploratory study, we performed a comprehensive profiling of 72 cytokines, chemokines and growth factors in well-characterized vmPFC samples from 34 depressed suicides and 14 matched sudden-death controls. A human antibody array (RayBio®, chemiluminescent detection) was used to measure all markers. In depressed suicide samples, no significant increase in any cytokine, chemokine or growth factor was detected compared to controls. In comparison, in an independent cohort we measured the levels of 43 inflammatory markers in plasma samples from 141 depressed living subjects and 36 controls using the Mesoscale Discovery V-plex assay. Our analyses indicated no significant difference in the levels of pro- or anti-inflammatory markers in the plasma of cases vs controls. We also conducted a detailed morphological analysis of Iba1-immunostained microglia in vmPFC gray matter samples from 28 depressed suicides and 13 healthy controls. The distributions of the various morphological phenotypes assessed were similar between groups, suggesting that microglia/macrophages do not display signs of morphological changes in the vmPFC of depressed suicides. Taken together, these complementary experiments do not provide evidence of depression-associated neuroinflammatory changes in the vmPFC, at least in the samples analyzed.

Obsessive-Compulsive Disorder (OCD) can present significant challenges to individuals mental health, characterized by intrusive thoughts and repetitive maladaptive behaviors. Recent research into alternative treatments has highlighted psychedelics, notably psilocybin, for their potential therapeutic benefits in various psychiatric disorders, including OCD. This case study evaluated the impact of self-administered, low-doses of psilocybin, commonly referred to as microdosing, on symptom reduction and cognitive flexibility in OCD, with a focus on identical twins discordant for the condition.

The study documents the experiences of one twin diagnosed with OCD who began a regimen of low-doses of psilocybin containing mushrooms, while the other twin, unaffected by OCD, served as a comparison. Case X was diagnosed with OCD by a general practitioner in the Danish healthcare system. Following years of severe OCD, case X began a self-medicated regimen consisting of psilocybin containing mushrooms, corresponding to 1-5 mg of psilocybin, every 3^rd day. The other twin, case Y, who remained unaffected by OCD, and did not take psilocybin containing mushrooms. Cognitive flexibility was evaluated in both cases using a set-shift task. The affected twin reported a notable reduction in OCD symptoms, along with improvements in emotional regulation and overall well-being. However, despite these symptomatic improvements, deficits in cognitive flexibility remained present compared to the unaffected twin.

This case study underscores the potential of low-doses of psilocybin as a promising avenue for mitigating symptoms of OCD. Nevertheless, the observed disparity in cognitive flexibility highlights the nuanced nature of OCD pathology, suggesting that while low-doses of psilocybin may alleviate certain symptoms, it may not fully address underlying cognitive impairments. Further research employing larger sample sizes and rigorous longitudinal designs is imperative to elucidate the mechanisms underlying the therapeutic effects of psilocybin low-doses in OCD, offering insights into its broader applicability as a treatment modality.

[This corrects the article DOI: 10.3389/fpsyt.2026.1798373.].

Police officers are exposed to elevated psychological risks due to both operational and organizational stressors. Additionally, police officers tend to resort to avoidant coping strategies, which exacerbate poor mental health outcomes, such as burnout and PTSD.

This study aims to examine clinical symptoms (stress, anxiety, depression), coping styles, and perceived stressors among police forces from Catalonia, Spain. A total of 741 officers completed an online survey comprising DASS-21, PSQ-Op, PSQ-Org, Brief COPE and brief open-ended questions.

Overall, both operational and organizational stressors were significant predictors of clinical symptoms, with the latter revealing a more pronounced impact. Avoidant coping emerged as the strongest risk factor for distress, while problem-focused coping emerged as a possible protective factor, especially against depression. Both gender and years of service influenced coping strategies: i) female officers reported higher use of adaptive coping, while male officers scored higher in avoidant coping; and ii) more experienced officers reported lower anxiety symptoms but also lower use of active coping strategies.

These findings underscore the importance of addressing both organizational culture and individual-level factors in promoting psychological resilience, while considering gender and career stage to support sustainable mental health within police forces.

Iron is an indispensable element for the normal physiological function of the brain. In terms of neuronal metabolism, iron is involved in multiple critical biological processes such as oxygen transport, energy metabolism, DNA synthesis, neurotransmitter synthesis and myelin formation. Maintaining brain iron homeostasis is crucial for neurodevelopment and function. Iron dyshomeostasis has been associated with the onset and progression of various neuropsychiatric disorders, including Parkinson's disease, Alzheimer's disease, depression, schizophrenia, attention deficit hyperactivity disorder, and autism spectrum disorder. In neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease, abnormally elevated iron levels can be detected in specific brain regions, including the basal ganglia and the prefrontal cortex. These changes are often accompanied by pathological processes such as oxidative stress, neuroinflammation, and pathological protein aggregation. Therefore, brain iron metabolism is an important entry point for understanding the pathophysiological process of neuropsychiatric disorders. Mechanistically, iron overload induces oxidative damage through the Fenton reaction, exacerbating mitochondrial dysfunction and abnormal protein aggregation. The effects of iron deficiency vary across different diseases; its impact on myelination and neurotransmitter synthesis may increase the risk of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD), while its effects on immune activation and energy metabolism may contribute to the development of mental disorders such as depression. This article systematically reviews the current research progress of the role of cerebral iron metabolism in neuropsychiatric diseases. It focuses on the mechanisms underlying iron homeostasis imbalances in neurodegenerative and psychiatric diseases. Building on this foundation, the article analyzes the therapeutic targets and clinical significance of iron metabolism-related interventions and outlines future research directions in this field.

Schizophrenia is a severe psychiatric disorder. Catatonia is relatively common in schizophrenia; its main manifestations include catatonic stupor, mutism, negativism, and other psychomotor symptom clusters. Patients with schizophrenia are at increased risk of infections, which are also recognized triggers for Guillain-Barré syndrome (GBS). GBS typically presents with limb weakness, paresthesia, facial weakness, respiratory muscle paralysis, and autonomic symptoms, and may similarly result in severe immobility and impaired communication. Consequently, when schizophrenia (especially with catatonic features) coexists with GBS, history taking and clinical assessment can be challenging, increasing the risk of misdiagnosis or delayed diagnosis.

We report a 28-year-old man with a 3-year history of schizophrenia who was found after 2 weeks of lost contact and admitted emergently. His first episode featured hallucinations, persecutory delusions, and catatonia, which remitted with antipsychotic and other medications treatment. He subsequently relapsed twice after discontinuing medication; both relapses presented mainly with hallucinations and delusions without catatonia and remitted after re-treatment, followed by regular risperidone maintenance. In the current episode, hallucinations and delusions recurred and progressed to apathy, reduced speech and activity, and eventually complete mutism, immobility, and inability to perform self-care. Schizophrenia was initially diagnosed per DSM-5 criteria and risperidone was initiated. Further evaluation revealed pulmonary infection with limb weakness and decreased tendon reflexes, differing from the increased muscle tone typical of catatonia. Cerebrospinal fluid showed albuminocytologic dissociation (protein 0.61 g/L; leukocytes 1.2×10^6/L), and comorbid Guillain-Barré syndrome was considered. He was transferred to neurology and treated with intravenous immunoglobulin (25 g/day for 5 days) plus rehabilitation, with gradual improvement. During the 1-year follow-up, the patient continued risperidone 4 mg as maintenance to prevent psychiatric relapse; his symptoms had essentially resolved, and he returned to normal work and daily life.

In psychiatric practice, mutism and immobility are often attributed to primary psychiatric illness, particularly in patients with established diagnoses, which can lead to missed or delayed detection of medical conditions. This case underscores the importance of thorough neurologic examination and timely investigations in uncooperative patients, especially after antecedent infection, including consideration of lumbar puncture to evaluate for comorbid neurologic disorders such as Guillain-Barré syndrome.

Healthcare professionals responding to disasters, mass casualty incidents, pandemics, and sustained high-acuity clinical environments face extraordinary ethical and emotional demands. While burnout and post-traumatic stress disorder (PTSD) have historically framed clinician distress, these constructs incompletely capture the moral and existential harm experienced when clinicians are forced to act in ways that conflict with deeply held professional and ethical values. Moral injury has emerged as a distinct framework to explain this phenomenon. This review synthesizes current understanding of moral injury in disaster, mass casualty, and crisis care settings, distinguishing it from burnout and PTSD, examines prevalence and impact on clinicians and healthcare systems, identifies unique individual, organizational, and situational risk factors, and reviews mitigation and recovery strategies across the disaster continuum. Critical gaps in measurement and research are highlighted, particularly in command-driven healthcare environments. Addressing moral injury requires system-level interventions, ethical transparency, and leadership accountability to sustain the healthcare workforce beyond the immediate crisis.

Shoulder pain (SP) is prevalent, costly, and linked to low quality of life, high pain levels, disability, and mental health issues. Despite guidelines, orthopaedic surgeons vary in surgical indicators and clinical decision-making. This study investigates if clinicians adhere to guidelines in an observational study.

In a French prospective multicentre study, four clinicians assessed patients with shoulder pain, recommended surgery or conservative management, and followed up at 4, 6, and 12 months. Comparative demographic and clinical data were used at baseline. Participants receiving surgery or conservative care within diagnostic and pain severity categories were compared to guidelines. An attrition analyses compared participants at baseline and 12-month follow-up.

Of 189 participants, the majority of impingement and tendinopathy diagnoses were managed conservatively. More full-thickness tear diagnoses were recommended for surgical repair, and those recommended for surgery had more severe pain. Participants with high SMS completion (≥80%) and low SMS completion (<80%) were similar at baseline (based on age, sex, education, pain severity, duration, and disability) and at 12-month follow-up.

Clinicians recommended treatment in line with guidelines, emphasising rotator cuff tear presence and high pain intensity. Patients recommended surgery differed from those recommended conservative management, so future analyses should compare these treatment groups.

Complex traits arise from the combined effects of rare and common genetic variation, development and environment, but resolving their joint contributions has been limited by statistical power. Here, we meta-analyze effects of recurrent copy number variants (CNVs), polygenic scores, sex, age and medications on height and body mass index in 1,447,001 individuals across 6 biobanks and clinical cohorts. CNVs show largely mirror dose-dependent effects of deletions and duplications on both traits, but a subset of loci exhibit asymmetric dose-responses on adult height, consistent with buffering of one allele but not the other. Polygenic background and medications combine with CNVs in ways broadly consistent with additivity. However, detailed analyses of loci at 16p11.2 and 22q11.2 reveal context-dependent effects that vary across development, physiology and sex. At 22q11.2, the net effect of a CNV reflects opposing and reinforcing contributions of multiple genes, providing a potential mechanism for buffering of dosage effects. These results indicate that genetic effects follow additive patterns in aggregate, while context-dependent deviations are widespread for specific loci.