Depersonalization/derealization (DPDR) involves feeling detached from one's body, thoughts, or emotions and is often triggered by trauma, stress, mental health issues, or drug use, typically causing high distress. Similar experiences are also reported in meditation contexts, where they are often described as positive, insightful, and meaningful. However, no study has systematically compared DPDR-like experiences across these contexts. This preregistered, cross-sectional study addresses this gap. Participants who had experienced DPDR-like states triggered through meditation (MEDT, n = 60) or through other triggers (NMEDT, n = 61) completed five questionnaires and provided additional information about their DPDR experience and meditation practice. The two groups significantly differed on all questionnaires except the Cambridge Depersonalisation Scale, including its subscales covering different DPDR aspects. The MEDT group rated their experiences as substantially more positive than NMEDT, though most participants in both groups described them as mixed. In MEDT, these experiences were reported across meditation types and experience levels. Overall, meditation can induce states phenomenologically similar to DPDR, but these are often experienced as more welcome, pleasant, and spiritually meaningful than those triggered by trauma, stress, or cannabis, although distress is not uncommon. These findings suggest contemplative approaches may inform clinical support for DPDR, while highlighting the need for recognition and guidance within meditation settings.

Dementia poses a threat to public health, especially among ethnically diverse Muslim communities in the UK, with quite some peculiar nuances. Within these communities, Black Muslims in the UK face unique risks shaped by complex ethnic, religious, and socioeconomic factors. However, there is a dearth of research that specifically explores perspectives on dementia in this population. The aim of this study was to explore and understand the perspectives of Black Muslims in the UK regarding the causes and prevention of dementia using a qualitative narrative inquiry approach guided by Intersectionality Theory and the Sociocultural Health Belief Model. The study involved 15 Black Muslims (8 women, 7 men), aged between 30 and 69 years, residing across the UK, with diverse roles including actively engaged community members (n = 6), religious figures (n = 3), and caregivers (n = 2). Data were collected through semi-structured interviews conducted virtually via Microsoft Teams. Thematic analysis was performed using an iterative approach with NVivo 14 software. The analysis yielded five major themes: (1) low awareness, misconceptions and stigma surrounding dementia; (2) faith-based health beliefs as protective factors; (3) stress, loneliness, and socioeconomic pressures as risk factors; (4) religious ideals, healthy lifestyles, and everyday realities; and (5) need for culturally tailored dementia education and engagement. Participants highlighted gaps between Islamic health principles, such as the encouragement of physical activity and their everyday practices, influenced by structural barriers. Black Muslims hold nuanced beliefs about dementia, shaped by cultural, religious, and socio-environmental factors such as stigma, limited awareness and socioeconomic pressures. These dynamics influence how dementia is understood and the extent to which preventive behaviours are adopted. Promoting dementia prevention in these communities requires culturally sensitive interventions that align with religious teachings, supported by policy changes that invest in community education and embed culturally and faith-informed approaches within public health strategies.

Post-COVID-19 condition (also known as long COVID) breathlessness is a common, complex, and frequently debilitating problem for which few evidence-based interventions exist. A previous randomised trial found that participation in an online 6-week breathing and wellbeing programme (ENO Breathe), using singing techniques, was associated with improvements in health-related quality of life (HRQOL) and breathlessness. We aimed to assess the impact of this intervention outside a trial setting.

In this cohort study, participants were referred from 51 UK-based National Health Service (NHS) long COVID clinics, where they had been diagnosed with breathlessness due to long COVID. The eligibility criteria of ENO Breathe were age 18 years or older, having long COVID with associated breathlessness, diagnosis and referral from a specialist collaborating NHS long COVID clinic, and access and ability to engage with the online programme. We compared baseline and post-intervention data to assess the effect of the ENO Breathe programme on HRQOL assessed using the RAND-36 Mental and Physical Health Composite (MHC and PHC) primary outcome, with an estimated minimally clinically important difference of 3; breathlessness (assessed using Dyspnoea-12 scores and visual analogue scales [VAS] for breathlessness at rest, walking, using stairs, and running); anxiety (assessed using the Generalised Anxiety Disorder-7 questionnaire [GAD-7]); and respiratory symptoms (assessed using the COPD Assessment Test [CAT]).

1413 programme participants were included in this analysis (mean age 49 years [SD 11·9], BMI 28 kg/m² [7·2]). 1130 (80%) participants were female, 273 (19%) were male, and ten (1%) did not disclose their gender. 1165 (82%) participants were White, 87 (6%) were Asian, 47 (3%) were Black, 48 (3%) were of mixed or multiple ethnic backgrounds, 31 (2%) reported their ethnicity or race as other (ie, not one of the categories specified), and 35 (2%) did not disclose their ethnicity or race. Participants reported having long COVID symptoms for a median of 415 days (IQR 246-601) at the time of registration with the programme. 1188 (84%) of 1413 participants provided follow-up data on completion of the programme. Completing ENO Breathe was associated with improvements in HRQOL (median difference in RAND-36 MHC 2·98, IQR -1·53 to 8·42; and median difference in PHC 1·69, -1·32 to 5·01), breathlessness (mean difference in Dyspnoea-12 -4·29, 95% CI -4·64 to -3·94; VAS breathlessness scores walking median difference -5, IQR -18 to 6; stairs median difference -10, -25 to 3; and running median difference -3, -19 to 0), anxiety (median GAD-7 score difference -1, IQR -4 to 1), and respiratory symptom impact (mean CAT score difference -2·50, -2·81 to -2·19; all p<0·0001). The VAS breathlessness score at rest did not significantly change (median difference 0, IQR -10 to 13; p=0·24). The response to the ENO Breathe intervention did not differ by age, gender, ethnicity, or pre-existing asthma. There were no reported clinically significant adverse events.

The ENO Breathe programme can improve HRQOL, breathlessness, anxiety, and respiratory symptoms in people with long COVID and breathlessness. ENO Breathe could be tested in other major causes of breathlessness and might help inform the development and delivery of other related interventions.

Imperial College London.

Bipolar II disorder (BDII) accounts for the majority of patients with bipolar disorder (BD), yet evidence supporting first-line mood stabilising treatment with lithium and lamotrigine is scarce, and the certainty of the evidence is very low. This highlights a critical evidence gap within psychiatric care. The lithium versus lamotrigine-bipolar randomised controlled trial (RCT) aims to compare lithium and lamotrigine on self-rated day-to-day mood instability (MI) and other patient-centred outcomes in BDII, hypothesising the superiority of lithium.

A two-arm, single-blind, parallel-group, superiority RCT with a target sample size of 200 patients (accounting for attrition), recruiting patients with newly diagnosed BDII from specialised outpatient mood disorder clinics in the capital region of Copenhagen, Denmark. Participants are randomised in a 1:1 ratio to receive either lithium or lamotrigine for 6 months. The primary outcome is MI, assessed via daily smartphone-based mood ratings. MI is chosen as the primary outcome measure due to its internal validity as a real-life measure for patients and external validity as it reflects both illness severity and functional impairment. Secondary outcomes include the proportion of participants showing a non-response to treatment and observer-rated changes in depressive symptoms over 6 months, measured using the six-item version of the Hamilton Depression Rating Scale. Primary analyses will follow the intention-to-treat principle using linear mixed models. The trial is monitored by the good clinical practice.Recruitment commenced on 8 May 2024, and the final participant follow-up (last patient last visit) is expected on 1 December 2027.

The trial has received approvals from the Danish Research Ethics Committee, the Danish Medicines Agency (EU CT No. 2023-5 09 607-32-00) and the Capital Region Data Agency (P-2023-307). Results will be published in peer-reviewed journals.

Clinicaltrials.gov/NCT06184581.

Adolescents experiencing emotional distress are at increased risk of developing mental health problems, which can negatively impact their academic performance, social relationships and long-term well-being. Schools provide a key setting for implementing preventive interventions that promote emotional and psychological resilience. This study presents the protocol for a randomised controlled trial designed to evaluate the effectiveness of a multicomponent, school-based intervention grounded in emotional intelligence (EI) in improving mental well-being, EI levels and resilience among adolescents aged 14-16 years experiencing emotional distress.

The trial will be conducted in public and publicly funded secondary schools in Terrassa, Spain, during the 2025-2026 academic year. Eligible participants will be identified using the short version of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). The intervention consists of nine 55-minute group sessions delivered during school hours by a nurse and a physiotherapist, supported by the school's psychopedagogue. Sessions focus on emotional regulation, self-esteem, mindfulness, assertiveness and other socio-emotional skills. Assessments will be conducted at baseline, postintervention and 24-week follow-up. The primary outcome is mental well-being (WEMWBS); secondary outcomes include EI (Trait Meta-Mood Scale-24 items) and resilience (Child and Youth Resilience Measure-32 items). It is anticipated that adolescents in the intervention group will show significantly greater improvements in mental well-being, emotional intelligence and resilience compared with the control group, with effects sustained at follow-up. This study will provide evidence on the effectiveness of a scalable, school-based intervention led by community health professionals. The programme could be integrated into educational and public health strategies to promote adolescent mental health and reduce emotional distress.

Approved by CEIm Consorci Sanitari de Terrassa (01-24-1CR-102). Low-risk study; predefined procedures are in place for participants at risk (eg, suicidal ideation, abuse) with referral pathways to health/social services. Findings will be disseminated via peer-reviewed publications, conferences and a plain-language summary to schools/stakeholders.

NCT06713460.

While humans are exposed to a wide range of potentially neurotoxic environmental chemicals, assessing their overall impact on the central nervous system (CNS) remains challenging due to the difficulty in quantifying multi-class chemicals at low concentrations and direct access to the CNS. We leverage our unique collection of paired plasma and cerebrospinal fluid (CSF) samples from pregnant women in an urban pregnancy cohort to comprehensively profile environmental exposures and explore their potential associations with postpartum neuropsychiatric symptoms. We quantified and characterized the distribution of 143 potential neurotoxic chemicals in 25 paired CSF-plasma samples, collected prior to delivery, using a high-sensitivity targeted multiclass assay. The chemicals spanned 16 classes including pesticides, phthalates and PFAS. We report wide detection of these chemicals or analytes not only in plasma but also in CSF, with 16 and 18 detected in all CSF and plasma samples, respectively. Additionally, 51 and 57 analytes were detected in >50% CSF and plasma samples, respectively, with 31 commonly detected in both and 17 (mostly phthalates and pesticides) at higher concentrations in CSF. We also observed an indication of a prospective associations between exposure mixture and Edinburgh Postnatal Depression Scale (EPDS) at six weeks postpartum using Weighted Quantile Sum (WQS) regression analysis, however confidence interval included zero. Our exploratory "exposome-scale" study is among the first to report a prevalent detection of numerous multi-class environmental chemicals in CSF, suggesting their ability to cross the blood-CSF barrier, and their collective presence in CNS may play a role in maternal postpartum mental health.

A recent systematic review has demonstrated objective neurocognitive difficulties in people with body dysmorphic disorder (BDD). Limited research has also shown that individuals with BDD frequently self-report cognitive difficulties, but little is known about how they understand these difficulties in relation to their disorder or daily and life functioning. This study aimed to comprehensively examine adults' perceptions of cognitive difficulties in BDD.

A mixed-methods design was employed using an international online survey, which analysed quantitative and qualitative data (Interpretative Phenomenological Analysis) of lived experiences of cognitive difficulties from participants who self-reported a BDD diagnosis or severe BDD symptomatology via the Dysmorphic Concern Questionnaire (N = 433).

Most participants (82%) endorsed significant cognitive difficulties they believed were linked to their disorder, with 75% reporting substantial effects on daily life and overall quality of life. Few had discussed these concerns with clinicians due to shame, misattribution, or uncertainty about their relevance. Participants expressed strong support for research into cognitive aspects of BDD.

Perceived cognitive difficulties are widespread, distressing, and functionally impactful for individuals with BDD. These findings highlight the need for clinicians to actively assess cognitive difficulties, consider the possibility of co-occurring conditions such as ADHD, and incorporate this understanding into treatment planning to enhance engagement and therapeutic outcomes.

Research Question(s) or Topic(s): How do adults with body dysmorphic disorder perceive their cognitive difficulties and what impacts do they report?

Adults who reported a diagnosis of body dysmorphic disorder or severe dysmorphic concerns described frequent cognitive difficulties they believed were connected to their condition. Most reported effects on daily functioning and quality of life, yet many had not discussed these concerns with clinicians due to shame, uncertainty about their cause, or not recognising their significance. Study Contributions: This study offers the most detailed account to date of how people with body dysmorphic disorder understand and experience their cognitive difficulties. It identifies barriers to disclosure, emphasises the need for clinicians to enquire proactively about cognitive concerns, and calls for further research to clarify their role in the disorder.

Less women participate in Alzheimer Disease (AD) trials compared to their estimated representation in the global dementia population.

We aimed to apply five most commonly used eligibility criteria to a real-world memory clinic population to compare male and female eligibility according to these criteria.

Observational.

Memory clinic setting.

Consecutive patients (2000-2024) from Amsterdam Dementia Cohort with a diagnosis of mild cognitive impairment (MCI) or AD (n = 3835).

Free-text eligibility criteria of n = 608 phase II and III AD drug trials were downloaded from ClinicalTrials.gov (March 28, 2025). A machine-learning model was trained and validated to extract all eligibility criteria. Next the criteria were applied on observational real world data from on memory clinic diagnostic work-up.

Top 5 most common AD clinical trial eligibility criteria were 1) no other central nervous system disorder related to cognitive impairment (84%), 2) participation of a caregiver (72%), 3) MMSE (66%, range 20-30), 4) no comorbidities, specifically vascular and mental health (62%), 5) no contra-indications for study procedures such as lumbar puncture, MRI and PET (59%). Applying the abovementioned criteria results in 33% of men and 23% of women remaining eligible (p<.001). Main reason for non-eligibility is caretaker absence (applicable for 20% of men and 38% of women) and low MMSE (32% of man and 54% of women).

Based on five commonly used eligibility criteria of AD clinical trials, women in our clinic-based cohort are less eligible for participation in AD drug trials than men. This discrepancy was mainly attributed to lack of caregiver presence and lower MMSE at presentation. These results provide clues for trial design to facilitate more equal inclusion of women.

Depression is currently one of the most impactful mental health conditions worldwide, with more than 280 million reported cases. However, there is a critical lack of data on Indigenous populations due to language barriers and the absence of culturally adapted assessment tools, limiting timely diagnosis and appropriate care. The aim of this work is to culturally and linguistically adapt the Patient Health Questionnaire-9 (PHQ-9) into the Shawi language and to evaluate its psychometric properties among Indigenous adults in Alto Amazonas, Peru.

A rigorous cultural adaptation process was carried out, including translation by bilingual experts and back-translation. Validation involved expert technical review and a pilot phase conducted within the participating community. Content validity was assessed using Aiken's V coefficient as a statistical indicator. The internal structure was evaluated using confirmatory factor analysis and structural equation modeling.

The sample consisted of 432 members of the Shawi community. The instrument showed excellent content validity (V = 0.90 to 1.00). Confirmatory factor analysis supported a unidimensional model with good fit (comparative fit index: 0.98; root mean square error of approximation: 0.06) and adequate internal consistency (α = 0.80; ω = 0.81). In addition, invariance of the PHQ-9 was demonstrated across age, sex, educational level, and marital status, supporting its applicability across different population subgroups.

The Shawi version of the Patient Health Questionnaire-9 has proven to be a reliable and valid tool for detecting depressive symptoms in this Indigenous population. This advancement represents a significant contribution to reducing mental health disparities by facilitating culturally appropriate diagnoses and improving care in historically underserved Amazonian communities.

Schizophrenia typically requires long-term treatment, making cost-effective interventions essential, yet the cost-effectiveness of individualized occupational therapy (IOT) remains unclear.

To compare the cost-effectiveness of IOT plus group occupational therapy (GOT) with GOT alone for inpatients with schizophrenia over 2 yr.

Secondary analysis of data from a multicenter, two-arm, parallel randomized controlled trial.

Fourteen clinical facilities.

Sixty-two inpatients with schizophrenia who completed 2-yr follow-up.

GOT alone or IOT+GOT during 3 mo of hospitalization.

Quality-adjusted life-years (QALYs) and total medical costs from a health care payer perspective over 2 yr.

Compared with GOT alone (n = 30), IOT+GOT (n = 32) produced greater cumulative QALYs (M difference = 0.156) and lower total medical costs (M difference = -¥290,784). The incremental cost-effectiveness ratio was -¥3,304,420 per QALY gained. Incremental net benefit was positive at willingness-to-pay thresholds of ¥5,000,000 and ¥6,000,000 per QALY. The cost-effectiveness acceptability curves showed a 94.2% probability of cost-effectiveness at a threshold of ¥6,000,000. Cost data were complete for approximately 40% of participants; missingness was addressed using multiple imputation, with complete-case sensitivity analysis yielding directionally consistent findings.

IOT+GOT was more cost-effective than GOT alone over 2 yr, supporting its wider adoption as an economically sound rehabilitation strategy for clients with schizophrenia. Given the extent of missing cost data, the results should be interpreted with appropriate caution. These findings offer long-term economic evidence to inform mental health policies and resource allocation in psychiatric care. Plain-Language Summary: Schizophrenia often requires long-term treatment, resulting in substantial health care costs. This study examined whether adding individualized occupational therapy to standard group occupational therapy offers a more cost-effective approach for inpatients with schizophrenia. Sixty-two patients were followed for 2 years after receiving either group occupational therapy alone or a combination of individualized occupational therapy and group occupational therapy during hospitalization. The results indicated that patients who received individualized occupational therapy and group occupational therapy experienced greater improvements in quality of life and slightly lower total medical costs. Furthermore, the cost-effectiveness analysis showed a 94.2% probability that the intervention would be cost-effective under Japan's commonly accepted willingness-to-pay threshold. These findings suggest that individualized occupational therapy combined with group occupational therapy is a potentially cost-effective strategy for schizophrenia rehabilitation. This evidence supports the integration of individualized occupational therapy into standard psychiatric rehabilitation programs and may inform future mental health policy and resource allocation.