Arabic-speaking refugees and displaced populations in the Middle East and North Africa (MENA) face ongoing adversity that negatively impacts their mental health. Despite increasing mental health needs, there is no published systematic review evaluating non-clinical mental health and psychosocial support (MHPSS) interventions in the MENA region for this population, particularly through a culturally grounded framework.

We conducted a systematic review of MHPSS interventions published from 2011 to 2022 targeting non-clinical Arabic-speaking adult refugees and/or displaced persons in MENA countries. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and PROSPERO registration (CRD42023421057), we searched ten databases and grey literature sources. Objectives were to identify, appraise and synthesise eligible MHPSS interventions and assess their alignment with the Integrative Complexity (IC)-Adaptation and Development After Persecution and Trauma (ADAPT) framework. Studies were appraised using four validated quality assessment tools and a novel tool assessing links to the IC-ADAPT framework, which integrates an eco-psycho-social model (ADAPT) and a cognitive-interactionist model (IC). A subset of ten top-rated interventions was synthesised for IC-ADAPT alignment.

Thirty-eight studies met the inclusion criteria. Most interventions were conducted in Lebanon or Jordan, group-based and delivered by non-specialist facilitators in community settings. Parenting, resilience-building and trauma-focused therapies were the most common modalities. Most studies prioritised feasibility and effectiveness over efficacy. While none explicitly applied IC-ADAPT, several implicitly aligned with its eco-psychosocial systems (eg, bonds/networks, safety/security and roles/identities) and IC (eg, increased 'differentiation'), reporting reduced harsh parenting and improved reflective capacity. Culturally adapted interventions that promoted complex thinking, relational healing and community participation were linked with more favourable outcomes.

This review highlights the value of culturally sensitive, non-clinical MHPSS interventions in enhancing mental health outcomes for Arabic-speaking refugee populations in MENA. Programmes grounded in eco-psychosocial and cognitive complexity frameworks-such as IC-ADAPT-offer effective, scalable strategies for addressing refugee mental health. Future work should embed these models explicitly to optimise intervention design, relevance and impact.

CRD42023421057.

Pharmacological augmentation is commonly used for patients with major depressive disorder (MDD) who respond inadequately to antidepressant treatment. However, the robustness of evidence supporting lithium, second-generation antipsychotics (SGAs), and triiodothyronine (T3) augmentation for MDD remains uncertain.

To reappraise the efficacy and robustness of evidence for pharmacological augmentation strategies for MDD, focusing on lithium, SGAs, and T3.

We systematically searched five electronic databases and included placebo-controlled RCTs in adults with MDD who received augmentation with lithium, SGAs, or T3. The primary outcome was response rate (defined as ≥50% depressive symptom reduction). Random-effects meta-analysis and trial sequential analysis (TSA) were conducted. We also performed publication-bias-adjustment analyses, including PET-PEESE and selection models. Subgroup analyses were conducted for individual SGAs.: To reappraise the efficacy and robustness of evidence for pharmacological augmentation strategies for MDD, focusing on lithium, SGAs, and T3.

Fifty-six RCTs were included (n=13616). SGA augmentation was associated with a higher response than placebo (k=45; reported as OR with 95% CI: 1.53; 1.42-1.65; I²=0%), and the evidence was supported by TSA. Conversely, while lithium showed benefit in conventional meta-analysis (k=17; OR 2.06; 1.30-3.27; I²=11.5%), this effect was not supported by TSA (accrued information size reached 8% of the required information size; 1.99, TSA-adjusted 95% CI 0.02-189.11) and became statistically non-significant in the PET-PEESE-adjusted and selection models. Additionally, T3 augmentation was not associated with significantly higher response than controls (k = 6; 1.19; 0.53-2.70). Among individual SGAs, only aripiprazole, quetiapine, brexpiprazole, and cariprazine demonstrated TSA-supported efficacy, whereas evidence for other SGAs was limited or inconclusive.

The certainty and robustness of evidence for lithium and T3 augmentation remained limited. Evidence for T3 was sparse and did not show a significant advantage over control, while interpretation of the lithium findings is further constrained by the fact that most trials were conducted before treatment-resistant depression was more operationally defined in contemporary research. SGAs with TSA-supported benefits (aripiprazole, quetiapine, brexpiprazole and cariprazine) may be prioritised, pending individual patient considerations.

https://osf.io/27gp9.

Placenta accreta spectrum (PAS) is a complex obstetric condition with a rising incidence in parallel with the rising rate of cesarean delivery. Given the significant and rapid hemorrhage associated with cesarean hysterectomy it is critically important to prepare for resuscitation and transfusion. Both neuraxial and general anesthesia can be used, each having their own advantages and disadvantages. The diagnosis of PAS can have significant mental health effects on the mother that need to be considered both during pregnancy and postpartum.

Infectious oral diseases represent the most prevalent categories of oral conditions, including dental caries, periodontitis, periapical lesions, and pericoronitis. Their bidirectional relationship with mental health has emerged as a critical interdisciplinary research frontier. This paper integrates epidemiological findings and molecular mechanism evidence to analyze the significant comorbidity and correlation characteristics between infectious oral diseases such as caries and periodontitis, and psychological disorders including depression and anxiety. Oral diseases not only directly impair mental well-being through pain, functional impairment, and social anxiety, but also induce systemic inflammatory responses that disrupt the blood-brain barrier, activate microglia, and alter neurotransmitter metabolism, thereby contributing to functional dysregulation within emotional regulatory centers. The dysbiosis of the oral microbiota caused by infectious oral diseases plays a central role in the vicious cycle of "oral infection-mental health disorders" through the"oral-gut-brain axis", inflammation-mediated neuroimmune cascades, and hypothalamic-pituitary-adrenal axis dysregulation. Meanwhile, mental disorders exacerbate oral microbial imbalance and tissue destruction through poor oral hygiene behaviors, xerostomia induced by psychotropic medications, and stress-related neuroendocrine alterations. This paper advocates for synergistically integrate oral clinical interventions with mental health improvement strategies, and for the development of microbiome-targeted precision modulation approaches. It further proposes an integrated health management paradigm that bridges dentistry and psychiatry, providing both theoretical foundations and practical pathways to transcend traditional disciplinary boundaries and achieve holistic oral-mental co-management.

This study aimed to (a) identify NexGen athletes' levels of mental health, anxiety, and depressive symptoms; (b) determine associations between sport type, psychological violence, mental performance, and athletes' mental illness and mental health; and (c) assess whether mental performance moderates these associations. A total of 318 NextGen athletes completed an online survey. Results showed that 19.8% and 21.4% reported clinical anxiety and depressive symptoms, respectively, and 45.3% were flourishing. Participating in an aesthetic sport was significantly associated with lower mental health. Only peer psychological violence was associated with higher mental illness scores and lower mental health. Higher mental performance was associated with less anxiety and depressive symptoms and higher mental health. Mental performance moderated the association between psychological violence from authority figures and anxiety symptoms when levels of authority-figure violence were low. Findings emphasize the importance of strengthening athletes' mental performance and addressing psychological violence through education and systemic safeguards.

Late-life depression (LLD) is commonly accompanied by cognitive impairment and poor response to first-line antidepressants. Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for treatment-resistant LLD, yet neurobiological predictors of cognitive and clinical outcomes remain unclear. Brain aging, quantified via magnetic resonance imaging (MRI)-derived centile scores from normative brain charts, may capture individual variability in neurostructural aging relevant to rTMS treatment response.

We examined relationships between centile scores, cognition, and antidepressant outcomes in older adults with LLD (n=112) and healthy controls (HC; n=41) who participated in a noninferiority clinical trial of bilateral dorsolateral prefrontal cortex (DLPFC) rTMS versus theta burst stimulation. Structural MRI was obtained before and after treatment. Centile scores leveraging cortical and subcortical tissue volumes were generated using BrainChart.io. Cognitive outcomes were assessed using standardized neuropsychological measures, including verbal learning and executive function.

Baseline centile scores did not differ between the LLD cohort and HCs and were unrelated to depression severity or antidepressant response. However, participants in a cognitively-diminished LLD subtype exhibited significantly lower centile scores driven by reduced white-matter volume. Across LLD participants, higher baseline centile scores predicted greater improvement in verbal learning following rTMS, but not global cognition or executive function, independent of antidepressant response. Centile scores remained stable post-treatment.

Brain age measures reflect cognitive, but not antidepressant, outcomes following rTMS in LLD. Structural-MRI based centile scores may serve as biomarkers of cognitive function and predictors of rTMS-related cognitive improvement in individuals with LLD.

Despite recent declines in overdose deaths in Maryland, Baltimore County, and the nation, families who have lost loved ones to overdose remain an underutilized resource in shaping overdose response efforts. To better understand their experiences and inform overdose prevention strategies, Baltimore County Department of Health (BCDH) conducted interviews with family members or close acquaintances who lost a loved one to overdose.

Potential participants were identified through medical examiner records and invited via personalized letters. After screening for knowledge of confidential information pertaining to cause of death, 32 family members /close acquaintances voluntarily participated from 2022 to 2024. A licensed clinical social worker conducted one-on-one interviews (60-90 min in length). Interviews focused on family members' experiences prior to the overdose, the overdose events themselves, including use of naloxone, interactions with medical and treatment systems, and recommendations. Interviews were manually coded and analyzed by four qualitative researchers using thematic analysis guided by Grounded Theory.

Most respondents were parents (72%) of the decedents, followed by partners (16%), siblings, and former partners (6% each). Decedents were predominantly male (81%), White (78%), non-Hispanic (97%), with an average age of 49. Themes were organized into three domains: (1) circumstances and stressors leading up to the overdose, (2) non-fatal and fatal overdose events, and (3) reflections and system recommendations. In Domain 1, families described marked changes in their loved one's behavior as drug use escalated, fractured relationships, emotional exhaustion, and the struggle to balance support with tough love. Domain 2 revealed experiences with multiple non-fatal overdoses, limited use of naloxone and mixed experiences with medical systems. Domain 3 highlighted calls for financial and navigational support for treatment, better integration of mental health and substance use, high-quality treatment, greater information about overdose circumstances, and more family guidance about addiction and supporting someone with substance use dependency.

Families face profound emotional and systems challenges. They often witness multiple non-fatal overdoses, often at home with limited use of naloxone. Findings suggest the need for family-centered naloxone education programs, greater awareness of treatment options, and family support programs to position families as key partners in overdose prevention and response.

Depression affects nearly half of patients with heart failure (HF), which is associated with increased morbidity and reduced health-related quality of life (HRQoL). This secondary per-protocol analysis of a previously published randomized trial evaluated the behavioral activation (BA) versus antidepressant medication (MEDS) among patients with depression and HF who adhered to study interventions.

This analysis is based on a pragmatic randomized comparative-effectiveness trial conducted from 2018 to 2022, with a 1-year follow-up. 416 participants diagnosed with HF and a DSM-5 depressive disorder were randomized to BA or MEDS, and the current analysis examined outcomes according to treatment adherence.

The primary outcome was depressive symptom severity (PHQ-9) at 6 months, and the secondary outcomes were physical and mental HRQoL (SF-12v2-PC and SF-12v2-MC, respectively) and HF-specific HRQoL (Kansas City Cardiomyopathy Questionnaire; KCCQ) overall and clinical scores (KCCQ-OS and KCCQ-CS), at 3, 6, and 12 months. High adherence was defined as completion of >75-100% of intervention components. Overall adherence rates were similar between BA and MEDS. At 6 months, among patients with >75-100% adherence who followed treatment as directed in both arms, BA was associated with higher Mental HRQoL (SF-12v2-MC: 5.22; 95% CI: 0.72 to 9.72; p = 0.023) and higher HF-specific HRQoL (KCCQ-OS: 16.08; 95% CI: 7.20 to 24.97; p < 0.001); KCCQ-CS: 16.04; 95%CI: 7.05 to 25.02; p < 0.001) compared to MEDS. There were no significant differences in depressive symptoms or physical HRQoL at 6 months.

Both BA and MEDS were equally effective treatments for depression in HF. However, among highly adherent patients, BA was associated with greater improvements in mental and HF-specific HRQoL than MEDS.

The study was funded by PCORI Award Number: 2017C2-7716.

Scurvy is a nutritional deficiency disorder caused by sustained vitamin C depletion and is historically associated with dietary deprivation.

To review published cases of scurvy co-occurring with psychotic-spectrum disorders, characterize the recurrent illness-related contexts linked to low ascorbate intake, and summarize the clinical features relevant to recognition in consultation-liaison settings.

We searched four databases for reports of scurvy with a psychotic-spectrum diagnosis, from inception to May, 2025.

Eighteen reports describing nineteen patients met the criteria. Patients were typically middle-aged (median age, 54.0 years, [IQR 42-64]) and predominantly male (n = 13/19). Across the descriptions, mental state and functional narratives repeatedly converged in two contexts that plausibly reduced vitamin C intake: (i) psychosis that directly constrained eating (e.g., delusional contamination or rigid rules restricting fresh foods), and (ii) negative symptoms associated with self-neglect, impaired meal preparation, and irregular intake. Diets were often severely monotonous and lacked fresh produce. Psychiatric or behavioral deterioration was the presenting complaint in 5/19 patients (26%). Vitamin C repletion was followed by clinical improvement within days to weeks, mainly in the physical manifestations of scurvy; one patient died from refeeding syndrome. However, smoking status was rarely reported.

These case descriptions are consistent with a conceptual framework that suggests two potential pathways linking psychotic-spectrum disorders to vitamin C deficiency: psychosis-driven restrictive intake and executive-dysfunction mediated self-neglect. Clinicians should consider vitamin C deficiency when compatible mucocutaneous, musculoskeletal, or hematological features are accompanied by impaired self-care or marked dietary monotony.