Early intervention in psychosis has improved symptomatic outcomes, yet little is known about how early metacognitive change relates to long-term identity reconstruction and durable recovery. This study examined five-year quantitative and narrative outcomes of adolescents with first-episode psychosis (FEP) or at-risk mental states (ARMS) treated with Recovery-Focused Metacognitive Interpersonal Therapy (MIT-FEP).

Twenty-three adolescents participated in the original naturalistic cohort study; 21 completed treatment and 19 were reassessed five years later. Quantitative measures included subjective recovery, symptom severity, metacognitive functioning, psychosocial performance, service use, and hospitalizations. A qualitative thematic analysis of follow-up narrative interviews explored identity integration, agency, and autobiographical meaning-making.

Improvements in metacognition, symptoms, and recovery were sustained or enhanced at five years. Seventy-nine percent met remission criteria, 63% achieved functional recovery, and 58% met integrated recovery criteria, defined as the concurrent presence of symptomatic remission, functional recovery, and subjective recovery. Thematic analysis identified four core processes: (1) reconstruction of agency, (2) integration of the psychotic episode into a coherent life narrative, (3) transition from illness-centred to developmental identity, and (4) future orientation and meaning-making. Narrative coherence and future orientation were more evident among participants achieving integrated recovery.

Findings suggest that early metacognitive intervention was associated with durable recovery trajectories extending beyond symptom reduction to include identity reconstruction and reduced service dependency. Metacognition may represent a developmental process associated with the maintenance of recovery and sustained psychosocial integration following early psychosis.

There is increasing research and applied clinical interest in self-compassion as a protective factor that may foster positive emotional adaptations to psychosis. The Self-Compassion Scale - Short Form (SCS-SF) is a popular and economical measure of self-compassion, but its psychometric properties are not yet validated in populations experiencing psychotic disorders.

The factorial validity, reliability, convergent validity, and criterion validity of the SCS-SF were evaluated in young adults with early psychosis (N = 170). Confirmatory factor analysis was utilized to compare the fit of six a priori structures of the SCS-SF. Additional post-hoc exploratory factor analyses were conducted. Structural equation modeling evaluated the convergent and criterion validity of the best-fitting structure of the SCS-SF with theoretically and clinically relevant outcomes.

All a priori structures exhibited inadequate fit, with some producing serious misspecification. Additional exploratory modeling indicated a two-factor model, which was retained as the preferred factor structure and used to develop an alternate, reduced-item model. The composite reliability of these factors was acceptable. A factor representing uncompassionate self-responding was associated with an array of affective and psychotic symptoms, whereas a compassionate self-responding factor was weakly or inconsistently related to fewer of these.

Findings provisionally support a two-factor structure of the SCS-SF in psychosis, but its factorial validity remains uncertain. For psychosis researchers using the SCS-SF, scoring according to the two-factor approach rather than a total score may be important for deriving an accurate understanding of the effects of self-compassion on outcomes in psychosis.

Women identified with psychosocial risk factors are at higher risk of interventions during labour and birth and adverse maternal outcomes. Midwifery Continuity of Care (MCoC) reduces interventions and improves maternal outcomes among low-risk women; however, evidence on MCoC's impact among women with psychosocial risk factors is limited. This study aimed to investigate whether an MCoC model targeting women with psychosocial risk factors improved maternal outcomes in Sweden.

We conducted a retrospective cohort study using data from the Swedish Pregnancy Register. The cohort included 14 956 women with psychosocial risk factors such as mental health conditions, fear of birth requiring counselling, foreign-born status, need for an interpreter, single household, unemployment, or low educational attainment, who received either MCoC or standard care. All women gave birth at a Swedish university hospital between 2019 and 2024. Modified Poisson regression was used to estimate adjusted risk ratios (aRRs) with 95% confidence intervals.

Compared with standard care, MCoC was associated with an increased likelihood of normal vaginal birth (aRR 1.09; 95% CI 1.06-1.13) and a reduced overall risk of caesarean section (aRR 0.71; 95% CI 0.63-0.80), particularly caesarean section on maternal request (aRR 0.24; 95% CI 0.15-0.40). MCoC was also associated with reduced risks of obstetric interventions including labour induction, oxytocin augmentation, epidural/spinal analgesia and episiotomy.

Among women with psychosocial risk factors, MCoC was associated with reduced use of obstetric interventions and improved maternal outcomes, without evidence of increased risk of adverse maternal outcomes.

Aneurysmal subarachnoid haemorrhage (aSAH) is a major cause of premature death and disability. Although evidence-based guidelines exist, implementation is inconsistent and variation in care persists. Ischaemic stroke registries have improved guideline-concordant care, and several reviews have described their variables, coverage, governance and resource requirements. However, there has been no previous review of national aSAH registries.

To systematically identify and describe aSAH registries with respect to governance, case identification, data collection and general characteristics.

We searched MEDLINE (Ovid) for English-language studies published from inception to 1st April 2026. Eligible registries included unselected national cohorts of aSAH patients with ≥1 year of prospective data collection. Two reviewers independently screened titles, abstracts and full-texts. Data were extracted from peer-reviewed publications, registry websites or reports.

Eleven registries were identified, established between 1994-2009. Only one was a dedicated aSAH registry and, of the screened stroke registries, ten included aSAH patients. Four mandated hospital participation, and 81.8% employed no-consent or opt-out models. Governance, case identification and data collection varied substantially, with limited standardisation of consent and data entry. While most captured core inpatient variables, only 36.4% included sufficient detail to derive aSAH severity scores or aneurysm characteristics. Most registries were government led, with variable coverage, quality control and feedback mechanisms, typically focused on ischaemic stroke rather than aSAH-specific indicators.

Few stroke registries include aSAH patients, and most are not optimised to capture disease-specific variables. International harmonisation of core aSAH data variables and development of dedicated or nested registry modules is likely to improve global aSAH care.

Ketamine and esketamine have reemerged as promising interventions for treatment-resistant depression (TRD), yet debate persists regarding the clinical relevance of acute dissociative experiences. This secondary exploratory analysis aimed to examine whether dissociative experiences induced by subcutaneous esketamine differed according to antidepressant response and were associated with depressive symptoms in patients with TRD.

Patients received up to eight weekly subcutaneous doses of esketamine. Dissociation was assessed using the Clinician-Administered Dissociative States Scale (CADSS), and depressive symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck Depression Inventory-II (BDI-II). Responders were defined as patients who achieved a ≥50% reduction in MADRS scores from baseline to the end of treatment, whereas participants who did not meet this criterion were classified as non-responders.

Of 30 patients eligible for inclusion, 23 were included in the final analysis (mean age, 34.3 years; 65.2% female). Dissociation levels remained stable across treatment sessions. Responders exhibited significantly higher CADSS total scores (p = 0.024) and derealization scores (p = 0.011) compared with non-responders across the treatment period. There were no significant differences in depersonalization or amnesia scores between responders and non-responders (p = 0.056 and p = 0.089, respectively).

These exploratory findings suggest that dissociative experiences, particularly derealization, may represent clinically relevant to antidepressant outcomes following subcutaneous esketamine treatment in TRD, although further prospective studies with larger samples and dose-controlled designs are needed before their clinical utility can be established.

A 49-year-old man presented with confusion, hallucinations, and seizure-like episodes. Evaluation revealed severe anemia and knee imaging showed lead synovitis from a gunshot wound received 27 years previously. Substance-related causes initially complicated the clinical picture, but further testing identified a critically elevated blood lead level. The patient was treated with chelation therapy and surgery to remove a retained bullet fragment and inflamed, metal-stained synovial tissue. After treatment, his mental status normalized and blood lead levels steadily declined.

This case highlights that retained intra-articular bullets can cause severe lead poisoning decades later, requiring early recognition and combined medical/surgical management.

Stress beliefs-general expectations about the nature and consequences of stress-have been linked to health and performance, yet their role in shaping responses to everyday stress remains less understood. This study examined whether stress beliefs moderate affective reactivity and stress regulation strategies in response to naturally occurring stressors in daily life. In a 7-day ecological momentary assessment study, 104 university students completed thrice-daily reports (1,939 observations) on social and work-related stressors, positive and negative affect, and two stress regulation strategies-situation selection and response modification-as proposed in the stress optimization model (Crum et al., 2020). At baseline, stress beliefs were assessed alongside variables to characterize the sample. Negative stress beliefs moderated the association between daily stressors and positive affect: Individuals with high negative stress beliefs showed reduced positive affect during social stress and no increase in positive affect under higher workload. By contrast, those with low or moderate negative stress beliefs maintained positive affect during social stress and showed increased positive affect under higher workload-consistent with a challengelike appraisal. Additionally, controllability beliefs buffered increases in negative affect in response to daily social stress, with lower beliefs linked to stronger affective reactivity. By contrast, stress beliefs did not moderate associations between daily stressors and the investigated stress regulation strategies. These findings suggest that stress beliefs tune affective reactivity to everyday social and work stressors, identifying them as a potential intervention target given the established links between affect and long-term health. The generalizability of these findings should be confirmed across broader populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Immune dysregulation, particularly inflammation, may contribute significantly to the pathophysiology of schizophrenia (SZ). Autophagy is an essential cellular process that maintains neuroimmune homeostasis, but its relationship with inflammation in SZ remains unclear. Eicosapentaenoic acid (EPA), an omega (n)-3 polyunsaturated fatty acid (PUFA), was reported to exert therapeutic effects by modulating inflammation. Here, we hypothesized that EPA alleviates SZ-related behavioral and neurochemical abnormalities via autophagy regulation. Transcriptomic analysis of peripheral blood from SZ patients revealed reduced autophagic markers (BECLIN1, LC3B), which were negatively correlated with symptom severity, while P62 levels were increased, which was positively correlated with symptoms severity. SZ patients also showed an altered n-3 PUFA profile (reduced EPA and DHA, while elevated n-6/n-3 ratio). In a mouse model of SZ induced by maternal immune activation, lower Beclin1, an autophagic marker, was observed in the brains of mice. EPA treatment ameliorated SZ-like behaviors, upregulated Beclin1 expression, rebalanced glial activation toward anti-inflammatory and neuroprotective states. EPA also suppressed pro-inflammatory cytokines (IL-6, TNF-α), increased IL-10 and decreased DA/5-HT ratio in the prefrontal cortex and restored the n-6/n-3 PUFA ratio. Notably, EPA effects were largely blocked by co-administration of an autophagy inhibitor 3-methyladenine (3-MA), whereas these effects were recovered following treatment with the autophagic activator rapamycin. EPA supplementation also increased brain DHA levels, suggesting that downstream DHA-related mechanisms may additionally contribute to the observed effects. Together, these findings indicate that autophagic impairment is associated with neuroimmune and neurochemical abnormalities in SZ and support the autophagic function involved in EPA therapeutic effects on SZ-like changes.

Poricoic acid A (PAA) is a bioactive triterpenoid from the fungus Poria cocos. Nevertheless, whether it exerts antidepressant-like effects and whether the gut microbiota and immune regulation are involved remain unknown.

Male C57BL/6J mice were subjected to chronic unpredictable stress (CUS) and treated with PAA treatment. Behavioral tests were performed, and hippocampal damage was evaluated by H&E and TUNEL staining. Gut microbiota composition was analyzed using 16S rRNA sequencing, and hippocampal transcriptomic profiling was performed using RNA-seq, followed by immune cell infiltration, correlation, and functional enrichment analyses.

PAA treatment eased CUS-induced depression- and anxiety-like behaviors. It also cut down hippocampal neuron damage and cell death. Besides, PAA fixed gut bacteria balance by lowering harmful germs like L. murinus and boosting good germs like A. muciniphila and L. reuteri. Hippocampal transcriptomic analysis revealed that PAA modulated immune cell infiltration by reducing M1 macrophages and restoring M2 macrophages, with significant correlations between gut microbial taxa and hippocampal immune-related gene expression. Functional enrichment analyses indicated that PAA regulates pathways related to synaptic plasticity, neuroinflammation, and neuronal development. qPCR and western blotting confirmed that PAA restored the hippocampal expression of key molecules involved in neuroinflammation (HSP90B1), synaptic plasticity (RPS6KB2 and IGF2BP2), and blood-brain barrier integrity (COL4A5) CONCLUSIONS: PAA alleviates depression-like Behaviors in CUS mice by remodeling the gut microbiota and modulating the hippocampal M1/M2 macrophage balance via the gut-brain axis. These findings support the potential of PAA as a prebiotic-like nutritional agent for major depressive disorder.