South Asian diaspora populations have relatively low utilization of mental health services, despite experiencing average or higher rates of mental health problems such as depression. Cognitive-behavioural therapy (CBT), an evidence-based treatment for depression, was developed based on Western values and may require adaptations to meet the needs of other ethnic populations. This study examined the perceptions of standard and culturally adapted CBT among South Asian youth in Canada. Using a repeated measures design, participants self-identifying as South Asian (N = 61; M_age = 20.7; 67% women, 31% men, 1% non-binary) rated the acceptability-adherence, credibility, and expectancy of improvement of standard and culturally adapted CBT descriptions. Participants rated their identification with their heritage and mainstream cultures. Standard and culturally adapted CBT did not differ significantly in treatment acceptability-adherence, credibility, or expectancy of improvement. However, individuals who strongly identified with South Asian heritage culture rated culturally adapted CBT higher in acceptability-adherence than standard CBT. In contrast, low identification with heritage culture was associated with greater acceptability-adherence for standard than culturally adapted CBT. This preliminary evidence suggests that acculturation should inform the choice of culturally adapted or standard CBT; however, these results need to be confirmed in larger clinical samples.

Sodium abnormalities are frequent in the neuro intensive care unit (ICU) settings. Dysnatremia can also manifest in the perioperative period in neurosurgical patients and can lead to adverse consequences. The burden of dysnatremia following elective pediatric neurosurgery is unclear. Hence, we aimed to assess the incidence, risk factors, and outcomes of dysnatremia in children undergoing elective neurosurgeries.

This was a single-center, prospective observational study in consecutive elective pediatric neurosurgical patients aged < 18 years. Perioperative data were collected for the first 3 postoperative days and included age, gender, weight, American Society of Anesthesiologists Physical Status classification, location of surgical pathology, preoperative sodium, intraoperative blood loss and transfusion, intraoperative fluid balance, balanced salt solution use, perioperative vomiting, steroid use, seizures, Glasgow coma scale score, duration of ICU and hospital stay, and in-hospital mortality. Hyponatremia was defined as serum sodium < 135 mEq/L, hypernatremia as serum sodium > 145 mEq/L, and dysnatremia as the presence of either hyponatremia or hypernatremia.

Six hundred sixty-eight children who underwent neurosurgery had perioperative sodium values assessed during the 22-month study period. The incidence of postoperative dysnatremia was 18.6% (124/668). In multivariate regression analysis, sellar/suprasellar region pathologies, preoperative dysnatremia, and higher blood loss were predictors of postoperative dysnatremia. Children with postoperative dysnatremia had a higher occurrence of seizures, neurological deterioration, and death, and longer ICU and hospital stays.

About one-in-five children undergoing neurosurgery develop postoperative dysnatremia, and it is predicted by preoperative dysnatremia, sellar/suprasellar pathology, and higher blood loss. Dysnatremia is associated with poor clinical outcomes.

Clinical Trials Registry-India: CTRI/2022/01/039795.

Premenstrual dysphoric disorder (PMDD) impairs quality of life in reproductive-aged women. Clinical nurses facing high occupational stress and irregular work schedules may be particularly vulnerable. Identifying modifiable risk factors in this population is crucial for developing effective prevention strategies.

This study aimed to investigate associations between lifestyle factors, work patterns (specifically night shifts), and PMDD symptoms among Chinese female nurses.

A cross-sectional study was conducted among 1,031 Chinese female nurses. Assessments included the Chinese version of the Core Symptoms of Premenstrual Dysphoric Disorder Questionnaire (CTDP-C), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Medical Staff Stressor Scale (MSSS).

The prevalence of PMDD symptoms was 42.4% in Chinese female nurses. Higher PMDD risk was associated with a body mass index (BMI) of 24-27.9 kg/m² (p < .05), weekly exercise <30 min (p < .05), a history of alcohol use (p < .05), and ≥ two night shifts/week (p < .001). CTDP-C scores showed strong positive correlations with depression (r = 0.702), anxiety (r = 0.680), poor sleep quality (r = 0.493), and occupational stress scores (r = 0.500) (all p < .01). Multivariate regression confirmed BMI, exercise, alcohol use, night shift frequency, and physical health conditions as significant predictors.

PMDD symptoms are highly prevalent among Chinese nurses, influenced by modifiable lifestyle and occupational factors. These findings highlight the need to integrate screening (night shifts, alcohol use) into occupational health exams. Nurse administrators should implement shift optimization, wellness programs, and stress management to protect reproductive mental health.

Medicaid is the largest insurer for patients with opioid use disorder (OUD) and finances a disproportionate share of medication treatment for OUD (MOUD). Within Medicaid, initiation and continuity of MOUD are associated with improved outcomes, but substantial inequities across populations and care settings remain. The Medicaid Outcomes Distributed Research Network (MODRN) has supported Medicaid agency efforts to improve MOUD receipt and continuity of care. In the context of MODRN-Examining Quality Improvement for Medicaid Programs, the Behavioral Health Treatment Engagement and Retention Learning Collaborative (BHTER) will implement and evaluate interventions focused on improving quality and reducing variation in process and clinical outcomes in Medicaid patients with OUD. BHTER's aims are to (1) estimate the effects of a quality improvement intervention on receipt and continuity of MOUD in intervention practices relative to comparison practices, (2) examine whether a quality improvement intervention narrows racial gaps in rates and continuity of MOUD in intervention relative to comparison practices, (3) examine provider perspectives on the quality improvement intervention, with a focus on practice and process changes that resulted in improvement, and factors that impede or facilitate delivery of high-quality MOUD care. In this protocol paper, we describe the rationale, methods, and impact of BHTER.

Suicide notes are a distinctive form of communication that may provide insights into how individuals express distress, construct meaning, and address others during psychological crisis. This review aimed to examine the formal characteristics, thematic content, and communicative functions of suicide notes. Studies focusing on the linguistic, structural, and communicative dimensions of suicide notes were included. Fifteen studies met the inclusion criteria. Suicide notes display recurrent rhetorical structures, including salutations, explanations, practical instructions, farewells. Beyond expressing distress, suicide notes perform relational and pragmatic functions: their content combines emotional disclosure, requests for forgiveness, expressions of affection, and references to hopelessness or perceived burden. This review highlights the impact of digital communication on the circulation and ethical management of suicide notes. Suicide notes can therefore be regarded as structured communicative acts rather than exclusively private expressions of despair. Further interdisciplinary research is needed to support grounded applications in mental-health communication and suicide prevention.

Attempts to initiate conversation about the genocide in Gaza within our institutions repeatedly raised the question: should psychiatrists speak out on this issue, or does neutrality require silence?

To clarify the meanings of medical and political neutrality in times of geopolitical violence and to explore the implications for psychiatrists in the consulting room, in the wider professional setting, and in their role as mental health advocate.

A reflective analysis based on literature, clinical experiences, and informal conversations with colleagues about the situation in Gaza.

Public silence about severe human rights violations conflicts with medical neutrality. Geopolitical violence elsewhere in the world affects the mental health of both patients and practitioners. In the consulting room, ignoring this context can lead to diagnostic failure. At the same time, discussing such violence may provoke tensions. Role awareness and peer consultation are essential to recognize (counter)transference and to develop the skills to manage it.

Advocacy within psychiatry against human rights violations is an extension of core medical values. Any tensions that arise from this in the workplace and in the consulting room should be openly addressed.

Although shared decision making (SDM) is considered the standard within mental health care, literature shows that its implementation remains limited. The lack of practical guidelines how to implement SDM in psychiatric practice may contribute to this gap.

To develop a pragmatic model for SDM in psychiatric practice and training purposes.

We conducted a literature review of existing SDM models. We examined which psychiatry-specific elements were missing from these models, while also considering didactic aspects. The resulting model was further refined through interdisciplinary focus groups with five different panels consisting of healthcare professionals, patients, relatives and students (n=48).

We opted for a linear stepwise model incorporating aspects characteristic of mental health care, such as the explicit formulation of treatment goals, the establishment of a &lsquo;decision team&rsquo;, assessment of decision-making capacity, and risk evaluation. Given that psychiatric care requires a stable and trusting therapeutic relationship, we also included an explicit evaluation of the collaboration between patient and clinician.

We present an initial pragmatic and didactic SDM model (&lsquo;Shared Steps &amp; Checks&rsquo;) that explicitly addresses the complexity of shared decision-making in mental health care. The model is designed for application in psychiatric clinical practice as well as for educational purposes within mental health services.

Adolescents and young adults with borderline personality disorder (BPD) features, often experience reduced quality of life. Whereas for many young people, friendships are usually supportive, friendships in young people with BPD features can be intense and challenging. Little is known about how support from a best friend might moderate the association between BPD features and quality of life, specifically during a developmental phase when forming friendships is an important developmental task.

To examine the association between BPD features and quality of life in young people in specialized mental health care. Additionally, the moderating role of social support from a best friend in these associations is investigated.

A clinical sample of 383 adolescents and young adults aged 12-25 years old, completed questionnaires assessing BPD features, quality of life, and social support from a best friend.

Young people who reported more BPD features experienced lower quality of life. The association between BPD features and quality of life was weaker in individuals reporting more support from a best friend.

The results confirm associations between BPD features and quality of life, with social support from a best friend appearing to play a buffering role. This emphasizes the importance of a best friend in the social context of young people with BPD features.