ObjectiveMajor depressive disorder (MDD) is a highly prevalent debilitating mental health disorder with a lifetime risk of 11-15% in Australia. The most effective treatment for severe depression is electroconvulsive therapy (ECT), but it is associated with high relapse rates. This review aimed to investigate non-ECT interventions for preventing relapse of MDD after an effective acute course of ECT.MethodThe search covered electronic databases, specifically PubMed, PsycINFO and Embase, and clinical trials registered with clinicaltrials.gov and Cochrane Register of controlled trials up to 1 June 2022. Medical Subject Headings and key words used in the search were 'electroconvulsive therapy', 'depressive disorder', 'continuation', 'maintenance', 'prevention', 'prophylaxis', 'relapse' and 'recurrence'.ResultsA total of fifteen articles were included in the review. Interventions investigated by the studies were lithium, lithium + nortriptyline, escitalopram, imipramine, phenelzine, amitriptyline, venlafaxine and cognitive behavioural therapy (CBT).ConclusionsLithium was investigated the most, demonstrating good outcomes either as monotherapy or combination therapy with nortriptyline or venlafaxine. Imipramine, phenelzine, amitriptyline and CBT demonstrated encouraging results, while escitalopram failed to show a favourable outcome. Clinicians aiming to reduce the risk of relapse after an effective acute course of ECT could consider lithium, nortriptyline, venlafaxine and CBT.

The Harmonized Cognitive Assessment Protocol (HCAP) neuropsychological assessment approach aims to support the collection of harmonizable data on cognitive function for cross-national cognitive aging and dementia research. As the measurement of cognition is sensitive to differences in contextual, cultural, educational, linguistic, social, and other factors that may influence cognitive test performance, HCAP requires adaptation to be appropriate for the contexts in which it is administered. We aim to provide methodological recommendations for the adaptation and implementation of the HCAP and other cognitive data collection tools in novel settings.

We drew from existing guidelines on cross-cultural psychological test adaptation (e.g., the International Test Commission Guidelines for Translating and Adapting Tests); the Cross-Cultural Survey Guidelines; and our shared experiences in adapting, administering, and harmonizing the HCAP in older populations across 10 countries.

Recommendations for HCAP adaptation include phases of preparation (assembling local expert teams; resource planning), implementation (construct-centered adaptation guided by local experts), pre-testing (iterative, mixed-methods approach), and field preparation (creating documentation; interviewer training; planning for ongoing quality assurance).

The HCAP neuropsychological assessment approach has unique considerations for adaptation that balance the needs of local validity with cross-national harmonization. Shared best practices for HCAP adaptation will improve the quality of cross-national HCAP data collection, data harmonization, analyses, and inferences. The HCAP is a useful model for cross-nationally harmonized data collection and research to improve our understanding of cognitive aging and dementia globally.

Clinical decision-making in infant and early childhood mental health can be complex, shaped by clinical, legal, contextual, and personal factors. At the core of this complexity, however, lies an ethical dimension, which interacts with all other aspects of decision-making. This paper introduces a multidimensional model that places ethics at the centre of clinical formulation, offering a structured yet flexible approach to understanding complex challenges faced by practitioners. Through a series of illustrative cases, we demonstrate the model's applicability across diverse practice settings. A Mother-Baby Unit case highlights tensions between maternal mental health and infant well-being. A home visiting case examines how to balance a mother's autonomy with concerns for infant safety in the context of domestic violence. A neonatal case explores how a physician's personal history influences treatment recommendations, raising questions about consent. A childcare case considers conflicts between institutional caregiving policies and parental preferences. These cases demonstrate how ethical considerations should underpin clinical reasoning, even when not obvious. By explicitly integrating ethics into clinical formulation, this model provides a tool for practitioners navigating complexity. It has applications in clinical training, professional development, and reflective supervision, fostering a culture of ethical awareness in infant and early childhood mental health practice.

Sleep problems are common in neurodevelopmental genetic disorders (NGD), with impacts on daytime functioning amplified in these individuals. However, despite their prevalence and clinical impact, correlates of sleep difficulties in this group remain poorly characterized. This study used a large cohort of individuals with several rare NGDs to (i) characterize sleep phenotypes across disorders; and (ii) examine predictors of poor sleep.

Parents of 173 individuals with rare NGDs including PTEN hamartoma tumor syndrome, SYNGAP1, NFIX, a mixed group of other NGDs (Mean age = 14.16 years, SD = 10.45) and 123 parents of neurotypical children (Mean age = 12.28 years, SD = 7.93) completed the Neurobehavioral Evaluation Tool (NET). The NET assessed sleep problems, social communication impairments, restricted and repetitive behaviors, executive functioning, and mood and anxiety symptoms.

Group comparisons revealed that the SYNGAP1 group experienced the most severe sleep problems. Hierarchical regression models showed that the independent statistically significant predictors for each sleep problem varied. Depressed affect and emotion regulation predicted sleep initiation and maintenance difficulties, insistence on sameness and separation anxiety predicted bedtime resistance, age and depressed affect predicted early morning somnolence, while sensory sensitivities and anxiety symptoms predicted decreased sleep length.

Findings highlight the elevated severity of sleep problems in NGDs. Correlates of specific sleep problems vary, providing further evidence to suggest that accurate assessment and diagnosis of sleep problems, and evaluation of correlates of sleep difficulties, is required in order to provide targeted interventions in rare NGDs.

This research examines the role of material values, financial well-being, and monetary motivation in shaping gambling behavior in young male sports bettors in Türkiye. A total of 562 participants aged 18-35 were surveyed using validated scales measuring materialism, financial well-being, gambling motives, and sports betting severity. Through latent profile analysis, four distinct profiles were identified: Stability-Oriented Participants, Instability-Driven Risk Takers, Financially Content-Low-Risk Bettors, and Financially Pressured-Materialistic Bettors. ANCOVA results indicated a significant difference in the severity of sports betting across profiles (η² = 0.35), with the most problematic behavior occurring in those with high materialism, low financial well-being, and strong monetary motives. The results were interpreted through the lenses of Contingent Self-Worth Theory, Prospect Theory, and Self-Regulation Theory, and situated within Türkiye's socioeconomic context. This person-centered study makes unique contributions by revealing psychological and structural patterns underlying gambling behavior and offering practical applications for clinical, educational, and policy-level interventions.

To characterize the clinical, electroencephalographic, and genetic features of epilepsies featuring absence seizures within monogenic etiology, highlighting the diagnostic, treatment and prognostic implications.

We conducted a retrospective, multicenter study including patients with monogenic epilepsies and electroencephalography (EEG)-documented absence seizures. We analyzed clinical data, electroclinical findings, neurodevelopmental outcomes, and treatment responses through standardized questionnaires and medical records. We classified genetic variants according to American College of Medical Genetics and Genomics (ACMG) guidelines and performed univariate and multivariate analyses to identify predictors of developmental outcomes.

We included 160 patients (111 female; median age at last follow-up: 13 years) with absence seizures and confirmed pathogenic or likely pathogenic monogenic variants. The most frequently implicated genes were SLC2A1, SLC6A1, SYNGAP1, CHD2, and SCN1A. Four genes-HESX1, NCKAP1, SON, STARD9-had not been previously associated with absence seizures. In 35% of patients, absence seizures were the only seizure type and in 67% were the initial manifestation. Atypical features included irregular EEG discharges (56%) eyelid myoclonia (42%), and automatisms (33%). Early-onset (before age 3) seizures occurred in 58% and was significantly associated with atypical features (p < .03). Using existing International League Against Epilepsy (ILAE) epilepsy syndrome classification, 60% of patients could not be classified. Developmental delay occurred in 54%, intellectual disability in 65%, and other neurodevelopmental comorbidities in 49%. Predictors of poor developmental outcomes included early developmental delay, drug-resistant epilepsy, and early absence onset. We found no difference in the prevalence of drug resistance across the various genetic etiologies. The most effective medications for absence seizures included valproate, ethosuximide, benzodiazepines, and lamotrigine. Disease-specific therapies (e.g., ketogenic diet in SLC2A1, stiripentol/fenfluramine in SCN1A) were effective in select cases.

Absence seizures are a common manifestation of different monogenic epilepsies, often associated with early onset, atypical clinical and/or EEG features, developmental delay or drug resistance. Classification models should incorporate genetic data alongside electroclinical features, especially as next-generation sequencing is increasingly used.

Self-injurious behaviour (SIB) is a serious and persistent phenomenon affecting a substantial proportion of autistic individuals. Autistic individuals with severe intellectual disabilities and co-occurring mental health disorders may be at increased risk of engaging in SIB. However, knowledge is limited concerning the relationship between mental health and SIB in this population.

Multimodal, comprehensive mental health assessments of 10 autistic adults with severe intellectual disabilities and severe and persistent SIB were conducted, following current recommendations and including multiple assessment tools.

All participants were diagnosed with a mental health disorder. While all participants had displayed SIB for decades (M = 22.80 years), for 8/10 participants, co-occurring mental health disorders had not been previously assessed or diagnosed.

Persistent SIB in autistic people with severe intellectual disabilities may be associated with unmet mental health needs. These results highlight the importance of conducting comprehensive mental health assessments in these individuals.

We evaluated the long-term effects of daily 40 Hz (gamma frequency) audiovisual stimulation on cognition and biomarkers in five patients with mild Alzheimer's disease (AD).

Over 2 years, patients received 1-h daily stimulation. Electroencephalography (EEG) was used to assess neural entrainment; magnetic resonance imaging (MRI) measured brain volumes; actigraphy monitored activity patterns; neuropsychological tests evaluated cognition; and S-PLEX assay measured plasma pTau217.

No adverse events occurred over the study period. Three female patients with late-onset AD (LOAD) retained strong EEG entrainment and showed less decline in Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Functional Assessment Scale (FAS) scores compared to matched controls from National Alzheimer's Coordinating Center (NACC), Alzheimer's Disease Neuroimaging Initiative (ADNI), and Longitudinal Early-Onset Alzheimer's Disease Study (LEADS). Plasma samples were available for only two of five participants - both with LOAD - and both showed pTau217 reductions of 47% and 19%.

These findings suggest that long-term 40 Hz audiovisual stimulation is safe, feasible, and may offer cognitive and biomarker benefits in some individuals with mild AD, supporting further investigation.

ClinicalTrials.gov (NCT04055376).

Five mild Alzheimer's disease (AD) patients safely used daily 40 Hz audiovisual stimulation for 2 years. Late-onset AD (LOAD) patients showed increased 40 Hz electroencephalography (EEG) power and improved cognitive scores. National Alzheimer's Coordinating Center (NACC) data enhanced early-phase analysis and support precision medicine in AD studies. Plasma pTau217 declined in 2 LOAD patients after 2 years of daily use. This small pilot is the first to link long-term 40 Hz therapy to AD biomarker change.

The complex skill of prescribing often fails to translate effectively from basic medical training into clinical practice, leading to poor patient management and medication errors. Previous research has demonstrated that learners face substantial challenges in achieving the threshold of integrated understanding and decision-making required for rational prescribing in different contexts. These challenges stem from the fact that learning to prescribe remains an implicit experience. Students tend to imitate physicians' prescribing patterns without understanding how the expert's cognitive schema operates, making it difficult to transfer this skill to new or diverse situations. While several interventions have been introduced, the challenge in transferring this skill may lie in the educational strategies for prescribing, further compounded by the complex web of underlying concepts inherent to the task. To address this, we explore the Four Component Instructional Design (4 C/ID) model, integrated with cognitive load theory. The 4 C/ID model posits that complex skills training requires a combination of learning tasks, supportive information, procedural information, and part-task practice. This integration aims to develop the knowledge, skills, and attitudes necessary for complex tasks and enhance knowledge transfer without overloading cognitive abilities. To illustrate this integration, we present a blueprint for an antimicrobial module spanning pre-clinical to clinical years, focusing on identified threshold concepts of pharmacology and fostering the practice of both routine and non-routine prescribing skills. Students engage in whole-task activities, supported by mental models, procedural knowledge, and repetitive practice. We recommend a blended learning approach for this module, using successful strategies from other domains. In traditional curricula, our module can be introduced during clinical rotations and culminate as a capstone course. This module offers a promising solution to current challenges in teaching and practicing prescribing.