Psychosis is a significant cause of reduced social and occupational function in those aged 18-35 years. This study investigates the feasibility of enhancing currently available Early Intervention for Psychosis (EIP) care using a moderated online intervention comprising therapist-supported online therapeutic interventions and peer-to-peer social mentoring and networking.

Study design: The Moderated Online Social Therapy (MOST) trial is a feasibility study for a randomised controlled study. Participants & Setting: Patients attending early intervention for psychosis (EIP) services in Ireland. Analysis: The trial explores data relevant to establishing the feasibility of delivering MOST to patients enrolled in EIP services and estimation of effect sizes for pre-post measures administered to inform power calculations for a full trial.

A total of 35 patients with early psychosis were recruited during the study period, with 17 (48.6%) retained in the study at 6 months. In the intervention arm, 65.4% of participants engaged with MOST for 5 weeks or more but only 15.4% continued to engage at six months. At six months, calculation of effect sizes for pre-post changes indicated small to moderate improvements in social and occupational function, small changes in clinical symptom severity and no changes in cognitive performance.

Findings partially supported the feasibility of conducting a trial of MOST in Irish EIP services. Recruitment and study procedures were successfully completed, while retention and sustained engagement suggested that intervention duration, delivery, and positioning within the care pathway may require consideration for further study of this promising intervention in the Irish context.

We evaluated the frequency and patterns of comorbidity and multimorbidity in adolescents with congenital heart disease (CHD) using data from a multisite population-based surveillance project.

Adolescents aged 11 to 18 years with at least 1 CHD-related diagnosis code and residing in one of 5 geographic areas in the US were identified using linked clinical and administrative data sources for the years 2011 to 2013. Sites linked data on all inpatient, emergency department, and outpatient visits. Multivariate Poisson regression with robust error estimates was used to assess the association of comorbidity with age, sex, insurance type, race, ethnicity, and CHD severity.

The study included 9626 adolescents. Of these, 26% had severe CHDs. Overall, 68% had at least one comorbidity during the study period, and 46% had multiple comorbidities. Noncardiac comorbidities (55%) were more frequent than cardiac comorbidities (40%). Major noncardiac comorbidities included mental health conditions, neurodevelopmental disorders, pulmonary obstructive disease, nutrition-related (overweight, obesity) conditions, and endocrine conditions. Cardiac comorbidities included arrhythmias and residual cardiac disease. Variations by age and sex were minimal, but a higher burden of comorbidity and multimorbidity was associated with CHD severity, multiracial background, and public insurance.

Comorbidities, both cardiac and noncardiac, are prevalent in adolescents with CHD, underscoring the need for targeted care strategies in this age group and effective transition programs from pediatric to adult CHD care.

Major depressive disorder (MDD) is a common psychiatric illness that is primarily treated with antidepressant medications in clinical practice. Depression that responds poorly to antidepressant therapy is referred to as treatment-resistant depression (TRD). However, the definition and pathogenesis of TRD are unclear, which may contribute to delayed diagnosis and management for some patients, ultimately affecting their prognosis. Although antidepressant drug therapy remains the first-line treatment for MDD, a growing body of evidence suggests that physical therapies may offer advantages over pharmacological treatments in improving depressive symptoms in selected patients. This review summarizes and comparatively analyzes recommendations from major international guidelines, including CANMAT, RANZCP, WFSBP, APA, and NICE, regarding the definition of TRD and physical treatment strategies. Widely used physical therapies for TRD are evaluated with respect to efficacy, safety and tolerability, clinical positioning, target populations, and regulatory status. Current evidence supports ECT and rTMS as the principal established treatment options for TRD. VNS may be considered for highly refractory TRD characterized by chronicity, recurrent episodes, and failure of multiple treatments, although it is generally positioned as a later-line intervention. Acupuncture and Neurofeedback may serve as adjunctive interventions with limited supporting evidence. Emerging techniques, including tACS, DBS, MST, EpCS, and FUS, lack sufficient high-quality evidence and standardized treatment protocols and should currently be conducted primarily in specialized centers or research settings. In addition, this review also highlights novel physical approaches and combination strategies with potential therapeutic value for TRD, provides scientific evidence and treatment references for clinical practice.

Mefloquine is an effective antimalarial drug widely used for malaria treatment and chemoprophylaxis. However, its use has been associated with a range of neuropsychiatric adverse effects, ranging from mild sleep disturbances to severe psychiatric reactions. The aim of this study is to systematically review the available evidence on neuropsychiatric adverse effects associated with mefloquine use and to characterize their clinical spectrum, time to onset, and reported outcomes. A systematic literature search was conducted to identify studies reporting neuropsychiatric adverse effects associated with mefloquine. Studies meeting the predefined eligibility criteria were included, and relevant clinical and adverse effect data were extracted. The methodological quality of included studies was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Of 207 records identified, 25 studies were included after removing duplicates and applying the eligibility criteria. These comprised 17 case reports and 8 clinical studies. The case reports described 19 patients aged 7-63 years with a wide range of neuropsychiatric manifestations. Frequently reported adverse effects included hallucinations, depression, anxiety, and insomnia, while psychosis, confusion, and mania were also reported. Other manifestations included paranoia, delusions, restlessness, nightmares, depersonalization/derealization, suicidal ideation, and delirium. The time to onset ranged from a few hours to several months after exposure. Clinical studies demonstrated variable frequencies of neuropsychiatric adverse effects across different populations and study designs. Mefloquine is associated with a broad spectrum of neuropsychiatric adverse effects, ranging from mild symptoms such as anxiety and insomnia to severe psychiatric manifestations. Early recognition and careful patient selection are important when prescribing mefloquine.

Adolescent suicide is a global public health concern. Emerging evidence from the gut-brain axis and interoception framework suggests links between functional gastrointestinal disorders, visceral bodily signals, and mental health vulnerability. However, evidence on the association between irritable bowel syndrome (IBS) and adolescent suicidality remains scant. This study aimed to examine the longitudinal associations of IBS with suicide risk and attempts among Chinese adolescents.

Data were drawn from a school-based prospective cohort study with citywide census-style recruitment in Southern China. IBS, demographic, behavioural, and emotional symptom measures were assessed, along with two suicidality outcomes: overall suicide risk and past-12-month suicide attempts as a behavioural indicator. Mixed-effects multivariable logistic regression was used to examine the associations between baseline IBS and follow-up suicidality. Subgroup analyses (sex, age group, residential area, only-child status, and subjective SES) tested the robustness of these associations. Alternative indirect pathways linking IBS, depressive and anxiety symptoms, and suicidality outcomes were examined.

The analytic sample comprised 92,120 adolescents with matched baseline and 12-month follow-up data (46,852 [50.9%] females, M = 13.27 years, SD = 1.99). IBS prevalence was 7.0% (n = 6435). Suicide risk and suicide attempts had incidence rates of 6.1% (n = 4454) and 3.5% (n = 3035), respectively. IBS was prospectively associated with increased suicide risk (OR [95% CI] = 2.33 [2.18, 2.49], p < 0.0001) and attempts (OR [95% CI] = 2.17 [1.93, 2.44], p < 0.0001). These associations remained significant after adjustment for demographic, behavioural, emotional symptom, and baseline suicidality covariates (suicide risk: aOR [95% CI] = 1.27 [1.18, 1.37], p < 0.0001; suicide attempts: aOR [95% CI] = 1.21 [1.06, 1.38], p = 0.0060). Depressive and anxiety symptoms partially mediated these associations.

IBS was prospectively associated with adolescents' elevated risk of suicidality. IBS may serve as a meaningful marker of suicide risk, potentially reflecting altered gut-brain and interoceptive processes, and underscoring the need to integrate mental health screening with gastrointestinal care for early suicide identification and prevention.

Research fund of Vanke School of Public Health, Tsinghua University.

Artificial intelligence (AI) is rapidly transforming healthcare delivery, research, and medical education. Within psychiatry, advances in machine learning, natural language processing, large language models (LLMs), and AI-enabled simulation are reshaping clinical practice and trainee education. Educational and clinical applications include personalized learning, virtual patient encounters, clinical decision support, longitudinal electronic health record (EHR) synthesis, automated feedback, and documentation assistance. These tools may strengthen diagnostic reasoning, psychopharmacology education, psychotherapy training, and administrative efficiency while allowing more time for patient-facing care. However, algorithmic bias, misinformation, privacy, academic integrity, cost, and overreliance may undermine independent clinical judgment. These risks are especially important for novice learners and in child and adolescent assessment, where chronological age does not capture cognitive development, cultural context, or nonverbal and affective cues. Empirical outcome data evaluating formal AI curriculum implementation in psychiatry residency and fellowship programs remain limited, with few studies assessing effects on trainee competence, clinical reasoning, error recognition, patient safety, or sustained clinical performance. This narrative review examines current applications, limitations, and ethical considerations and proposes a staged, competency-based curriculum in which trainees establish core interviewing, observation, and diagnostic skills before progressing to supervised clinical AI use. AI should augment, rather than replace, human interpretation, therapeutic relationships, and professional accountability. Accordingly, this review is primarily directed toward graduate medical education leaders, psychiatry residency and fellowship program directors, and clinical educators who are responsible for the development, implementation, and oversight of competency-based AI curricula within psychiatric training programs.

Acute poisoning is a major public health challenge and a frequent cause of emergency department (ED) admission in Tunisia and North Africa. This study aimed to describe the epidemiological, clinical, and therapeutic characteristics of acute poisoning cases and to identify factors associated with mortality.

A retrospective, single-center study was conducted at the ED of Taher Sfar University Hospital, Mahdia, from January 2022 to January 2024. All patients aged ≥12 years admitted for acute poisoning were included. Variables reflecting in-hospital interventions were excluded from the multivariate model to avoid reverse causality; only variables available at ED presentation were considered as candidate predictors. Multivariate logistic regression identified factors associated with in-hospital mortality.

Among 7645 ED admissions, 234 cases (3.06%) were for acute poisoning. The mean age was 30 years, with a female predominance (67.5%). Intentional poisoning accounted for 86.3% of cases. Pharmaceuticals (51.7%) and pesticides (30.3%) were the most common agents. The overall mortality rate was 12.8%, highest with aluminium phosphide (68.4%). Multivariate analysis identified three independent predictors of mortality, all available at ED presentation: altered mental status (GCS ≤ 8) (aOR=8.9, 95% CI 3.2-24.7), tachypnea (aOR=9.4, 95% CI 3.2-27.6), and poisoning by aluminium phosphide (aOR=10.2, 95% CI 3.5-29.7).

Acute poisoning in this cohort predominantly involves intentional self-harm by young women, with high mortality linked to specific toxic agents and early clinical severity markers. These findings highlight the need for enhanced mental health services, stricter regulation of highly toxic pesticides, and optimized emergency care protocols in similar settings.

This study examined the feasibility and preliminary clinical indications of an imagery rescripting intervention integrating the Pathological Affective Dependence framework (ImRs-PAD) in survivors of Intimate Partner Violence (IPV). Pathological Affective Dependence (PAD) refers to a trauma-related relational vulnerability associated with difficulties in disengaging from abusive intimate relationships.

A multiple case series design was used with three female IPV survivors referred by a mental health center in Italy (mean age = 31.3 years, SD = 2.08). All participants reported histories of abusive relationships, marked difficulties with separation, and clinically significant levels of PAD. Participants received an online ImRs-PAD intervention. Repeated self-report measures assessed changes in PAD, trauma-related symptoms, depression, anxiety, somatic symptoms, resilience, self-compassion, and psychological well-being.

Across cases, reductions were observed in PAD, depressive and anxiety symptoms, and trauma-related and somatic complaints, alongside increases in resilience, self-compassion, and overall psychological well-being. The online delivery of the intervention was feasible, with no technical or safety issues reported.

The findings provide preliminary support for the potential clinical relevance of ImRs-PAD for IPV survivors. Addressing PAD may facilitate disengagement from violent partners and reduce the risk of re-exposure to severe forms of violence.

Nonsuicidal self-injury (NSSI) is a severe and prevalent mental health problem. Measures to detect which individuals are at risk of engaging in NSSI would be valuable for clinical practice. However, we still lack strong predictors of future NSSI behaviour, with the most notable exception being prior NSSI behaviour. Yet, the measurement of prior NSSI behaviour with self-report measures can be difficult because individuals may be motivated to conceal this harmful behaviour. To overcome this problem, an implicit measure was developed that assesses automatic responding to statements about prior NSSI behaviour (i.e., the Past Nonsuicidal Self-Injury Implicit Association Test: P-NSSI-IAT). Previous studies tested the predictive utility of this measure in online studies with samples of at-risk participants and produced promising results. The current study examines the predictive utility of the P-NSSI-IAT for NSSI in clinical samples.

Outpatients (N = 68) completed the P-NSSI-IAT and reported on past-year and past-month NSSI, as well as perceived likelihood of future NSSI.

Patients with recent NSSI had significantly higher IAT scores than those without a history of NSSI. The P-NSSI-IAT predicted past-year NSSI but did not significantly predict past-month NSSI or perceived future likelihood of NSSI. It did not add predictive value beyond self-report risk factors in multivariate models.

These findings suggest that the P-NSSI-IAT may help detect prior NSSI in clinical contexts but offers limited added value for the prediction of NSSI beyond existing self-report measures.

Cognitive deficits are prevalent in major depressive disorder (MDD), span multiple cognitive domains, and often persist during remission. However, long-term associations between cognitive functioning and depression remain unclear. This study explores bidirectional associations using 20-year longitudinal data, providing follow-up twice as long as previously reported.

Individuals in remission of recurrent MDD underwent neuropsychological assessments at baseline (n = 137, 21-65 years) and 20-year follow-up (n = 33), covering multiple domains. Psychiatric assessments occurred at eight time points. Cox proportional hazard models and linear mixed-effects models tested bidirectional associations between cognitive functioning and depression. Group-level cognitive change was tested using paired sample t-tests and Bayesian analyses, and individual-level change using reliable change indices (RCI's).

No cognitive domains significantly predicted time-to-depressive-relapse, the number of depressive episodes, or total time depressed over 20 years. Similarly, the number of episodes, total time depressed, and changes in depression severity did not significantly predict cognitive changes. At follow-up, we observed declines in speed of information processing (p < .001, d = -0.73, RCI: 32.1% deteriorated) and speed of memory processing (p = .015, d = -0.49, RCI: 39.3% deteriorated). Learning and memory improved (p < .001, d = 1.19, RCI: 28.6% improved). Working memory and executive functioning remained stable. Findings were not explained by selective drop-out.

We found only minor long-term cognitive change, with no clear worsening or evidence of scarring and state effects. Cognitive functioning remained relatively stable, and we observed no link to depression trajectories over 20 years, providing a more optimistic outlook for depressed patients.