Background/Objectives: Age at alcohol initiation is consistently associated with later alcohol use disorder (AUD), but it remains uncertain whether initiation across distinct developmental stages identifies clinically different adult phenotypes. We examined whether alcohol initiation during early, middle, or late adolescence was associated with graded differences in addictive, psychiatric, and treatment-related complexity among adults with AUD. Methods: This cross-sectional study included 436 treatment-seeking adults with lifetime AUD recruited from addiction programs in Spain. Primary analyses included 409 participants who reported alcohol initiation during early (10-13 years; n = 85), middle (14-16 years; n = 182), or late adolescence (17-21 years; n = 142). Participants underwent structured assessment with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Between-group comparisons, ordinal logistic regression, and exploratory latent class analysis (LCA) were performed. Results: Earlier initiation was associated with graded increases in comorbid non-alcohol substance use disorders (67.1%, 64.8%, and 47.2% across early, middle, and late initiation; FDR-adjusted p = 0.003), childhood conduct disorder (21.2%, 9.3%, and 4.2%; FDR-adjusted p < 0.001), and higher rates of lifetime therapeutic community treatment and mutual-support participation. Median age at AUD diagnosis was 19.0, 23.5, and 30.5 years, respectively (p < 0.001). In the model including age at AUD diagnosis, childhood conduct disorder (OR = 3.42, 95%CI 1.50-7.76) and mood disorder (OR = 2.13, 95%CI 1.41-3.21) were associated with earlier initiation. LCA identified a high externalizing/polysubstance complexity class (15.2%) enriched for earlier initiation (p < 0.001). Conclusions: Developmental timing of alcohol initiation was associated with a multidomain adult AUD phenotype. These findings suggest that initiation age could serve as a simple historical prompt for broader assessment; however, its incremental clinical utility was not tested, and it should not be interpreted as evidence of causality or a validated prediction tool.

Background: Visual impairment is associated with mental health difficulties in children, yet emotional and behavioral profiles across different etiologies and levels of visual impairment remain poorly characterized. We investigated whether these outcomes were associated with syndromic etiology or visual impairment severity. Methods: In this cross-sectional study, parents of 69 children and adolescents aged 6-17 years with visual impairment completed the Child Behavior Checklist (CBCL/6-18). Participants were grouped by etiology (syndromic, n = 14; non-syndromic, n = 55) and by visual impairment severity (mild-to-moderate, n = 33; severe-to-profound, n = 36). Group differences were assessed using Mann-Whitney U tests with false discovery rate (FDR) correction, complemented by categorical analyses using scale-specific CBCL clinical thresholds. Results: No significant differences in emotional or behavioral symptoms were observed between the syndromic and non-syndromic groups, although the small syndromic subgroup limited statistical power. In contrast, children with mild-to-moderate visual impairment had significantly higher scores on the Anxious/Depressed and Somatic Complaints scales than those with severe-to-profound impairment, with both differences remaining significant after FDR correction. Categorical analyses also showed a higher prevalence of clinically significant Anxious/Depressed and Internalizing Problems in the mild-to-moderate group. Conclusions: Children with mild-to-moderate visual impairment exhibited higher Anxious/Depressed and Somatic Complaints scores than those with severe-to-profound impairment. These findings suggest that children with residual vision may represent an underrecognized subgroup at risk for emotional difficulties and support routine psychological screening across the spectrum of pediatric visual impairment.

Adverse childhood experiences (ACEs) are robust estimators of poor health across the lifespan, yet most research relies on retrospective reports from adult samples and conventional ACE measures that exclude community-level adversity. Focusing on emerging adulthood-a developmental period when adversity may exert increased lifetime associations-provides a clearer view of near-term impacts and a critical window for intervention.

To examine associations between conventional and community-level ACEs and mental health, substance use, interpersonal violence, and educational outcomes in emerging adulthood, and to assess the relative contributions of ACE domains to key outcomes.

Longitudinal cohort study using data collected in waves 5 (March to August 2023) and 6 (February to August 2024) of a population-based sample recruited from urban and suburban schools in the Southern US. Of 2768 participants, 1850 with complete data were included in the present analyses.

Conventional and community-level ACEs assessed at wave 6, categorized as 0, 1 to 3, 4 to 5, or 6 or more exposures.

Depression, posttraumatic stress disorder, suicidality, substance use, dating violence (DV), sexual assault, and academic mobility.

Among the 1850 participants (mean [SD] age at wave 6, approximately 19 [0.6 years; 1395 [50.4%] female; 389 [14.1%] Asian, 709 [25.6%] Black, 1025 [37.0%] Hispanic, 200 [7.2%] White, and 445 [16.1%] other race and ethnicity), higher ACE exposure showed graded associations with nearly all outcomes. Compared with 0 ACEs, those with 4 to 5 and 6 or more ACEs had higher rates of depression (70 [21.0%] individuals with 0 ACEs vs 165 [46.5%] with 4 to 5 ACEs and 141 [56.9%] with 6 or more ACEs), PTSD (7 [2.1%] with 0 ACEs vs 54 [15.2%] with 4 to 5 ACEs and 77 [30.9%]), suicidal ideation (20 [6.0%] with 0 ACEs vs 98 [27.8%] with 4 to 5 ACEs and 103 [41.4%] with 6 or more ACEs), illicit substance use (ie, speed, hallucinogens, heroin, or ecstasy; 1 [0.3%] with 0 ACEs vs 22 [6.3%] with 4 to 5 ACEs and 27 [10.8%] with 6 or more ACEs), and interpersonal violence (eg, experiencing physical DV, 9 [2.7%] with 0 ACEs vs 30 [8.5%] with 4 to 5 ACEs and 37 [14.9%] with 6 or more ACEs). Academic achievement and college attendance decreased with increasing ACE exposure. Ten of 14 ACE domains were independently associated with key outcomes and 11 with experiencing DV. Emotional abuse, sexual abuse, witnessing domestic violence, and discrimination showed the most consistent associations.

In this cohort study of emerging adults, both conventional and community-level ACEs were associated with poorer mental health, interpersonal violence, substance use, and reduced academic mobility. These findings highlighted emerging adulthood as a critical period for intervention and suggested that, beyond cumulative exposure, specific forms of adversity were more consistently associated with adverse outcomes than others.

Recent advances in dry electrode EEG have enabled rapid setup and recording in unconventional scenarios. However, past developments were primarily driven by brain-computer interfaces (BCI), leaving their comparability to wet electrodes in clinical and daily life applications an open question. Here, we developed a new dry EEG system and systematically benchmarked its performance against a commercial wet EEG system across various tasks.

Participants (n = 19) underwent simultaneous recording using both devices. We first collected resting-state EEG under both eyes-closed and eyes-open conditions, followed by a steady-state visual evoked potential (SSVEP) task at different flicker frequencies and a motor imagery (MI) task. System performance was evaluated using power spectral density (PSD), signal to noise ratio (SNR), event-related spectral perturbation (ERSP), and single-trial classification accuracy.

The two systems performed similarly across different tasks. During the resting state, no statistically significant differences were observed between the two systems in the PSD of the five frequency bands (p > 0.05 in all cases). Similarly, SNR in the SSVEP task showed no significant differences at 8 Hz, 10 Hz, and 12 Hz after correction. For cognitive tasks, classification accuracies were comparable (SSVEP: dry 80.08% ± 7.1% vs. wet 81.10% ± 6.5%; MI: dry 72.46% ± 3.89% vs. wet 70.7% ± 2.37%).

The developed dry EEG system can effectively record electrophysiological measurements commonly employed in research and clinical settings, with quality comparable to that of traditional wet EEG systems.

As smartphones become progressively embedded in students' social, academic, and personal lives, concerns have been raised about the emotional consequences of nomophobia (no-mobile-phone phobia). Although previous research has shown an overall correlation between nomophobia and increased mental health symptoms, little is known about whether its main dimensions exerted differential associations with different mental health symptom dimensions or whether sleep quality can influence these relationships. Addressing these gaps, this research tested the associations between four dimensions of nomophobia-Not Being Able to Communicate (NBAC), Losing Connectedness (LC), Not Being Able to Access Information (NBAI), and Giving Up Convenience (GUC)-and three mental health symptoms: depression (Dprtn), anxiety (Enzt), and stress (Strs), while testing the moderating role of sleep quality (SQ) among university students. Drawing upon Conservation of Resources (COR) Theory and Self-Determination Theory (SDT), a quantitative cross-sectional survey was conducted among 980 university students. The proposed research model was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results demonstrated that the psychological consequences of nomophobia are dimension-specific rather than homogeneous. LC emerged as the most consistent predictor, showing significant positive associations with depression, anxiety, and stress. In contrast, NBAC was not significantly associated with any of the three mental health outcomes. NBAI showed mixed effects, with a significant positive association with depression, a significant negative association with anxiety, and no significant association with stress. GUC was significantly and positively associated with depression, anxiety, and stress. Furthermore, sleep quality functioned as a selective moderator, with significant interaction effects for SQ × NBAC on depression and anxiety, SQ × NBAI on depression, and SQ × GUC on depression and stress. No significant moderation effects were observed for the remaining hypothesized interactions. These findings highlight the dimension-specific nature of nomophobia and indicate that the role of sleep quality varies across the specific nomophobia dimension and the mental health outcome considered.

Digital gaming is a common leisure activity among adolescents, yet its relationship with mental health remains poorly understood. Emerging evidence suggests that gaming motivations may be more informative than gaming behavior per se for understanding adolescent psychological outcomes. The present study examined associations between gaming motives and mental health and identified distinct motivational profiles among adolescent gamers. Participants were Swedish adolescents aged 14-17 years (n = 418; 62.2% boys). Gaming motives were assessed across seven domains, and mental health was operationalized across both dimensions of the dual-continua model: psychopathology, indexed by internalizing and externalizing problems, and positive mental health, indexed by subjective well-being. Latent profile analysis identified four motivational profiles: low-motive gamers, broadly motivated gamers, competition-oriented gamers, and highly motivated gamers. Avoidance-oriented motives (escape, coping, fantasy) were associated with lower well-being and higher internalizing and externalizing problems, whereas competence-related motives (competition, skill development) were associated with more favorable well-being. Two profiles represented potential clinical risk groups: broadly motivated gamers reported the highest internalizing problems, and highly motivated gamers the highest externalizing problems. These findings suggest that assessing gaming motivations and not merely gaming frequency, may improve identification of at-risk adolescents and inform more targeted clinical screening and intervention.

Advance care planning (ACP) involves nuanced conversations to elicit an individual's beliefs, values, and preferences regarding future care. However, despite recognition of the positive impact, representative population surveys indicate low uptake of ACP, figures replicated internationally. Complex medical issues, including cognitive impairment, can interact with and exacerbate mental health challenges in later life, which can make decision-making more complex. ACP and Advance Healthcare Directives support people during periods of incapacitating mental illness. This paper reporting on the first stage of an action research study exploring ACP from the perspective of interdisciplinary mental healthcare professionals in the context of Older Person's Mental Health, took place in the dawn of the Assisted Decision-Making Capacity Act (2015), which has considerable implications for practice.

The first action research stage consisted of three sub-stages combining quantitative and qualitative methods, with the findings of each sub-stage iteratively informing the development of the next.

The results of the study indicate that whilst overall ACP is largely viewed as positive by healthcare professionals, confidence, and experience levels vary in practice, with a strong desire for additional specific training and tools to support ACP engagement indicated. The study also revealed facilitators and barriers to ACP; and addressing existential anxiety, giving voice, person-centred approach, and push and pull factor themes.

This study highlights some important implications for person-centred practice centring on the need to balance an active stance to ACP whilst also respecting the right not to engage for varying psychological and emotional reasons.

Indicators of motor symptom severity, cognitive functioning, and level of depression have been independently associated with fear of falling in Parkinson's disease (PD); however, it is unclear how these variables combine to predict fear of falling and which specific measures of cognition are most related to fear of falling in PD. The goal of this study was to address these questions.

Fifty-eight (27 female) individuals diagnosed with PD completed the Falls Efficacy Scale International (FES), Part III of the Unified Parkinson's Disease Rating Scale, Geriatric Depression Scale, Symbol-Digit Modalities Test, and Trail Making, Verbal Fluency and Color-Word Interference Tests from the Delis-Kaplan Executive Function System. Scores from the motor, cognitive, and depression measures were entered into a standard multiple regression predicting FES scores.

All variables significantly correlated with the FES, with r-values ranging from .26 to .45. In the regression, the independent variables predicted 38.5% of the variance in FES, R2 = .385, F(5, 52) = 7.70, p < .001. Letter Fluency made the largest contribution to FES, β = -.38, t = -2.92, p = .005, with the Geriatric Depression Scale, β = .31, t = 2.48, p = .016 contributing significant additional unique variance in FES.

Fear of falling is a multifactorial construct in PD and appears independently related to elements of executive functioning and level of depression.

Do reproductive outcomes, including live birth rates, differ between Canadian-born women and immigrant women with infertility in Ontario, Canada?

Immigrant women with infertility, particularly refugees, had lower probabilities of live birth within 2 years of diagnosis compared with Canadian-born counterparts.

Immigrant populations experience barriers to fertility care, yet population-level data on reproductive outcomes among immigrant women diagnosed with infertility are limited.

This population-based retrospective cohort study used linked administrative and registry data from ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario between 2010 and 2019, with follow-up through 2021. The cohort comprised 254 463 women aged 18-55 years with a new physician-diagnosed infertility visit (OHIP 628), including 177 289 Canadian-born (69.7%) women, 66 131 non-refugee immigrants (26.0%), and 11 043 refugee immigrants (4.3%).

Immigration status (Canadian-born, non-refugee immigrant, refugee immigrant) was derived from Immigration, Refugees and Citizenship Canada (IRCC-PR) data. The primary outcome was live birth within 2 years of infertility diagnosis. Secondary outcomes included time-to-pregnancy and birth by assisted conception. Relative risks were estimated using log-binomial regression and fecundability odds ratios (FORs) using discrete-time Cox models, adjusting for age, parity, income quintile, rurality, chronic conditions, and index year. Analyses followed the STROBE reporting guidelines.

Among 177 289 Canadian-born, 66 131 non-refugee immigrant, and 11 043 refugee immigrant women, live birth within 2 years occurred in 68 394 (38.5%) Canadian-born women, 22 363 (33.8%) non-refugees, and 3525 (31.9%) refugees, with aRRs of 0.96 (95% CI 0.94-0.97) and 0.90 (95% CI 0.87-0.94), respectively, compared to the Canadian-born cohort. The median time-to-pregnancy was 10 months (IQR 4-23) for Canadian-born women and 11 months (IQR 4-24) for immigrants, with reduced fecundability among both non-refugee (aFOR 0.97, 95% CI 0.96-0.99) and refugee immigrants (aFOR 0.89, 95% CI 0.86-0.91). Among those who achieved pregnancy, births by assisted conception occurred in 21 449 (24.5%) Canadian-born women, 5174 (17.6%) non-refugees, and 666 (14.4%) refugees, with adjusted RRs of 0.73 (95% CI 0.70-0.75) and 0.64 (95% CI 0.60-0.69), respectively, compared to the Canadian-born cohort.

Administrative data capture physician-diagnosed infertility, which may under-represent immigrants who are less likely to receive a diagnosis, leading to potential selection bias and underestimation of disparities. Residual confounding and incomplete ascertainment of conception type or social determinants remain possible.

Despite universal health coverage and a publicly funded IVF program, inequities in fertility outcomes persist for immigrants, especially refugees. These findings underscore the need for equity-focused fertility policy that addresses cultural acceptability, diagnostic access, and integration of mental-health supports in reproductive care.

This study was supported by the Canadian Institutes of Health Research (CIHR) Project Grant Impact of Infertility and its Treatment on Women's Mental Health (FRN 165840). The research was conducted at ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care.

None of the authors report conflicts of interest relevant to this study.

Not applicable.

Schizophrenia is a serious mental health condition that can cause long-term disability and major disruption to daily life. People living with schizophrenia may experience psychosis, causing frightening and distressing experiences. At times, this distress may lead to aggressive or violent behaviour towards themselves or others. On such occasions, medications used for the management of aggression and agitation in psychiatric settings must have a rapid onset of action, low frequency of administration and exhibit a minimal adverse-effect profile. Zuclopenthixol acetate is reported to have these properties.

To evaluate the clinical effectiveness of zuclopenthixol acetate in the management of acute behavioural disturbance in people with acute schizophrenia and similar major mental illnesses, compared with other pharmacological agents used for the treatment of similar clinical presentations.

We searched the Cochrane Schizophrenia Study-Based Register of Randomised Controlled Trials, CENTRAL and MEDLINE, supplemented by citation searching and contacting study authors. The date of the last search was 8 September 2025.

Randomised controlled trials (RCTs) involving participants with major mental illnesses that compared zuclopenthixol acetate with standard pharmacological treatments were included, with predefined exclusion criteria applied.

Our outcomes were tranquillisation, sedation (measured between 15 minutes and 48 hours), global state (including the need for additional medications), behaviour, mental state and adverse effects (evaluated up to seven days). These outcomes were also used to compare lower doses of zuclopenthixol acetate (25 mg to 50 mg per injection) with higher doses (50 mg to 100 mg per injection).

We used the Cochrane risk of bias tool (RoB 1).

Data extraction and cross-checking were performed independently by the review authors, and the risk of bias in the included studies was systematically assessed. We synthesised results for each outcome using meta-analysis where possible. Review Manager and the GRADE profiler were used for data synthesis and evaluation of the certainty of evidence.

We included 11 studies with 714 participants. All studies were RCTs and investigated the effect of intramuscular zuclopenthixol acetate. The risk of bias was variable: two studies reported adequate random sequence generation, one confirmed allocation concealment, four reported participant blinding and five reported assessor blinding. Outcomes were clearly reported in three studies, but selective reporting was identified in 10 of 11 included studies. Overall, the certainty of evidence ranged from moderate to very low.

Tranquillisation and sedation There may be no difference in the proportion of participants achieving tranquillisation at 15 minutes between zuclopenthixol acetate versus intramuscular haloperidol plus promethazine (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.89 to 5.81; P = 0.09; 1 study, 74 participants; low-certainty evidence). Zuclopenthixol acetate may not differ from standard medications in the number of participants who were sedated at two hours (RR 0.60, CI 0.27 to 1.34; P = 0.21; 1 study, 40 participants); four hours (RR 1.04, CI 0.76 to 1.43; P = 0.81, I² = 85%; 2 studies, 114 participants); or eight hours (RR 0.72, CI 0.51 to 1.03; P = 0.07; 1 study, 40 participants). At 15 minutes, the evidence suggests that probably more participants in the haloperidol plus promethazine group were sedated than in the zuclopenthixol acetate group (RR 1.31, CI 1.06 to 1.63; P = 0.01; 1 study, 74 participants; moderate-certainty evidence). In contrast, probably more participants in the zuclopenthixol acetate group were sedated at 24 hours (RR 0.25, CI 0.11 to 0.54; P < 0.001; 1 study, 74 participants; moderate-certainty evidence; and at 48 hours (RR 0.62, CI 0.43 to 0.89; P = 0.009; 1 study, 74 participants). Global state No differences were identified between zuclopenthixol acetate and standard medications on the Clinical Global Impression scale, the Brief Psychiatric Rating Scale (BPRS) or the Nurses' Observational Scale for Inpatient Evaluation. No differences were identified between zuclopenthixol acetate and standard medications regarding the use of supplementary antipsychotics (RR 1.49, CI 0.97 to 2.30; P = 0.07, I² = 79%; 3 studies, 134 participants), although the use of additional benzodiazepines was lower in the zuclopenthixol acetate group (RR 0.03, CI 0.00 to 0.47; P = 0.01; 1 study, 50 participants); however, the evidence for these outcomes was very uncertain. There was no evidence of a difference between groups in aggressive or related behaviours among participants (2 studies). Adverse effects The evidence suggests that there may be no difference in adverse effects between zuclopenthixol acetate and standard medications (day 1: RR 0.62, CI 0.29 to 1.31; P = 0.21, I² = 0%; 2 studies, 222 participants; low-certainty evidence). Dose comparison Zuclopenthixol acetate doses of 25 mg to 50 mg per injection may be as effective as doses of 50 mg to 100 mg per injection for mental state outcomes (BPRS: RR 1.10, CI 0.69 to 1.76; P = 0.69; 1 study, 30 participants) and there may be no difference in adverse effects (Treatment Emergent Symptom Scale (TESS): RR 2.33, CI 0.74 to 7.35; P = 0.15; 1 study, 30 participants), but the evidence is very uncertain.

Based on the evidence in this review, there may be no difference between zuclopenthixol acetate and standard medications in the management of acute psychiatric symptoms, tranquillisation and adverse events. Zuclopenthixol acetate was probably associated with a greater degree of sedation at 24 and 48 hours of administration. The use of zuclopenthixol acetate may be associated with a lower requirement for adjunctive benzodiazepines, but this is uncertain. Doses of zuclopenthixol acetate of 25 mg to 50 mg per injection may be as effective as doses of 50 mg to 100 mg per injection (very low-certainty evidence). Recommendations favouring zuclopenthixol acetate over standard medications for the management of acute behavioural disturbance should be interpreted with caution, given the methodological limitations of most included studies.

This study received no external funding.

Original review (2001) DOI: 10.1002/14651858.CD000525 Review update (2004) DOI: 10.1002/14651858.CD000525.pub2 Review update (2012) DOI: 10.1002/14651858.CD000525.pub3.