Despite increasing recognition of GNAL-associated dystonia as a genetic cause of adult-onset isolated cervical dystonia, the full phenotypic spectrum, longitudinal pattern of disease progression, and genotype-phenotype relationships remain incompletely defined. We retrospectively reviewed our case of genetically confirmed patient with GNAL-associated dystonia and reviewed genetically confirmed cases published up to June 2026. Demographic, clinical, treatment, neuroimaging, and genetic data were extracted. Genotype-phenotype comparisons were performed between patients with missense and loss-of-function (LoF) variants. Our review showed seventy-six patients, with a median age at onset of 35 years (IQR, 22-44) and female predominance (57.9%). Dystonia was predominantly focal at onset, with cervical dystonia being most common; and 54% patients with focal onset progressed to segmental or generalized dystonia, with a median time to generalization of 6 years. Most patients had isolated dystonia. Among 46 detected genetic variants, missense variants predominated and nearly all were heterozygous. Twelve patients underwent globus pallidus interna deep brain stimulation (GPi-DBS), with greatest benefit for cervical dystonia. The LoF variants were associated with a shorter time to generalization than missense variants (2 vs. 10 years, p=0.021). This association was not confirmed in a censoring-based survival analysis (log-rank p=0.904) and should be regarded as hypothesis-generating. GNAL-associated dystonia presents as adult-onset isolated dystonia with focal onset, with substantial longitudinal progression to segmental or generalized dystonia (54%). GPi-DBS appears beneficial, particularly for cervical dystonia. The genetic spectrum is highly heterogeneous, with predominantly heterozygous missense distributed across the α-helical and Ras-like GTPase domains. The observed association between LoF variants and more rapid generalization warrants validation in larger longitudinal cohorts.

Continuous, non-invasive blood pressure (BP) monitoring is essential for understanding cardiovascular dynamics in real-world settings. This study evaluated the reliability and validity of a cuffless method for ambulatory BP monitoring using pulse wave travel times derived from bio-impedance, impedance cardiography, and electrocardiography. We examined whether this method can accurately estimate systolic and diastolic BP cross varying conditions.

Forty-one young, healthy participants completed a protocol involving postural changes, physical activity, and mental stress tasks. Pulse arrival time (PAT) and pulse transit time (PTT) were extracted, and person-specific models estimated BP using (1) all data of the person ('double-dipping') - used in most previous studies -, (2) half of a person's data (calibration), or (3) person-invariant parameters (calibration-free) which would enhance practical utility. Cuff-based BP served as the reference. Test-retest reliability, and construct and convergent validity were assessed.

Test-retest reliability was high for PAT- and PTT-based BP for all approaches (ICC > 0.7), comparable to cuff-based measurements. Construct validity was generally poor: BP changes during physical activity were detected, but responses to mental stressors were not. Only double-dipping showed acceptable convergent validity, likely reflecting overfitting. In the calibration approach, convergence with cuff-based BP was moderate (MAE = 10.1-12.9 mmHg), with 59.2-68.5% of estimates within 10 mmHg of reference values. The strongest deterioration of convergentvalidity occurred with person-invariant models.

Although cuffless pulse wave travel time-based BP estimators showed strong reliability, validity was insufficient for clinical or stress research use, even with person-specific calibration. Future work should explore extended calibrationperiods before testing in naturalistic settings.

Adolescence is a critical period of neurodevelopment during which psychopathological trajectories associated with the risk of psychosis may emerge. The construct of the At-Risk Mental State (ARMS) enables the identification of subclinical presentations preceding psychosis; however, its course and predictors in the general adolescent population remain poorly understood. Most available studies have focused on clinical samples or cross-sectional designs, limiting our understanding of the longitudinal and transdiagnostic nature of psychosis risk in the general adolescent population, where psychotic-like experiences are often transient. A longitudinal observational study was conducted with two assessments separated by 24 months in a community sample of school-attending adolescents (T1: n = 697; T2: n = 575; ages 11-17 years). Psychosis risk screening was conducted using standardized screening questionnaires, followed by the Comprehensive Assessment of At-Risk Mental States (CAARMS) clinical interview for diagnostic confirmation. Psychopathological variables (depression, anxiety, attention-deficit/hyperactivity disorder [ADHD], trauma, suicidal behavior, and emotional and behavioral problems), addictions, and parental socialization were assessed. Descriptive analyses, intergroup comparisons, ordinal logistic regression analysis, and structural equation modeling were applied to identify predictors of ARMS. At the 2-year assessment, 3% of participants were classified as ARMS. Only 0.9% of those initially classified as healthy controls developed an ARMS during follow-up, and diagnostic stability from baseline to 2 years was limited. Adolescents with ARMS already showed, at T1, higher levels of depression, anxiety, trauma, ADHD symptoms, suicidal ideation and planning, as well as poorer academic performance and greater exposure to bullying. In adjusted regression models, in addition to ARMS status at T1, only depression, hyperactive-impulsive ADHD and suicide planning emerged as independent predictors of ARMS at T2. These findings suggest that ARMS in the general adolescent population is embedded within dynamic, transdiagnostic psychopathological trajectories. Depression, hyperactive-impulsive ADHD symptoms, and suicidal behavior emerge as key clinical signals for early risk identification. Together, these results underscore the potential value of preventive strategies in adolescence that prioritize the early detection and targeted management of affective distress, neurodevelopmental difficulties, and suicidality within community and educational settings.

Emergency department (ED) visits for child and adolescent psychiatric presentations have increased in recent years. Psychotropic treatments are frequently used during visit, and sometimes at discharge. However, there are no clear guidelines, and current practices are poorly described and understood in this domain. We propose exploring these practices and the factors leading to psychotropic medication in emergency settings in-visit and at discharge for children and adolescents. We conducted a retrospective cohort study of 1,527 patients seen at Necker Hospital (Paris, France) between 2021 and 2025, using clinical data warehouse (CDW) data. Sociodemographic and clinical variables, psychotropic administration during the ED stay, and prescriptions at discharge were analyzed using multilevel logistic regression and gradient boosting models, integrating structured data and SNOMED concepts extracted from free-text notes. Among 2,060 psychiatric ED visits, psychotropic medications were administered in 21.9% and prescribed at discharge in 13.9%. In-ED administration was mainly driven by markers of acute severity, including prolonged length of stay, older age, psychiatric diagnosis, and frequent ED use, while anxiety disorders were associated with lower odds. In contrast, discharge prescriptions were independently associated with in-ED psychotropic administration, psychiatric diagnosis, and socioeconomic context. Models using free text in addition to structured data significantly improved prediction, allowing for a comprehensive and global understanding of factors involved in prescribing. Psychotropic use in pediatric psychiatric emergencies reflects distinct processes of acute symptom management and discharge decision-making, influenced by different clinical and social factors. Leveraging unstructured clinical data enhances understanding of these practices and may inform future guidelines and continuity of care.

Quality of life comparisons with non-Hispanic White (NHW) breast cancer survivors remain limited for Asian Americans, particularly across diverse subgroups, potentially obscuring important disparities. This study investigated ethnic disparities in quality of life among breast cancer survivors, focusing on Chinese, Vietnamese, and Japanese Americans compared with NHW survivors.

Participants (N = 403) completed the Functional Assessment of Cancer Therapy-General (FACT-G) and the SF-36 Health Survey. The FACT-G total score assessed cancer-specific quality of life while the SF-36 component scores included the Physical Component Summary (PCS) and Mental Component Summary (MCS), representing physical and mental health-related quality of life.

After controlling for clinical covariates (Ps < .05), Asian Americans scored lower on all three outcomes (FACT-G, and PCS, MCS) than NHWs (ps < .05); Chinese and Vietnamese Americans also scored lower on all three outcomes than NHWs (all Ps < .05). Financial hardship, lower education, and not being employed full-time were associated with lower FACT-G, PCS, and MCS. Adjustment for these social determinant factors attenuated or eliminated group differences.

Findings highlight disparities in quality of life among Asian American cancer survivors, challenging the model minority stereotype. The attenuation of group differences after adjustment for social determinants suggests that socioeconomic factors play an important role in observed disparities, underscoring the need for targeted interventions.

Under-representation in research may mask disparities in quality of life and social determinants among Asian American survivors, underscoring the need for more inclusive study designs.

The present study aimed to examine dropout rates from individual versus group trauma-focused therapy among Israeli combat reservists seeking help following the October 7th War. This retrospective observational cohort study included 390 combat reservists treated in either individual (75.1%, n = 293) or group-based (24.9%, n = 97) trauma-focused therapy formats. Dropout was the dependent variable. Measures included the PCL-5, BSI-18, and POAMS. Time to dropout was analyzed using Cox proportional hazards regression, adjusting for demographic, military, and clinical covariates. Dropout rates varied substantially across modalities. Among individual therapies, rates ranged from 12.5% (PE) to 50.0% (CPT), while group interventions showed consistently lower rates, with group WET the lowest (7.84%). Individual therapy was associated with significantly higher dropout risk (HR = 2.58, 95% CI [1.40, 4.78], p = .003), remaining significant after adjustment (adjusted HR = 2.34, 95% CI [1.23, 4.46], p = .010). Baseline PTSD severity did not moderate this association when PCL-5 was modeled continuously (treatment modality × PCL-5: HR = 1.004, 95% CI [0.965, 1.043], p = .854), and the interaction remained non-significant after covariate adjustment (HR = 1.001, 95% CI [0.963, 1.040], p = .974). However, group-based trauma-focused therapy, and particularly group WET, was associated with significantly lower dropout rates compared to individual therapy among combat-exposed veterans. Importantly, this advantage persisted across varying levels of PTSD symptom severity at baseline. These findings have meaningful clinical implications for treatment planning in military populations.

This pilot study aimed to examine the feasibility and acceptability of a 12-week intensive, multidisciplinary, synchronous online intervention for caregivers of children and young adults with anorexia nervosa (patient age range: 10-24 years) that integrated Family-Based Therapy (FBT) principles with Dialectical Behavior Therapy (DBT) skills training. A secondary aim was to explore preliminary changes in caregiver and patient outcomes.

Using a single-arm, pre-post design, 45 caregivers from 26 families (patients' mean age = 16.19 years, SD = 3.57, range = 10-24) completed assessments at baseline (T0), Week 4 (T1), Week 8 (T2), post-intervention (Week 12, T3), and 3-month follow-up (Week 24, T4). The 12-week program (approximately 57 contact hours) comprised weekly theory workshops, multidisciplinary clinical rounds, and skills practice sessions. The primary outcome was caregivers' subjective burden (Zarit Burden Interview, ZBI); secondary outcomes included eating-disorders-related family impact (Eating Disorders Symptom Impact Scale, EDSIS), caregivers' general psychological distress (Depression Anxiety and Stress Scale, DASS-21), and AN patients' Body Mass Index (BMI). Linear mixed models with unstructured covariance structures examined changes over time, with Bonferroni-adjusted pairwise comparisons and Hedges' g effect sizes.

The intervention was successfully delivered in an online format and demonstrated acceptable feasibility, with moderate retention across the intervention and follow-up periods. Exploratory clinical analyses suggested significant reductions in caregiver burden (ZBI; F(4, 31.61) = 12.96, p < 0.001) and eating-disorder-related family impact (EDSIS; F(4, 37.19) = 8.78, p < 0.001) over time. Significant improvements emerged by Week 8 and were maintained at follow-up. Patients' BMI also increased significantly across the study period (F(4, 33.95) = 32.65, p < 0.001). In contrast, caregivers' general psychological distress showed no significant improvements relative to baseline.

This pilot study provides preliminary evidence that an intensive online intervention integrating FBT and DBT can be feasibly delivered and is acceptable to Chinese caregivers of youth with AN. Exploratory findings suggested potential benefits for caregiver burden, eating-disorder-related family impact, and patient BMI; however, the single-arm design precludes conclusions regarding intervention effectiveness. These findings should therefore be considered hypothesis-generating and warrant evaluation in future randomized controlled trials.

Phrenic nerve involvement in neuralgic amyotrophy (NA) may cause diaphragm paresis and respiratory impairment, for which chronic non-invasive ventilation (NIV) may be beneficial. Data on treatment success and predictors are lacking. This study evaluated NIV treatment success and its predictors in NA patients with diaphragm paresis.

Clinical data of all NA patients initiated on chronic NIV at the Centre of Home Mechanical Ventilation (Maastricht, the Netherlands) between September 2008 and April 2023 were retrospectively analyzed. Successful NIV use was defined as continued NIV or successful step-down due to clinical improvement. Cox proportional-hazards regression analyses were performed to identify predictors of successful outcome.

Fifty-four patients (mean age 62.5 ± 10.9 years; 72.2% male) were included. Mean baseline postural decline in forced vital capacity (ΔFVC) was -35.1% ± 19.6%. Median NIV adherence was 6.4 [3.6-8.1] hours/day. Thirty-eight patients (70.4%) continued NIV during a mean follow-up of 4.9 years. Of these, six (11%) were successfully stepped down from NIV following clinical and/or functional improvement. Sixteen patients discontinued NIV because of lack of effect or intolerance. Baseline ΔFVC (sitting to supine) independently predicted successful NIV use (HR 0.947; 95% CI: 0.91-0.99).

Chronic NIV was successful in most NA patients with diaphragm paresis, supporting its role as a long-term treatment option. Greater postural decline in FVC predicted treatment success, suggesting that postural spirometry may help identify patients most likely to benefit from NIV.

Childhood trauma is a risk factor for sleep problems. However, the longitudinal relationship between childhood trauma and sleep problems and the mechanism underlying this link remains unclear. The present study explored the longitudinal relation between childhood trauma and sleep problems, and the mediating role of perceived stress and the moderating role of RSA suppression in this link among adolescents. Altogether, 284 adolescents completed the Childhood Trauma Questionnaire at baseline, the Perceived Stress Scale 1.5 years later, the Pittsburgh Sleep Quality Index at baseline and 1.5 years later, and a speech task during which their data of vagal regulation indexed by respiratory sinus arrhythmia (RSA) suppression was obtained at baseline. Results revealed that, after controlling for baseline sleep problems, childhood trauma was positively related to sleep problems 1.5 years later, and perceived stress 1.5 years later mediated this association. RSA suppression moderated the relation between perceived stress and sleep problems among male but not female adolescents. Specifically, perceived stress was positively related to sleep problems among male adolescents with lower RSA suppression, but this association was weaker in those with higher RSA suppression. The findings suggest that perceived stress may represent an important pathway in the longitudinal association between childhood trauma and sleep problems, and male adolescents with lower RSA suppression are more vulnerable to perceived stress and exhibit more sleep problems.

This scoping review examines how leadership shapes employees' mental health in disruptive, uncertain organizational contexts between 2020 and 2025. Following PRISMA-ScR guidelines, a systematic search across Web of Science, Scopus, PubMed, and PsycINFO yielded 43 eligible sources (30 empirical, 13 conceptual/theoretical). Data were extracted and synthesized through critical interpretive synthesis. Findings indicate that transformational, ethical, servant, inclusive, and health-oriented leadership are associated with favorable well-being outcomes and with psychosocial resources including psychological safety, trust, and psychological capital. Conversely, authoritarian, toxic, destructive, and laissez-faire leadership are associated with burnout, psychological distress, organizational silence, and turnover intentions. Building on these observed associations, the interpretive synthesis generates three theoretically plausible propositions: leaders' emotional regulation may condition the protective potential of prosocial leadership; resource depletion under disruption may contribute to the intensification of dysfunctional leadership; and psychological safety, trust, and psychological capital may operate as interconnected mechanisms linking leadership with emotional exhaustion and resilience. These propositions represent synthesis-generated relationships requiring direct empirical testing rather than effects established by the reviewed evidence. Synthesizing these insights, this review proposes a dynamic emotional regulation framework of leadership under disruption. Rather than viewing leadership through static styles, the framework conceptualizes it as a relational, context-sensitive process whose implications for occupational mental health depend on psychosocial and contextual conditions.