This narrative review examines how asylum seekers navigate access to mental health care and identifies where barriers most consistently emerge. We synthesized peer-reviewed literature from high-income host countries and interpreted it using the Levesque patient-centered access framework. Included studies were read qualitatively and mapped across dimensions of approachability, availability, affordability, acceptability, and appropriateness, alongside corresponding abilities to perceive, reach, pay for, and engage with care. Across contexts, several patterns appear repeatedly. Fragmented service structures, heavy reliance on frontline gatekeeping, and administratively complex enrollment processes often delay or prevent entry into care. Limited interpreter availability and time-pressured clinical encounters further constrain communication and therapeutic fit. Legal uncertainty and financial precarity appear to shape whether individuals remain engaged once care is initiated. Taken together, the literature suggests that the presence of services does not guarantee meaningful access. Policy responses may be most effective when they reduce administrative friction, clarify referral pathways, strengthen interpretation support, and better equip providers to work within trauma-informed and culturally responsive models of care.

The mass civilian attack on October 7th, 2023, marked a watershed moment in Israeli history, particularly for frontline communities such as Sderot. This paper presents an in-depth descriptive analysis of the response provided by the Sderot Resilience Center (SRC), a community-based mental health facility established in 2007 to address chronic exposure to security-related trauma based on over 13,000 electronically documented treatment records, this study documents a dramatic surge in service demand following the events of October 7th, identifies demographic and treatment-related shifts-including a marked increase in adult service utilization and a relative decline among children and adolescents-and reflects on the unique therapeutic model employed by resilience centers in Israel. Beyond the clinical response, the SRC exemplifies an innovative community-based governance model that integrates mental health, welfare, education, and community services under a unified resilience framework. Operated independently but closely collaborating with the municipality, the SRC's longstanding presence within Sderot fostered trust and accessibility, allowing residents to view it as a familiar, reliable resource rather than an external intervention. This foundation of trust, combined with the center's capacity to rapidly scale interventions and adapt to evolving needs, formed the basis of its success in responding to the crisis. Findings demonstrate that such centers can rapidly scale mental health interventions and adapt to evolving needs in times of national crisis.

Mood instability (MI) and functional impairment are core features of Major Depressive Disorder (MDD), yet their dynamic relationship in daily life remains understudied. This pilot study used Ecological Momentary Assessment (EMA) to examine the association between MI and daily functioning in 27 inpatients with MDD and 37 controls. Participants completed baseline assessments of depression severity, daily function, and Quality of Life (QoL), followed by 11 days of EMA monitoring for mood and activities. We calculated MI using the root mean square of successive differences and quantified the uniformity of daily activities using the Gini impurity score. Results indicated that participants with MDD experienced significantly higher MI compared to controls (p < .001). Higher MI was correlated with greater depression severity (p = .022) and lower QoL (p = .022). Furthermore, the MDD group showed lower occupational balance, reduced participation in daily activities (p < .001), and a less uniform distribution of activities (p = .002). Within the MDD group, we observed a complex pattern: higher MI was associated with greater participation levels (measured by the Activity Card Sort; p = .060) and a significantly more uniform activity distribution (p = .022). This suggests that in patients with MDD, greater mood instability may be associated with engagement in a wider variety of occupations. This study presents a novel EMA-based measure for daily function patterns, revealing a complex interplay with mood instability that may reflect a broader imbalance mechanism across multiple domains. These findings underscore the importance of incorporating real-time mood and functional monitoring into clinical assessment and treatment.

Clozapine's immune-modulating effects, including neutropenia and suppression of adaptive immunity, have raised concerns about its potential impact on SARS-CoV-2 infection risk and COVID-19 severity in individuals with treatment-resistant schizophrenia. Findings in the literature remain inconsistent.

First, we conducted a longitudinal retrospective study in which we analysed 995 outpatients with severe mental disorders receiving antipsychotic treatment to assess the association between clozapine use and SARS-CoV-2 infection and disease severity. Secondly, we performed a systematic review of the literature and searched for studies published up to July 2025 examining the link between clozapine exposure and SARS-CoV-2 infection. Eight cohort studies plus our dataset were meta-analysed using a random-effects model.

In our cohort, clozapine users demonstrated a higher rate of SARS-CoV-2 infection (18% vs. 10%, p < 0.001) and increased COVID-19 severity compared to non-users. The meta-analysis comprised 155,945 participants, with individual study ORs ranging from 0.40 to 2.80. The pooled random-effects OR was 1.53 (95% CI: 1.02-2.30, p = 0.044), indicating a significant association between clozapine exposure and increased infection risk. However, high heterogeneity (I² = 91.2%) suggests variation in effects across studies.

Clozapine treatment is associated with an increased risk and severity of SARS-CoV-2 infection. Although meta-analytic results support this association, substantial heterogeneity in pooled estimates highlights the need for further research to clarify underlying clinical and methodological factors influencing risk.

Educational interventions can influence not only individuals who directly receive them but also nonparticipating individuals within the same cluster. This study examined whether an educational spillover effect within a cluster occurs during real-world implementation of clinical practice guidelines.

Discharge data for inpatients with schizophrenia (n = 22,032) and major depressive disorder (MDD) (n = 11,207) from 298 facilities among those participating in the Effectiveness of GUIdeline for Dissemination and Education in psychiatric treatment (EGUIDE) project between 2016 and 2024. Patients were categorized into three groups based on psychiatrist participation and facility participation: Group 1 (psychiatrist[-], facility[-]), Group 2 (psychiatrist[-], facility[+]), and Group 3 (psychiatrist[+], facility[+]). Primary outcomes were implementation rates of guideline-recommended treatments (Quality Indicators: QIs). The EGUIDE training effect was modeled as an ordinal variable (Group 1 < Group 2 < Group 3). Logistic regression adjusted for age, sex, and facility type was used to estimate Odds Ratios (ORs).

Significant positive associations were observed for 9 of 11 QIs in schizophrenia and 5 of 7 QIs in MDD (e.g., QI-S1: assessment of treatment-resistant schizophrenia diagnosis, adjusted OR 1.98, P < 2.78 × 10^-192). Guideline adherence increased sequentially from Group 1 to Group 3.

This study was the first to empirically demonstrate, in a non-randomized real-world setting, that educational spillover effects extended beyond participating psychiatrists to influence nonparticipating psychiatrists within the same facility. These findings underscore the importance of leveraging facility-level spillover effects in guideline implementation strategies.

Psoriasis is a chronic inflammatory disease often accompanied by musculoskeletal symptoms and psoriatic arthritis (PsA). Early identification of PsA remains challenging, underscoring the need for interdisciplinary care between dermatology and rheumatology. To evaluate the diagnostic and therapeutic impact of an interdisciplinary dermatology-rheumatology board (IDRB) for patients with psoriasis, we initiated a non-randomized, prospective bicentric study.

A total of 182 patients with psoriasis were enrolled at baseline (V0), of whom 111 completed the 12-month follow-up (V2). Forty-seven (25.8%) patients participated in the IDRB, and 135 (74.2%) patients received standard dermatological care. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-A/D), pain, systemic inflammation, psoriatic arthritis (PsA) diagnosis, and systemic therapy courses were analyzed. Group differences and changes over time were assessed using non-parametric and parametric tests, and predictors of therapy modification were explored using univariate logistic regression.

Over 12 months, patients in the IDRB group showed statistically significant improvements in PASI, DLQI, and HADS-A (all p ≤ 0.05). Among participants without PsA at baseline and with complete PsA documentation at follow-up, new PsA diagnoses occurred more often in the IDRB cohort (31%) than in standard care (9.8%) (Fisher's exact p = 0.0295; χ² p = 0.0360; OR = 4.14). In univariate analyses, higher baseline PASI, DLQI, and HADS-A values were each associated with subsequent therapy modification. Within the IDRB group, biologic treatments shifted over time toward IL-17- and IL-23-targeted agents, indicating a move toward more streamlined and targeted systemic therapy patterns compared with standard care.

An IDRB may contribute to more structured PsA assessment and to more informed therapeutic decisions in patients with psoriasis. Integrating objective clinical measures together with patient-reported burden appears crucial for guiding treatment modification and optimizing outcomes. Given the non-randomized, self-selected design, these findings should be interpreted as associations.

DRKS-Deutsches Register Klinischer Studien listing: DRKS00037907.

Panic disorder (PD) and generalized anxiety disorder (GAD) are among the most prevalent anxiety disorders (ADs), yet their neural mechanisms remain unclear. This study aimed to characterize EEG microstate patterns and their functional connectivity (FC) in patients with GAD and PD to explore the neural mechanisms underlying anxiety symptoms. Resting-state EEG was collected from 35 patients with PD, 31 patients with GAD, and 39 healthy controls (HCs). Four microstate classes (A-D) were selected to calculate the parameters, including the mean duration, time coverage, occurrence, mean global field power (GFP), and transitions. Furthermore, the FC patterns underlying each microstate class were analyzed. Correlation analyses were performed between anxiety symptoms and microstate metrics. Compared with HCs, ADs presented increased duration of microstate D and decreased time coverage of microstate A, suggesting altered neural dynamics in ADs, characterized by impaired sensory processing and executive functioning.The correlation analysis revealed that the features of microstate C (associated with self-referential processing) were positively correlated with anxiety symptoms. In contrast, the features of microstates A and B (involved in sensory network functioning) showed consistent negative correlations with anxiety symptoms. Furthermore, PD and GAD groups exhibited distinct FC patterns within microstate A. These FC differences in microstate A demonstrated potential value in distinguishing between GAD and PD.

The global rise in mental health conditions has prompted interest in interventions that act beyond conventional psychopharmacology. Psychobiotics, broadly understood as live microorganisms or microbe-derived products that interact with the microbiota-gut-brain axis, have been suggested to exert neuroactive effects through neural, immune, endocrine and metabolic routes. This narrative review synthesizes recent preclinical, mechanistic and early clinical observations. Experimental studies show that selected strains can modulate cytokine signalling, influence stress-responsive systems such as the hypothalamic-pituitary-adrenal axis, and support synaptic plasticity via factors such as brain-derived neurotrophic factor. A limited number of human trials using well-characterized Lactobacillus and Bifidobacterium strains have reported improvements in affective and stress-related outcomes, but these effects are generally small to moderate, more apparent in adjunctive than stand-alone use, and dependent on strain, dose, population and intervention length (typically 4-12 weeks). Evidence on neurodevelopmental conditions (e.g., autism spectrum disorder, attention-deficit/hyperactivity disorder) remains preliminary, based on small and heterogeneous samples. Across studies, key constraints include methodological heterogeneity, incomplete strain-level reporting, and gaps in mechanistic resolution that make it difficult to link microbial shifts to psychiatric benefit. Emerging microbiome- and metabolomics-informed approaches may help identify likely responders and improve translational precision, but they are not yet ready for routine clinical application. Overall, psychobiotics should currently be viewed as a promising adjunct within integrative mental health care, warranting larger, standardized trials with clearly defined strains, doses and mechanistic endpoints.