Individuals with psychosis face persistent barriers to care. Peru's recent mental health reform expanded services nationwide but coincided with the COVID-19 pandemic. We hypothesized that service utilization among individuals with psychosis would increase between 2018 and 2024, particularly in underserved regions.

We analyzed outpatient morbidity data from the Peruvian National Superintendence of Health (2018-2024). Sex was available as binary male/female coding; gender identity and race/ethnicity data were not available. Service utilization was compared across three groups: psychosis, non-psychotic mental disorders, and general medical conditions. We examined changes in access (rate ratios, rate differences), the impact of the pandemic (interrupted time series), and decentralization trends (Poisson regression), separately for each disorder group.

In 2024 compared with 2018, monthly service utilization per 100,000 declined for psychosis (28.2 in 2018-19.2 in 2024; rate ratio 0.68), rose for non-psychotic mental disorders (225.2 in 2018-304.6 in 2024; 1.35), and slightly fell for general medical conditions (12,688.1 in 2018-12,370.4 in 2024; 0.97). The pandemic caused a comparable immediate drop in service utilization, with rates falling to 37.9%, 37.0%, and 35.3% of expected levels for the three groups in March 2020, followed by gradual monthly increases (psychosis 1.3%, non-psychotic mental disorders 2.6%, general medical conditions 2.2%). A shift from tertiary to primary and regional facilities was seen for both mental disorder groups, but greater utilization in underserved regions was observed only for non-psychotic mental disorders.

Despite nationwide expansion of mental health services, individuals with psychosis did not experience higher service use. The pandemic's impact was acute and enduring for this group. Findings underscore the need to examine reasons for this stagnation in service utilization and evaluate the acceptability and appropriateness of Peru's current service model for psychosis.

Canadian Institutes of Health Research, Canada Research Chairs program.

Psychosocial oncology (PSO) is essential to comprehensive cancer care, yet access and delivery remain inconsistent and inadequate globally. This study mapped patient- and provider-reported experiences of barriers shaping PSO access globally.

Cross-sectional, web-based surveys were administered separately to adults with a self-reported cancer diagnosis and to oncology healthcare providers (HCPs) in five languages between November 12, 2024 and April 25, 2025. Descriptive statistics and multivariable logistic regressions examined associations between sociodemographic and clinical factors with PSO access, perceptions, and delivery.

The final sample included 200 patients from 16 countries and 237 HCPs from 38 countries. Among patients, 85.0% rated PSO care as highly important, with 81.0% considering it as important as biomedical care, yet 63.5% reported receiving no PSO care. Among HCPs, 53.2% indicated PSO is not routinely provided at their institutions. Mental health stigma and cultural norms affecting comfort discussing emotional concerns were commonly reported barriers, reported by 57.0% and 64.0% of patients, respectively, and 52.7% and 74.3% of HCPs. Workforce and training gaps were substantial, with 66.6% of HCPs reporting insufficient specialized staff, and 42.1% reporting no formal training in PSO. Investment in PSO research was perceived as low, with 60.3% of HCPs estimating that <10% of national cancer research funding was allocated to PSO and 69.6% viewing overall research support as insufficient.

Patients and providers emphasized the importance of PSO; however, PSO was reported to be under-delivered worldwide due to stigma, cultural factors, workforce and training limitations, and insufficient research investment. System-level strategies are needed to address these challenges and close the global PSO care gap.

This study was supported by a seed grant from the Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Toronto, Canada.

Psychoactive substance use often begins during adolescence, and early initiation increases risks of problematic use and adverse health outcomes. Few evidence-based, technology-supported substance use prevention programs for adolescents exist in Europe. OurFutures (previously Climate Schools) is a web-based substance use prevention program developed in Australia that has been shown to improve substance-related knowledge and strengthen refusal and harm-minimization skills. This study aimed to adapt the OurFutures Alcohol and Cannabis course for German schools and to evaluate its feasibility and preliminary effectiveness. To strengthen the link between prevention and early intervention, the program was connected to the Mobile Online Portal for Questions on Addiction (MOFA), enabling students to access counseling services via chat, email, or telephone.

The Alcohol and Cannabis course was adapted for the German school and addiction systems, and the online portal was created. Effectiveness and implementation were assessed in four German secondary schools using a controlled pilot study with quantitative surveys, complemented by exploratory qualitative feedback from a focus group (n = 2) and three individual interviews.

Analyses of covariance demonstrated that the intervention group's knowledge about alcohol (n = 62) and cannabis (n = 63) increased significantly more than of controls (n = 28 and 31). No significant differences were observed for attitudes or intentions to use. Most students evaluated the Alcohol module positively and relevant. Qualitative findings indicated satisfaction among students and teachers, with suggestions for school implementation.

This blended-learning program increased substance-related knowledge and may strengthen school-based prevention in Germany. Wider implementation requires coordination between education and addiction systems.

Internet-delivered cognitive behavioral therapy (iCBT) is a scalable approach to address the mental health treatment gap. Its effectiveness for People of Diverse Ethnocultural Backgrounds (PDEGs) remains uncertain due to persistent underrepresentation in research and routine care.

This secondary analysis examined ethnocultural differences in symptom change, engagement, and adherence in a healthcare-embedded iCBT program, and whether engagement or adherence mediated ethnocultural differences in treatment outcomes.

Data from 2604 adults receiving guided iCBT for depression and anxiety through the Online Therapy Unit in Saskatchewan, Canada (February 2020-December 2021) were analyzed. Participants were categorized as White (n = 2281) or PDEGs (n = 323; multiple ethnocultural subgroups). Engagement metrics included logins, therapist messages, and phone contacts. Adherence metrics included lessons completed, program completion (≥4 lessons), and weekly questionnaire submission. Depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Regression and mixed-effects models compared outcomes across groups, controlling for age, dataset, and baseline symptoms. Exploratory mediation analyses were conducted.

Both groups showed significant reductions in depression and anxiety, with no differences in symptom improvement. Engagement was comparable. However, PDEGs were less likely to complete the program. Mediation analyses did not indicate engagement or adherence explained outcome differences.

Our findings did not indicate differences in symptom improvement or engagement between White participants and PDEGs, although aggregation due to small subgroup sizes may have obscured subgroup-specific differences. Modest adherence differences and PDEG underrepresentation highlight the need for further research to understand barriers to program completion and equitable access to iCBT.

Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur and are associated with a more severe clinical profile than either disorder alone. Prolonged Exposure (PE) is empirically supported treatment for PTSD and has demonstrated effectiveness among those with a co-occurring SUD. However, PE is not typically offered in substance use treatment settings, in part due to concerns about feasibility, retention, and symptom exacerbation, as well as structural misfit with time-limited residential and outpatient programs. Massed Prolonged Exposure (M-PE), PE delivered multiple times per week and completed within a condensed timeframe, yields comparable treatment outcomes to PE and may better align with the structure of residential and outpatient care and address key barriers to implementation. Here, we describe an ongoing randomized controlled trial investigating the efficacy of M-PE versus trauma treatment as usual (TAU) delivered concurrent to SUD TAU, among individuals with co-occurring PTSD and substance use disorders enrolled in a comprehensive residential and outpatient SUD program. In addition to examining treatment outcomes, this trial utilizes qualitative methods to gain a deeper understanding of participants' experiences and evaluate M-PE implementation barriers and facilitators in an SUD treatment setting. We describe the development and implementation of this randomized clinical trial.

The issue of psychiatric workforce renewal is no longer merely a human resource problem; it lies at the intersection of professional identity, training structure, and the organizational logic of the healthcare system. International medical education literature describes professional identity formation as a gradual process of socialization in which the novice physician progresses from performing professional tasks to internalizing the vocation itself. This process is strongly influenced by the clinical learning environment, the presence of role models, structured reflection, the gradual transfer of responsibility, psychological safety, and whether the resident is truly able to practice the chosen specialty. A specific challenge in Hungarian psychiatry is that the process of becoming a psychiatrist is often constrained by systemic pressures that lead to blurred professional boundaries, distortion of training, increased risks to patient safety, and erosion of professional self-identity. The aim of this paper is to examine the educational and organizational conditions necessary for psychiatry to become an attractive and sustainable career choice again. The article is based on a synthesis of the international literature on professional identity formation, Hungarian research on psychiatric professional identity, and a qualitative case-based analysis. Orv Hetil. 2026; 167(29): 1142-1151.

Cognitive impairment is a common and debilitating complication of multiple sclerosis (MS), but non-pharmacological strategies such as diet for its management have not yet been fully explored. The aim of this review is to synthesize the evidence on the relationship between diet and cognitive outcomes in people with MS. Clinical interventional and observational studies evaluating the association between the diet and cognitive outcomes in MS were considered. The diets most frequently evaluated were Mediterranean (n = 3), modified Paleolithic/Wahls (n = 3), Swank (n = 1), ketogenic (n = 2), and time-restricted eating (n = 1). Other included studies investigated the broader association between overall dietary quality, healthy-eating patterns, and cognitive outcomes in MS patients. Trials of the Mediterranean diet have generally shown no significant cognitive improvements, although a recent study on a low-calorie Mediterranean diet, as well as observational studies, has reported increased processing speed, manual dexterity, and fewer cognitive complaints. The Wahls/Paleolithic interventions showed improvements in processing speed and mental cognition that were comparable to the Swank diet. Limited evidence from small studies suggested potential benefits of ketogenic and time-restricted diets, while findings were inconsistent for general healthy or high-fiber diets. Dietary interventions may hold promise as adjunctive strategies for cognitive health in MS; however, inconsistencies in study designs, cognitive measures, and intervention duration, combined with limited high-quality evidence, undermine strong recommendations, which warrant further evaluations.

Depression is a global mental health crisis, and the rapid-acting antidepressant scopolamine (Scop) is limited by systemic administration drawbacks. This study developed a scopolamine-loaded bilayer dissolving microneedle (Scop-DMN) system for transdermal delivery and evaluated its antidepressant efficacy in a chronic restraint stress (CRS)-induced mouse model. Bilayer DMNs were fabricated via sequential centrifugal molding, with a polyvinyl alcohol (PVA) backing layer and a dextran‑sodium hyaluronate drug-loaded tip matrix. Physicochemical properties, biocompatibility, and in vivo therapeutic effects were systematically characterized. Scop-DMNs showed uniform conical morphology, high drug loading homogeneity, and complete dissolution within 2 min in porcine skin. In C57BL/6 J mice, Scop-DMNs significantly ameliorated CRS-induced depressive-like behaviors in open field, sucrose splash tests, and tail suspension tests 24 h post-administration, outperforming conventional intraperitoneal scopolamine. Mechanistically, Scop-DMNs robustly activated the brain-derived neurotrophic factor / mammalian target of rapamycin (BDNF/mTOR) pathway and upregulated synaptic proteins (postsynaptic density protein 95 (PSD95), Synapsin I (SynI)) in the medial prefrontal cortex (mPFC), reversing stress-induced neurotrophic and synaptic deficits. This Scop-DMN system provides a safe, minimally invasive, and effective transdermal platform for scopolamine delivery, offering a promising clinical strategy for rapid management of acute depressive episodes.

Genetic and environmental factors contribute to eating disorder risk, yet their interplay is poorly understood. We examined whether childhood maltreatment and polygenic scores for anorexia nervosa (PGS-AN) and binge-eating broad (PGS-BEB) are associated with eating disorders. We also examined the interactions between childhood maltreatment and PGSs in predicting eating disorders.

This nested case-control study used data from up to 63,989 mothers in the MoBa (Norwegian Mother, Father and Child Cohort Study). Mothers reported on their own experiences of 4 childhood maltreatment types: long-term humiliation or degradation, threats to self or someone close, physical abuse, and sexual abuse. Diagnoses of AN, bulimia nervosa (BN), binge-eating disorder (BED), purging disorder (PD), and binge-eating spectrum disorders (BESP) were obtained using self-report data from 5 time points and population health registers.

The prevalence of AN, BN, BED, PD, and BESP was 2.19%, 4.15%, 10.39%, 0.60%, and 12.96%, respectively. All childhood maltreatment types were strongly associated with elevated eating disorder likelihood (with odds ratios [ORs] ranging from 1.71 to 3.29) as were eating disorder PGSs (with ORs ranging from 1.05 to 1.31). There were no multiplicative interaction effects between childhood maltreatment and PGSs. Small additive interactions were observed between PGS-AN and PGS-BEB and degradation/humiliation for BN and BESP in exploratory analyses.

Eating disorder PGSs and childhood maltreatment are associated with higher odds of eating disorders. Furthermore, we found tentative evidence of small additive interaction effects between polygenic liability and childhood maltreatment, suggesting that their combined influence further elevates the risk of some eating disorders.

Burnout is a job-related phenomenon that results from prolonged, unresolved workplace stress. It is characterized by feelings of exhaustion, increased mental distance from one's job, and reduced professional efficacy. In Nigeria, the ongoing emigration of the medical workforce, coupled with growing work load and poor working conditions, has heightened the risk of burnout, especially in states with severe healthcare manpower shortages, such as Adamawa State. This study assessed the prevalence, patterns, and predictors of burnout among healthcare workers at Modibbo Adama University Teaching Hospital, Yola, Adamawa State, Northeastern Nigeria.

A cross-sectional study was conducted among 200 doctors and nurses at Modibbo Adama University Teaching Hospital, Yola, Northeastern Nigeria, selected through a two-stage sampling. Data were collected using a semi-structured, self-administered questionnaire incorporating the Maslach Burnout Inventory for Human Services Survey adapted for Medical Personnel. Predictors were determined using a multivariable logistic regression analysis.

The prevalence of burnout was high, affecting 140 (70.0%) respondents, with low personal achievement being the most common dimension (103; 51.5%). High emotional exhaustion was reported by 58 (29.0%) respondents, while depersonalization was observed among 52 (26.0%). Professional cadre and perception of the work environment were significantly associated with burnout, with nurses (AOR: 3.62, 95% CI: 1.37 - 9.59, p: 0.010) and those reporting a negative perception of their work environment (AOR: 6.98, 95% CI: 2.22 - 22.01, p: 0.001) showing higher levels of burnout.

Burnout was highly prevalent among the healthcare workers, potentially affecting their well-being and the quality of care provided. Improvements in the work environment, institutional stress-management programmes, and staffing policy reforms are recommended.