Chronic pain often coexists with psychiatric disorders, yet less is known about the specific types of chronic pain conditions that may co-occur. This study aimed to classify chronic pain according to ICD-11 categories and provide an overview of the types and frequency of these conditions in a patient sample with psychiatric disorders and coexisting chronic pain.

This descriptive cross-sectional study consecutively recruited 151 patients (78.8 % females, mean age 36 years) from psychiatric outpatient units. Common psychiatric diagnoses included anxiety disorders (27.8 %), stress-related disorders (23.2 %), mood disorders (22.5 %), attention deficit disorders (10.6 %), personality disorders (9.3 %) and other psychiatric disorders (6.6 %). Chronic pain was assessed by structured interviews and comprehensive clinical examinations conducted by physicians and physiotherapists. Examination verified pain conditions were classified into subcategories of chronic primary and secondary pain (ICD-11). We used descriptive statistics to analyze the data.

Chronic primary pain was present in 99 % of the participants; most commonly musculoskeletal pain (94.0 %), e.g. low back pain and neck pain, headache and orofacial pain (80.8 %), e.g. tension-type headache and migraine, and visceral pain (31.8 %), e.g. irritable bowel syndrome. Chronic secondary pain affected 49 % of the participants; most frequently musculoskeletal pain (33.8 %), e.g. osteoarthritis and tendinitis, and neuropathic pain (11.3 %), e.g. sciatica. The distribution of primary and secondary pain conditions was quite similar across the subgroups of psychiatric disorders. Participants had on average 5.7 chronic pain conditions. Females had significantly more pain conditions, chronic widespread pain and primary visceral pain than males.

This study indicates that chronic pain in patients with psychiatric disorders may include complex and multiple chronic primary and secondary pain conditions. Given such complexity, implementing pain assessment and management into routine psychiatric care as well as collaboration across different areas of medical expertise is warranted.

Poor school attendance is a high priority for schools. Parental mental health is associated with school attendance problems, however, the direction of this relationship is unclear. This study examines the longitudinal direction of association between school attendance-related difficulties and parental mental health in two prospective UK birth cohorts.

Data from two prospective birth cohorts were utilised: the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 6375) and the Wirral Child Health and Development Study (WCHADS) (n = 718).

In ALSPAC, school avoidant behaviours were associated with increased likelihood of subsequent maternal depression symptoms above clinical threshold (RR = 1.48 [95% CI 1.11, 2.00] p = 0.006) but maternal depression was not associated with later school avoidance (RR = 1.02 [95% CI 0.74, 1.40] p = 0.911). Similarly, separation anxiety behaviours were associated with increased maternal depression (RR = 1.20 [95% CI 1.21, 1.30], p < 0.001) but maternal depression did not predict later separation anxiety (RR = 1.06 [0.97,1.15] p = 0.237). In WCHADS, attendance-related difficulties at age 7 were associated with higher maternal depression symptoms at age 9 (b = 0.22, 95% CI 0.03, 0.42, p = 0.028), whereas maternal depression symptoms at age 7 were not associated with attendance-related difficulties at age 9 (OR = 0.98, 95% CI 0.78, 1.23, p = 0.869).

We provide the first evidence that relationships between maternal mental health and school attendance-related difficulties most likely operate from child behaviours to maternal depression, not the other way around. This indicates that attendance interventions should replace parenting blaming narratives and instead integrate support for parents when issues arise.

Artificial intelligence (AI) is increasingly entering medicine and nursing education, raising concerns about how healthcare students respond to AI-related occupational uncertainty. AI replacement anxiety (ARA) may become more or less salient across academic days, but little is known about its short-term within-person temporal associations with state anxiety and day-level academic burnout indicators.

This 10-day weekday diary study included 751 medicine and nursing students who provided 4,625 observed diary records after quality screening. Daily surveys assessed ARA and three academic burnout constructs using single day-adapted proxy indicators, together with a two-item state-anxiety measure. Two-level Bayesian dynamic structural equation modeling tested six primary dimension-specific models in the ARA-to-state-anxiety and state-anxiety-to-ARA directions. Supplementary joint multivariate models, a stricter 695-participant sensitivity sample, and a targeted calendar-spacing sensitivity analysis examined unique effects, posterior contrasts, and robustness.

In the ARA-to-state-anxiety direction, higher daily ARA was associated with higher subsequent cynicism, and higher cynicism was associated with later state anxiety. This M2 component pattern remained supported when the weekend interval was represented using calendar-day spacing. In the reverse direction, higher state anxiety was consistently associated with a higher subsequent score on the academic-inefficacy proxy indicator, but the subsequent association of this indicator with ARA was less robust across model specifications and was attenuated in the weekend-spacing sensitivity analysis. The model-based indirect effects remained uncertain, with 95% credible intervals including zero. Joint models indicated that the clearest cross-dimension differences were concentrated mainly in first-stage associations rather than complete unique downstream indirect processes.

The findings support dimension-specific temporal associations among ARA, state anxiety, and academic burnout-related daily indicators, highlighting cynicism and academic-inefficacy-related daily appraisals as particularly relevant components of the temporal links between ARA and state anxiety among medicine and nursing students. These findings provide a more differentiated basis for future research on targeted support and intervention in health-professions education.

A multi-modal approach to pain control, including subanesthetic-dose ketamine infusion (SDKI), may improve postoperative pain management, especially in patients with opioid tolerance. Identifying preoperative patient characteristics associated with receiving SDKI in the postanesthesia care unit (PACU) may help clinicians anticipate which patients could benefit from timely SDKI.

This study was designed to examine preoperative patient characteristics associated with SDKI in the PACU.

Retrospective cohort study of consecutive adults (≥18 years) undergoing scheduled surgery between January 1, 2020, and December 31, 2021, at a large academic medical center. Demographics, opioid use history, mental health diagnoses, and surgical service type were extracted from the electronic health record. A stepwise regression model was used to identify patient characteristics associated with SDKI in the PACU.

Among 6,419 patients, 90 (1.4%) received a SDKI in the PACU. Predictor variables in the final model included age (p = .031), White race (p = .014), history of psychoactive substance use (p < .001), prescribed morphine equivalent daily dose (MEDD) ≥60 mg (p = .0019) or ≥90 mg (p = .0018), and orthopedic/neurological surgery (p = .0079). Patients prescribed an MEDD ≥60 mg or ≥90 mg had nearly fourfold higher odds of receiving SDKI, whereas those with a history of mental and behavioral disorders due to psychoactive substance use had approximately threefold higher odds.

Preoperative screening for these characteristics in patients undergoing scheduled surgery may help identify patients who could benefit from proactive SDKI therapy in the immediate postoperative period.

Adult autism assessments prioritise clinician observations and developmental history, whereas many adults understand autism through lived experience. Within this tension, factors influencing high endorsement of autistic traits remain unclear. We analysed 245 consecutive NHS first adult autism assessments (median age = 33 years, 52% female), including Social Responsiveness Scale-2 (SRS‑2), Generalised Anxiety Disorder-7 (GAD‑7), Patient Health Questionnaire-9 (PHQ‑9) and Adverse Childhood Experiences (ACE) questionnaire. Although internalising symptoms and childhood adversity were common, neither was significantly associated with clinic-diagnosed autism (CA; 56.7%, n = 141). We defined 'experienced autism' (EA) as moderate or above scores on both SRS‑2 domains. Thirty‑five per cent of EA adults (64/181) did not meet clinical diagnostic thresholds. Linear models adjusted for sex closely associated EA with elevated internalising symptoms (GAD‑7 and PHQ‑9) regardless of CA (all p ⩽ .002). Cumulative ACE scores did not distinguish EA/CA groups but were independently associated with female sex (p = .012). Exploratory multinomial analyses suggested that childhood sensory overwhelm and internalising may contribute to convergence of EA and CA. Associations involving childhood maltreatment were less robust and should be considered hypothesis-generating. These findings support a preliminary hypothesis that elevated autism self-reports may sometimes reflect transdiagnostic associations between adversity and internalising symptoms.Lay AbstractMany adults seeking autism assessments score highly on autism questionnaires, but not all receive an autism diagnosis. This can feel invalidating and may leave people without support. During autism assessments at our NHS clinic, previously unassessed adults completed questionnaires about autism, anxiety, low mood and adverse childhood experiences, including abuse, family difficulties and sensory overwhelm. We reviewed 245 assessment reports (average age 35 years, about half women). We found high levels of childhood adversity, previous mental health diagnoses and current anxiety and depression in our clinic. These levels were similar for adults who received a diagnose of autism (57%) and those who did not (43%). High scores on autism questionnaires were common, yet 35% of adults with moderate or higher scores did not receive a diagnosis. Statistical analyses suggested that high autism questionnaire scores were strongly linked to higher anxiety and depression symptoms for both men and women. Women attending the clinic reported more adverse childhood experiences. When we considered current anxiety and depression, childhood adversity and sex together in the same statistical model, adults who scored highly on the autism questionnaire and were diagnosed autistic at the clinic were more likely to report sensory difficulties in childhood. Some exploratory findings suggested that childhood experiences may contribute differently across groups, although these patterns require replication in future research. Overall, our findings suggest that in first-time adult autism assessments, autism questionnaire scores may be influenced by worry, low mood, difficult childhoods and social experiences, as much as by autism. Our findings support closer connections between adult autism clinics and trauma and mental health specialists, both for diagnosis and for support options. As research links difficult childhoods with many adult health conditions, it may be important to consider anxiety, depression and childhood experiences when thinking about possible autism or connections to other conditions.

Virtual clinical triage is central to digital front door strategies, yet how interaction mode-structured, closed-ended AI questionnaires vs large language model (LLM)-enabled conversational dialogue-affects information capture, engagement, and alignment with care recommendations is unclear.

This study compared demographics, clinical content, engagement, and alignment with recommended care between a traditional, structured questionnaire interface (traditional triage [TT]) and an LLM-enabled conversational interface (conversational triage [CT]) sharing the same validated Bayesian reasoning engine.

This comparative, retrospective observational study analyzed 116,890 encounters over 28 weeks (January 2025 to August 2025) completed on a virtual triage website. Users self-selected TT or CT. Primary end points included demographic and clinical characteristics, engagement patterns, and self-reported intended adherence to triage recommendations. Analyses used poststratification weighting by age and sex. Group differences were assessed with the chi-square test (with Rao-Scott correction for weighted data) and survey-weighted Wilcoxon rank-sum test; P values for comparisons of proportions were adjusted for multiple comparisons using the Benjamini-Hochberg false discovery rate procedure. For CT, opening and closing sentiment (positive, neutral, or negative) was labeled using a prompt in Gemini 2.5 Flash.

Of 116,890 respondents, 100,533 (86%) used TT and 16,357 (14%) used CT. Female users were the majority in both groups but less predominant in CT (10,402/16,357, 64% vs 71,039/100,533, 71%) than in TT. TT users skewed younger (aged 18-29 years >50%), whereas CT was more evenly distributed with higher shares at ages 12 to 17, 30 to 44, and ≥45 years. Median session duration was longer with CT than with TT (8 minutes 21 seconds, IQR 6 minutes 10 seconds to 11 minutes 51 seconds vs 4 minutes 25 seconds, IQR 3 minutes 14 seconds to 6 minutes 22 seconds, respectively). CT elicited more clinical findings (median 36, IQR 31-43 vs 32, IQR 27-38; P<.001) and surfaced more mental health evidence (eg, depressive symptoms, 8.5% vs 6.2%; P<.001). Posttriage intent survey completion was higher with CT (5104/16,357, 31.2% vs 5968/100,533, 5.9%). Self-reported intended adherence to the recommended level of care was higher with CT (1749/5104, 34.3% vs 1740/5968, 29.2%; P<.001), especially at extremes of acuity: self-care (534/625, 85.4% vs 325/525, 61.9%), emergency room (171/723, 23.7% vs 100/949, 10.5%), and ambulance (39/339, 11.5% vs 27/554, 4.9%; all P<.001). Among CT encounters, positive sentiment increased markedly, while negative sentiment rose slightly.

The LLM-enabled CT was used by a more demographically diverse user base and was associated with richer clinical context, deeper engagement, and higher self-reported intended adherence among survey respondents, particularly for low-acuity self-care and high-acuity emergency scenarios, where reassurance or urgent escalation is critical. This highlights the potential of hybrid LLM tools that integrate validated clinical logic to support engagement, information gathering, and care navigation in digital front door settings.

Pediatric primary care providers (PCPs) play a central and growing role in identifying and addressing mental health problems (MHPs), yet the clinical-decision making processes are poorly understood. We reviewed the literature on PCP recognition, referral, and management of pediatric MHP to identify opportunities for future research related to diagnostic accuracy and mental health service delivery in primary care.

Scoping review methodology was used to examine the published research on PCP recognition, referral, and management decisions for pediatric MHPs. Data was organized by decision type and factors that influence decision making, including child characteristics, family characteristics, and clinician or practice context variables.

Forty-five peer-reviewed studies were included. Compared to gold standard assessments and parent-reported questionnaires, PCPs consistently under-recognized MHPs. The decision to refer patients varied by disorder and was largely influenced by problem severity and parental disclosure. Management decisions were primarily shaped by disorder and clinician comfort level. Across decision domains, problem severity, parental engagement, clinician training, and practice context emerged as consistent determinants of PCP decision making.

PCPs face persistent challenges in addressing pediatric mental health concerns. This review underscores many opportunities to improve outcomes and reduce inequities in primary care mental health service delivery. There is a need to improve accurate identification, clarify thresholds for referral, and strengthen PCP knowledge and confidence in addressing internalizing disorders and higher acuity concerns. Future research should explore sequential screening, targeted training, and integrated behavioral health approaches to support clinicians and improve systems.

Posttraumatic stress disorder (PTSD) is associated with impaired fear extinction and dysfunction in amygdala-centered circuits, for which treatments remain insufficient. The endocannabinoid system, particularly anandamide signaling regulated by fatty acid amide hydrolase (FAAH), has been implicated in stress and fear regulation. Preclinical studies suggest increased FAAH is linked to heightened stress responsivity, but FAAH status in PTSD remains unclear. We used [¹¹C]CURB positron emission tomography (PET) to characterize FAAH levels in the amygdala and in corticolimbic regions in PTSD and examine associations with clinical symptoms.

Participants with PTSD and controls underwent clinical assessment and PET/MRI. Trauma histories were characterized using clinical interviews and the Traumatic Life Events Questionnaire (TLEQ). FAAH levels ([¹¹C]CURB) were quantified using an irreversible two-tissue compartment model with arterial input function. Associations with PTSD symptoms were examined.

86 participants were included (35 PTSD, 51 controls). PTSD participants showed lower amygdala FAAH levels than controls (-10%; p = 0.02), with no differences in other corticolimbic regions. Exploratory analyses showed that childhood trauma was associated with higher corticolimbic FAAH levels, irrespective of diagnosis (+11.6%; p = 0.014; n = 28 vs. 24 with TLEQ data). FAAH levels were not associated with clinical symptoms.

Despite preclinical evidence linking increased FAAH activity to stress-related phenotypes, we found reduced amygdala FAAH in PTSD. Exploratory analyses showed higher corticolimbic FAAH in individuals with childhood trauma. These findings provide in vivo evidence of altered endocannabinoid signaling in PTSD and may inform interpretation of limited efficacy in FAAH inhibitor trials.

Automated speech analysis offers a promising avenue for objective assessment in schizophrenia by capturing its core feature of disorganised thinking, but the reliability of speech markers across different conversational contexts remains a critical unknown. We hypothesized that more complex speech elicitation tasks would lead to larger patient-control differences. We collected speech samples from patients (diagnosed with schizophrenia-spectrum disorders) and controls using tasks of varying complexity: reading, storyboard, and personal narrative. We extracted four speech markers known to be linked to schizophrenia and applied linear mixed-effects models to examine within-task stability and task effects. Results indicated that while speech markers are stable within tasks, significant group differences emerge specifically in the more cognitively demanding personal narrative and storyboard tasks, but not in the simpler reading task. Thus, it appears that clinical utility of routinely assessed automated speech variables in psychosis is task dependent. Our results provide evidence to guide the selection of sufficiently complex elicitation tasks for both research and applied clinical tool development.

The randomized IFCT-0302 trial compared chest CT-scan to chest X-ray for surveillance follow-up in resected NSCLC. Chest CT-scan enabled the detection of more cases of early recurrence and second primary lung cancer, which were more amenable to curative-intent treatment but did not result in improved survival. After surgery for NSCLC, guidelines recommend a follow-up with chest CT-scan. Therefore, the impact of follow-up on patient health-related quality of life (HRQoL) needs to be considered. We present the results of patient-reported outcomes (PROs) of the IFCT-0302 trial.

Patients were randomly assigned to the CT-based follow-up group or to the minimal follow-up arm (clinic visits and chest x-rays). HRQoL were a prespecified secondary analysis of the IFCT-0302 trial. Procedures, including HRQoL assessed using the Short Form-12 (SF-12) questionnaire were repeated at randomization, every 6 months for 2 years and annually until 5 years. Time to deterioration (TTD) was used for longitudinal data.

A total of 1775 patients were randomized. At baseline, 756 of the 888 patients (85.1%) in the minimal follow-up group had at least one HRQoL score available, and 747 of 887 (84.2%) in the CT-based follow-up group. There were no differences between groups in the TTD for the two dimensions of the SF-12 questionnaire: mental dimension [HR (CT-based follow-up group vs. minimal follow-up group): 0.97; 95% CI, 0.82-1.15; p = 0.74] and physical dimension [HR (CT-based follow-up group vs. minimal follow-up group): 1.13; 95% CI, 0.92-1.38; p = 0.24)].

No impact in HRQoL was demonstrated adding thoracic CT scans in the follow-up after resection of NSCLC.