Sarcopenia is a progressive skeletal muscle disorder prevalent in older adults, yet its role as a risk factor for acute postoperative cognitive decline-an early manifestation within the spectrum of perioperative neurocognitive disorders (PND)-remains underexplored. We hypothesize that preoperative sarcopenia increases the incidence of early postoperative cognitive impairment and adverse surgical outcomes in geriatric patients.

This prospective cohort study enrolled 443 older adult patients (mean age 72.8 ± 5.8 years, 58.3% male) undergoing elective noncardiac surgery at a single centre in China. Preoperative sarcopenia was diagnosed according to the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, which included assessments of muscle mass, strength, and physical performance. Neurocognitive function was assessed via the Mini-Mental State Examination (MMSE) 1 day before and 3 days after surgery, with acute cognitive decline defined as a postoperative decrease of ≥ 2 points. Of the 443 patients, 391 (88.2%) completed 6-month telephone follow-up for assessment of longer-term functional outcomes. In an exploratory subset of 60 patients, preoperative faecal samples underwent 16S rRNA sequencing and untargeted metabolomics to characterize gut microbial and metabolic signatures.

The prevalence of preoperative sarcopenia was 28.0% (124/443). Acute postoperative cognitive decline occurred in 27.3% (121/443) of patients. Multivariate logistic regression identified preoperative sarcopenia (adjusted OR = 3.291; 95% CI: 1.295-7.531; p < 0.001) and frailty (adjusted OR = 4.012; 95% CI: 1.854-8.456; p < 0.001) as independent risk factors for acute cognitive decline. Sarcopenic patients exhibited significantly higher rates of postoperative complications (adjusted RR = 1.21; 95% CI: 1.12-1.44; p = 0.025) and ICU admission (adjusted RR = 2.41; 95% CI: 1.03-4.41; p = 0.008). Among the 391 patients with complete 6-month follow-up, the sarcopenia group exhibited elevated risks of falls (adjusted RR = 2.89; 95% CI: 1.55-5.08; p = 0.028) and all-cause mortality (adjusted RR = 3.07; 95% CI: 1.17-7.87; p = 0.016). Exploratory microbiome analysis revealed an elevated Firmicutes/Bacteroidetes ratio, reduced Bacteroides abundance, and upregulated faecal stercobilin and estradiol derivatives in sarcopenic patients who developed cognitive decline.

Preoperative sarcopenia is an independent risk factor for acute postoperative cognitive impairment and poor surgical outcomes in older adults. These findings support the integration of sarcopenia screening into preoperative risk stratification and suggest a potential role of the gut-muscle-brain axis in perioperative neurocognitive vulnerability.

Many Veterans see a clinician shortly before suicide. Clinicians report a lack of training in firearm secure storage conversations as a barrier to initiating these conversations. We aimed to determine the needs of Veterans Health Administration mental health clinicians for training in discussing secure storage. A needs assessment survey of attitudes, barriers, facilitators, and desired training topics was sent to mental health clinicians at 15 Veterans Administration medical centers in the South, including Texas. Of clinicians completing the needs assessment (N = 566), most (93%) endorsed "usually" to "always" discussing secure storage. Reported barriers included Veterans not being open to such discussion (30.3%) and clinician discomfort (21.9%). Clinicians wanted more training regarding secure storage, scripts for conversations, and repairing rapport. Clinicians can discuss secure storage with Veterans to reduce suicide risk. Our results highlight the need to develop training to support clinicians in discussing secure storage with Veterans to prevent suicide.

Background and Purpose: The physical health of people with severe mental disorders is often neglected. Nurses' attitudes and confidence may vary across cultures, highlighting the need for contextual validation. This study aimed to translate, culturally adapt, and psychometrically evaluate the Greek Physical Health Attitude Scale (PHASe). Methods: A total of 145 mental health nursing staff participated. Exploratory factor analysis (Kaiser-Meyer-Olkin = .81; Bartlett's p < .001), internal consistency, and test-retest reliability were assessed. Results: A five-factor structure explained 55.6% of the variance. Coefficient alpha ranged from .70 to .82, and the intraclass correlation coefficient was >.80. Attitudes were generally positive, though barriers and knowledge gaps were noted. Conclusions: The Greek PHASe demonstrates acceptable psychometric properties and may support the assessment of educational needs and the development of targeted interventions in mental health services.

The existent classifications of the distinct evidence-based psychological interventions (EBPs) are broad, not systematically developed or restricted to one mental disorder.

To identify the unique EBPs and their variations evaluated for six severe mental disorders (schizophrenia and psychosis, bipolar disorders, bulimia nervosa, anorexia nervosa, one type of substance use and borderline personality).

We established a large cohort of EBPs by selecting all randomised controlled trials (RCTs) from six recent and large network meta-analyses for severe mental disorders in adults. Pairs of researchers independently selected all psychological intervention arms and assigned them to macro-families based on labels and theoretical background. Subsequently, within each macro-family, groups of identical arms, that is, referencing the same manual or protocol, were consolidated as distinct psychological interventions. Adaptations related to content, structure, delivery or culture were also described.

From 260 RCTs, 422 psychological intervention arms were grouped in 45 macro-families and reduced to 266 distinct interventions (63% of total arms) across disorders. Intervention variability, that is, the proportion of unique psychological interventions out of the total number of arms, was lowest for the substance use disorder selected-stimulant use disorder (47/104, 45%) and bulimia nervosa (25/45, 55.5%). Variability was high for bipolar disorders (48/59, 81%), anorexia nervosa (20/29, 69%), schizophrenia/psychosis (86/123, 70%) and borderline personality disorder (40/62, 64.5%). 79 of the 266 distinct interventions (29%) contained adaptations (12% multiple adaptations) and 75/266 (28%) had openly available manuals or protocols.

Mapping EBPs across macro-families and distinct interventions could inform evidence synthesis and identification of active ingredients, guide mechanisms of change exploration and support prioritising interventions for research and dissemination.

The growing burden of chronic diseases in aging populations has made mental health a pressing public health concern, but the combined contributions of lifestyle and social factors to depression and anxiety in this group are still poorly defined. Mental health is essential for promoting healthy aging and sustaining a good quality of life in later years. However, the influence of healthy lifestyles and social determinants on the mental health of older adults with chronic diseases-whether considered individually or in combination-remains poorly understood. This study investigates the associations of these factors with depression, anxiety, and their comorbidity.

This cross-sectional study included older adults (aged ≥60 years) with chronic conditions. A total of 8986 patients with chronic diseases were surveyed from July to September 2024. Healthy lifestyle factors (diet, physical activity, sleep, and social engagement) and social determinants of health (economic status, educational attainment, healthcare accessibility, built environment, and social environment) were assessed. Depressive symptoms and anxiety symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) and the 7-item Generalized Anxiety Disorder scale (GAD-7), respectively. Logistic regression analysis was conducted to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for relevant covariates.

Compared with the reference group (0-1 healthy lifestyle behaviors and 0-1 SDH), both the subgroup with a higher number of healthy lifestyle behaviors and the subgroup with a higher number of favorable SDH factors were significantly associated with lower odds of depressive symptoms, anxiety symptoms, and their comorbidity. Adjusted logistic regression analysis indicated that both healthy lifestyle behaviors and social determinants were significantly associated with lower odds of depressive symptoms, anxiety symptoms, and co-occurring depressive symptoms and anxiety symptoms. The observed associations with healthy lifestyle behaviors were primarily related to balanced nutrition, moderate physical activity, and adequate sleep, whereas the associations with social determinants were mainly related to access to quality education, positive neighborhood relationships, and supportive community environments.

Depressive symptoms and anxiety symptoms are highly prevalent worldwide and contribute substantially to the global burden of disease. In resource-limited settings, promoting healthy lifestyles and strengthening community-based social support have been associated with a lower burden of depressive symptoms and anxiety symptoms. This dual-level approach represents a practical public health response to the growing need for accessible mental health care in contexts where specialized services remain limited.

Depression and anxiety commonly emerge during adolescence and are associated with substantial personal, social, and economic burden. Parenting practices are well-established modifiable risk and protective factors for adolescent affective disorders, yet many parents lack access to evidence-based guidance. Digital parenting interventions offer a potentially scalable approach, but evidence for their effectiveness in high-risk adolescent populations remains limited.

The PIPA Trial was a school-based, UK-wide, two-arm randomised controlled trial evaluating a personalised online parenting programme compared with a standard educational parenting package. Parent-adolescent dyads were eligible if adolescents aged 11-15 years scored ≥7 on the Short Mood and Feelings Questionnaire (SMFQ). The primary outcome was change in parent-reported adolescent depressive symptoms (SMFQ) from baseline to 15 months. Secondary outcomes included parenting practices, parent-child attachment, adolescent anxiety, wellbeing, and parent wellbeing.

A total of 512 dyads were randomised, with 510 included in intention-to-treat analyses. Adolescents presented with elevated baseline depressive symptoms and substantial prior mental health difficulties. Depressive symptoms declined over time in both trial arms, with no significant between-group difference at 15 months (adjusted difference - 0.12 SMFQ points, 95% CI -1.23 to 0.98). In contrast, parents allocated to the personalised programme showed greater improvements in guideline-concordant parenting practices and parent-child attachment. Engagement was modest, and over 40% of adolescents triggered duty-of-care procedures due to elevated risk during the trial.

In this high-risk UK sample, a personalised digital parenting programme improved parenting practices but did not reduce adolescent depressive symptoms beyond an active educational control. These findings highlight the importance of matching intervention intensity to baseline symptom severity and support the role of digital parenting programmes as part of stepped prevention and early intervention frameworks.

ISRCTN63358736.

The temporal course of antipsychotic drug action in schizophrenia remains poorly understood. We aimed to explore how different symptom domains of schizophrenia improve over time. Such knowledge has important implications for treatment decisions and for understanding the mechanisms of action of antipsychotic drugs.

We analysed individual patient data from an existing repository comprising six antipsychotic drug trials of 6-12 months' duration in patients with acute schizophrenia (n=2079; 1328 [64%] men, 751 [36%] women; 1577 [76%] White, 502 [24%] non-White; mean age 34·72 years [range 16-73]). We used descriptive statistics to examine improvement trajectories across five PANSS symptom domains according to an established five-factor model (positive symptoms, negative symptoms, hostility and excitement, anxiety and depression, and cognitive and disorganisation). Time-to-response analyses were conducted using a threshold of at least 50% symptom reduction to define response within each domain. We used path analysis to explore whether improvements in negative, positive, and cognitive symptoms were mediated by changes in other symptom domains. People with lived experience were not involved in the project.

All five symptom domains showed substantial improvements during the first weeks of treatment, which slowly plateaued from week 15 onwards. While the factors improved in parallel, some improved more than others. Within the first 6 months, on average, hostility and excitability symptoms decreased by 76% (95% CI -80·5 to -71·1) from baseline, positive symptoms by 64% (-68·0 to -60·5), anxiety and depression symptoms by 57% (-61·2 to -53·2), cognitive and disorganisation symptoms by 61% (-64·0 to -57·2), and negative symptoms by 50% (-53·9 to -46·4). Median time to response adjusted for baseline symptom severity, age, and sex, was 3 weeks (95% CI 3 to 3, restricted mean survival time [RMST] 6·60, SE 0·20)) for hostility and excitement and 4 weeks for positive symptoms (4 to 4, RMST 7·76, SE 0·20) and anxiety and depression symptoms (4 to 4, RMST 8·71, SE 0·22), compared with 8 weeks for negative symptoms (6 to 9, RMST 12·45, SE 0·25) and cognitive and disorganisation symptoms (6 to 9, RMST 12·06, SE 0·25). Exploratory investigations using path analysis suggested that only a small proportion of the improvement in negative symptoms was mediated by improvements in cognitive and disorganisation and anxiety and depression domains.

Clinicians should be aware of earlier attainment of substantial response of hostility and excitement, then positive symptoms, before substantial reductions in other domains. Treatment changes should not be made prematurely when negative and cognitive and disorganisation symptoms persist, as improvement in these domains lags behind. Researchers should consider these temporal patterns when investigating the mechanisms of action of antipsychotic drugs.

None.

Suicide in young people is a global priority and strengthening mental health support in education is central to England's suicide prevention strategy. Few studies have examined in detail the individual characteristics of higher-education students nationally who died by suicide. We aimed to describe individual and institutional characteristics of suspected student suicide, contact with support services, and adherence to sector guidance on serious incident investigations.

We used a national case-series design to identify suspected suicide deaths in higher-education students in the 2023-24 academic year (from Aug 1, 2023, to July 31, 2024). Anonymised serious incident reports were obtained from higher-education providers in England. Data were systematically extracted using a structured pro forma developed with bereaved families and sector organisations and charities. Serious incident reports were also assessed for adherence to national guidance.

Higher-education providers in England informed us of 107 suspected suicide deaths during the 2023-24 academic year. A serious incident report was completed for 86 of these deaths, of which 79 were obtained from 50 providers. Most students who died were men (50 [71%] of 70 with available data were men and 18 [26%] were women). Where known (n=24), mean age was 23·9 years (SD 7·0; range 19-47). Ethnicity was unknown for most students (70 [89%] of 79). Most students were undergraduates (45 [71%] of 63) who lived away from home (44 [72%] of 61). 11 (22%) of 50 deaths with available data occurred in university-managed or privately managed student accommodation. Six reports indicated potential suicide clusters. Mental health difficulties (45 [62%] of 73), academic problems (38 [52%] of 73), and neurodivergence (30 [41%] of 73) were the most common features reported before death, often alongside relationship problems (24 [33%] of 73), self-harm (16 [22%] of 73), social isolation (11 [15%] of 73), housing or financial problems (15 [21%] of 73), and violence (nine [12%] of 73). 52 (69%) of 75 students had previous contact with university support services, although reports highlighted recurring issues with access to support, information sharing, monitoring engagement, and joint working between academic and pastoral supports. Despite national guidance, family involvement in serious incident investigations was only reported for 19 (24%) of 79.

A range of actions, including prioritising mental health on campus and offering targeted support to those at risk (eg, neurodivergent or financially insecure students) could contribute to suicide prevention. Universities should ensure the safety of accommodation and routinely involve families in an independent investigation process, promoting openness and transparency from the earliest point.

UK Department for Education.

What drives the heterogeneity of survival estimates in genetic frontotemporal dementia is unknown. We sought to understand the natural history and predictors of disease trajectory, which are crucial not only for effective care but also for the design of therapeutic clinical trials and efficacy evaluation.

In this international, cohort study, we used the Kaplan-Meier method to retrospectively assess survival estimates in patients enrolled in the GENFI cohort, which included 32 research sites located in Belgium, Canada, Finland, France, Germany, Italy, the Netherlands, Portugal, Spain, Sweden, and the UK, and comprised participants carrying a causal C9orf72 expansion or a causal mutation in GRN or MAPT genes. Survival was calculated as the time from symptom onset to time of death or censoring date; median survival estimate for all patients was the primary endpoint. Cox proportional hazards models were used to identify predictors of survival, which were subsequently externally validated in an independent cohort. We further designed a structural equation model to assess the relationships between predictors, applying a least absolute shrinkage and selection operator method.

Of 278 participants of the GENFI cohort included in this study, 160 (58%) were men and 118 (42%) were women. 162 died during follow-up (58%) and 116 were still alive (42%) on June 1, 2024, the chosen censoring date. 138 participants carried a C9orf72 expansion, 94 carried a GRN mutation, and 46 a MAPT mutation. 179 participants were diagnosed with behavioural variant frontotemporal dementia, 46 with primary progressive aphasia, and 31 with frontotemporal dementia-amyotrophic lateral sclerosis. 22 participants had other diagnoses. The median survival estimate for all patients with genetic frontotemporal dementia was 6·94 years (95% CI 6·59-7·80) from symptom onset. The median survival estimate for patients with GRN mutations was 6·63 years (6·08-7·98), for patients with a C9orf72 expansion was 7·04 years (6·45-8·77), and for patients with MAPT mutations was 8·56 years (7·06-13·50). Older age at onset, shorter disease duration from onset to enrolment in the GENFI study, clinical presentation (ie, frontotemporal dementia-amyotrophic lateral sclerosis), domain of first symptom (ie, motor or language onset), and geographical area of residency (ie, central and southern Europe) were associated with poorer prognosis. Genetic group did not directly affect survival estimates; rather its effect was mediated by age at onset and clinical phenotype. We computed a genetic frontotemporal dementia survival risk index, which can be used at an individual patient level.

Our results highlight that motor impairment in addition to cognitive and behavioural symptoms should be considered when estimating prognosis in genetic frontotemporal dementia. Individual risk scores might be of help for patient stratification in future therapeutic trials, although refinement and prospective validation are now needed.

Italian Ministry of Health (Ricerca Corrente), Fondation Philippe Chatrier, and Fondation Vaincre Alzheimer.

Humans can create impressive art, make major scientific breakthroughs, and generate creative solutions that solve everyday life problems. But how are these creative activities supported by the brain? This question is of great scientific interest but remains unanswered. New hypotheses, grounded in converging evidence from cognitive neuroscience, are needed to guide breakthroughs in understanding the neural basis of creative thought. It has long been suggested that creativity is a distinct mental function. However, converging clinical-cognitive neuroscience evidence is starting to suggest that creative thought is not functionally distinct but, instead, might arise from general purpose cognitive mechanisms supporting semantic cognition, controlled episodic memory retrieval, and executive mechanisms (i.e., Cognitive Cornerstones Hypothesis; Chan et al., 2023). Results from this large-scale activation likelihood estimation (ALE) meta-analysis, based on 787 experiments with 10,357 foci from 17,228 healthy adult participants, showed that the brain regions implicated in creativity tasks heavily overlap with the brain regions implicated in the cognitive cornerstones of creative thought (i.e., pre-existing knowledge and executive mechanisms). These striking results suggest that innovative insights will arise from considering the roles of these fundamental cognitive functions and their interactions in supporting creative thought.