To estimate an optimal treatment selection in data from a recent RCT comparing short-term psychodynamic (STPP) and cognitive behavioral therapy (CBT) for depression.

An estimator from causal inference with a valuesearch optimization was applied to estimate the optimal treatment choice for 100 patients diagnosed with major depressive disorder. Cross-validated prediction was performed, and the population mean outcome under optimal treatment was estimated.

Outcomes (psychosocial functioning and depressive symptoms) for estimated optimal treatment were stratified by treatments received and compared for concordant versus discordant assignments. Large effect sizes were observed (range 0.41-2.07). "Positive beliefs about rumination" was found to be an important predictor, with higher baseline levels favoring CBT. An improvement of more than 30% relative to randomized treatment was considered clinically significant. For most patients (75%), CBT was identified as the optimal treatment, whereas patients in the optimal STPP group showed the greatest benefit for concordant assignment.

The valuesearch method showed effective personalization, with greater improvement than typically reported in other methods of personalization with similar therapies and outcomes. A simple parametric user-specified treatment regime is easy to interpret, and robustness to model misspecification is appealing. Limited external validity is expected (small sample), and prospective validation is needed to guide clinical treatment selection. Head-to-head comparisons with other methods are required to draw conclusions about relative performance.

This study aimed to identify factors associated with in-hospital mortality following suicide attempts and examine the disparities between methods used amongst older and younger cohorts.

A retrospective analysis of data from the National Trauma Data Bank was completed for the year 2022 for younger adults (18-54) and older adults (≥55) that presented to trauma centers following suicide attempts. The primary outcome was in-hospital mortality with secondary outcomes including any in-hospital complications as well as intensive care unit (ICU) and hospital length of stays.

Older adults demonstrated higher in-hospital mortality compared to younger adults and differed in suicide methods, injury patterns, and clinical presentation. Older adults (40.7%) had a higher percentage of firearm use compared to younger adults (24.9%). Older adults were more frequently admitted to the intensive care unit compared to younger adults (44.5% vs 36.5%). In multivariable models, factors associated with increased mortality included, male sex, greater injury severity, lower GCS, head injury, and multiple comorbidities. Interaction analysis demonstrated that the effect of age on mortality differed by suicide method, with a greater age-related difference observed for jumping/lying-in-front injuries. In sensitivity analyses restricted to inpatients, the inverse association between ICU admission and mortality was attenuated.

Mortality following suicide attempts is influenced by both age and method, with older adults experiencing higher risk. The impact of early deaths on observed associations highlights the importance of incorporating timing of death in trauma-based analyses. These findings highlight age-related disparities and emphasize the need for tailored suicide prevention strategies.

Proximal hamstring avulsion is an uncommon but disabling injury that may cause persistent pain, weakness, sitting intolerance, and sciatic nerve-related symptoms. Surgical repair is commonly considered in active patients with complete three-tendon avulsions or two-tendon avulsions with substantial retraction, although optimal management remains debated. This study aimed to describe functional outcomes, health-related quality of life, neurological symptoms, and return to sport after open repair of complete or retracted proximal hamstring avulsions in recreational athletes.

A retrospective descriptive case series was conducted at a single center. Recreational athletes who underwent open proximal hamstring repair by the same surgeon between April 2022 and July 2025 were included if they had complete two-tendon avulsion with >2 cm retraction or complete three-tendon avulsion. Patients with <6 months of follow-up, low sporting demand, or incomplete records were excluded. Final follow-up outcomes included the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT), Short Form-36 Health Survey (SF-36), time to return to sport, and return to preinjury level. Normality of continuous variables was assessed using the Shapiro-Wilk test, and results were reported as mean ± standard deviation or median with interquartile range according to data distribution.

Eleven patients were included, with a mean age of 47.7 years and a mean sports participation frequency of 3.2 sessions per week. All injuries were Wood type 5, and 81.8% involved three tendons. Mean time from injury to surgery was 16.2 days, and mean clinical follow-up was 18.9 months. Preoperative sciatic symptoms were present in 36.4% of patients. Immediate postoperative numbness occurred in 54.5% and persisted at final follow-up in 36.4%. All patients returned to sport at a mean of 5.1 months; however, only 36.4% returned to their preinjury sporting level. The median LEFS was 96.3% of the maximum score, the mean PHAT score was 92.3 ± 6.5, the median Short Form-36 Physical Component Summary was 62.7, and the median Short Form-36 Mental Component Summary was 50.7.

Open repair of complete or retracted proximal hamstring avulsions in active recreational athletes was associated with excellent patient-reported function and universal return to sport at mid-term follow-up. However, return to preinjury sporting level was achieved by only one-third of patients, and persistent sensory symptoms were relatively frequent. These findings support surgical repair in selected active patients while emphasizing careful preoperative counseling and larger comparative studies.

Level IV, Retrospective case series.

The neurobiological correlates of remission/recovery in depression remain unclear, particularly across treatments. We investigated temporal gray matter volume (GMV) changes across four modalities: antidepressant medication (ADM), cognitive behavioral therapy (CBT), electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS).

This multi-center longitudinal observational study included 307 participants in the final analyses: 155 patients with depression (DEP; ADM: 53, CBT: 60, ECT: 22, and rTMS: 20) and 152 healthy controls (HC). DEP underwent magnetic resonance imaging and clinical evaluations at three timepoints (pre-treatment, post-treatment, and 6-month follow-up), and HC at two timepoints. Voxel-based morphometry identified baseline GMV differences between DEP and HC, assessed longitudinal GMV changes per modality, and correlated GMV changes with symptom changes. ComBat harmonization minimized scanner effects.

At baseline, DEP showed smaller GMV in the bilateral hippocampus, amygdala, thalamus, left insula, and middle frontal gyrus. Longitudinal changes occurred only in ECT and ADM. ECT showed GMV increases from pre- to post-treatment in the bilateral hippocampus, amygdala, and left insula, maintained at 6-month follow-up in the right hippocampus and amygdala. In ADM, the left insula initially increased then decreased toward baseline. No significant changes occurred in CBT or rTMS. Later-phase left insular GMV reduction correlated with worsening in ADM (r = -0.342).

All four modalities achieved clinical improvement, yet GMV changes differed substantially across groups, suggesting treatment-characteristic patterns of structural change within this observational framework. Later-phase insular GMV reduction correlated with worsening in ADM, highlighting its potential as a biomarker for long-term response.

Bipolar disorder (BD) is a severe mental illness associated with cognitive and functional impairment. This cross-sectional study evaluated the heterogeneity of cognitive and psychosocial functioning in BD, compared cognitive performance between BD and dementia groups, and identified factors associated with cognitive dysfunction. The study included 108 individuals with BD, of whom 32 were euthymic, while the remainder were symptomatic and 39 with major neurocognitive disorder. Sociodemographic data and mood symptoms were collected through structured interviews. Cognitive and functional status were assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA), neuropsychological tests, and the Functioning Assessment Short Test (FAST). BD participants were classified into three cognitive-functional profiles: Dementia-like (BD-DL; N = 69), Mild (BD-M; N = 22), and Preserved (BD-P; N = 17), based on MoCA and FAST scores. A multivariate analysis of covariance, adjusted for age and years of education (Pillai's Trace = 0.65, F = 6.14, p < 0.001; Wilks' Lambda = 0.39, F = 7.96, p < 0.001) showed significant group differences in neuropsychological tests. BD-P showed the highest performance in semantic and phonemic fluency, immediate verbal memory (RAVLT A1), and delayed verbal memory (RAVLT A7) while a pronounced impairment was observed in BD-DL and Dementia. Multinomial logistic regression analyses indicated that younger age, lower rates of hypertension, and fewer depressive symptoms were associated with greater odds of belonging to the BD-P and BD-M groups compared with the Dementia. Our findings support distinct cognitive-functional subgroups and indicate that cognitive deficits in BD may approximate the severity observed in dementia.

Dystonia is a complex movement disorder that can cause functional disability and reduce quality of life. Deep brain stimulation (DBS) provides meaningful benefits in patients with medically refractory dystonia, but clinical outcomes can vary substantially. This variability likely reflects the heterogeneity in clinical presentations, genetic background, and brain networks involved in motor control. Dystonia is a network disorder involving abnormal interactions across cortico-basal ganglia-cerebellar circuits. Therapeutic effects of DBS therefore arise from modulation of distributed motor circuits rather than a single anatomical target. Advances in non-invasive neurophysiological techniques, intraoperative recordings, and connectome-based neuroimaging have provided new insights into how DBS modulates these pathological networks. Individual response to DBS and long-term outcomes are shaped by the interaction between clinical and genetic factors, neurophysiological abnormalities, and distributed network connectivity. Combining these variables can help refine patient selection for clinical studies and support individualised neuromodulation strategies.

This paper argues to understand racially minoritised people's experiences of mental illness and mental healthcare, we must expand the focus from inpatient stays to understanding a series of interactions with state institutions. We extend Goffman's concept of mortification beyond the inpatient unit to demonstrate how carceral practices are routinely used by state institutions, contributing to the worsening of racially minoritised people's mental health. Drawing upon 22 in-depth interviews from participatory action research (PAR) with racially minoritised people diagnosed with severe mental illness in the UK, we show mortification and carceral practices experienced by racially minoritised patients are related to their racialised identities. This is shown in our data by: institutions' failure to act on reported incidents of racism; controlling and withholding information and services related to patients' mental healthcare; and the assumed criminality and threat of racially minoritised people, often resulting in increased police involvement and surveillance. Specifically, we show (1) mortification is not a process that happens solely inside the physical psychiatric hospital. It happens in a series of interactions with state institutions with harmful effects and (2) mortification is not a discrete event that takes place within one period, in one type of institution. Instead, degrading, racist experiences are interspersed throughout the life course compounding the feelings of identity loss and erosion. We conclude it is vital to bring together the concepts of racism, carcerality and mortification to develop a thorough understanding of the experiences of racially minoritised people diagnosed with severe mental illness.

Coercion in psychiatry refers to a continuum of measures applied against the patient's will. Epidemiological studies demonstrate that beyond the observation of frequent use in most countries, there are significant disparities between locations where coercion is used, even within a single country. Such is the case in France, where in certain hospitals restraints continue to be used with most patients, while in other institutions restraints are not used at all and wards employ an open-door policy. From a salutogenic perspective, we will turn out attention to the latter category in order to examine the protective factors, which we shall refer to as levers of least coercion. Adopting an interactionist and contextualized approach, we carried out an ethnographic study of four hospitals which in decades past have rarely, if ever, resorted to seclusion or mechanical restraint, and in which wards are left unlocked. This study, which took place between February to June 2022, was led by sociologists and nurse-researchers. It combines observations (62 days) and interviews among a diverse sample (mental health care professionals including psychiatrists, administrative staff, service users) (n = 78). It allows us to confirm that in comparable patients, and without increasing the level of violence or recourse to other methods of restraint, it is possible to keep wards open and still see infrequent or non-existent use of seclusion or mechanical restraint. Facilitating this state of affairs is the activation of relatively ordinary clinical measures based upon the quality of the caretaking relationship, the skills of caretaking teams, and a favorable therapeutic environment. Such clinical levers must be supported by both organizational methods and an institution, emphasizing the essential role played by the management team, the community of psychiatrists, and directors. The importance of a common culture and value system has also been pointed out - a culture which is equal parts caretaking and institutional organization.

Physical restraints refer to the immobilization of patient movement to address safety concerns or manage treatment interference. Interventions to reduce restraints have been effective in long-term care and psychiatric facilities. In contrast, rates of restraint have increased in general medical hospitals, possibly because of high patient volume and heterogenous patient populations. This high level of heterogeneity makes it difficult to develop preventative interventions. The current study aims to address this heterogeneity by generating profiles of restrained patients.

Latent class analysis (LCA) was conducted using hospital data incorporating demographic and clinical variables to identify restrained patient subgroups, then class membership was used to examine differences in contextual factors and characteristics of restraint episodes.

Five classes were identified: (1) Men with high-risk alcohol use and traumatic head injuries; (2) men in acute physical and mental distress with psychiatric comorbidities; (3) middle-aged men with severe medical conditions and histories of substance use disorders; (4) older male and female patients with severe medical illness and comorbid neurological impairments; (5) relatively young, black patients with psychiatric conditions and comorbid substance use. Classes were found to differ in terms of the reasons for restraint and the settings in which restraints occurred.

The current study extends previous findings and is the first to examine profiles of restrained patients across a general medical hospital. These profiles are recognizable to clinicians and readily derived from available data, facilitating more rapid classification of patients.These data could guide the development of tailored interventions to reduce restraint use.

Low circulating testosterone and reduced sexual activity are common in men with obstructive sleep apnea.

To evaluate the effect of an interdisciplinary weight loss and lifestyle intervention on circulating testosterone concentrations and, secondarily, on scores on the intimate relationships and sexual activity subdomain of the Functional Outcomes of Sleep Questionnaire (FOSQ).

Eighty-nine men were assigned to either usual care (n = 49) or an 8-week interdisciplinary intervention (n = 40). Assessments were conducted at baseline, at the end of the intervention (8 weeks), and 6 months post-intervention. Plasma testosterone was measured by chemiluminescence immunoassay. Sexual activity was assessed using the intimate relationships and sexual activity subdomain of the FOSQ. Sleep parameters and body weight and composition were also evaluated.

Compared with the control group, higher plasma testosterone concentrations were observed in the intervention group at 8 weeks (between-group difference 77.6 [95% CI 4.2 to 150.1] ng/dL; p = 0.042) and at 6 months (between-group difference 90.4 [95% CI 11.7 to 169.0] ng/dL; p = 0.027). Scores on the FOSQ intimate relationships and sexual activity subdomain increased in the intervention group both at 8 weeks (between-group difference 1.0 [95% CI 0.5 to 1.5]; p = 0.004) and 6 months (between-group difference 0.8 [95% CI 0.2 to 1.3]; p = 0.003) compared with controls. Changes in testosterone and FOSQ-derived sexual activity scores correlated with favorable changes in sleep quality, body weight and body composition, particularly from baseline to 6 months and from 8 weeks to 6 months (all p < 0.05).

In men with overweight or obesity and moderate to severe obstructive sleep apnea, an interdisciplinary weight loss and lifestyle intervention increased circulating testosterone concentrations compared with usual care. Improvements were also observed in scores on the intimate relationships and sexual activity subdomain of the FOSQ; however, these findings should be considered exploratory because this subdomain does not assess erectile function, libido, hypogonadal symptoms, or validated multidimensional domains of male sexual function. Further studies using comprehensive endocrine profiling and validated male sexual function instruments are warranted.

ClinicalTrials.govNCT03851653.