People with severe mental illness (SMI) continue to experience a marked mortality gap, driven largely by preventable cardiometabolic conditions. This review examines recent advances in metabolic health that move the field beyond monitoring towards earlier, more proactive, and better integrated interventions.

Recent pharmacological evidence supports metformin's role in mitigating antipsychotic-induced weight gain, and also supports glucagon-like peptide-1 receptor agonists as effective treatments for established obesity and dysglycaemia in SMI. Evidence for behavioural interventions suggests that meaningful improvement, including remission of metabolic syndrome, is achievable when interventions are sufficiently intensive, tailored, and embedded within routine care, rather than delivered as low-intensity education alone. Updated clinical guidance endorses a "screen and intervene" approach and promotes integrated models of mental and physical healthcare, but major implementation gaps remain, particularly in low- and middle-income settings. Finally, emerging genetic and biological evidence indicates that metabolic dysfunction may be partly intrinsic to SMI, underscoring the clinical relevance of metabolic psychiatry.

Metabolic health in SMI should now be considered a core therapeutic target. The central challenge is not only recognising the problem, but also implementing effective metabolic interventions, at scale, across diverse, often siloed, care settings.

Loss of blood-brain barrier (BBB) integrity is observed in patients with hypertension and is hypothesized to contribute to cerebral small vessel disease (SVD) pathogenesis. Blood pressure increase and decrease within individuals and the effects on BBB integrity have never been examined.

To examine BBB leakage in middle-aged patients with hypertension following subsequent blood pressure increase and decrease.

The Hyperintense study included hypertensive adults who temporarily discontinued antihypertensive medication for diagnostic purposes. MRI was done at three timepoints: before medication withdrawal (visit 1), during withdrawal (visit 2) and after medication restart (visit 3). BBB integrity was measured with 3T dynamic contrast-enhanced (DCE)-MRI. We assessed leakage rate Ki [min-1] and blood plasma volume Vp. Linear regression was used to examine association between changes in blood pressure and BBB leakage.

Fourteen patients with hypertension (mean age 48.2 ± 4.5 years; 36% female) were included. After medication withdrawal, blood pressure increased in 11/14 participants (79%). Increase in blood pressure between visit 1 and visit 2 was associated with increased Ki in white (WM) (β = 0.683, P = 0.007) and grey matter (GM) (β = 0.587, P = 0.027) and Vp in the GM (β = 0.666, P = 0.009). Following medication restart, blood pressure decreased in seven participants, with Ki decreasing in four of them. There was no association between decrease in blood pressure and Ki or Vp between visit 2 and visit 3.

Blood pressure increase was associated with increased BBB leakage. Reduction in BBB leakage following medication restart was observed in most, but not all participants. This suggests that BBB leakage is dynamic and influenced by blood pressure.

Boredom is a universal affective-cognitive state arising from unmet needs for meaningful engagement. Although unpleasant, boredom can inspire creativity and purposeful action or trigger maladaptive behaviors such as problematic social media use (PSMU). The present study developed and validated the Metacognitions About Boredom Scale (MABS), a new instrument designed to assess positive and negative metacognitions about boredom.

The research comprised two studies. Study 1 involved mixed-methods item generation and large-scale validation among Iranian adults (N = 1,021; 58.0% females; mean age = 39.4 years), employing exploratory and confirmatory factor analyses. Study 2 involved at-risk individuals with problematic social media use (N = 234); bifactor and ROC analyses were conducted to determine an optimal cut-off score for positive and negative metacognitions about boredom.

Study 1 supported a stable two-factor structure of positive and negative metacognitions about boredom, confirmed through both exploratory and confirmatory analyses. Both subscales demonstrated excellent reliability, strong test-retest stability, and full measurement invariance across gender and age. Incremental validity analyses showed that the MABS predicted boredom and PSMU beyond general metacognitions. Study 2 confirmed the bifactor model, and ROC analysis indicated an optimal cut-off of ≥32 on the negative belief subscale for distinguishing individuals at risk of boredom-driven PSMU, yielding 95.3% sensitivity and 97.1% specificity.

The MABS is a valid, theory-based tool assessing boredom-related metacognitions and identifying cognitive risks for maladaptive online behaviors.

Neuromuscular electrical stimulation (NMES) uses surface electrodes to deliver electrical impulses that stimulate motor nerves causing muscle contractions. A potential use of NMES is for intradialytic rehabilitation strategy for patients undergoing maintenance haemodialysis (HD), but its effectiveness remains uncertain. This review analysis and meta-analysis evaluated whether the effects of NMES improve outcomes on physical performance, muscle strength, biochemical markers and Quality of Life (QoL) in patients undergoing long-term haemodialysis.

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) were selected on PubMed, Scopus, Web of Science and Embase. Selected eligible studies were analysed for Quality of Life, functional capacity and physical performance, muscle strength, biochemical parameters and adverse effects. Results were expressed as mean differences (MD) or standardised mean differences (SMD) with a 95% confidence interval.

11 RCTs met the inclusion criteria, involving a total of 346 patients from 7 countries on long-term HD. NMES was associated with a significantly increased handgrip strength (pooled MD = 3.34 kg, 95% CI 0.95-5.73, P = 0.006); however, statistical significance was lost when one contributing trial was excluded in the leave-one-out analysis. There were no statistically significant benefits in pooled analysis of broader measures of physical performance including the six-minute walk test or sit-to-stand test, nor in biochemical markers or other SF-36 domains including mental health, vitality and social functioning.

NMES may offer selective benefits in patients undergoing long-term haemodialysis such as improved handgrip strength; however, this was based on two small trials and was sensitive to the exclusion of one contributing study. No consistent benefits were observed across broader functional, biochemical or patient-reported outcomes. NMES may therefore represent a potential adjunct, but current evidence is insufficient to support replacing conventional intradialytic rehabilitation.

Psychedelics (hallucinogenic 5-HT_2A agonists such as psilocybin) are being investigated for their potential to treat a range of conditions, including anxiety-related psychopathology. Despite promising results, the mechanisms by which psychedelic therapy may alleviate anxiety are not well understood. Here, we review neural and cognitive mechanisms underlying anxiety-related psychopathology and how psychedelics may impact these mechanisms. This review culminates in a tentative neurocognitive account of how psychedelics may promote long-term anxiolysis. We propose a model of anxiety related psychopathology wherein anxiety-related contextual information from the hippocampus may influence amygdala and salience network activity, biasing information processing toward anxiety-related content that thereby is encoded by the hippocampus and perpetuates this cycle. We posit that psychedelic may acutely free cortical networks from hippocampal-dependent contextual constraints in part through 5-HT_2A expression on excitatory and inhibitory neurons in the cortex and hippocampus, respectively, while the intrinsic plasticity of the hippocampus and/or psychedelic-mediated plasticity allows for a "resetting of the hippocampal buffer." Following acute effects, increased cortical plasticity may enable the hippocampus to adaptively integrate novel information into a contextual frame less biased or constrained by prior aversive conditioning, promoting an overall reduction in anxious thoughts and appraisals. We end by discussing potential challenges of psychedelic therapy for anxiety, and suggest directions for future research to determine the optimal treatment paths informed by cognitive neuroscience.

Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by motor/vocal tics and premonitory urges. The triple network model (TNM)-including the salience network (SAN), frontoparietal network (FPN, also known as control network, Con), and default mode network (DMN)-provides a framework for understanding large-scale brain dysfunction. However, the TNM's role in the "urge-to-tic" mechanism in pediatric TS remains unclear. This study aimed to characterize network-level functional connectivity (FC) within the TNM in pediatric TS, examine its associations with clinical symptoms, and propose a refined neurobiological hypothesis for the urge-to-tic process. We enrolled 68 children with TS and 65 matched controls. Resting-state fMRI was used to quantify FC within the TNM. Clinical severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Sensory Phenomenon Assessment Scale (SPAS). Group differences in FC were identified, and random forest (RF) regression models were employed to predict symptom severity based on FC within the TNM. Children with TS exhibited significant inter-network FC alterations, specifically involving increased connectivity between the left DMN and bilateral SAN. While YGTSS and SPAS score were significantly associated with TNM connectivity, no significant correlation was found with PUTS scores. The RF models successfully predicted YGTSS (R² = 0.169) and SPAS scores (R² = 0.139), with the left DMN-right SAN circuit emerging as the most robust predictor. TNM dysconnectivity is a core neural signature of pediatric TS, highlighting the TNM as a crucial framework for understanding the pathophysiology of the "urge-to-tic" process.

Parent-led interventions are used to address child mental health, but it is unclear whether, or how, children have been involved in their development and evaluation. This review describes methods used to involve children (5-12 years), summarising outcomes and reflections and provides recommendations for best practice and further research. Searches were conducted in five databases in October 2023 and March 2025. Searches of key organisation websites, Google searching, and requests for articles via social media were also conducted. Eligible studies involved children (5-12 years) in the development and/or evaluation of parent-led interventions aimed at preventing or treating child mental health problems delivered in any setting. Study findings were combined using narrative synthesis and shared with children in participatory focus groups (17 children aged 8-11 years, 70.6% male). Review and focus group findings were combined into practice recommendations. From 9,647 studies retrieved, 16 were included. Most were evaluation studies (n = 12) involving children via self-reported outcome measures. Four studies involved children in development, with methodologies including workshops, interviews and feasibility testing. Reporting of outcomes from the co-design process was limited but revealed the importance of creative, art-based parent-mediated activities and rewards for progress. Early involvement in intervention design, use of interactive child-specific co-design workshops, and involvement of children with lived experience are recommended. While involving children may require increased planning and time, benefits include increased acceptance, credibility, parental engagement and feasibility. Future research should include greater detail on codesign methods and effectiveness, to enable more extensive understanding of best practice.