To examine the efficacy of intermittent theta burst stimulation (iTBS) for depressive symptoms and anhedonia in adolescents with depression, and explore potential moderators of treatment response.

We conducted a randomized controlled trial enrolling 60 adolescents (11-19 years) with depression from a tertiary hospital in Anhui Province, China; with participant-and assessor-blinding, whereas TMS operators were not. Participants were allocated by an independent researcher using a computer-generated random number list to active iTBS (n = 30) or sham stimulation (n = 30). The intervention was delivered over two weeks (10 treatment days), with three sessions per weekday(30 sessions total). Clinical assessments were performed at baseline and post-intervention using standardized instruments: the Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale-14 items (HAMA-14), and Temporal Experience of Pleasure Scale (TEPS). Treatment effects were examined using 2 × 2 repeated-measures ANOVA, and exploratory moderation was examined using PROCESS Model 1 with 5000 bootstrap resamples, with Holm-Bonferroni correction applied across five interaction tests.

Baseline clinical scale scores were comparable between groups (P > 0.05). Following treatment, significant group× time interactions indicated greater improvement in the active iTBS group than sham on depressive symptoms (HAMD-17: F = 40.300, P < 0.001) and anxiety symptoms (HAMA-14: F = 23.802, P < 0.001). Significant group× time interactions were also observed for TEPS total and its four subscales (P < 0.05). In exploratory moderation analyses, the Group×baseline TEPS-AA interaction was nominally significant(P = 0.014) but did not survive Holm-Bonferroni correction(adjusted P = 0.070).

iTBS was feasible and associated with greater short-term improvements in depressive symptoms and anhedonia in adolescents compared with sham stimulation. Exploratory analyses indicated that baseline hedonic traits (particularly abstract anticipatory pleasure) may be related to differential treatment response, but moderation effects should be interpreted cautiously given multiple-testing correction and require confirmation in adequately powered trials with longer follow-up. These findings support further investigation of iTBS for adolescent depression and the prospective evaluation of candidate predictors of response. Generalizability may be limited by the single-center design and the accelerated treatment schedule.

To identify clinical predictors of 6-month rehospitalization or suicide events following repetitive transcranial magnetic stimulation (rTMS) in hospitalized patients with depression.

This retrospective cohort study analyzed electronic health records (EHRs) from a tertiary psychiatric hospital in Shanghai, China. Inpatients with depression (ICD-10 codes F31.3-F31.5, F32 or F33) treated with rTMS during hospitalization were included. Missing data were addressed using multiple imputation by chained equations (MICE). Based on univariate analyses of baseline characteristics, further multivariable logistic regression, group least absolute shrinkage and selection operator (LASSO), and random forest analyses were used to identify predictors of rehospitalization or suicide events within 6 months post-discharge. Firth logistic regression was used for bipolar depression (BD) subgroup analyses due to the limited sample size.

A total of 275 inpatients were included, including 222 with unipolar depression (UD) and 53 with BD. Among them, 25.5% experienced rehospitalization or suicide-related events. Comorbid substance use disorders (SUDs), previous electroconvulsive therapy (ECT), and use of benzodiazepines were independently associated with higher odds of these outcomes in the overall cohort and the UD subgroup (all p < 0.05). Predictive models in UD showed moderate discrimination and calibration, whereas no significant predictors were identified in BD. These findings reflect observations from a single-center, retrospective cohort.

Clinically accessible factors were associated with poor long-term outcomes in hospitalized patients with UD receiving rTMS. These findings may help inform patient stratification and support future research aimed at improving risk assessment and personalization of rTMS treatment.

Pattern separation refers to the neural process by which overlapping inputs are transformed into distinct representations, enabling discrimination of similar experiences. This mechanism, central to episodic memory, critically depends on hippocampal integrity, which is vulnerable to age-related atrophy. The present study examined whether pattern separation is significantly reduced in older adults. We recruited healthy younger (n = 20) and older (n = 20) participants who completed a scene-based pattern separation task requiring classification of images as old, new, or lure. Images varied in visual completeness to simulate degraded sensory input. Behavioral analyses revealed that older adults showed markedly lower overall accuracy than younger adults. They also exhibited a substantially reduced lure discrimination index and lower corrected recognition scores. Furthermore, older adults responded significantly slower. Collectively, our findings demonstrate robust age-related reductions in memory discrimination and recognition that are consistently observed across levels of perceptual degradation, in line with the vulnerability of hippocampal-dependent memory processes in aging. This research builds upon previous studies by using a scene-based MST with parametric image occlusion, offering a nuanced behavioral framework for assessing cognitive decline and memory deficits in older persons.

Mental disorders are frequently associated with accelerated brain aging, yet the diagnostic and classificatory utility of brain age remains uncertain. This study aimed to evaluate the diagnostic value of brain age across multiple mental disorders and to identify the underlying neural mechanisms. Articles published through November 2025 were retrieved from PubMed, Web of Science, and Embase, resulting in 68 eligible studies covering DSM-5 diagnostic categories. We compared brain age across disorders and extracted key contributing brain regions. The largest effect was observed in schizophrenia spectrum disorders (Cohen's d = 3.49, 95% CI 2.62-4.37, p < 0.05), followed by neurocognitive disorders (Cohen's d = 3.27, 95% CI 2.31-4.24, p < 0.05), mood disorders (Cohen's d = 1.41, 95% CI 0.69-2.14, p < 0.05), and neurodevelopmental disorders (mean = 0.60). Analysis of covariance indicated a significant effect of diagnostic category on brain age (F = 5.13, p = 0.004), and Bonferroni tests further confirmed intergroup differences (p < 0.05). The central executive, default mode, and salience networks, emerged as a common system implicated across disorders, although the relative contributions differed by diagnosis. Overall, these findings suggest that brain age may serve as a biomarker for the diagnosis and classification of mental disorders.

Abnormal emotional processing serves as a common deficit across psychiatric disorders and a primary target of pharmacotherapy. However, the neuroimaging findings underlying emotion processing recovery (EPR) are heterogeneous, hampering the development of new therapies.

Here, we reviewed neuroimaging studies of pharmacotherapy in psychiatric disorders, focusing on brain activation associated with pharmacotherapy-induced EPR. Using a novel therapeutic network mapping approach with a functional connectome dataset (n = 652), we tested whether the identified brain activations could be reconciled into a common brain network. We also collected longitudinal functional MRI and emotion data of 213 patients with psychiatric disorders before and after clinical treatment for further clinical validation.

Across 23 experiments spanning four psychiatric disorders (major depressive disorder, bipolar disorder, anxiety disorders, and substance use disorder), we identified 208 brain activation coordinates associated with pharmacotherapy-induced EPR. These heterogeneous regions were reconciled into a common EPR network anchored in the bilateral insula and putamen. This network was robust across multiple analytical strategies and closely aligned with networks associated with psychiatric genetic and neurotransmitter features. The pharmacotherapy-induced EPR network showed generalizability to electroconvulsive therapy but not to psychotherapy. Finally, we found that effective emotional treatment targets were highly co-localized with this network. After clinical treatment, patients with psychiatric disorders exhibiting enhanced functional connectivity within this network demonstrated a high probability of emotional improvement.

The heterogeneous EPR findings across four psychiatric disorders could be reconciled on a common brain network, which provides a potential basis for transdiagnostic emotion treatment.

Mannitol, an osmotic diuretic and free radical scavenger might decrease cerebral oedema after acute intracerebral haemorrhage.

The Mannitol for cerebral oedema after acute intracerebral haemorrhage trial is testing the feasibility of performing a phase II trial to define the optimal approach for a phase III trial of testing mannitol in patients with cerebral oedema or at risk of it to improve outcome.

MACE-ICH is a multicentre, prospective, randomised, open-label, blinded-endpoint outcome assessment trial. Participants presenting within 72 h of ictus were randomised to one of three groups: 1:1 g/kg 10 % single dose mannitol infusion at 10 ml/min, in addition to standard care; 1 g/kg 10 % mannitol at 10 ml/min followed by a second dose 1 g/kg repeated 24 h later (providing serum osmolality <320 mOsm/Kg and sodium<160 mmol/L), in addition to standard care or standard care alone. The trial was registered prospectively: ISRCTN15383301.

46 (of planned 45) participants were recruited from 8 sites between February 2024-April 2025. Baseline characteristics: mean age 74.7 years (standard deviation 12.0); male 69 %; onset-to-randomisation 22.9 h; severity (National Institutes of Health Stroke Scale) 12.1 (8.3); blood pressure 155.3 (29.0)/78.9 (16.5) mmHg. Haematoma characteristics: lobar 58 %, mass effect 58.7 %, midline shift (34.8 %). The mean maximum haemorrhage diameter was 4.3 cm.

MACE-ICH successfully enroled patients with cerebral oedema after acute intracerebral haemorrhage to assess the feasibility and safety of intravenous mannitol. The trial is novel with a dose-comparative approach with assessment of single and repeated mannitol dosing regimens, addressing an important gap in clinical practice.

Benzodiazepines (BZDs) and Z-drugs are commonly prescribed for anxiety and insomnia, but their long-term use remains a public health concern. Evidence from Asia remains limited. This study investigated trajectories and predictors of long-term use in Taiwan by using a population-based cohort.

We conducted a register-based cohort study by using a nationally representative sample from Taiwan's National Health Insurance Research Database (NHIRD), covering a 20-year period from January 1, 2000, to December 31, 2019 after a 1-year washout. Incident users were identified and followed to evaluate long-term use patterns on the basis of two discontinuation thresholds: 90 days and 365 days. Cox regression models were used to estimate adjusted hazard ratios (aHRs) for long-term use by demographic, physical, and psychiatric factors.

Among 896,163 incident users, 3.8% progressed to long-term use under the 90-day definition, increasing to 14.7% under the 365-day definition. Under the 90-day definition, clonazepam and hypnotic BZDs showed the highest persistence (10.3% and 8.4%). More than 70% of initiations occurred in nonpsychiatric specialties. Long-term use was associated with male sex, older age, and higher Charlson Comorbidity Index; strong predictors included cancer, pneumonia, moderate-to-severe renal disease, alcohol- or drug-induced mental disorders, and personality disorders.

In Taiwan, most BZD and Z-drug use is short-term, and their usage patterns are affected by both clinical and system-level factors. These findings highlight the need for risk-based monitoring, cross-specialty prescribing oversight, and further research into treatment substitution strategies.

Previous studies have uncovered a negative correlation between problematic smartphone use (PSU) and both depression and anxiety, yet the investigation of PSU with depression and anxiety on a symptomatic level among medical students remains limited. This study aims to analyze the network structure of PSU and its relation to symptoms of depression and anxiety, as well as examine the role of mindfulness among these factors. A sample of 456 medical students was assessed using the Smartphone Addiction Scale - Short Version (SAS-SV), the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the Mindful Attention Awareness Scale (MAAS). Network analysis was employed to build the network structure and to identify central and bridge symptoms with centrality indices. The analysis revealed that preoccupation with smartphone and withdrawal symptoms serve as central symptoms in the development of PSU among medical students. Excessive use and fatigue emerged as bridge symptoms linking PSU to depression, while excessive use and restlessness were identified as bridge symptoms connecting PSU with anxiety. Mindfulness exhibited a negative association with numerous symptoms across PSU, depression, and anxiety. The findings indicate that targeting preoccupation with smartphone and withdrawal symptoms might prevent the development of PSU among medical students. Targeting excessive use may be essential in preventing the progression of PSU to depression and anxiety. Given the backgrounds of medical students, online mindfulness interventions could be a viable approach to mitigate PSU and improve mental health among them.

Ketamine, an N-methyl-d-aspartate antagonist, shows promise for treatment-resistant depression (TRD), with psychedelic doses potentially enhancing efficacy. However, its transient antidepressant effects and the need for repeated infusions raise concerns about optimal duration and long-term safety. Two clinical trials have tested the combination of ketamine with psychotherapy for depression, with mixed results. While real-world data on ketamine infusion protocols exist, reports on clinical outcomes, long-term follow-up, and the role of subjective experiences when ketamine is combined with psychotherapy are limited. This real-world case series examines 12 TRD patients treated with a novel protocol combining ketamine (0.5-1.5 mg/kg IM, total 5-8 sessions) and brief psychodynamic psychotherapy. Response and remission rates were 67% and 58%, respectively, with 50% maintaining remission at 3-month and 1-year follow-ups. Ego dissolution during session 3 correlated with symptom improvement and psychological insight. Our results highlight the therapeutic potential of combining ketamine with psychotherapy to optimize clinical outcomes.

Gambling Disorder is recognized as a behavioural addiction with clinical and neurobiological similarities to substance use disorders and overlaps with other psychiatric conditions and comorbidities. While research has documented cognitive impairments in gamblers, most studies have compared this population with healthy controls or viewed it only through the lens of substance use. However, some studies have examined neurocognitive functioning with other psychiatric and comorbid conditions. Synthesizing this literature is important, given the high comorbidity rates, to clarify shared versus disorder-specific cognitive functioning and refine the clinical characterization of gambling for more accurate assessment and intervention.

A systematic search across 4 databases conducted in May' 2025 retrieved 22,058 records, out of which 316 full-text articles were assessed and 30 studies included. Screening reliability was good (Cohen's κ = 0.88), and overall study quality assessed using the Joanna-Briggs-Critical-Appraisal-Checklists for cross-sectional studies came up to 6.63 (SD = 1.03).

Results indicated that most impaired performance was found among cocaine-dependent individuals and gamblers with comorbid attention-deficit/hyperactivity disorder, followed by those with eating disorders, obsessive-compulsive disorder, and substance dependence. Gamblers with no comorbidities or with comorbid depression indicated intermediate functioning, where performance was better among methamphetamine and alcohol-dependent individuals and those with gaming disorder. More preserved cognition was reported among smokers and individuals with Tourette syndrome smokers.

Findings showed both shared and distinct patterns of neurocognitive functioning between gambling disorder, substance use disorders comorbid conditions and other psychiatric disorders, supporting reconsideration of assessment frameworks and targeted interventions that draw on the cognitive perspectives identified in this study.