It remains unclear to what extent long-term lithium use leads to significant eGFR decline. This study examines the course of eGFR in a 10-year prospective cohort of lithium users and the association with duration of lithium use, lithium serum concentration, and comedication.

This 10-year prospective cohort study included patients using lithium at inclusion. Medical records were reviewed for lithium concentration, eGFR, discontinuation of lithium, and other medication use. Primary outcome was a description of eGFR decline, quantified as delta eGFR per year of follow-up.

In total 196 patients were analyzed (42% male, mean age 51.1 ± 12.2, median follow-up time 8.8 years [IQR 1.3]). Median yearly decline was 0.79 mL/min/1.73 m². Of the participants, 48% had a yearly decline between 0.5 and 2.5 mL/min/1.73 m², while 11% showed a decline > 2.5 mL/min/1.73 m². Duration of lithium use was associated with eGFR decline. A positive association between lithium serum concentration and kidney function decline was shown, when corrected for age, sex and duration of lithium use. Comedication was not associated with eGFR decline. In the participants who discontinued lithium (20%) during follow up, there was no significant difference in eGFR before and after cessation.

This study provides further evidence that eGFR decline occurs in most long-term lithium users. Of this cohort, 59% of the participants had faster eGFR decline than the mean decline in the general population. Lithium exposure, quantified as mean serum lithium concentration, could be a contributing factor in this decline. eGFR trajectory was not altered by ceasing lithium.

Youth participation in mixed martial arts (MMA) has increased in recent years; however, the psychological impact of participation on mental health remains relatively unexplored. To date, no studies have specifically examined depression and resilience in youth MMA athletes. The objective of this study was to evaluate rates of depression and resilience among youth MMA participants.

Youth MMA athletes aged 8-17 were surveyed from January to April 2024 using the validated Short Mood and Feelings Questionnaire (SMFQ) and the Connor-Davidson Resilience Scale (CD-RISC 2) to assess depression and resilience, respectively. Data were analyzed using descriptive statistics, Fisher's exact tests, and ANOVA.

A total of 276 athletes were recruited via email and in person at a Youth National event. Of these, 108 participants completed the surveys fully (39% response rate). The mean SMFQ depression score was 1.26, with 4 athletes (3.7%) screening positive for depression using the SMFQ cutoff of 8. The mean CD-RISC 2 resilience score was 6.97. No significant differences in depression or resilience scores were observed based on age, gender, race, training hours, weight-cutting practices, parental coaching, injury history, or years of competition experience (p > 0.05).

This study provides baseline data on depression and resilience among youth MMA athletes. Compared with peers of similar age reported in the literature, youth MMA participants in this study had lower depression scores and higher resilience scores. Further large-scale longitudinal studies are warranted to guide mental health resources for youth MMA athletes as the sport continues to grow.

This study explored the health priorities and challenges of midlife women (ages 45-70) in British Columbia, Canada, to identify key elements for a comprehensive, dedicated midlife care program.

We conducted a cross-sectional, mixed methods online survey using convenience, non-probability sampling.

An online survey (N = 980) assessed health priorities and concerns, care sources, and preferences for a dedicated midlife health program.

Staying physically fit was the top priority, followed by weight management, brain health, and mental wellness, with variations noted: Younger women prioritized weight and mental health, while older participants focused on brain and bone health. Respondents relied on family physicians or walk-in clinics for care, but reported unmet needs across services, including access barriers, care quality, and information gaps. Key components for a midlife program identified in this study were as follows: (1) integrated, whole-person care support; (2) preventative care and early detection; (3) mental health as a priority; (4) access that fits women's lives; (5) relational, personalized, and competent care; (6) accessible information and navigation; and (7) community and peer connection.

The findings offer insights for developing a midlife women's health program that responds to varied and evolving health priorities through holistic, accessible, and patient-centered approaches.

Despite the burden associated with bipolar disorder (BD), research into early diagnosis and treatment of BD lags approximately 20 years behind the field of early intervention for psychosis. This study evolved through a partnership between Orygen (Melbourne, Australia) and the Daymark Foundation (Toronto, Canada). The primary focus was to answer the question: "How might we advance an early intervention approach for people at-risk of or with BD?".

Semi-structured interviews were conducted with international experts and other stakeholders in early intervention and BD to identify challenges and barriers in early intervention approaches to BD.

Twenty-eight experts participated. Nine themes emerged as challenges: (i) limited recognition and understanding of BD across stakeholders; (ii) lack of definitions; (iii) poor resourcing and lack of prioritisation in funding models; (iv) absence of validated tools for diagnosis, monitoring treatment response and/or disorder progression; (v) absence of "big data"; (vi) scarcity of evidence-based treatments and clinical guidelines for the early stages of the disorder; (vii) obscurity around optimal service models; (viii) the need for better support and involvement of families and significant others; and (ix) the need for collaboration (across disciplines, stakeholders, and settings) to progress the field.

Of those approached, 54.9% participated in the study. Given the qualitative nature of the study, recruiting more experts to the study would not necessarily change the outcomes as data saturation was achieved.

This work lays the foundations for developing a collaborative research framework to progress early intervention for young people with BD.

This paper aims to synthesise the current, global evidence on addressing psychological concerns of women presenting with domestic and family violence within the ED and suggest avenues for future research.

This discursive paper draws on clinical experience and research of the authors and critical synthesis of current literature on management of victim-survivors of DFV presenting with psychological symptoms in ED.

Academic databases and grey literature were systematically searched to identify relevant sources, and findings were narratively synthesised.

DFV victim-survivors often present with mental health symptoms in ED; however, many health professionals in EDs fail to correctly identify the underlying trauma and offer support to address DFV. The most reported barriers to DFV screening/identification include time constraints, privacy issues, and lack of education/training about DFV and its support mechanisms. As a result, only mental health symptoms are being treated, ignoring the broader psychosocial needs of DFV victim-survivors. Use of trauma-informed support models is recommended to address the mental and psychosocial needs of DFV victim-survivors visiting the ED.

DFV victim-survivors visiting the ED are often treated for their mental health symptoms without addressing their underlying trauma and risk of future victimisation. To address the ongoing adverse impact of DFV, it is necessary to ensure holistic and continual support from ED professionals for victims.

The importance of not only education but the implementation of sustained education and training programs surrounding DFV identification, screening, and cannot be understood. DFV is a global problem whereby many victim-survivors become healthcare patients. It would be poor decision making for clinicians to not prioritise appropriate responses to this societal problem within their clinical practice.

The analysis of care trajectories for chronic diseases has gained increasing importance, particularly for mental health conditions that are often neglected despite their alarming prevalence. This study aimed to identify and describe care trajectories of Quebec adults with self-reported mood disorders.

We used data from the TorSaDE cohort, which links data from the Canadian Community Health Surveys (CCHS) with administrative data from Quebec's health insurance board Régie de l'assurance maladie du Québec (RAMQ) over a 21-year period (1996-2016). Sequence analysis (SA) was used for 4421 Quebec adults who self-reported mood disorders within a 7-year follow-up period.

SA revealed three distinct user groups: Low healthcare users (Type 1, n = 2714), moderate users with diverse services (Type 2, n = 1120), and moderate users with high psychiatric service use (Type 3, n = 587). Average healthcare costs over 7 years varied significantly between trajectory types, ranging from $94,434 for low users to $230,899 for moderate users.

Results show that the burden of mood disorders is unevenly distributed across care trajectories: a small vulnerable group accounts for a disproportionate share of specialized healthcare use, while the majority relies only marginally on the public system. These findings highlight the heterogeneity of patients with mood disorders and underscore the need for differentiated, profile-specific approaches to healthcare planning rather than uniform treatment strategies.

Antidepressant (AD) use in bipolar I disorder (BD-I) remains controversial due to concerns about inducing manic/mixed episodes. We examined hospitalization risk following AD initiation in BD-I patients.

Using electronic health records from Catalonia (2010-2019), we conducted a retrospective cohort study of 7946 BD-I patients. We performed 1:1 propensity score matching based on age, sex, comorbidity count, and baseline mood stabilizer and antipsychotic use, yielding 3973 AD users matched to 3973 controls (mean age 50.9 years, 47.3% female) with 12-month follow-up. AD users were categorized by treatment strategy: AD monotherapy, AD plus antipsychotic (AD + AP), AD plus mood stabilizer (AD + MS), and AD plus both (AD + MS + AP). We estimated hospitalization risk using Cox proportional hazards models adjusted for clinical and demographic factors.

During follow-up, 6.3% of patients experienced manic/mixed episode hospitalization. Overall, AD use was associated with increased risk (HR = 1.27, p = 0.008), with AD monotherapy showing highest risk (HR = 1.51, p < 0.001). Notably, AD + MS combinations showed no significant risk increase. All AD strategies were associated with substantially higher risk for mixed episodes compared to pure mania. Age significantly modified risk, with patients 18-35 years showing greatest vulnerability to AD monotherapy (HR = 2.36, p < 0.001).

In BD-I, AD use increases manic/mixed episode hospitalization risk by approximately 30%, with differential effects across treatment strategies and patient subgroups. Combining ADs with mood stabilizers appears to mitigate this risk, while mixed episodes and younger age represent particularly high-risk scenarios. These findings support guideline recommendations against AD monotherapy while suggesting opportunities for personalized treatment approaches in BD-I.

Hereditary angioedema with C1INH deficiency (HAE-C1INH) is a rare, debilitating genetic disorder characterizedby recurrent, unpredictable attacks. Although treatments exist, patients with HAE still alter their lives to avoid triggersand experience substantial physical, psychosocial, and financial burdens.

To estimate the burden that HAE-C1INH patients experience despite currently approved therapies, aiming to identify unmet needs related to HAE, its therapies and the ability to achieve normalization of life.

A web-based survey was conducted from March to April 2025 among 100 US adults with HAE-C1INH currently receiving long-term prophylaxis and/or on-demand therapies. Responses captured attack frequency, the impact of living with HAE, avoidance of attack triggers, and the patients' unmet needs. Descriptive statistical analysis was conducted.

Even with treatment, 80% of respondents reported 1 HAE attack in the past year and 61% thought about HAE at least weekly. Mental health was the aspect that respondents felt was most impacted by HAE (54% of respondents), and 73% reported taking 2 measures to avoid attack triggers. Several concerns impacted the ability to reach normalization; lifetime use of medication was the most commonly reported concern (68% of respondents). The greatest unmet needs associated with long-term prophylaxis were cost- and access-related.

Substantial unmet needs related to disease control and achieving normalization remain for patients with HAEC1INH,despite existing treatments. This study re-enforces the need to not only assess the frequency and severity of attacks, but also the psychosocial, mental, logistical, and financial burden of lifelong management of HAE-C1INH in clinical practice.

Transgender and gender diverse (TGD) adolescents experience disproportionately higher rates of mental health concerns compared to cisgender adolescents. This paper compares the clinical and psychosocial risk profiles of TGD and cisgender adolescents seeking treatment for mental health concerns. Data was obtained from adolescents waiting for psychiatric care (age 12-17; N = 1362). Severity of mental disorder symptoms, substance use, self-harm, suicidal ideation, trauma experiences, and daily functioning were compared. TGD adolescents experienced significantly more symptoms of depression, anxiety and ADHD, self-harm, suicidal ideation and attempts and trauma experiences than cisgender peers. This data replicates previous findings that TGD adolescents experience greater psychopathology and psychosocial stressors than cisgender peers adding findings from a treatment seeking sample.

Gambling disorder (GD) poses severe impacts on both individuals and society. Impairment in risky decision-making is a key behavioral characteristic of GD, but the underlying cognitive processes of these deficits remain unclear.

A total of 100 male participants with GD and 59 healthy controls were recruited to complete psychological assessments and the Balloon Analog Risk Task. Since GD involved abnormal loss evaluation, we developed a novel cognitive model incorporating diminishing loss sensitivity and revealed the processes underlying the risk-taking behaviors with hierarchical Bayesian analysis.

Participants with GD exhibited stronger loss aversion (H1 = 50.00, p < 0.001, η2 = 0.325) but faster-diminishing loss sensitivity (H1 = 24.60, p < 0.001, η2 = 0.152), regardless of severity. The faster-diminishing loss sensitivity can explain the deficits in the overall performance of risky decision-making (H1 = 6.79, p = 0.009, η2 = 0.039; β = 206.81, 95% HDI [135.13, 278.49], t93 = 5.66, p < 0.001, Cohen's d = 0.565). Overconfident prior belief (H1 = 8.58, p = 0.003, η2 = 0.050) and higher updating rate (H1 = 7.91, p = 0.005, η2 = 0.049) were observed among participants with GD. Slower diminishing loss sensitivity was negatively correlated with higher non-planning impulsiveness (R = -0.24, p = 0.015).

This research provides novel perspectives on cognitive processes underlying the risky decision-making of GD, highlighting the role of diminishing loss sensitivity during loss evaluation and its clinical implications, which inspire future research on assessment and therapy for GD.