To examine psychiatrists' prescribing patterns, attitudes, and knowledge regarding clozapine use in Saudi Arabia, and to identify factors associated with clozapine prescribing.

A cross-sectional survey was distributed to psychiatrists and trainees across Saudi Arabia between January and June 2024. The questionnaire assessed demographics, prescribing patterns, attitudes, and clinical decision-making regarding clozapine. Descriptive statistics summarised responses, and comparisons between consultants and trainees were conducted using chi-square and t-tests. Binary logistic regression was applied to identify independent predictors of clozapine prescribing.

Ninety-seven psychiatrists participated; 69.1% had prescribed clozapine during the previous year. Consultants were significantly more likely than trainees to prescribe clozapine (p = 0.012). The majority (79.4%) agreed that clozapine is the most effective antipsychotic, yet 71% viewed its initiation as an administrative burden. Only 42.3% reported confidence in managing side effects, and 36.1% indicated access to clozapine-specific clinics. Logistic regression showed that perceiving clozapine initiation as an administrative burden significantly reduced the likelihood of prescribing (B = -1.44, p = 0.045, OR = 0.24, 95% CI = 0.06-0.97).

Despite high awareness of clozapine's efficacy, administrative and structural barriers continue to limit its use among psychiatrists in Saudi Arabia.

Hepatology visits present an opportunity to engage patients with alcohol-associated liver disease in care. This quality improvement pilot integrated a behavioral health provider (BHP) into the hepatology clinic at one Veterans Health Administration site and assessed its impact on alcohol use disorder (AUD) treatment.

Hepatologists across Veterans Health Administration facilities developed a workflow to refer patients with signs of unhealthy alcohol use to a BHP co-located in the hepatology clinic. Data during the first year of BHP integration (December 2022 to January 2024) were obtained through chart reviews and the Veterans Health Administration Corporate Data Warehouse. t tests and χ2 tests compared baseline characteristics and assessed the associations of referral status with receipt of evidence-based AUD treatments within 6 months of referral or index liver clinic appointment. Two hundred ninety-three patients with signs of unhealthy alcohol use were identified, representing 19.9% of all liver clinic patients engaged in care during the pilot. Of these, 86.4% had a prior mental health diagnosis, 79.2% had an AUD diagnosis, 57.7% had a positive AUDIT-C screen, 40.3% had an alcohol-associated liver disease diagnosis, and 71 patients (24% of patients with unhealthy alcohol use) were referred to the BHP. Referred patients were more likely to receive AUD psychotherapy and/or pharmacotherapy and had significantly more AUD pharmacotherapy fill days (35.2 vs. 10.3, p<0.001) but not AUD psychotherapy visits (5.2 vs. 3.2, p=0.172).

Referral to a co-located BHP was associated with a higher likelihood of receiving AUD treatment and a greater amount of AUD treatment, but gaps in referral remain and need to be addressed. Integrating BHPs into general hepatology clinics may improve AUD treatment uptake, addressing an important gap in care.

Burnout syndrome (BOS) and psychological distress among intensive care unit (ICU) staff are escalating global threats to workforce sustainability.

To map the global research landscape, intellectual structure and emerging frontiers of ICU burnout literature (2000-2025) in order to guide future interventional studies.

Bibliometric analysis.

4776 English records from Web of Science Core Collection (WOSCC), PubMed, Scopus and CINAHL databases were analysed by Bibliometric, VOSviewer and CiteSpace for publication trends, collaboration nets, keyword evolution and co-citation clusters.

Annual output rose exponentially after 2020. The USA led with 409 papers (16 862 citations), whereas China displayed the broadest international collaborations. 'Mental health' and 'conflict of interest' were identified as the latest burst keywords, signalling a paradigm shift toward systemic ethical frameworks.

ICU burnout research is transitioning from descriptive surveys to holistic mental health interventions. Future work should prioritise longitudinal, multicentre controlled trials that embed organisational ethics.

The findings provide nurse leaders and policymakers with an evidence map for designing targeted burnout-reduction programmers that go beyond individual resilience training.

Neurofibromatosis type 1 (NF1) is a genetic condition presenting with variable symptomatology, however most individuals will demonstrate cognitive and behavioural difficulties, including autism. Using a heterozygous germline knockout mouse model of NF1 (Nf1 +/-), we performed in-depth behavioural evaluations encompassing learning and memory, stereotypy, social interaction, anxiety- and depression-like behaviour. Anatomical and functional studies of the brain and gastrointestinal tract were followed by the first investigation of gut microbiota composition (via full-length 16S rRNA sequencing) in a Nf1 +/- mouse model. The cognitive and autism-like behavioural phenotype seen in Nf1 +/- mice was accompanied by a striking increase in relative brain size which is highly relevant to clinical NF1. Furthermore, brain size was correlated with behaviour, supporting a potential mechanistic link. Nf1 +/- mice showed significant alterations in gut microbiota composition vs. Nf1 +/+ wild-type controls, with males additionally showing significant changes to species abundance of the Clostridium and Blautia genera, and the Lachnospiraceae family, findings which partially overlap with those in preclinical and clinical autism. Composition of associated functional pathways was not globally altered, however +/- mice showed significant changes in a pyrimidine deoxynucleotide biosynthesis pathway. In male Nf1 +/- mice, we also identified a genotype-specific host-microbial signature, pointing towards a mechanistic link between gut microbiome composition and brain size. These findings significantly expand our understanding of brain and behavioural abnormalities in this preclinical model of NF1 and, importantly, have uncovered the gut microbiome as a highly promising new area of research and a potential therapeutic target for these symptom clusters.

Autism spectrum disorder (ASD) is highly heterogeneous. Molecular subtyping of ASD based on gene expression data will help address the biological heterogeneity of ASD. We analyze RNA-seq data from 1711 ASD samples, employing unsupervised non-negative matrix factorization (NMF) to identify subtypes, and characterize them with five categories: overall ASD symptoms, social-communication deficits, restricted-repetitive-stereotyped behaviors, cognitive-adaptive function and behavior problems. We also explore subtype-specific differentially expressed genes, functional pathways, and spatiotemporal/cell-type characteristics. NMF analysis identifies three ASD subtypes. The three subtypes exhibit different phenotypic patterns: Cluster 1 has severe restricted and repetitive behaviors, Cluster 3 mainly has social communication impairments, Cluster 2 presents milder symptoms and better cognitive function. Differential expressed genes analysis links Cluster 1 and Cluster3 to nervous system dysfunctions and morphogenesis of a branching structure, while Cluster 2 to immune system processes. The clusters also exhibit distinct gene expression patterns across brain regions, developmental stages, and cell types. Validation in two independent datasets confirms the reproducibility of the distinct clusters. This molecular subtyping reveals biologically and clinically distinct subtypes of ASD, helping to understand the atypical mechanisms underlying ASD heterogeneity. It also contributes to the development of personalized therapeutic strategies for distinct subtypes.

Ecological momentary assessment (EMA) is a tool facilitating the repeated collection of real-time data in naturalistic settings that can be applied to clinical research. Despite established methodological strengths, EMA protocols may be burdensome for participants, potentially leading to problems with adherence. Existing meta-analytic evidence is insufficient to inform the decision making of clinical researchers in using EMA in their work. In the current registered report, we address this need by conducting a systematic review with meta-analysis (1) examining adherence (enrollment, dropout, and compliance) in children and adolescents with psychological disorders and symptoms and (2) identifying aspects of study design that maximize adherence. In January 2023, we searched five databases for empirical EMA studies of youth (8-17 years) with psychological symptoms/diagnoses with data on adherence. We extracted data, assessed study quality, and conducted meta-analyses using random-effects models. We included 130 studies with 14,400 participants. On average, surveys contained 15 items, took over 3 min to complete, and incorporated surveys with multiple response scale types delivered using smartphones/cell phones provided to participants. Meta-analyses revealed that study enrollment was moderate to high (82% in youth with psychopathology, 67% in community youth) and dropout prior to starting EMA protocols was low (<1-2%). Dropout during EMA protocols was 12% for youth with psychopathology and 8% for community youth, underscoring the importance of maintaining participant engagement throughout EMA studies. Compliance approximated the 80% field benchmark for healthy youth but was lower for youth from the community and with psychopathology. Participant characteristics (e.g., younger age) and design factors (e.g., incentive-based compensation) were associated with greater compliance in certain groups. Despite limitations (missing data, methodological constraints), findings have important implications for researchers developing and conducting pediatric EMA protocols. The stage 1 protocol for this Registered Report was accepted in principle on April 19, 2024. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.25732482.v1 . This research was supported by the Intramural Research Program (IRP) of the NIMH and the NIH Library's and Office of Research Service's support of the NIH IRP.

Large language models (LLMs) have transformed various sectors, including education, finance, and medicine, by enhancing content generation and decision-making processes. However, their integration into the medical field is cautious due to hallucinations, instances where generated content deviates from factual accuracy, potentially leading to adverse outcomes. To address this, we introduce Hyper-RAG, a hypergraph-driven Retrieval-Augmented Generation method that comprehensively captures both pairwise and beyond-pairwise correlations in domain-specific knowledge, thereby mitigating hallucinations. Experiments on the NeurologyCrop dataset with six prominent LLMs demonstrated that Hyper-RAG improves accuracy by an average of 12.3% over direct LLM use and outperforms GraphRAG and LightRAG by 6.3% and 6.0%, respectively. Additionally, Hyper-RAG maintained stable performance with increasing query complexity, unlike existing methods which declined. Further validation across nine diverse datasets showed a 35.5% performance improvement over LightRAG using a selection-based assessment. The lightweight variant, Hyper-RAG-Lite, achieved twice the retrieval speed and a 3.3% performance boost compared with LightRAG. These results confirm Hyper-RAG's effectiveness in enhancing LLM reliability and reducing hallucinations, making it a robust solution for high-stakes applications like medical diagnostics.

Childhood trauma and other early adverse experiences are consistently associated with increased risk for psychopathology and greater positive symptom severity for individuals on the psychosis spectrum. Mounting evidence suggests that childhood trauma may lead to impairments in reward and motivational processes, contributing to negative symptoms of psychosis such as anhedonia and avolition. However, the mechanisms underlying this relationship are not well characterized. This review proposes a model in which hippocampal alterations following childhood trauma contribute to later reward-related deficits, which in turn influences risk for psychopathology. Drawing on both human and animal literature, we discuss the critical role of the hippocampus in modulating dopaminergic circuits crucial to reward learning and motivation. Although much of the literature on reward processes emphasizes striatal function, we focus on hippocampal circuitry to highlight its influence on sustained motivational states and goal-directed behaviors. Additionally, we address the broader impact of stress on hippocampal structure and function. By integrating findings across clinical and non-clinical populations, we aim to advance understanding of the hippocampus as a potential mediator between early life adversity and negative symptoms, offering insights into potential therapeutic targets to mitigate the long-term effects of childhood trauma on mental health outcomes.

Veterans experiencing criminal-legal involvement and/or homelessness (VCLI/H) are at elevated risk for suicide attempt and death relative to the broader Veteran population. Characterizing suicide-related outcomes in these Veteran groups is vital for Veteran suicide prevention efforts.

Using data from clinician-administered suicide risk assessments gathered from Veteran electronic medical records, this study examined rates and correlates of suicide-related outcomes in 249,011 VCLI/H.

At assessment, 1 in 7 VCLI/H endorsed suicidal ideation, and 1 in 32 were designated by clinicians as high acute risk for suicide. Within 12 months following assessment, 1 in 37 VCLI/H had a documented suicide attempt. These outcomes were more common among Veterans experiencing both criminal-legal involvement and homelessness than Veterans experiencing only one of these. Suicide attempts were most common among Veterans with bipolar disorders, psychotic disorders other than schizophrenia, and personality disorders compared to other psychiatric disorders. Clinician-identified risk demonstrated high specificity but low sensitivity in predicting subsequent suicide attempts of VCLI/H.

Findings reiterate the exceptionally high prevalence of suicide-related outcomes among VCLI/H and suggest a potential need to augment current risk assessment practices to increase sensitivity to better predict suicide-related outcomes among members of these populations.