Subacute sclerosing pan encephalitis (SSPE) is a slow viral disease that follows the wild-type measles infection of early childhood with a subsequent progressive encephalitic illness with seizures and global regression after a long latent period. Mostly considered an invariably progressive and terminal degenerative disorder, the intriguing variability in course with plateaus and spontaneous remissions, while rare, have been recognized [1, 2]. The predictors of disease trajectory and the mechanisms at molecular and immunological levels that determine these differences in outcome remain largely undetermined. Here, we describe a young lady with classical and well-defined features of SSPE who had a relatively favourable outcome with remissions and atypical relapses spread over more than a decade. This highlights the crucial need for detailed documentation and consistent follow-up instead of resorting to a blanket approach of therapeutic pessimism when treating SSPE.

Emotional Disorders (EDs) are highly prevalent among university students, with only a small percentage (16.4%) receiving treatment. This study examines the feasibility and acceptability of delivering the Unified Protocol (UP) in two scalable formats and explores preliminary clinical outcomes in a university student population.

Thirty-five university students (80% women, mean age = 21.29 years, SD = 1.87) with primary diagnoses of EDs were randomly assigned to either the blended-UP condition (n = 18) or the synchronous online UP condition (n = 17). The intervention involved 8 UP modules, delivered as either 9 weekly 2-h synchronous online group sessions or a blended format (4 synchronous online group sessions for modules 1, 4, 6 and 7+ autonomous work via the UP-APP). Depression, anxiety, transdiagnostic variables, difficulties in emotion regulation, maladjustment and quality of life were assessed at baseline, post-treatment and at 3- and 6-month followups. Satisfaction with the intervention received was also measured.

Statistically significant changes were observed over time (main effect of time) for all evaluated variables (except in quality of life and positive temperament), with no 'Time × Condition' interaction, meaning that the scores evolved similarly in both conditions. Participants reported high satisfaction scores (8.91/10 in the blended condition and 9.38/10 in the synchronous online UP condition) and rated highly how the intervention had helped them to properly regulate their emotions (8.83/10 in the blended condition and 9.00/10 in the synchronous online UP condition).

This study demonstrates that both the blended and synchronous online group formats of the UP are feasible and well accepted by university students, with associated improvements in emotional symptoms, and that the UP in these formats could be an efficient alternative to address the high demand for mental health support among university students.

The personality dimensions of self-criticism and dependency have been shown to confer vulnerability to depression, and psychopathology more broadly, in adults. However, evidence for the roles of these personality dimensions in young people is weaker, particularly because most studies in this area have been conducted in non-clinical samples. The current study aimed to examine associations among self-criticism, dependency and a wide array of indices of interpersonal and intrapersonal functioning in a large sample of clinically depressed adolescents.

The study sample consisted of 465 adolescents with clinical depression. Associations among self-criticism, dependency and indices of clinical symptoms and intrapersonal functioning (e.g., depression, anxiety, antisocial behaviour, obsessive-compulsive features, self-harm and suicidality) and interpersonal functioning (i.e., friendship, family functioning and parenting as reported by adolescents) were examined using correlation and multiple regression analyses.

Consistent with findings in adults, self-criticism was more consistently associated with indices of maladaptive functioning than dependency. There was also evidence for gender incongruence effects in that self-criticism in girls and dependency in boys were associated with increased anxiety, obsessive-compulsive symptoms and suicidal ideation.

This is the first study in a large sample of clinically depressed adolescents to demonstrate that the personality dimensions of self-criticism and dependency are associated with clinical features and functioning. The implications of these findings for future research on the role of these personality dimensions in adolescent depression are discussed.

Equitable deployment of clinical artificial intelligence systems requires consistent performance across diverse patient populations. However, race information in electronic health records is often missing/inconsistently documented, limiting the ability to construct representative cohorts or assess algorithmic bias. This study evaluates model performance and fairness in predicting race from clinical text.

We compared four transformer-based deep learning models with a hierarchical convolutional neural network designed to capture the multilevel structure of clinical narratives. A two-phase active learning framework guided annotation of a primary care database. A fairness-aware loss function was applied to mitigate disparities across racial groups. Each model was trained with and without fairness-aware optimization. Performance and equity were evaluated using 10-fold cross-validation and subgroup audits across race, sex, age, and their intersections.

Here we show that the hierarchical convolutional neural network achieves higher accuracy and performance equity than transformer models (macro F1 = 98.4%). Fairness constraints enhance parity across most transformer architectures, but degrade hierarchical model performance and cause one clinical model to collapse toward majority predictions, demonstrating that fairness interventions are highly model dependent. Persistent disparities across race, sex, and age indicate that inequities reflect architectural limitations and systemic biases.

This study demonstrates that fairness can be integrated into clinical language models, though effects vary by model type. Architectures aligned with clinical text structure inherently promote fairness, yet mixed fairness constraint outcomes highlight the need for tailored interventions. Persistent demographic disparities show that algorithmic bias often reflects upstream documentation inequities. This framework offers a scalable path toward equitable NLP for clinical artificial intelligence.

This Review summarises the research into five common mental health problems that can affect adults living with type 1 diabetes, type 2 diabetes, or gestational diabetes: fear of hypoglycaemia, diabetes distress, depression, disordered eating, and sleep disorders. Mental health problems are common among adults with diabetes and can substantially decrease the quality of life and self-care, and increase the risk of adverse health outcomes, such as high HbA_1c, comorbidities, and premature mortality. Many mental health problems are bi-directionally linked to diabetes. Randomised controlled trials have shown that psychological interventions are effective in reducing symptoms in the short term, including cognitive behavioural therapy, mindfulness-based cognitive therapy, and stepped care, which can also be offered digitally as a first step. However, diabetes distress, depression, and other mental health problems are known to recur and the longer-term outcomes of prevention or treatments are unclear. In general, mental health problems are understudied in diabetes, particularly gestational diabetes. People with diabetes want to talk with their diabetes health professionals about the emotional side of living with and managing diabetes. These findings support the integration of routine monitoring and psychological support into clinical practice. Health-care policy makers should ensure that diabetes health-care professionals are well equipped to discuss mental health and refer to appropriate digital health tools and mental health specialists when needed.

Pediatric patients with in-remission inflammatory bowel disease (IBD) often report persistent gastrointestinal symptoms, suggesting a potential overlap with disorders of gut-brain-interaction (DGBIs). While DGBIs affect up to 40% of the general population, their prevalence in quiescent IBD children remains limited. We aimed to evaluate the prevalence and distribution of DGBIs, based on Rome-IV criteria, in children with quiescent IBD compared to healthy controls, identifying demographic, clinical and therapeutic factors associated with DGBIs.

In this multicenter, prospective, controlled study, in-remission IBD pediatric patients and healthy controls were enrolled completing the Rome IV-Questionnaire. IBD-remission was defined by pediatric ulcerative colitis activity index (PUCAI)/pediatric Crohn's disease activity index scores < 10, normal inflammatory markers and recent endoscopic mucosal healing.

Forty-one pediatric patients with IBD in remission and 179 healthy controls were enrolled. DGBIs were found in 41.46% of IBD-patients versus 27.93% of controls (p = 0.089). Functional Dyspepsia was significantly more prevalent in IBD patients (p < 0.001), while irritable bowel syndrome was more frequent among controls, though not significantly (p = 0.466). No differences in DGBI prevalence emerged between Crohn's disease and ulcerative colitis (p = 0.54). At the multivariate analysis, psychological comorbidities (odds ratio [OR] 40.767, p < 0.001) and low weight (0.953, p ≤ 0.001) were significantly associated with DGBIs. Notably, 5-aminosalicylic-acid (ASA) administration was associated with reduced DGBIs likelihood (OR 0.139, p = 0.005).

In our cohort, the overall DGBIs prevalence was numerically but not significantly higher in quiescent-IBD patients compared to controls, while upper gastrointestinal DGBIs were significantly more frequent in IBD patients. Psychological and nutritional factors emerged as strong predictors of DGBIs, while 5-ASA may be associated with lower likelihood of DGBIs.

Background The Additional Roles Reimbursement Scheme (ARRS) launched in England in 2019 to expand the multidisciplinary primary care workforce, but its impact on workload since implementation is unclear. Aim To examine changes in workload complexity associated with ARRS implementation. Design and Setting Longitudinal cohort study used the Clinical Practice Research Datalink (CPRD) AURUM. We analysed 3,530,628 consultations involving General Practitioners (GPs), nurses, or direct patient care (DPC)-ARRS roles for 420,986 patients from 369 English practices in 2018 and 2021. Methods Multilevel logistic regression assessed associations between 17 patient and consultation complexity factors and being seen by a DPC-ARRS role, adjusting for year, age, sex, region, deprivation, and consultation mode. Results Complex consultations with DPC-ARRS-eligible roles increased from 15.8% in 2018 to 18.8% in 2021. Diagnostically capable ARRS roles were more likely than GPs to conduct the first consultation after diabetes diagnosis (OR=1.4, 95%CI=1.3-1.6) and consultations with ≥2 preventive tasks (OR=5.7, 95%CI=5.5-5.8), but less likely to manage chronic pain (OR=0.9, 95%CI=0.8-1.0), dementia (OR=0.4, 95%CI=0.3-0.4), mental illness (OR=0.4, 95%CI=0.3-0.4), learning disabilities (OR=0.3, 95%CI=0.3-0.4), consultations with ≥3 medicines prescribed (OR=0.6, 95%CI=0.5-0.6), consultations resulted in emergency admission (OR=0.7, 95%CI=0.6-0.9), and consultations with ≥2 diagnoses coded (OR=0.5, 95%CI=0.5-0.5). Patients with interpreter needs (OR=1.2, 95%CI=1.1-1.3), recent homelessness (OR=1.4, 95%CI =1.1-1.7) or ≥3 long-term conditions (OR=1.1, 95%CI=1.1-1.1) were more likely to be seen by diagnostic ARRS staff. Conclusions Following ARRS implementation, primary care activity was delivered by a broader workforce managing increasingly complex care. Further research should assess the safety, quality, and system impacts of ARRS roles.

Few studies have investigated the association between ambient temperature and the risk of mental disorders in Japan. In this study, we investigated a short-term association between the risk of hospitalizations for mental disorders and ambient temperature using municipal health insurance data.

We used the data of the Longevity Improvement & Fair Evidence Study in Japan, and the data of 17 municipalities were employed in the analysis. The daily number of hospitalizations for schizophrenia, depressive disorders, and anxiety disorders was used as the outcome variable. The time-stratified case-crossover design was employed in this ecological time-series study, and a distributed-lag non-linear model using a conditional quasi-Poisson regression model was employed to investigate an association between ambient temperature and hospitalizations for the abovementioned mental disorders. The model was applied to each municipality, and a multivariate meta-analysis was conducted to pool the results of municipalities. In addition, subgroup analyses by sex and age groups were conducted, and temperature-related attributable fractions of the mental disorders were also calculated.

The results of the overall cumulative effect of ambient temperature on hospitalizations for mental disorders indicated that the risk ratio (RR) tended to increase with an increase in temperature regardless of the type of mental disorder. An analysis by sex indicated that the RR tended to increase with an increase in temperature regardless of sex. In addition, an analysis by age group indicated that an increase in RR with increasing temperature was more evident in persons aged <65 years compared to those aged ≥65 years regardless of mental disorders, and that the temperature-related attributable fractions were also higher in persons aged <65 years.

Higher temperatures were associated with a higher risk of hospitalization for mental disorders in Japan, while the degree of the association differed by age group.

Identifying early markers for autism spectrum disorder (ASD) is a clinical priority. This study investigated interpersonal affect synchrony (IAS) as a measure of interactional quality in a longitudinal cohort of 90 high-risk infants. We aimed to disentangle its contribution from mutual gaze and identify data-driven social interaction profiles linked to sensory traits. Parent-infant interactions were recorded at 6-18 months; IAS was quantified using Cross-Recurrence Quantification Analysis, and ASD outcomes were determined at 18-24 months. Infants later diagnosed with ASD (n = 25) showed significantly lower IAS (F(1,84) = 5.89, p FDR = 0.023) and synchrony stability (F(1,84) = 5.37, p FDR = 0.023) than non-diagnosed infants (n = 65), yet the groups did not differ in mutual gaze (p = 0.200). Logistic regression analysis further showed that IAS (OR = 0.561, p FDR = 0.038) and synchrony stability (OR = 0.013, p FDR = 0.038) both significantly predict clinical outcome. K-means clustering revealed three profiles: "High Gaze-High Synchrony," "Mid Gaze-Low Synchrony," and "Low Gaze-High Synchrony." The "Mid Gaze-Low Synchrony" profile was significantly associated with a later ASD diagnosis (p adj = 0.031), while the "Low Gaze-High Synchrony" profile was linked to higher sensation-seeking traits (p adj = 0.028). The quality of parent-infant affective connection is a more robust early marker for ASD than the quantity of mutual gaze. These findings reveal critical heterogeneity, identifying a high-risk "gaze without engagement" pattern and a potential adaptive pathway to synchrony, underscoring the need for individualized strategies in early screening and intervention.