Although individuals with psychosis represent a minority of homicide perpetrators, they are overrepresented in 'overkill' cases, yet little is known about the characteristics of this specific group.

To describe the characteristics of people with psychosis who not only kill another person but also use far more force than necessary to do so.

A 10-year cross-sectional clinical chart review was conducted at two major forensic psychiatry centres in Türkiye found 183 homicide perpetrators with psychotic illness whose index offences met overkill criteria, operationalised as the infliction of violence beyond that necessary to cause death. Data on background, clinical and homicide-related factors were analysed and an exploratory cluster analysis was performed.

Almost all (91%) perpetrators were men, with a mean age of 38 years and long-standing illness with impaired psychosocial functioning and prior psychiatric contact. Most usually the victim was a relative, killed in a private indoor setting with a sharp weapon, easily to hand, when the perpetrator was experiencing active psychotic symptoms. Cluster analysis confirmed two distinct subgroups: this psychosis-dominant/domestic type, but also a smaller externalising/premeditated type, these perpetrators characterised by more planning and much greater likelihood of prior involvement with crime and/or substance use and targeting peers rather than family.

The profile of overkill perpetrators with psychotic illness largely resembles that of people with psychosis who kill without excessive violence, but the identification of two distinct subgroups highlights important heterogeneity within this population. Given that the perpetrators had almost all been known to mental health services at some point, these findings should help focus assessments and guide risk management approaches, which, particularly for the domestic attacks, may include environmental strategies.

To evaluate whether the combination of exercise and intra-articular injection (IAI) effectively improves pain, function, and quality of life in patients with knee osteoarthritis (OA) compared to any control group in the short, medium, and long term through a systematic review.

A comprehensive search strategy was applied in the databases Embase, PubMed, MEDLINE, CENTRAL, CINAHL, and PEDro. Inclusion criteria focused on randomized controlled trials examining the effects of exercise combined with IAI in patients with knee OA, with outcomes assessed at short-, medium-, and long-term follow-ups. The primary outcomes were pain and function. The quality of the evidence was evaluated using the GRADE system.

Eleven studies, comprising 802 participants, were included. All studies investigated the combination of IAI and exercise. A statistically significant difference in pain was observed: in the short and medium term, the Botulinum toxin IAI group demonstrated superior pain reduction compared to the Hyaluronic acid IAI group (MD -1.32, 95% CI -2.20 to -0.44 and MD -9.09, 95% CI -13.16 to -5.01, respectively). In the medium term, Saline IAI was more effective than Corticosteroid IAI (MD 1.99, 95% CI 0.49 to 1.90). Regarding function, Saline IAI outperformed IAI with any medication in the short term (MD 0.50, 95% CI 0.20 to 0.79). In terms of quality of life, the Corticosteroid IAI group demonstrated superior physical function and mental health outcomes compared to the Saline IAI group in the medium term (MD -0.43, 95% CI -0.77 to -0.08 and MD -0.38, 95% CI -0.76 to -0.01, respectively). In the long term, physical function improved more with IAI combined with exercise compared to exercise alone.

Given the very low quality of the evidence, it is not possible to definitively conclude that the combination of IAI and exercise is more effective than IAI or exercise alone in patients with knee OA. Further high-quality studies are needed to establish more definitive conclusions.

The International Prospective Register of Systematic Reviews (PROSPERO): CRD42021277729.

Not applicable.

Evidence shows that grandchild care can affect grandparents' mental health. However, whether the grandparent's age, grandchild's age, continuity of care, number of grandchildren, and number of hours per caregiving can be involved in this connection is unclear. The present study investigated the relationship between grandparents' depression and dimensions of grandchild care. The present study was a cross-sectional study, where the studied population included grandparents aged 50-70 and having at least one grandchild aged 12 years or less. 432 cases were included in the study by multi-stage random sampling method. Demographic information questionnaire, which includes demographic questions and questions related to grandchild care, the Geriatric Depression Scale (GDS-15), and the short form of the Beck Depression Inventory (BDI-S) were used to collect information. Data analysis was done using non-parametric tests and SPSS version 26 software. The average age of the participants was 60.00 ± 5.416. In the age group of 50 to 59 years, no significant relationship was observed between taking care of a grandchild and depression, while this relationship was significant in the age group of 60 to 70 years (p = 0.022); the average depression scores in the group that took care of a grandchild was significantly higher. Furthermore, a significant relationship was found between the age of each grandchild under care and the depression status of the participants. Further investigations in the age group of 50 to 59 years old revealed that the average scores of depression in the group who cared for a grandchild of three to six years old were significantly higher (p < 0.001). Long-term care of grandchildren in non-elderly grandparents is less threatening to their mental health. However, it can be associated with depression in older adults.

Multiple sclerosis (MS) diagnosis relies on identifying disease episodes disseminated in space and time, and excluding other disease explanations. MS is a genetically complex autoimmune and neurodegenerative disorder that shares features with some monogenic progressive neurological conditions. The extent to which people diagnosed with MS have an alternate diagnosis (MS mimic), or genetic multimorbidity is unknown. Additionally, the burden of rare variation associated with MS risk and severity in monogenic neurological disease genes has not been evaluated. We investigated the prevalence of disease-causing variants in progressive neurological disease genes, and their contribution to MS risk and severity, in 4,340 MS cases diagnosed in sub-speciality clinics in Australia and New Zealand, and in 2,861 local controls.

Exome sequencing and array-based genotyping data were analysed for 1,680 genes with pathogenic or likely pathogenic variants reported in ClinVar. Clinical history reviews of MS cases with putative disease-causing variants were conducted. We specifically examined the contribution of rare, likely deleterious variants in a subset of 30 hereditary spastic paraplegia (HSP) genes in 421 individuals with progressive onset MS (POMS). Gene-based association tests with MS risk and severity were performed for all genes in the cohort.

We identified 166 MS cases (3.82%) with variants prompting clinical history reviews, and of 75 cases reviewed, four (0.13% of all cases) had either genetic multimorbidity in addition to MS or a potential misdiagnosis. In contrast to previous findings we observed no enrichment of likely deleterious variants in HSP genes in POMS, nor did we find significant associations between neurological disease genes and MS risk or severity.

Our findings suggest that rare deleterious genetic variation in progressive neurological disease genes does not play a substantive role in MS risk or severity, and that misdiagnosis is exceedingly rare in this cohort. Consequently, among individuals diagnosed with MS by a specialist, a very small proportion may benefit from clinical genomic testing to inform MS diagnosis or an alternate diagnosis, which could have implications for healthcare management.

Unconscious bias refers to automatic, implicit attitudes or stereotypes that influence our understanding, decisions, and actions without our conscious awareness. It is recognised as a significant problem in healthcare contributing to disparities in treatment. To date it remains unclear how unconscious bias towards patients develops among health professionals. One hypothesis is that such bias is acquired during education, either through teaching content or by observing other health professionals interacting with patients and adopting their behaviour. We investigated whether health care students show an unconscious bias and whether there are indications that it develops during their professional education.

We conducted a factorial survey experiment with bachelor's and master's students enrolled in various health professions' programmes. Unconscious bias was assessed using three written vignettes describing clinical situations involving patients. Participants were asked to evaluate their likelihood of helping immediately, expected patient adherence, and expected quality of the patient relationship. Vignette dimensions contained common sources of bias that were experimentally manipulated: gender, age, socio-economic status, migration status, diagnosis (physical or mental illness), and sexual orientation. Multivariable regression models were used to estimate the causal effects of patient characteristics on vignettes on students' responses. Additionally, an Implicit Association Test (IAT) on unconscious bias regarding homosexuality was used to measure implicit bias. Explicit attitudes were assessed via self-report.

A total of 470 students (response rate 21.5%) participated. Vignette analysis showed no differences in stated helping intention, adherence expectations, or relationship assessments with regard to patient characteristics such as gender, age, socio-economic status, foreign name, sexual orientation or diagnosis. No systematic differences were observed for subgroups of participants such as year of study, programme type, prior work experience, or reported exposure to bias behaviour by health care staff. Similarly, IAT results indicated no overall bias towards homosexuality.

We found no evidence of systematic unconscious bias among students' helping intentions, expected patient adherence, and expected patient relations across various patient characteristics. Comparisons across study years and programs provided no indication that such biases emerge or intensify during training. If replicated, these results would be encouraging, as it indicates an absence of unconscious bias in health care students.

Geriatric patients undergoing oral and maxillofacial surgery are at high risk of delayed neurocognitive recovery (dNCR), yet reliable predictive tools remain unavailable.

This prospective cohort study (July 2021-January 2025) enrolled patients aged ≥ 65 undergoing elective oral and maxillofacial surgery under general anaesthesia. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed at baseline and postoperative 1, 3, 7, and 30 days. Serum lipidomics analysis via liquid chromatography-mass spectrometry was performed preoperatively and 24 h postoperatively. The predictive performance of lipid metabolites for dNCR was assessed using receiver operating characteristic curve analysis, with their independent association further evaluated by logistic regression.

Among 160 patients, 52 patients (32.5%) developed dNCR. Preoperatively, dNCR patients exhibited significantly lower serum triglyceride (TG), particularly TG(58:7/22:5) (OR = 0.014, 95% CI 0.002 to 0.109, adjusted P < 0.001) and TG(54:2/18:1) (OR = 0.051, 95% CI 0.010 to 0.252, adjusted P = 0.002), which demonstrated strong predictive performance (AUC = 0.86, sensitivity = 0.73, specificity = 0.85). Postoperatively, reduced levels of TG(58:7/22:5) (OR = 0.067, 95% CI 0.015 to 0.309, adjusted P = 0.003) and TG(54:2/18:1) (OR = 0.034, 95% CI 0.006 to 0.176, adjusted P < 0.001) persisted in dNCR patients at 24 h, retaining predictive value for dNCR (AUC = 0.82, sensitivity = 0.75, specificity = 0.78).

Low serum TG(58:7/22:5) and TG(54:2/18:1) are promising biomarkers for early prediction of dNCR, supporting lipidomics-guided perioperative neurocognitive risk stratification.

Disordered eating behaviors (DEBs), including restrictive eating, binge eating and purging, are associated with mental health problems and an increased risk of eating disorders (EDs), which often occur in adolescence and can have serious health consequences. In addition, the increasing rates of overweight and obesity among children and adolescents raise concerns about their associated physical and mental health risks. Attentional biases (ABs) to food- and body-related cues have been proposed as cognitive mechanisms that contribute to the development and maintenance of EDs and are also discussed in the etiology of overweight and obesity. While theoretical models suggest that ABs may contribute to the maintenance of EDs, DEBs, and obesity, empirical evidence in young populations is still limited.

This systematic review (PROSPERO: CRD42023399292) examined literature from PsycINFO, PubMed, and Scopus on ABs to food- and body-related stimuli in children and adolescents with overweight, obesity, or ED symptoms, compared to healthy comparisons. A total of 30 peer-reviewed studies published in English since 2003 were included.

The evidence on AB for food in young people with overweight and obesity remains inconclusive, and studies provide conflicting results. Similarly, studies in adolescents with AN show heightened attention to low-calorie foods and inconsistent attentional patterns toward high-calorie foods, indicating a complex and heterogeneous picture. Evidence on AB for food in young people with BED is scarce, with one study reporting an attentional bias towards food. For LOC eating, findings were mixed and less conclusive. This suggests that body-related AB may serve as a relevant marker for the psychopathology of EDs, particularly in AN.

This review underscores the role of ABs in EDs and overweight/obesity and highlights methodological inconsistencies as well as research gaps, particularly in samples beyond AN and overweight/obesity. Future studies should therefore employ standardized methods, diverse samples, and developmental perspectives to improve understanding of AB in the etiology of these pathologies and inform targeted interventions for at-risk youth.