Psychiatric disorders display high levels of comorbidity and genetic overlap^1,2, challenging current diagnostic boundaries. For disorders for which diagnostic separation has been most debated, such as schizophrenia and bipolar disorder³, genomic methods have revealed that the majority of genetic signal is shared⁴. While over a hundred pleiotropic loci have been identified by recent cross-disorder analyses⁵, the full scope of shared and disorder-specific genetic influences remains poorly defined. Here we addressed this gap by triangulating across a suite of cutting-edge statistical and functional genomic analyses applied to 14 childhood- and adult-onset psychiatric disorders (1,056,201 cases). Using genetic association data from common variants, we identified and characterized five underlying genomic factors that explained the majority of the genetic variance of the individual disorders (around 66% on average) and were associated with 238 pleiotropic loci. The two factors defined by (1) Schizophrenia and bipolar disorders (SB factor); and (2) major depression, PTSD and anxiety (Internalizing factor) showed high levels of polygenic overlap⁶ and local genetic correlation and very few disorder-specific loci. The genetic signal shared across all 14 disorders was enriched for broad biological processes (for example, transcriptional regulation), while more specific pathways were shared at the level of the individual factors. The shared genetic signal across the SB factor was substantially enriched in genes expressed in excitatory neurons, whereas the Internalizing factor was associated with oligodendrocyte biology. These observations may inform a more neurobiologically valid psychiatric nosology and implicate targets for therapeutic development designed to treat commonly occurring comorbid presentations.

Financial challenges are a significant issue navigated by family caregivers of individuals across the lifespan due to employment challenges and costs of caregiving, yet there are no scoping reviews to summarise financial interventions for family caregivers. The purpose of this scoping review is to understand the nature and effect of financial interventions for family caregivers. This study used the Arksey and O'Malley framework to conduct a scoping review. A systematic search for articles across multiple databases and grey literature was conducted. Articles published from 1997 to September 2024 were included for the review. After the title, abstract and full-text review, 11 studies of 2774 remained for data extraction. Data from articles were extracted and summarised for financial intervention nature, scope, measurement, effect and health system context. Ten articles and one dissertation synthesising findings from randomised controlled trials, quasi-experiments and one natural experiment were included. Financial interventions ranged from embedded supports in larger programmes (n=8) to stand-alone initiatives (n=3) across diverse health conditions and economic contexts. Some studies noted improvements in mental health, caregiver preparedness and cost-effectiveness. Direct measurement of income or perceived financial well-being was not assessed as an outcome. Findings suggest diverse approaches for financial interventions with an opportunity for more direct assessment of financial outcomes. Palliative care team members can use these findings to build interventions and initiatives that address the financial needs of family caregivers.

Background: Artificial intelligence (AI) offers promising solutions for nurse practitioner education, especially in addressing challenges related to evaluating Objective Structured Clinical Examinations (OSCEs), such as examiner bias and delayed feedback. AI tools employing natural language processing and generative AI have the potential to enhance the accuracy and efficiency of clinical assessments. Objective: This product evaluation was conducted to determine whether AI-generated OSCE assessments align with faculty evaluations. Methods: A descriptive correlational design was used to assess product acceptability, feasibility, and agreement between AI and faculty assessments. A convenience sample of 13 nurse practitioner students was randomly divided into either a traditional evaluation group or an AI-assisted group. The AI-generated transcripts were scored using the same rubric used by faculty, and agreement was measured with Spearman's correlation, Cohen's Kappa, and interrater reliability percent agreement (IRR%). Results: Spearman's correlations ranged from negligible to moderate, with the highest in the physical/mental health exams category (r = .54, p < .05). However, Cohen's Kappa (.14-.41) and IRR% (31%-54%) showed weak agreement. Conclusions: These results suggest that AI feedback was inconsistent with faculty assessments, possibly due to technical issues and limitations in the rubric. Despite these limitations, this product evaluation demonstrated that the AI tool was easy to use and that faculty believed it could improve feedback quality. Implications for Nursing: These findings underscore both the promise and the current limitations of AI-supported clinical assessment. With thoughtful attention to these shortcomings, the ease of integration and capacity for enhanced learning offered by AI tools can help advance clinical competence and foster excellence in nurse practitioner and doctoral nursing education.

Mental disorders occur frequently in physicians owing to overwork and poor psychosocial work environment. This study aimed to investigate the circumstances, characteristics, and background factors affecting mental disorders in physicians. Basic data such as sex, age at onset, alive or dead, occupation, name of disease, industrial accident recognition factors, load factors other than working hours, and overtime hours (for 31 cases of mental disorders and suicides for 11 years from 2010-2020) were obtained from the Japan Research Center for Overwork-Related Disorders database. The results showed 13 cases of suicide (41.9%) and 21 cases of mood disorders (67.7%). As for the factors recognized as industrial accidents, "extreme long working hours" related to overwork accounted for 6 cases (20.7%), and "quantity and quality of work" accounted for 27 cases (93.1%). Furthermore, clinical residents comprised 14 cases (45.2%) of the 31 mental disorder cases and 7 cases (53.8%) of the 13 suicide cases. Therefore, measures to prevent overwork and suicide in clinical residents are urgently needed in the context of mental disorder in physicians.

Substance use disorder (SUD) is a polygenic psychiatric condition characterized by persistent drug use despite negative consequences. Several studies support that higher cognitive performance and educational attainment (EA) are associated with a reduced risk for SUD. Here, we aimed to understand better the genetic relationship between EA and SUD, using a general addiction risk-factor (addiction) as a proxy of SUD.

We used GWAS summary statistics on EA (n = 766 345) and addiction (n = 647 703) and applied a multistep approach to: (i) examinate the genetic overlap between EA and addiction; (ii) test the polygenic contribution of addiction and EA on SUD diagnosis and its clinical heterogeneity in an independent in-house clinical sample (1427 individuals with SUD and 2309 controls); and (iii) dissect the genetic liability of addiction according to its role in EA and assessing its genetic overlap with SUD-related traits, other mental disorders and behavioral traits.

We confirmed a negative genetic correlation between addiction and EA [r_g = -0.33, standard error (SE) = 0.02, P = 1.14e-57]. When we dissected the genetic liability of addiction by its relationship with EA we found that the discordant overlapping variation between addiction and EA, highly enriched for the genetic background of addiction (h² _SNP = 2.42%, P = 6.37e-21), showed the strongest effect on SUD (OR = 1.66, 95% confidence interval = 1.54-1.79, P = 2.01e-40) and was associated with worse sociodemographic, health and SUD-related outcomes in individuals with SUD compared with the other genomic partitions studied.

Our results provide new evidence on the shared genetic basis between addiction and educational attainment. By separating the genetic liability of addiction according to its relationship with educational attainment, we were able to clarify its polygenic effects on substance use disorder diagnosis and related outcomes, providing novel insights into the shared genetic signatures between addiction and other comorbid traits.

One important way to ensure quality and standardization of medicolegal death investigation is medical examiner/coroner (ME/C) office accreditation. The two existing accrediting bodies for ME/C offices (National Association of Medical Examiners and International Association of Coroners and Medical Examiners) both specify autopsy caseload limits as part of accreditation standards; however, no such benchmark staffing number exists for medicolegal death investigators (MDI) in office accreditation standards. This pilot study assesses which model for MDI staffing is preferred as an accreditation item, subjective job stressors, typical MDI job tasks, and whether other "workload" complexity factors should be considered for MDI staffing in future accreditation standards. Results from 333 total respondents in an online questionnaire show: (1) the vast majority favor MDI workload standards, (2) the majority indicate the standards should be based on either jurisdiction population, the number of cases investigated by the office, or by the number of ME/C deaths in the jurisdiction, (3) MDI jobs require "extensive mental effort," (4) MDIs have feelings of workplace anxiety, stress, and a marked need for situational self-control, and (5) workload considerations for indirect investigative activities and individual case complexity for non-natural deaths should be considered when developing MDI workload staffing standards.

The current study examined predictors of posttraumatic stress (PTS) and general distress symptoms following two campus-wide "armed and dangerous person" lockdowns at the University of North Carolina at Chapel Hill. Participants (N = 287) completed baseline surveys four weeks post-lockdowns, with 115 participating in follow-ups over seven months. Utilizing the cognitive model of PTSD, we investigated posttraumatic cognitions, anxiety sensitivity (AS), and prior trauma as predictors of PTS and general distress. Results revealed that higher initial posttraumatic cognitions and AS were associated with greater PTS and distress symptom severity. Interestingly, elevated posttraumatic cognitions predicted a faster reduction in PTS symptoms over time, while AS effects remained stable. Prior trauma did not significantly predict outcomes. These findings highlight the roles of specific cognitive factors in shaping responses to trauma and emphasize the potential for targeted interventions to mitigate symptoms following collective stressful events.

Chronic hassles in life are a well-established stressor, and stress is a recognized risk factor for major depressive disorder (MDD). While psychological resilience is increasingly recognized as a protective factor against MDD severity and relapse, existing research focuses mainly on major life events and lacks a nuanced understanding of daily stressors.

This research aims to clarify the role of psychological resilience in the complex interplay among daily hassles, perceived stress, and depression severity.

We investigated 220 MDD patients (average age 37.85 years; 83 males, 137 females) using validated questionnaires: the Resilience Scale for Adults (RSA), the Chinese 14-item Perceived Stress Scale (CPSS), the Daily Hassles Scale (DHS) and the Hamilton Depression Rating Scale (HDRS-17).

A correlation analysis revealed that RSA correlated negatively with DHS, CPSS, and HDRS-17scores, while DHS showed positive correlations with CPSS and HDRS-17 scores. Serial mediation analysis revealed a significant direct effect (β = .348, p < .05, 95 % CI [.054, .641]) and an indirect effect (β = .806, 95 % CI [.694, 1.072]) of daily hassles on depression severity, mediated by perceived stress and resilience.

This study revealed the intricate relationships among daily stressors, perceived stress, and resilience in patients with MDD. Notably, perceived stress levels and psychological resilience jointly mediate the impact of daily hassles on depression severity, emphasizing the crucial role of psychological resilience in mitigating the adverse effects of stress. These findings inform the development of targeted prevention and intervention strategies to enhance resilience and alleviate depressive symptoms in MDD patients.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition involving obsessions/compulsions, with genetic and epigenetic mechanisms implicated in its pathophysiology. We describe a novel Danish case-control cohort (138 cases, 151 controls) designed to investigate epigenetic risk factors for OCD. Mental health assessments included parts of the K-SADS-PL and CYBOCS, alongside clinical and familial histories. Blood genome-wide DNA methylation (DNAm) was profiled using Illumina's EPIC array at birth/adolescence. Epigenome-wide association analyses identified several differentially methylated regions (DMRs) associated with OCD (Šidák-adjusted p < 0.05), including three DMRs replicated at both developmental stages. These were annotated to genes ZFP57 and PIWIL1, previously linked to OCD, and POU6F2, associated with schizophrenia and autism. Direction of DNAm change was consistent across time points. Our data suggests that differences in DNAm levels in genes implicated in mental illness are associated with OCD diagnosis, and that some of these epigenetic signals can be detected both at birth and adolescence.