Overmedicalisation in the treatment of mental health problems occurs when normal emotional responses are inappropriately framed as disorders requiring primarily pharmacological intervention, or when social and environmental contributors to distress are overlooked in favour of a narrowly biological model. Critically, this risk is not confined to biological psychiatry: psychotherapeutic models are equally capable of framing ordinary human distress as requiring professional intervention. Evolutionary psychiatry (EP) broadens the scope of the standard biopsychosocial model to consider both individual level (ontogenetic) and species level (phylogenetic) development of emotional and psychological phenomena and associated behaviours. By understanding that many psychiatric symptoms, such as anxiety, low mood and hypervigilance, have phylogenetic roots as adaptive responses to ancestral environments, clinicians can better distinguish between normal variation and disabling or disorder-level pathology. EP also illuminates how mismatches between evolved psychological mechanisms and modern environments contribute to distress, suggesting non-pharmacological interventions may often be more effective. At the same time, the evolutionary criterion for distinguishing disorder from normal variation - while scientifically grounded - has limited utility in clinical practice, where cultural trends can push judgement towards either overmedicalisation or diagnostic nihilism. In this paper, we outline how an evolution-informed perspective can inform clinical reasoning, promote diagnostic discernment, and support a holistic, evobiopsychosocial approach to the prevention and treatment of psychiatric illness.

The recent classification of mental health establishments under the Mental Healthcare Act, 2017, is based largely on institutional affiliation. This viewpoint proposes a care-level-based classification comprising acute, intermediate, and rehabilitation services. Such an approach may better reflect clinical needs, support service planning, and align with the objectives of the Mental Health Care Act.

War-related mass trauma and large-scale terrorist attacks disproportionately affect clinically vulnerable adolescents, exacerbating self-harm and suicidality while burdening under-resourced public mental health systems. This study evaluated the feasibility and preliminary efficacy of a parent-only Dialectical Behavior Therapy (DBT) skills group within routine care. We hypothesized that the parent-only DBT skills group would be associated with improved parental emotion regulation, decrease helplessness and family conflict, and indirectly reduce adolescent risk behaviors.

A 20-session DBT group was delivered to 41 parents of 32 adolescents aged 12-18 presenting with severe emotion dysregulation, self-harm behaviors, and/or a history of suicide attempts. Parental outcomes were assessed at baseline, post-intervention, and 3-month follow-up; adolescent clinical improvement was rated using the CGI-S 3-6 months post-treatment. Adolescent clinical severity was evaluated using the CGI-S, rated by independent clinical assessors fully blinded to participant identity, assessment time points, and duplicate cases.

Of the 43 parents who began the parent-only DBT skills group, 41 (95.3%) completed the intervention. Intervention participation was associated with significant reductions in parental helplessness and family power struggles. These family-level improvements coincided with clinician-rated global clinical improvement among adolescents at 3-6 months post-treatment.

Findings support the feasibility and scalability of a targeted, parent-focused DBT adaptation. This model offers a viable clinical model for overburdened public mental health systems treating high-risk adolescents, and may be especially relevant during ongoing war and collective trauma, when clinical needs intensify while resources remain limited.

Epidemiological data indicate that the prevalence of depression among young people (YP) is increasing. Although evidence-based interventions are effective for many, 20 to 40% fail, and relapse is common. This study focused on second-line treatments. Modifying psychological processes that predispose individuals to treatment failure or relapse necessitates the development of interventions, but their evaluation depends on a clear understanding of current practice to enable meaningful comparison and assessment of effectiveness. We explored treatment as usual (TAU) for YP receiving support for depression in a two-site pilot, feasibility trial comparing Mindfulness for Adolescents and Carers (MAC) and TAU against TAU in UK Child & Adolescent Mental Health Services (CAMHS). Qualitative data were collected via interviews with senior managers and case-managing clinicians. Quantitative data were gathered through Treatment Recording Sheets completed by clinicians and a clinical service audit. Data were synthesised across sites to provide a comprehensive description of TAU, informing the design of a future definitive trial of MAC. Despite site-level variation in service delivery, key components and processes of CAMHS TAU were identified. Typical pathways included referral and intake; waiting/supportive provision; first- and second-line treatment/s; discharge and re-referral; and crisis support. Care coordination emerged as the most common second-line provision and was provided to YP in both trial arms. Participants received varied combinations of support; those allocated to MAC received less CAMHS input than those allocated to TAU. There is substantial variability in service provision for YP experiencing depression. Future studies should compare treatment plus care coordination with TAU.

The online version contains supplementary material available at 10.1007/s44250-026-00412-0.

Perioperative psychological distress may affect surgical recovery, yet evidence specific to urological and genitourinary procedures remains fragmented. These procedures can affect urinary control, sexual function, genital integrity, body image, and long-term self-management. This scoping review mapped reported mental health problems, associated risk factors and supportive interventions, and examined their implications for perioperative care pathways.

This scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Embase, Web of Science, ScienceDirect, PsycINFO, and CINAHL were searched for English-language studies published from January 2000 to May 2026. Two reviewers independently screened the studies and charted the data, and the findings were synthesized descriptively using evidence mapping.

Forty-four studies were included. Most evidence came from adult oncological populations, and observational designs predominated. The heterogeneous evidence could be organized into a provisional staged pattern comprising preoperative concerns related to uncertainty and fear, early postoperative concerns related to pain, sleep, and device adaptation, and longer-term concerns related to urinary, sexual, body-image, and social adjustment. Longer-term distress was concentrated in selected subgroups and was commonly linked to urinary diversion, incontinence, sexual dysfunction, altered genital anatomy, body-image concerns, social constraints, limited support, self-perceived burden, and prior mental health vulnerability. Reported supportive approaches included prehabilitation, structured education, multidisciplinary or pathway-based care, digital and virtual reality strategies, transcutaneous electrical acupoint stimulation, multimodal analgesia, and opioid stewardship.

The available evidence remains heterogeneous and largely observational. These findings identify candidate components for the future development and prospective evaluation of perioperative mental health pathways, including repeated assessment, structured education, family-inclusive support, and referral mechanisms.

Body image (BI) is a complex construct that broadly encompasses the myriad of psychological experiences associated with living an embodied life. Despite this, body image and mental health research has often been narrowly focused on body image disturbance in the context of eating disorders. BI has been linked to other mental health concerns, yet no review to date has summarized and integrated these findings. Therefore, the present paper provides a comprehensive, state-of-the-science review of the relationship between BI and mental health concerns. Significant research indicates that negative BI is generally associated with worsened mental health and wellbeing, although it is frequently unclear if BI disturbance causes or results from mental health concerns. Notably, the existing literature is severely limited by a lack of longitudinal research and studies that are designed to investigate potential bidirectional relationships between BI and psychopathology. Nonetheless, research suggests that improving BI has the potential to positively impact individuals in many domains and across many diagnoses; thus, longitudinal research is urgently needed to elucidate pathways between BI and mental health and wellbeing. Also discussed are limitations in our understanding of BI among historically underrepresented communities. Finally, we propose adjustments needed to close this research gap and to better serve these communities.

Environmental pollution has emerged as one of the biggest threats to health in the contemporary world. Pollutants modify immune responses and may induce immunotoxicity. In this review, we describe the impact of significant environmental pollutants on the innate immune system, including ozone (O₃), particulate matter (PM), diesel exhaust particles (DEPs) and cigarette smoke (CS), as well as emerging pollutants such as chemical contaminants, nanomaterials, and microplastics, with a particular focus on the regulatory mechanisms of innate lymphoid cells (ILCs). ILCs, tissue-resident lymphocytes without antigen-specific receptors, have been demonstrated to be essential regulators linking environmental detection and immunological responses. Studies indicate that environmental pollutants activate ILCs and alter the immune responses by compromising the epithelial barrier and triggering the release of alarmins, including interleukin (IL)-33, IL-25, and thymic stromal lymphopoietin (TSLP). Among ILCs, group 2 innate lymphoid cells (ILC2s) are highly sensitive to pollutant-induced epithelial signals and play a critical role in type 2 inflammation. Beyond canonical alarmin signaling, accumulating evidence indicates that environmental pollutants regulate ILC2 biology thereby contributing to immune dysregulation and inflammatory diseases. A better understanding of how environmental pollutants regulate ILC2 activation, plasticity, and functional adaptation will facilitate the development of more precise preventive and therapeutic strategies for pollution-associated diseases.

To characterize the transabdominal ultrasound (US) features of pancreatic serous cystic neoplasm (SCN) morphological subtypes, evaluate US-MRI agreement, and explore reducing overtreatment.

This retrospective study included 125 patients with pathologically confirmed pancreatic SCNs who underwent preoperative US. Lesions were morphologically classified into macrocystic, microcystic, mixed, and solid subtypes. US-MRI concordance (71 patients, 56.8%) was assessed using Cohen's kappa. Demographics, grayscale features, and CEUS patterns (exploratory n = 14) were described.

US demonstrated excellent agreement with MRI for SCN subtyping (κ = 0.817, 95% CI: 0.711-0.923). Macrocystic was most common (38.4%) and occurred in younger patients (42.0 ± 12.3 years, p < 0.001). Overall, exophytic growth (84.1%) was a hallmark feature. Mixed subtypes exhibited the highest lobulation rate (p < 0.001) and peripheral macrocysts, whereas solid subtypes were predominantly non-lobulated. US and MRI discrepancies arose when microcysts were too small to resolve on US, mimicking solid. On CEUS, microcystic SCNs showed honeycomb architecture, whereas solid SCNs demonstrated arterial iso- or slight hyper-enhancement followed by slow washout.

Conventional US provides reliable morphological subtyping of SCNs, comparable to MRI. Recognizing fine internal architectures, distinctive growth patterns (exophytic/lobulated), and the potential value of slow CEUS washout patterns may aid in the characterization of SCNs and provide supportive information for differential diagnosis. Given that most SCNs are benign and do not require routine intervention, improved non‑invasive characterization by US can help inform clinical decision‑making and potentially reduce surgical overtreatment.

To develop and validate mapping algorithms that estimate EQ-5D health state utility values (HSUVs) from two diabetes-specific patient-reported outcome measures, the Problem Areas in Diabetes (PAID) and Diabetes Distress Scale (DDS), to support economic evaluations when EQ-5D data are unavailable.

Data from 662 adults with diabetes in Germany included PAID-20, DDS-17, and EQ-5D-5L responses. Direct mapping models predicted EQ-5D utilities using Tobit and censored least absolute deviation (CLAD) regressions, while indirect mapping models used proportional and partial proportional odds regressions to predict EQ-5D dimensions. Six model specifications were tested, incorporating PAID and DDS items with covariates (age, sex, diabetes type), with selection of predictors guided by item correlations and backward stepwise procedure to retain statistically relevant variables. Model performance was assessed using a selection of performance metrics including root mean square error (RMSE) and mean absolute error (MAE). Internal validation of the models employed 10-fold cross-validation.

The strongest-performing direct mapping models consisted of a model with a selection of PAID-20 items and covariates (Tobit regression; RMSE: 0.159; MAE: 0.117) and a model that incorporated PAID-20, DDS-17, and covariates (CLAD regression; RMSE: 0.146; MAE: 0.09), and a model based on DDS-17 items and covariates (Tobit regression; RMSE: 0.164; MAE: 0.121). Indirect mapping models demonstrated higher prediction errors overall (RMSE: 0.187-0.21; MAE: 0.124-0.141) than their counterparts.

We present novel algorithms that enable estimation of EQ-5D utilities from PAID and DDS scores, facilitating economic evaluation in diabetes. Preferred models demonstrated predictive accuracy comparable to published mapping studies.

Simultaneous pancreas-kidney transplantation (SPKTx) and kidney transplantation alone (KTx) are common treatment modalities for individuals with type 1 diabetes with end-stage kidney disease. This study compared metabolic and macrovascular disease outcomes between SPKTx and KTx in recipients with type 1 diabetes.

We conducted a systematic search of the Embase, MEDLINE and Scopus databases (last searched 23 February 2025). We included retrospective and case-control studies, owing to a lack of randomised controlled trials in English, with adult patients. We excluded studies reporting on a return to dialysis post transplant, islet-kidney transplantation or separate pancreas-kidney transplants. Bias and study quality were assessed via the Newcastle-Ottawa scale for cohort studies. Demographic and outcome data were synthesised as both categorical and continuous data, with pooled means and summary statistics computed where applicable. Meta-analysis was performed on post-transplant outcomes in studies evaluating total cholesterol (TC), triglyceride (TG) level, HDL, LDL, blood pressure, HbA_1c and renal function. Macrovascular outcomes included the frequency of new or adverse events associated with coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD).

A total of 15 studies (n=564 SPKTx, 419 KTx) were included. Meta-analysis demonstrated lower post-transplant TC (mean difference -0.41 mmol/l [95% CI -0.60, -0.22], p<0.01, I²=37%), TG level (mean difference -0.76 mmol/l [95% CI -1.02, -0.49], p<0.01, I²=86%), LDL (mean difference -0.28 mmol/l [95% CI -0.42, -0.14], p<0.01, I²=15%), HbA_1c (mean difference -28.79 mmol/mol [95% CI -35.75, -21.82], p<0.01, I²=98%; mean difference -2.61% [95% CI -3.05, -2.16], p<0.01) and creatinine levels (mean difference -21.54 μmol/l [95% CI -39.23, -3.85], p=0.02, I²=90%) following SPKTx compared with KTx. Mean antihypertensive agent use per participant decreased post SPKTx (1.0 vs 2.5 pre transplant; p<0.01), but was not significantly different from post-KTx groups. HbA_1c increased following KTx (69 mmol/mol [8.5%]) compared with pre KTx (53 mmol/mol [7.0%], p<0.01). Progression of CAD, CeVD and PVD occurred across both groups post transplant. PVD showed more than a twofold increase in amputations and revascularisations post transplant. No difference was observed in the post-transplant frequency of CAD, CeVD or PVD between SPKTx and KTx. Evidence from this study was limited by a lack of subgroup data for analysis, a lack of randomised studies and a paucity of reported lifestyle factors influencing outcomes.

SPKTx demonstrates a superior metabolic profile post transplant to that in KTx in recipients with type 1 diabetes. However, this does not translate into differences in the risk of CAD or PVD post transplant, with PVD accounting for the greatest burden of macrovascular disease.

This protocol has been registered a priori on PROSPERO (CRD42024622408).