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Summary: Background/Aims: Patients with hepatocellular cancer (HCC) are vulnerable to psychological distress given a new cancer diagnosis superimposed on pre‐existing chronic liver disease. We aimed to characterise the psychiatric burden in HCC, risk factors for incident diagnosis and treatment patterns over time. Methods: Using IQVIA PharMetrics® Plus for Academics—a nationally representative claims database of the commercially insured US population—we identified psychiatric diagnoses and treatment among patients with newly diagnosed HCC. Multivariable logistic regression modelling identified factors associated with psychiatric diagnosis and treatment. Results: Of 11,609 patients with HCC, 2166 (18.6%) had a psychiatric diagnosis after cancer diagnosis with depression (58.3%) and anxiety (53.0%) being most common. Women (aOR 1.33, 95% CI [1.19–1.49]), pre‐existing psychiatric diagnoses (aOR 9.12 [8.08–10.3]) and HCC treatment type (transplant: aOR 2.15 [1.66–2.77]; locoregional therapies: aOR 1.74 [1.52–1.99]; hospice: aOR 2.43 [1.79–3.29]) were significantly associated with psychiatric diagnosis. Female sex, ascites, higher comorbidity and treatment type were associated with incident psychiatric diagnosis. Pharmacotherapy was used in 1392 (64.3%) patients with a psychiatric diagnosis, with antidepressants (46.2%) and anxiolytics (32.8%) being most common. Psychiatric diagnoses increased from 14.8% in 2006–2009 to 21.1% in 2018–2021 (p < 0.001). In almost 20% of patients with pre‐existing psychiatric conditions, therapy was discontinued after HCC diagnosis. Conclusions: Nearly 2 of 10 patients with HCC were diagnosed with a psychiatric condition after cancer diagnosis with unique sociodemographic and clinical risk factors identified. This highlights a risk for increased psychological burden in need of early evaluation and treatment among patients with newly diagnosed HCC. [ABSTRACT FROM AUTHOR]

Abnormal experiences of time (ATEs) are an established object of research in phenomenological psychopathology. Objective: The purpose of this study was the first validation of the Transdiagnostic Assessment of Temporal Experience (TATE), a structured phenomenological interview concerning ATEs in individuals with diverse mental health conditions, and its adaptation for the Polish language. Methods: The research employed a mixed-method approach and consisted of several phases including (1) consensual translation; (2) construct and content validation by an expert panel; (3) direct feedback from patients with lived experiences of alcohol addiction, borderline personality, autism, and clinical depression; (4) an auditorium questionnaire with 98 respondents without mental health issues, who were both interviewed and gave qualitative feedback; and (5) a final expert panel and approval. Results: Following multiple stages of modification, the final TATE demonstrates strong internal consistency and validity (Cronbach's α = 0.9), with strong correlations between the frequency, intensity, and impairment of various forms of ATEs as well as their rare occurrence among healthy participants. Conclusions: TATE represents a multidimensional and structured quantitative phenomenological approach to temporal experience for psychiatry and clinical psychology. This article presents the validated version of TATE for Polish alongside updated administration guidelines. It is now the state-of-the-art TATE that may be further adapted to other languages, including English. [ABSTRACT FROM AUTHOR]

This article is a response to a previous meta-analysis on the prevalence of attention-deficit hyperactivity disorder (ADHD) among adults in prison. The authors of the response defend their decision to only include studies with unselected samples of adult prisoners, excluding samples that exclusively consisted of people with psychiatric disorders or solely those with violent index offenses. They argue that including selected samples would inflate the prevalence of ADHD. They also criticize a re-analysis of the prevalence of ADHD in detained adults, stating that the included studies were not representative of the general prison population. The authors conclude that their estimate of 8.3% prevalence of ADHD in the general prison population is more accurate than the re-analysis estimate of 22.2%. [Extracted from the article]

Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

Divergent conceptualization of posttraumatic stress disorder (PTSD) within the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5) and International Statistical Classification of Diseases and Related Health Problems (11th ed..; ICD‐11) significantly confounds both research and practice. Using a diverse sample of trauma‐exposed youth (N = 1,542, age range: 8–20 years), we compared these two diagnostic approaches along with an expanded version of the ICD‐11 PTSD criteria that included three additional reexperiencing symptoms (ICD‐11+). Within the sample, PTSD was more prevalent using the DSM‐5 criteria (25.7%) compared to the ICD‐11 criteria (16.0%), with moderate agreement between these diagnostic systems, κ =.57. The inclusion of additional reexperiencing symptoms (i.e., ICD‐11+) reduced this discrepancy in prevalence (24.7%) and increased concordance with DSM‐5 criteria, κ =.73. All three PTSD classification systems exhibited similar comorbidity rates with major depressive episode (MDE) or generalized anxiety disorder (GAD; 78.0%–83.6%). Most youths who met the DSM‐5 PTSD criteria also met the criteria for ICD‐11 PTSD, MDE, or GAD (88.4%), and this proportion increased when applying the ICD‐11+ criteria (95.5%). Symptom‐level analyses identified reexperiencing/intrusions and negative alterations in cognition and mood symptoms as primary sources of discrepancy between the DSM‐5 and ICD‐11 PTSD diagnostic systems. Overall, these results challenge assertions that nonspecific distress and diagnostically overlapping symptoms within DSM‐5 PTSD inflate comorbidity with depressive and anxiety disorders. Further, they support the argument that the DSM‐5 PTSD criteria can be refined and simplified without reducing the overall prevalence of psychiatric diagnoses in youth. [ABSTRACT FROM AUTHOR]

Background: One of the criticisms of the operational/diagnostic criteria, generalised since DSM‐III, has been that they were shaped solely to achieve the best inter‐peer reliability with no considerations for validity. This does not fully reflect reality since throughout the development of the criteria, there was an effort to define and fulfil some validity requirements. However, despite several attempts to create alternative diagnostic systems, there is still a widespread misunderstanding of the epistemological foundations that support this paradigm. Methods: In this article, we intend to analyse the epistemological context in which the operational criteria (OC) emerged and some of the validation processes they have undergone since their conception. Results: On the epistemological basis of these operational criteria (OC) the influence of Hempel has been widely discussed. However, the group from St. Louis and, also the DSM‐III editors, never openly acknowledged his role and his contribution and revealed other influences such as other medical specialties (that used and validated several OC in the diagnosis of their diseases). On the other hand, contrary to what has often been mentioned there has been a continuous attempt to validate the OC since their conception. In the implementation and development of the operational paradigm, a more instrumental trend was followed, focused on utility, but with successive attempts to achieve realistic validity by searching for biological or psychological causality. The methodologies were initially expert‐driven and gradually more data‐driven and included some variables external to the construct itself, such as familial aggregation, diagnostic consistency over time, prognostic and other psychometric measures. [ABSTRACT FROM AUTHOR]

Objective: Associations were examined between six psychiatric diagnoses in parents and a broad range of psychiatric and nonpsychiatric outcomes in their offspring. Methods: All individuals born in Sweden between 1970 and 2000 were linked to their biological parents (N=3,286,293) through Swedish national registers. A matched cohort design, with stratified Cox regression and conditional logistic regression analyses, was used examine associations between six psychiatric diagnoses in the parents and 32 outcomes in their offspring. All children, including those exposed and those not exposed to parents with psychiatric diagnoses, were followed from their date of birth to the date of emigration from Sweden, death, or December 31, 2013, when the offspring were 14–44 years old. Results: In terms of absolute risk, most children who had parents with psychiatric diagnoses were not diagnosed in specialist care themselves, and the proportion of offspring having any of the 16 types of psychiatric conditions ranged from 22.17% (of offspring exposed to parental depression) to 25.05% (of offspring exposed to parental drug-related disorder) at the end of follow-up. Nevertheless, in terms of relative risk, exposure to any of the six parental psychiatric diagnoses increased probabilities of the 32 outcomes among the offspring, with hazard ratios that ranged from 1.03 to 8.46 for time-to-event outcomes and odds ratios that ranged from 1.29 to 3.36 for binary outcomes. Some specificities were observed for parental diagnoses of psychosis and substance-related disorders, which more strongly predicted psychotic-like and externalizing-related outcomes, respectively, in the offspring. Conclusions: The intergenerational transmission of parental psychiatric conditions appeared largely transdiagnostic and extended to nonpsychiatric outcomes in offspring. Given the broad spectrum of associations with the outcomes, service providers (e.g., psychiatrists, teachers, and social workers) should consider clients' broader psychiatric family history when predicting prognosis and planning interventions or treatment. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard care (paper-and pen-based screening or no screening). The second aim was to identify barriers and enablers to implementing digital screening in pregnancy and postpartum. Method: OVID MEDLINE, PsycINFO, SCOPUS, CINAHL, Embase, Web of Science, Joanna Briggs Database and All EMB reviews incorporating Cochrane Database of Systematic Reviews (OVID) were systematically searched for articles that evaluated digital screening for mental health in pregnancy and postpartum between 2000 and 2021. Qualitative articles were deductively mapped to the Theoretical Domains Framework (TDF). Results: A total of 34 articles were included in the analysis, including qualitative, quantitative and mixed-methods studies. Digital screening was deemed acceptable, feasible and effective. TDF domains for common barriers included environmental context and resources, skills, social/professional role and identity and beliefs about consequences. TDF domains for common enablers included knowledge, social influences, emotion and behavioural regulation. Conclusion: When planning to implement digital screening, consideration should be made to have adequate training, education and manageable workload for healthcare professionals (HCP's). Organisational resources and support are important, as well as the choice of the appropriate digital screening assessment and application setting for women. Theory-informed recommendations are provided for both healthcare professionals and women to inform future clinical practice. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. The research question was What is mental health nurses' empathy towards consumers with co‐existing mental health and drug and alcohol problems? Design and Methods: A cross‐sectional survey was carried out to understand mental health nurses' empathy. The convenience sample included 96 mental health nurses from various mental health settings with experience working with consumers with dual diagnosis. We assessed empathy using the Toronto Empathy Questionnaire. We utilised SPSS™ software to analyse both the descriptive data and multiple‐regression. Results: The mean empathy score was 47.71 (SD 8.28). The analysis of the association between demographic variables and individual subscales showed an association between the clinical setting and empathy (p =.031) and sympathetic physiological arousal (p =.049). The work sector was associated with sympathetic physiological arousal (p =.045) and conspecific altruism (p =.008). Emotional contagion (β =.98, p <.001), emotional comprehension (β = 1.02, p <.001), sympathetic physiological arousal (β = 1.01, p <.001) and conspecific altruism (β = 10.23, p <.001) predicted mental health nurses' empathy. Conclusions: This study found that most mental health nurses showed empathy towards consumers with dual diagnosis. Mental health nurses who are more empathetic towards their consumers experience emotional contagion. They understand emotions better, show sympathetic physiological responses and exhibit kind behaviour towards consumers. Implications for the Profession and Patient Care: Further research is required to understand how mental health nurses adapt to consumers' emotional states in different mental health settings. This information can help clinicians make better decisions about care quality for consumers with dual diagnosis. Impact: This study addressed mental health nurses' empathy towards consumers with dual diagnosis. Mental health nurses showed increased empathy towards consumers with dual diagnosis. The empathy levels vary based on age, clinical setting, work sector and work experience. Mental health nurses' empathy levels were predicted by emotional contagion, emotion comprehension, sympathetic physiological arousal and conspecific altruism. Empathy enhancement among mental health nurses, particularly towards consumers with dual diagnosis, is crucial and should be regarded as a top priority by healthcare leaders and educators. Reporting Method: Outlined by the Consensus‐Based Checklist for Reporting of Survey Studies (CROSS). Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether information about the gender, ethnicity, and socioeconomic status of the patient affects psychiatric assessments in a sample of practicing clinicians in Swedish adult psychiatry. Method: The study used an experimental design in which vignettes describing patients were identical except for information regarding their gender, ethnicity, and socioeconomic status. The outcome variables included assessments of the severity of the patient's clinical condition, how dangerous the patient was to themselves and others, the likelihood of reporting to social services (due to concern for the welfare of children), and whether the patient was recommended psychotherapy or psychopharmaceutical treatment. Results: A series of ANOVAs were performed to investigate main and interaction effects of the studied variables. The performed analyses identified several instances in which the clinicians' assessments varied as a function of the social categories under investigation. For example, male patients and "Arab Swedish" patients were perceived as more dangerous, "Arab Swedish" patients, male patients, and patients with low socioeconomic status were less likely to be recommended psychotherapy, and "Arab Swedish" patients were more likely to be reported to social services. The effect sizes were generally small. Conclusions: The study provides support for the suggestion that information regarding patient gender, ethnicity, and socioeconomic status affects central aspects of psychiatric assessments. The results are interpreted and discussed in relation to other studies on the influence of social stereotypes on psychiatric assessments and the practice of clinical psychiatric assessments. [ABSTRACT FROM AUTHOR]

In educational systems around the world, there is a long tradition of using psychiatric diagnoses when providing support in the special educational field. For instance, many countries have special schools and special classes for students with psychiatric diagnoses such as Attention-Deficit Hyperactivity Disorder, Autism spectrum disorder and general learning disabilities. This case study draws on data from Denmark and investigates how this organising principle is currently being challenged. The study shows that a main challenge to the widespread use of diagnoses is a shift in how the psychiatric system diagnoses students. Factors affecting the current situation are that a) an increasing proportion of students receive more than one diagnosis, and b) children with social problems are more likely to be diagnosed with a psychiatric condition as well. The outcome is that the institutional tradition of distinguishing between support to be provided for different diagnoses comes under pressure, and a paradoxical situation occurs where the growing complexity of children's psychiatric diagnoses leads to practices where more differentiated special needs are taught within the same classrooms. The situation has led the Danish school system to search for alternative ways of organising support for students. The study investigates these new emerging methods of providing support. [ABSTRACT FROM AUTHOR]

People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed. • People with HIV (PWH) are at elevated risk for suicidal ideation (SI). • Computerized screening in primary care can help identify those at risk. • SI risk increased with greater number of substances patients reported using. • Stimulant use, depression, anxiety, and public insurance were associated with SI. • Providers should assess key risk factors to address SI among PWH. [ABSTRACT FROM AUTHOR]

Purpose: Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric–mental health nurse practitioners (PMHNPs). Method: The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. Results: In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. Conclusion: Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 19–24.] [ABSTRACT FROM AUTHOR]

This study aimed to validate a novel parent-report measure of ADHD symptom inflation, the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS), in a clinical sample. The PRASIS is composed of an Infrequency subscale and an ADHD subscale. Online participants were assigned to one of three groups: mothers of children with diagnosed ADHD (n = 110), mothers of children with diagnosed ODD and/or anxiety (n = 116), and mothers of children without ADHD, ODD, or anxiety. The third group was then randomized to either receive instructions to complete the questionnaire honestly (controls, n = 164) or to complete the questionnaire as if they were trying to convince a provider that their child has ADHD (simulators, n = 141). Results indicated good to excellent internal consistency (INF α = .83, ADHD Total α = .93); strong convergent validity of the PRASIS ADHD scale with the ADHD Rating Scale-5 (r(529) = .85, p < .001); excellent group discrimination of the PRASIS Infrequency scale and the PRASIS ADHD scale (η2 = 0.38–0.42); and specificity of 86.7, sensitivity of 67.4%, and an AUC of .86 for the Infrequency scale. Overall, these outcomes supported the utility of the PRASIS in samples including mothers of children with psychiatric diagnoses of ODD and/or anxiety. [ABSTRACT FROM AUTHOR]

Background: Poor self-control is a strong correlate of criminal propensity. It is conceptualized and operationalized differently in criminology than in other scientific traditions. Aims: (1) To verify the dimensionality of the criminological Grasmick selfcontrol items, other self-regulation items and morality ones. (2) To re-interpret the dimensions using a clinical perspective, a taxonomic/diagnostic model and references to possible "biological underpinnings." (3) Validate the dimensions by associations with crime. Method: Population: all persons born 1995 in Malmö and living there at age 12. A random sample (N = 525) filled in a comprehensive self-report questionnaire on themes like personality, crime/abuse and social aspects at age 15, 16 and 18. Age 18 data were analysed: 191 men and 220 women. Results: Self-regulation items were 4-dimensional: ADHD problems (Behavior control and Executive skills) and two Aggression factors. Morality items formed a fifth dimension. Negative Affect and Social interaction factors covered the rest of the variance. The validity of these factors was backed up by correlations with similar items/factors. Self-regulation subscales predicted crimes better than the Grasmick scale; an interaction with morality improved prediction still further. Sex differences were over-all small with three exceptions: Aggression, Morality and Negative affect. Conclusion: We identified four dimensions of the 20-item Grasmick instrument: Cognitive action control (impulsiveness/sensation seeking, response inhibition), Executive skills/future orientation, Affective/aggression reactivity and Aggression control. All should be possible to link to brain functional modules. Much can be gained if we are able to formulate an integrated model of self-regulation including distinct brain functional modules, process-and trait-oriented models, relevant diagnoses and clinical experiences of individual cases. [ABSTRACT FROM AUTHOR]

The move from psychiatric hospitals to community-based care is the goal of policies in many countries. Latvia has attempted to reach this goal by establishing two outpatient centers in Riga. Since 2005, when the first outpatient centers opened, the ability of day clinics to reduce the total length of stay for hospital inpatients has been observed, although using the outpatient centers did not affect the number of patients treated. The opendoor inpatient wards of the centers also attracted a new patient group. However, due to the COVID-19 pandemic, the number and length of stay of both outpatients and inpatients at psychiatric hospitals decreased. Therefore, other factors that can affect the move from psychiatric hospital inpatient care to outpatient centers should be further investigated. [ABSTRACT FROM AUTHOR]

Integration of diagnosis and treatment for mental, neurological, and substance use (MNS) disorders into primary health care is a recommended strategy to improve access to services in low-and middle-income countries. Despite numerous initiatives for integration of mental health care in Uganda, there has not been an evaluation of health management information system (HMIS) records to determine whether MNS disorders are routinely diagnosed. We sought to determine diagnostic pattern of MNS disorders at primary health facilities in Wakiso and Kampala districts, the most populous regions of Uganda. Lower-level primary health facilities were visited to obtain records from HMIS registers, to document diagnoses of MNS disorders. Secondary data analysis was conducted and descriptive statistics reported. A total of 40 primary health care facilities were visited representing 58.6% of the health facilities in the study districts. More than half (54.8%) and almost all (87.5%) of the lower-level health facilities in Wakiso district and Kampala district respectively were visited. The proportion of MNS disorders diagnosed at lower-level primary health facilities in Uganda is very low with Epilepsy the most common MNS diagnosis recorded. Reasons for such low numbers of diagnoses at primary health facilities are discussed as are possible solutions. [ABSTRACT FROM AUTHOR]

Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE. The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups. Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system. Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities. Gender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR. Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR. Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective. [ABSTRACT FROM AUTHOR]

Background: Despite mounting evidence of gut-brain involvement in psychiatric conditions, functional data remain limited, and analyses of other microbial niches, such as the vaginal microbiota, are lacking in relation to mental health. This aim of this study was to investigate if the connections between the gut microbiome and mental health observed in populations with a clinical diagnosis of mental illness extend to healthy women experiencing stress and depressive symptoms. Additionally, this study examined the functional pathways of the gut microbiota according to the levels of psychological symptoms. Furthermore, the study aimed to explore potential correlations between the vaginal microbiome and mental health parameters in young women without psychiatric diagnoses. Methods: In this cross-sectional study, 160 healthy Danish women (aged 18-40 years) filled out questionnaires with validated scales measuring symptoms of stress and depression and frequency of dietary intake. Fecal and vaginal microbiota samples were collected at the beginning of the menstrual cycle and vaginal samples were also collected at cycle day 8-12 and 18-22. Shotgun metagenomic profiling of the gut and vaginal microbiome was performed. The Kyoto Encyclopedia of Genes and Genomes (KEGG) was used for functional profiling and 56 Gut Brain Modules were analyzed in the fecal samples. Results: The relative abundance in the gut of the genera Escherichia, Parabacteroides, and Shigella was higher in women with elevated depressive symptoms. Women with high perceived stress showed a tendency of increased abundance of Escherichia, Shigella, and Blautia. Amongst others, the potentially pathogenic genera, Escherichia and Shigella correlate with alterations in the neuroactive pathways such as the glutamatergic, GABAeric, dopaminergic, and Kynurenine pathways. Vaginosis symptoms were more prevalent in women reporting high levels of stress and depressive symptoms. Conclusions: The findings of this study support the concept of a microbiotaassociated effect on the neuroactive pathways even in healthy young women. This suggest, that targeting the gut microbiome could be a promising approach for future psychiatric interventions. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence is a key period of vulnerability for poor mental health as the brain is still developing and may be more sensitive to the negative impacts of stress and adversity. Unfortunately, few measures comprehensively assess wellbeing in adolescents. Methods: The 26-item COMPAS-W Wellbeing Scale for adults was validated in a sample of 1,078 adolescents aged 13–17 years old (51.67% male, 79.13% nonclinical vs 20.87% psychiatric or developmental clinical cases). The six COMPASW sub-scales and total scale were examined in this sample using second-order confirmatory factor analysis, and psychometric testing. Results: The 23-item COMPAS-W demonstrated the best fit for this sample according to goodness-of-fit indices (c2 (220, 1078) = 1439.395, p < 0.001, CFI = 0.893, TLI = 0.877, RMSEA = 0.070, SRMR = 0.095). Internal reliability for the confirmed 23-item COMPAS-W model was run for the total scale (a = 0.912) and sub-scales (Composure, a = 0.735; Own-worth, a = 0.601; Mastery, a = 0.757; Positivity, a = 0.721; Achievement, a = 0.827; and Satisfaction, a = 0.867). Testretest reliability over 6 weeks was also good for the total scale at r = 0.845 and the sub-scales: Composure (r = 0.754), Own-worth (r = 0.743), Mastery (r = 0.715), Positivity (r = 0.750), Achievement (r = 0.750), and Satisfaction (r = 0.812). Compared with non-clinical participants’ wellbeing (M = 90.375, SE = 0.400), those with clinical diagnoses reported lower wellbeing, both for those with developmental diagnoses (M = 85.088, SE = 1.188), or psychiatric diagnoses (M = 78.189, SE = 1.758), or combined developmental and psychiatric diagnoses (M = 77.079, SE = 2.116). Yet, when wellbeing category scores were considered by diagnosis group, both non-clinical and clinical groups demonstrated incidence across all three categories of languishing, moderate and flourishing wellbeing, in support of the dual-continua model of mental health. On average, younger adolescents’ (13–14 years) wellbeing did not differ from older adolescents’ (15–17 years) wellbeing; however, for sex, males scored 1.731 points significantly higher in wellbeing compared with females (p = 0.028); and American participants scored 3.042 points significantly higher in wellbeing compared with Australian participants (p < 0.001). Discussion: In conclusion, the 23-item COMPAS-W is a reliable measure of wellbeing for adolescents, both for those with and without developmental and psychiatric diagnoses. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common disorder affecting patients' psychiatric illness, characterized by a high rate of underdiagnosis, misdiagnosis, and high risks. However, previous studies frequently excluded patients with psychiatric illness, leading to limited knowledge about risk factors and optimal assessment tools for delirium in psychiatric settings. Objectives: The scoping review was carried out to (1) identify the risk factors associated with delirium in patients with psychiatric illness; (2) synthesize the performance of assessment tools for detecting delirium in patients with psychiatric illness in psychiatric settings. Design: Scoping review. Data sources: PubMed, Web of Science, and Embase were searched to identify primary studies on delirium in psychiatric settings from inception to Dec 2023 inclusive. Two independent reviewers screened eligible studies against inclusion criteria. A narrative synthesis of the included studies was conducted. Results: A final set of 36 articles meeting the inclusion criteria, two main themes were extracted: risk factors associated with delirium in patients with psychiatric illness and assessment tools for detecting delirium in psychiatric settings. The risk factors associated with delirium primarily included advanced age, physical comorbid, types of psychiatric illness, antipsychotics, anticholinergic drug, Electroconvulsive therapy, and the combination of lithium and Electroconvulsive therapy. Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale, and Delirium Diagnostic Tool-Provisional might be valuable for delirium assessment in patients with psychiatric illness in psychiatric settings. Conclusions: Delirium diagnosis in psychiatric settings is complex due to the overlapping clinical manifestations between psychiatric illness and delirium, as well as their potential co-occurrence. It is imperative to understand the risk factors and assessment methods related to delirium in this population to address diagnostic delays, establish effective prevention and screening strategies. Future research should focus on designing, implementing, and evaluating interventions that target modifiable risk factors, to prevent and manage delirium in patients with psychiatric illness. What is already known about the topic?: • Delirium is common among individuals living in psychiatric settings and remains clinically under-detected, and it is associated with the length of hospital stay and poor prognoses. • Dementia with behavioral and psychological symptoms of dementia (BPSD) and other psychiatric illnesses has been shown to make delirium more likely. However, despite extensive research on factors associated with delirium, there is a notable lack of studies conducted in psychiatric settings. • Early detection and identification of delirium are crucial in psychiatric settings; however, literature regarding the assessment and identification of delirium has not been synthesized, particularly in the context of comorbid psychiatric illness. What this paper adds?: • Risk factors associated with delirium in patients with psychiatric illness primarily include advanced age, physical comorbid, types of psychiatric illness, antipsychotics, anticholinergic drug, Electroconvulsive therapy (ECT), and the combination of lithium and ECT. • Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale, and Delirium Diagnostic Tool-Provisional might hold promising value as assessment tools for delirium in patients with psychiatric illness in psychiatric settings. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo describe the therapy approaches and clinical outcomes of an integrated care model for patients with functional movement disorder (FMD).A retrospective chart review was conducted for all treated individuals with a primary diagnosis of FMD between January 2020 and July 2022. Patients received time-limited integrated therapy (n = 21) (i.e., simultaneous therapy delivered by psychiatry, neurology and physiotherapy), physiotherapy (n = 18) or virtual physiotherapy alone (n = 9). Primary outcomes included the Simplified-Functional Movement Disorders Rating Scale (S-FMDRS) and Clinical Global Impression-Improvement scale (CGI-I) collected at baseline and post-intervention.Forty-eight patients completed treatment (42% male; mean age, 48.5 ± 16.6 years, median symptom duration 30 months). The most common presentations were gait disorder, tremor and mixed hyperkinetic FMD. Common comorbidities included pain and fatigue. Three-quarters of patients had a comorbid psychiatric diagnosis. There was a significant reduction in S-FMDRS score following therapy (71%, p < 0.0001) and 69% had “much” or “very much” improved on the CGI-I. There was no difference between therapy groups. Attendance rates were high for both in-person (94%) and virtual (97%) visits.These findings support that a time-limited integrated model of care is feasible and effective in treating patients with FMD.An integrated approach that draws from both mental health and physiotherapy-oriented strategies reframes functional movement disorder treatment targets and clinical outcomes, influences triage criteria, and produces new and innovative therapies.Successful outcomes depend on triaging suitable participants and individualized treatment plans that focus on functional goals.Virtual telerehabilitation in functional movement disorder is effective and offers the opportunity to work with patients in real-time in the environment where they most often experience functional neurological symptoms.An integrated approach that draws from both mental health and physiotherapy-oriented strategies reframes functional movement disorder treatment targets and clinical outcomes, influences triage criteria, and produces new and innovative therapies.Successful outcomes depend on triaging suitable participants and individualized treatment plans that focus on functional goals.Virtual telerehabilitation in functional movement disorder is effective and offers the opportunity to work with patients in real-time in the environment where they most often experience functional neurological symptoms. [ABSTRACT FROM AUTHOR]

Can a human right to good mental health be justified? This is an under‐explored question: until recently, rights in relation to mental health have been framed and debated primarily in terms of their relevance to psychosocial disability and mental ill‐health/mental distress. By contrast, in this article, I propose the basis of a normative justification for a population‐wide right to good mental health, focusing in particular on individuals who do not experience mental ill‐health/distress or do not have (or may never have) a psychiatric diagnosis or a psychosocial disability. The article is structured into three parts. First, I will outline the emergence of a population‐wide right to good mental health in mental health discourse, led by recent reports published by the former United Nations Special Rapporteur on the Right to Health, Danius Pūras. I will then go on to explore what we might understand by ‘good mental health’. Finally, I will explain how a right to good mental health may be justified, drawing on insights from compassion, ‘vulnerable agency’, and James Wilson's account of ‘a right to public health’. I then respond to feasibility and demandingness concerns about such a right, which together inform the basis of the qualified public health right to good mental health I propose. [ABSTRACT FROM AUTHOR]

Background: Understanding pathways to dual diagnosis (DD) care will help organize DD services and facilitate training and referral across healthcare sectors. Aim: The aim of our study was to characterize the stepwise healthcare and other contacts among patients with DD, compare the characteristics of the first contact persons with common mental disorder (CMD) versus severe mental illness (SMI), and estimate the likelihood of receiving appropriate DD treatment across levels of contacts. Methods: This cross-sectional, descriptive study in eight Indian centers included newly enrolled patients with DD between April 2022 and February 2023. The research spans varied geographic regions, tapping into regional variations in disease burden, health practices, and demographics. The study categorized healthcare contacts by using the WHO Pathways Encounter Form. Results: The sample (n = 589) had a median age of 32 years, mostly males (96%). Alcohol was the most common substance; SMI (50.8%) and CMD were equally represented. Traditional healers were a common first contact choice (18.5%); however, integrated DD care dominated subsequent contacts. Assistance likelihood increased from the first to the second contact (23.1% to 62.1%) but declined in subsequent contacts, except for a significant rise in the fifth contact (97.4%). In the initial contact, patients with CMD sought help from public-general hospitals and private practitioners for SUD symptoms; individuals with SMI leaned on relatives and sought out traditional healers for psychiatric symptoms. Conclusion: Recognizing the cultural nuances, advocating for integrated care, and addressing systemic challenges pave the way to bridge the gap in DD treatment. [ABSTRACT FROM AUTHOR]

Traditional healing practices are prominent in recent studies. Particularly, there is focused attention on holistic healing in treatment interventions for various illnesses, including mental disorders. This paper quantitatively evaluates the perspectives of traditional health practitioners (THPs) regarding their knowledge, diagnosis, and treatment practices of mental disorders, especially schizophrenia. Special attention was paid to symptoms of schizophrenia as they seem to overlap with the symptoms of bewitchment and an ancestral calling. Self-developed questionnaires were administered to 100 THPs from Harry Gwala District, KwaZulu-Natal. Black, middle-aged female THPs classified as diviners were prevalent. They reflected knowledge of mental disorders and played a role in their diagnosis and treatment. Medicinal concoction was the commonly prescribed treatment option. [ABSTRACT FROM AUTHOR]

Background: Intentional self-harm presents a significant challenge within the mental health system, yet misconceptions persist regarding its nature, particularly the view that nonsuicidal self-injury (NSSI) serves as a mere call for attention and represents impulsive behavior. This study aimed to explore the process and experiences of self-harm among young adults in India to address this stigmatization. Methods: Semi-structured interviews were conducted with eight participants aged 21-24 years, encompassing diverse psychiatric diagnoses and a history of NSSI. These interviews aimed to delve into the nuanced experiences and perspectives surrounding self-harm in this demographic. Results: Thematic analysis of the interviews unveiled six overarching themes: distal risk factors, proximal risk factors, methods and conditions to self-harm, during the act, after the act, and considerations to be taken while planning intervention. These themes shed light on various factors influencing self-harm behaviors and the context in which they occur. Conclusion: The findings underscore the necessity of incorporating individuals' unique processes of self-harm into intervention planning to effectively support those at risk of self-harm. By understanding the complex interplay of factors involved, mental health professionals can develop targeted and comprehensive interventions to address NSSI effectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many individuals with psychiatric disabilities face workplace challenges that motivate them to pursue self-employment, but accessible self-employment support is lacking. Using participatory action research, Reclaiming EmploymentTM (RE), an online interactive platform that provides self-employment education for people who experience mental health-related challenges around work, was developed to address these gaps. OBJECTIVE: An observational pilot study of RE examined usage, usability, self-efficacy, and self-employment income. METHODS: Participants (N = 97) used RE for six months; survey data was collected at three timepoints to measure entrepreneurial self-efficacy (ESE) and income generated from self-employment. Usability was assessed post-intervention using the System Usability Scale. RESULTS: More than 70% of participants used RE; there was no association between non-usage and demographic characteristics, nor prior use of other self-employment supports. RE users rated the platform at above average usability, although those who experienced long-term unemployment rated the platform significantly lower compared to wage or self-employed users. In longitudinal regression models, we found use of RE was significantly associated with increases in some ESE subscales and mean ESE. Use of RE was not associated with gains in income. CONCLUSION: This pilot study demonstrates acceptability, feasibility, and preliminary effectiveness of an online entrepreneurship training for individuals with psychiatric disabilities. [ABSTRACT FROM AUTHOR]

Background: Postintensive care syndrome (PICS) has adverse multidimensional effects on nearly half of the patients discharged from ICU. Mental disorders such as anxiety, depression and post-traumatic stress disorder (PTSD) are the most common psychological problems for patients with PICS with harmful complications. However, developing prediction models for mental disorders in post-ICU patients is an understudied problem. Aims: To explore the risk factors of PICS mental disorders, establish the prediction model and verify its prediction efficiency. Study Design: In this cohort study, data were collected from 393 patients hospitalized in the ICU of a tertiary hospital from April to September 2022. Participants were randomly assigned to modelling and validation groups using a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was performed to select the predictors, multiple logistic regression analysis was used to establish the risk prediction model, and a dynamic nomogram was developed. The Hosmer-Lemeshow (HL) test was performed to determine the model's goodness of fit. The area under the receiver operating characteristic (ROC) curve was used to evaluate the model's prediction efficiency. Results: The risk factors of mental disorders were Sepsis-related organ failure assessment (SOFA) score, Charlson comorbidity index (CCI), delirium duration, ICU depression score and ICU sleep score. The HL test revealed that p = .249, the area under the ROC curve = 0.860, and the corresponding sensitivity and specificity were 84.8% and 71.0%, respectively. The area under the ROC curve of the verification group was 0.848. A mental disorders dynamic nomogram for post-ICU patients was developed based on the regression model. Conclusions: The prediction model provides a reference for clinically screening patients at high risk of developing post-ICU mental disorders, to enable the implementation of timely preventive management measures. Relevance to Clinical Practice: The dynamic nomogram can be used to systematically monitor various factors associated with mental disorders. Furthermore, nurses need to develop and apply accurate nursing interventions that consider all relevant variables. [ABSTRACT FROM AUTHOR]

Background: Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents. Methods: This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12–18 prescribed isotretinoin over a 10‐year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms. Results: One hundred seventy‐seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p =.650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p <.001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p =.037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p =.009). Conclusions: A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new‐onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin. [ABSTRACT FROM AUTHOR]

A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society. [ABSTRACT FROM AUTHOR]

Evidence suggests that psilocybin has therapeutic benefit for treating depression. However, there is little consensus regarding the mechanism by which psilocybin elicits antidepressant effects. This systematic review summarizes existing evidence. Ovid MEDLINE, EMBASE, psychINFO, and Web of Science were searched, for both human and animal studies, using a combination of MeSH Terms and free-text keywords in September 2021. No other mood disorders or psychiatric diagnoses were included. Original papers in English were included. The PRISMA framework was followed for the screening of papers. Two researchers screened the retrieved articles from the literature search, and a third researcher resolved any conflicts. Of 2,193 papers identified, 49 were selected for full-text review. 14 articles were included in the qualitative synthesis. Six supported psilocybin's mechanism of antidepressant action via changes to serotonin or glutamate receptor activity and three papers found an increase in synaptogenesis. Thirteen papers investigated changes in non-receptor or pathway-specific brain activity. Five papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex. Several neuroreceptors, neurotransmitters, and brain areas are thought to be involved in psilocybin's ability to mitigate depressive symptoms. Psilocybin appears to alter cerebral blood flow to the amygdala and prefrontal cortex, but the evidence on changes in functional connectivity and specific receptor activity remains sparse. The lack of consensus between studies suggests that psilocybin's mechanism of action may involve a variety of pathways, demonstrating the need for more studies on psilocybin's mechanism of action as an antidepressant. [ABSTRACT FROM AUTHOR]

Aim: Study the outcomes in terms of registered neurodevelopmental diagnoses and out‐of‐home placements in children whose parents had been diagnosed with mild intellectual disability (ID) in childhood. Methods: The study groups consist of (1) a population‐based sample of 78 individuals, born in 1979–1985, meeting criteria for mild ID during childhood, and (2) their 88 children. From national registers, data on outcomes were retrieved in 2020 regarding psychosocial and psychiatric outcomes for the adults, and neurodevelopmental diagnoses and out‐of‐home placements for the children. Results: Of the 78 adults with mild ID, 31 were parents of 88 children, aged 0–21. The age‐adjusted prevalence of neurodevelopmental disorders among the children was 67%. Of the 27 children aged between 13 and 21 years at follow‐up, 16 had at least one registered neurodevelopmental diagnosis; 11 had ADHD and 7 had ID. Nine of these 27 children had experienced out of home placement. Conclusion: Children of parents with mild ID are at high risk of neurodevelopmental disorders, in particular ADHD and ID, and out‐of‐home placements. Our findings indicate that individuals with mild ID who become parents routinely should be offered individually tailored parent support and their children offered assessment regard neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

Aims: Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. Methods: A systematic search of Medline, PubMed, Embase and PsycINFO for relevant systematic reviews and/or meta-analyses. Where available, participants on community treatment orders were compared with controls receiving voluntary psychiatric treatment. This review is registered with PROSPERO (CRD42023398767) and the Open Science Framework (https://osf.io/zeq35). Results: In all, 17 publications from 14 studies met the inclusion criteria. Quantitative synthesis of data from different systematic reviews was not possible. There were mixed findings on the effects of community treatment orders on health service use, and clinical, psychosocial or forensic outcomes. Whereas uncontrolled evidence suggested benefits, results were more equivocal from controlled studies and randomised controlled trials showed no effect. Any changes in health service use took several years to become apparent. There was evidence that better targeting of community treatment order use led to improved outcomes. Although there were other benefits, such as in mortality, findings were mostly rated as suggestive using predetermined and standardised criteria. Qualitative findings suggested that family members and clinicians were generally positive about the effect of community treatment orders but those subjected to them were more ambivalent. Any possible harms were under-researched, particularly in quantitative designs. Conclusions: The evidence for the benefits of community treatment orders remains inconclusive. At the very least, use should be better targeted to people most likely to benefit. More quantitative research on harms is indicated. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life. Methods: Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), illness severity (Clinical Global Impression), medications, adverse events (Systematic Monitoring of Adverse Events Related to Treatments), and quality of life (Recovering Quality of Life Scale) were assessed along with clinical components for MetS in 323 psychiatric patients receiving routine care and monitoring in a Community Mental Health Team. Results: MetS was present in 50.5% (95% CI: 45.0–55.9). It was significantly associated with higher age, duration of mental illness, body mass index (BMI), QTc, QRISK, and antipsychotic drugs. In logistic regression, age, QTc, QRISK, and BMI remained significantly linked to MetS. Patients with or without MetS were comparable in their lifestyle factors such as diet, exercise, and substance use, along with the family history of metabolic disorders, age at onset of mental illness, duration of antipsychotic medication, side effects, psychiatric diagnoses, and quality of life. However, many patients with or without MetS had poorer diet and physical inactivity, indicating scope for interventions. Conclusions: Around half of the psychiatric patients had MetS, and modifiable lifestyle factors did not differentiate individuals with or without MetS. The need for further research on the prevention and management of MetS in psychiatric patients is highlighted. [ABSTRACT FROM AUTHOR]

There exists a significant need of screening, measuring, and assessing phobic reactions to the negative effects and consequences of coronavirus disease 2019 (COVID‐19) across the world. For this purpose, the C19P‐S has b een developed and adapted to several languages and cultures including Turkish, Russian, Arabic, English, Korean, and soforth. This study aimed to adapt the scale into Japanese. Convenience sampling was used in the recruitment of the participants. The sample involved 310 Japanese‐speaking natives from different prefectures of the country (MeanAGE = 49.97; SD = 13.07). The scale is a self‐report instrument, which includes 20, 5‐point Likert‐type items. The scale assesses the levels of COVID‐19 phobia in four areas: Psychological, Somatic, Economic, and Social. The validity (content, construct, convergent, and discriminant) and reliability (internal consistency) analyses were conducted. Multivariate analysis of variance (MANOVA) was used for group comparisons. MANOVA results show that women scored statistically higher in the psychological area. Furthermore, the participants with a lower educational level scored higher than those with a higher level in the somatic area. Among other scales measuring fear and anxiety, the C19P‐S Japanese (C19P‐SJ) is the first measurement tool specifically designed and adapted for evaluating coronaphobia. It is suggested that the individuals with psychiatric diagnoses be included to measure and support the construct validity of the scale. [ABSTRACT FROM AUTHOR]

Importance: Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. Objective: To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. Design: Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. Setting: VHA inpatient psychiatric setting. Participants: Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). Outcomes and Measures: Occupational therapy utilization. Results: Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. Conclusions and Relevance: Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need. This is the first study to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration. [ABSTRACT FROM AUTHOR]

(1) Background: Mental health problems are associated with negative connotations that may lead to discrimination and rejection of people diagnosed with mental disorders. The present study aimed to develop and validate a new scale (the Spanish Social Stigma Scale—S3) to assess the current level of social stigma in the general Spanish population. (2) Methods: The assessment tool was developed after reviewing the items of existing tools that represent the most appropriate indicators for the assessment of social stigma. A review was performed by volunteer subjects and by a group of experts in the field, based on the participation of 563 respondents to a survey. (3) Results: The confirmatory factor analysis revealed that the developed tool fits with the factors that determine the level of social stigma and shows good internal consistency (χ2SB = 412.0321, gl = 293, p < 0.01; BBNNFI = 0.922; CFI = 0.930; IFI = 0.931; RMSEA = 0.028 [0.022, 0.035]). (4) Conclusions: The S3 is useful for assessing knowledge, attitudes, and behavior towards people diagnosed with a mental disorder. This tool may be used for the identification and development of mechanisms necessary for the reduction of social stigma in the general population. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine if the presence of a standing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, psychiatric diagnosis is associated with worse outcomes for patients who develop a confirmed fracture-related infection (FRI). Materials and Methods: Included patients had open or closed fractures managed with internal fixation and had confirmed FRIs. Baseline demographics, injury information, and outcomes were collected via chart review. All patients who had a diagnosis of psychiatric illness, which included depression, bipolar disorder, anxiety disorder, and schizophrenia, were identified. Patients with and without a psychiatric diagnosis were statistically compared. Results: Two hundred eleven patients were diagnosed with a confirmed FRI. Fifty-seven (27.0%) patients had a diagnosis of a psychiatric illness at the time of FRI diagnosis. Patients with a psychiatric diagnosis had a higher rate of smoking (56% vs 40%, P=.039) and drug use (39% vs 19%, P=.004) and a higher American Society of Anesthesiologists (ASA) classification (2.35±1.33 vs 1.96±1.22, P=.038); however, there were no other demographic differences. Clinical outcomes also did not differ between the groups, as patients with an FRI and a psychiatric diagnosis had a similar time to FRI diagnosis, similar confirmatory FRI characteristics, and a similar rate of reoperation. Furthermore, there was no difference between patients with FRI with and without a psychiatric diagnosis regarding rate of infection resolution (89% vs 88%, P=.718) or time to final follow-up (20.13±24.93 vs 18.11±21.81 months, P=.270). Conclusion: The presence of a psychiatric diagnosis does not affect clinical outcomes in the patient population with FRI. This is the first study exploring the impact of psychiatric illness on patient outcomes after a confirmed FRI diagnosis. [Orthopedics. 2024;47(4):198–204.] [ABSTRACT FROM AUTHOR]

The prevention paradox describes circumstances in which the majority of cases with a suicide attempt come from a population of low or moderate risk, and only a few from a 'high-risk' group. The assumption is that a low base rate in combination with multiple causes makes it impossible to identify a high-risk group with all suicide attempts. The best way to study events such as first-time suicide attempts and their causes is to collect event history data. Administrative registers were used to identify a group at higher risk of suicidal behaviour within a population of six national birth cohorts (N = 300,000) born between 1980 and 1985 and followed from age 15 to 29 years. Estimation of risk parameters is based on the discrete-time logistic odds-ratio model. Lifetime prevalence was 4.5% for first-time suicide attempts. Family background and family child-rearing factors were predicative of later first-time suicide attempts. A young person's diagnosis with psychiatric or neurodevelopmental disorders (ADHD, anxiety, depression, PTSD), and being a victim of violence or sex offences contributed to the explanatory model. Contrary to the prevention paradox, results suggest that it is possible to identify a discrete high-risk group (<12%) among the population from whom two thirds of all first-time suicide attempts occur, but one third of observed suicide attempts derived from low- to moderate-risk groups. Findings confirm the need for a combined strategy of universal, targeted and indicated prevention approaches in policy development and in strategic and practice responses, and some promising prevention strategies are presented. [ABSTRACT FROM AUTHOR]

The Level of Personality Functioning Scale–Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of.63; p =.027; 95% CI:.52-.74). The current study provided evidence of the LPFS-SR's unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation. [ABSTRACT FROM AUTHOR]

Prompt engineering, the process of arranging input or prompts given to a large language model to guide it in producing desired outputs, is an emerging field of research that shapes how these models understand tasks, process information, and generate responses in a wide range of natural language processing (NLP) applications. Digital mental health, on the other hand, is becoming increasingly important for several reasons including early detection and intervention, and to mitigate limited availability of highly skilled medical staff for clinical diagnosis. This short review outlines the latest advances in prompt engineering in the field of NLP for digital mental health. To our knowledge, this review is the first attempt to discuss the latest prompt engineering types, methods, and tasks that are used in digital mental health applications. We discuss three types of digital mental health tasks: classification, generation, and question answering. To conclude, we discuss the challenges, limitations, ethical considerations, and future directions in prompt engineering for digital mental health. We believe that this short review contributes a useful point of departure for future research in prompt engineering for digital mental health. [ABSTRACT FROM AUTHOR]

Background: There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors. Aims: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings. Methods: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis. Results: The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures". Conclusion: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study. [ABSTRACT FROM AUTHOR]

Background: Adjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore's largest psychiatric emergency department. Methods: Administrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions. Results: Sixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1–1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26–84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613–1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders. Conclusions: A large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders. [ABSTRACT FROM AUTHOR]

Background: Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks. Methods: We used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis. Results: We reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients' data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm. Conclusion: This study provides the groundwork for assessing PCPs' perceptions of AI systems' features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents' perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population. [ABSTRACT FROM AUTHOR]

Background: Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women. Methods: This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high blood pressure, high triglycerides, or low HDL (1-year prior to delivery); perinatal comorbidities (9-months prior to and 4-month postpartum); and mental disorder (1-year prior to and 1-year post-delivery). Additionally, demographics and the number of days until mental disorder diagnosis were evaluated in this cohort. The analysis included descriptive statistics and multivariable logistic regression. MetS-C, perinatal comorbidities, and mental disorder were assessed using the International Classification of Diseases, Ninth, and Tenth Revision diagnosis codes. Results: 372,895 deliveries met inclusion/exclusion criteria. The prevalence of MetS-C was 13.43%. Multivariable logistic regression revealed prenatal prevalence (1.64, CI = 1.59–1.70) and postpartum incident (1.30, CI = 1.25–1.34) diagnosis of mental health disorder were significantly higher in those with at least one MetS-C. Further, the adjusted odds of having postpartum incident mental illness were 1.51 times higher (CI = 1.39–1.66) in those with 2 MetS-C and 2.12 times higher (CI = 1.21–4.01) in those with 3 or more MetS-C. Young women (under the age of 18 years) were more likely to have an incident mental health diagnosis as opposed to other age groups. Lastly, time from hospital discharge to incident mental disorder diagnosis revealed an average of 157 days (SD = 103 days). Conclusion: The risk of mental disorder (both prenatal and incident) has a significant association with MetS-C. An incremental relationship between incident mental illness diagnosis and the number of MetS-C, a significant association with younger mothers along with a relatively long period of diagnosis mental illness highlights the need for more screening and treatment during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Objective: Increasing service user involvement and collaboration with providers has become an important facet of the recovery movement. This study explored perspectives on the implementation and delivery of an intervention (Just Do You [JDY]) designed to improve treatment engagement among marginalized young adults diagnosed with serious mental illnesses. Method: Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews (N = 11) with nine participants that included agency leaders, clinical providers, and researchers involved with the planning, delivery, and evaluation of JDY. We used grounded theory coding techniques and constant comparison to develop themes that capture the data on implementation and collaboration related to the delivery of JDY. Results: Two broad themes emerged: (a) collaboration between the clinician and person with lived experience and (b) collaborative culture within and between organizations. Findings capture how collaboration occurred between providers within the clinical encounter (e.g., combined strengths of clinicians and peers) and within and between organizations, clustering around several CFIR domains (e.g., inner setting, process, characteristics of individuals, intervention characteristics). Findings speak to the importance of a "culture of collaboration" in which collaboration is occurring across multiple levels of an organization to support the delivery and implementation of JDY. Conclusions and Implications for Practice: JDY can complement other collaborative approaches given its focus on improving initial engagement. Findings point to the perceived benefits of interventions that are facilitated by a clinician and a person with lived experience along with how their combined expertise can support recovery. Impact and Implications: This study examines the perspectives of agency leaders, clinical providers, and researchers on the implementation and delivery of an engagement intervention for young adults diagnosed with serious mental illnesses. Results point to the benefits of initial engagement interventions that are facilitated by a clinician and a person with lived experience, as a step toward participation in more long-term treatment decision making. Their combined expertise can support recovery and can complement other treatments. [ABSTRACT FROM AUTHOR]

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18–22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18–22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18–22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed. [ABSTRACT FROM AUTHOR]