Transitional age youth (TAY ; ages 16-25) is a developmental period marked by major biopsychosocial changes and a peak onset of mental disorders. While psychiatric diagnoses rely heavily on distress as a criterion, the concept remains underdefined, particularly for youth who often report subthreshold symptoms. This study aims to explore how TAY with mental disorders experience and describe their suffering, in order to clarify its phenomenological features and clinical relevance within the context of emerging adulthood. We conducted individual, semi-structured interviews with 15 TAY receiving psychiatric care at a public hospital in Brussels. Participants were aged 17-25 and came from both inpatient and outpatient settings. Each interview began with a visual tool, where participants brought visual materials representing their suffering. The interviews were analyzed using thematic analysis. We identified five themes. First, for participants, suffering meant enduring "mental pain," an aversive and inescapable experience, often tied to suicidality. Second, this pain was described as submerging their reality, disrupting their sense of time, world, and self. Third, participants struggled to explain this pain to others and themselves. Fourth, they nonetheless thought it to be abnormal and to require professional help, as it signaled the presence of a mental disorder. Lastly, they reported the underlying cause of their mental pain as having no place in the world, due to patterns of social adversity or an inability to meet social expectations Conclusion: For these TAY, suffering was tied to a damaged social sense of self, fueled by ideals of autonomy and self-improvement that are increasingly hard to achieve. Excessive suffering was often characterized as "depression" and many of their experiences did echo phenomenological accounts of depression. While prior definitions of suffering emphasize causes or outcomes, this study details the experiential core of suffering as mental pain. However, some participants distinguished between pain as an immediate pre-reflective experience and suffering as its reflective aftermath. This supports the view that clinicians must address not only the raw experience but also help patients build meaning from it, bridging symptom relief with narrative understanding.

Ketamine has emerged as a promising rapid-acting antidepressant with distinct advantages for the treatment of treatment-resistant depression (TRD). Its therapeutic effects are mediated through multi-target modulation of the glutamatergic system. Unlike conventional antidepressants, ketamine exerts a markedly faster onset of action; however, its long-term safety profile and potential risk of dependence require rigorous evaluation. This scoping review aims to systematically summarize recent advances in research on ketamine's role in depression treatment. This review synthesizes current evidence regarding ketamine's molecular mechanisms of action, neuroimaging correlates, pharmacological characteristics, and associated ethical considerations. By primarily antagonizing N-methyl-D-aspartate (NMDA) receptors, ketamine rapidly disinhibits the mesolimbic dopamine reward pathway and upregulates brain-derived neurotrophic factor (BDNF) expression via eukaryotic elongation factor 2 kinase (eEF2K) suppression, thereby activating the mammalian target of rapamycin (mTOR) pathway and enhancing synaptic plasticity. Neuroimaging studies further reveal that ketamine induces rapid remodeling of prefrontal-limbic functional connectivity, modulates default mode network activity, and promotes the normalization of cerebral metabolism and structure. Pharmacologically, ketamine exhibits a rapid onset of action and a relatively broad therapeutic window, though notable pharmacodynamic and pharmacokinetic differences exist between its enantiomers and active metabolites, which warrants further investigation. Ketamine displays rapid onset and high efficacy in the management of TRD; nevertheless, its long-term safety, risk of dependence, and potential cognitive effects necessitate close clinical monitoring. Future research should prioritize the exploration of synergistic treatment regimens and the development of novel ketamine derivatives with improved target specificity and safety profiles to advance the application of precision psychiatry. Collectively, this review provides a foundational reference to guide clinical practice and inform subsequent mechanistic studies on ketamine-based antidepressant therapies.

Epidemiological studies have reported associations between creativity and genetic vulnerability for schizophrenia and other severe mental disorders. Alterations of selfhood have been proposed as a possible link between these phenomena. In this explorative study, we examined disturbances of basic selfhood and imagination, as well as general psychopathology, in a non-clinical sample of professional visual artists. Methods Ten visual artists, exhibiting at prestigious galleries, were recruited through professional networks. They underwent a comprehensive interview assessment of psychopathology, including the Present State Examination (PSE), the Examination of Anomalous Self-experience (EASE), the Examination of Anomalous fantasy and Imagination (EAFI), and a qualitative interview exploring the creative working process. Results Four participants described a moderate to high level of self-disorders and/or anomalies of imagination and described an involvement of these experiences in their creative working process. The participants met ICD-10 research criteria for lifetime diagnoses of mood, anxiety and schizophrenia-spectrum disorders. Discussion The findings are exploratory and based on a small sample. Drawing on phenomenological considerations, we tentatively suggest that, for some individuals, alterations of the pre-reflective structure of subjectivity may be related to creativity through subtle alienation from fundamental common-sense categories, an inclination towards preoccupation with the imaginary, and a spatialized mode of experiencing the inner life.

Major depressive disorder (MDD) is one of the most frequent psychiatric diseases worldwide. Growing evidence suggests that cortical gyrification measures may present an early risk marker for depression. Medial views of cortical surface reconstructions provide the basis for a simple, expert-rated measure of cortical gyrification. In this study, we examined left anterior cingulate cortex (ACC) gyrification as a potential marker of MDD. We selected this region of interest based on the limbic-cortical dysregulation model of depression and prior research results. One third of subjects exhibited two antero-posterior gyri in the left hemisphere, whereas the other subjects exhibited one longitudinal gyrus or longitudinal gyrification was interrupted. Subjects with the fewer-gyri left ACC variant more often experienced MDD at some point in their lifetime (p = .048). Moreover, among all subjects with MDD, disorder onset happened earlier in subjects with the fewer-gyri variant (d = -0.30), hinting at early developmental contributions to the phenotypic marker. In addition, subjects with fewer longitudinal gyri scored higher on neuroticism (η2= .02), but not on extraversion. Automatically derived measures of gyrification and cortical surface area were largely consistent with the differences observed using the expert rater-based gyrification measure. Future studies should investigate left ACC gyrification and to what extent it exists in at-risk subjects, further elucidating it with ACC structural and functional connectivity measures.

Background: Phenomenological psychopathology has traditionally focused on individual experience, yet contemporary clinical practice increasingly requires understanding of how collective cultural forces shape psychological life. In an era of advanced globalization, stable social aggregates have given way to fluid “cultural flows” that transcend geographical and social boundaries, necessitating new conceptual frameworks for clinical assessment. Summary: This paper proposes a critical expansion of phenomenological psychopathology of the individual to explicitly integrate the collective dimension. In order to accurately describe the scenario of collective life, and its relationship with the psychology and psychopathology of individual existences, we propose two moves: (1) a shift of focus from society (which denotes an organized aggregate of individuals) to culture (a transversal symbolic system, capable of extending beyond the boundaries of the original social group) since in the context of advanced globalization the conception of stable social aggregates has been replaced by models of fluid and changing “cultural flows” and (2) to phenomenologically describe these cultural flows that traverse the contemporary world, we introduce the concept of “cultural existentials” (time, space, body, and others) as a priori conditions of experience derived from the analysis of the fundamental structures of individual lifeworlds, as employed in phenomenology. These cultural existentials are integrated into a dialectical experiential matrix (DEM), designed to overcome the reductionism of both structuralism and subjectivist individualism. The DEM frames the patient’s experience as a dynamic interplay between individual freedom (the capacity for self-positioning) and cultural influence. An illustrative application analyzing the convergence between “pornographic culture” and the “homo œconomicus” anthropological type is provided to demonstrate how cultural existentials offer a collective model for specific narcissistic vulnerabilities and dysregulations of alterity, providing a crucial diagnostic device for the clinician. Key Messages: The DEM provides clinicians with a diagnostic device for understanding how contemporary cultural configurations shape individual psychopathology. By articulating the dialectical relationship between cultural existentials and individual positioning, this framework enables more accurate phenomenological description of patients whose suffering reflects not merely idiosyncratic biography but participation in collective cultural patterns. This approach addresses the limitations of purely individualistic psychopathology while maintaining phenomenological rigor.

Plain Language SummaryThis study aimed to investigate a presumed mechanism of efficacy of a certain type of psychotherapy for people with borderline personality disorder. Since failed social interactions often trigger strong feelings of anger and sometimes aggressive behavior in this psychiatric disorder, patients are greatly affected. It is therefore essential to tailor treatment to this specific symptom by targeting the suspected mechanisms of efficacy. One such factor is thought to be a lack of ability to regulate one’s own emotions. Our working group has developed a special mechanism-based anti-aggression psychotherapy that focuses on this specific problem, among other things. Here, we used a laboratory task performed in a MRI scanner to test whether this new therapy was capable of positively influencing this affective dysregulation compared to a competing intervention and whether this was reflected in the brain activity pattern. Our therapy program increased activity in certain areas of the brain that are generally believed to play an important role in the voluntary control of emotions and behavior, which in turn was associated with a reduction in aggressive behavior among participants. However, participants in the competitive therapy program showed opposite results. Brain activity declined in the specified areas, and at the same time, more aggressive behavior was reported by the group. Our study thus makes an essential contribution to the targeted optimization of therapy programs and to the understanding of the mechanisms behind them.

Background: The shift in mental health towards ecological and collaborative models, in alignment with the recovery paradigm, has sparked interest in dialogical and coproductive practices. These practices aimed to promote epistemic justice and strengthen the therapeutic alliance. Among these, collaborative writing (cowriting) is emerging as a promising tool. However, it currently lacks a robust theoretical and methodological foundation, particularly in its integration with phenomenology and its clinical applications. This article proposes the core elements of a “phenomenological cowriting” model that seeks to frame the practice within clinical phenomenology, distinguish it from purely narrativist approaches, and highlight its unique contributions. Summary: This study conducts a theoretical analysis with a focus on clinical applicability, integrating the principles of clinical phenomenology with collaborative and dialogical methods. The relevance of a phenomenological cowriting model is demonstrated through a comparative analysis with other collaborative writing approaches, such as those based on narrativist or ethnographic traditions, and is exemplified by a case vignette. From a clinical perspective, we propose a three-phase model: (1) therapeutic dialogue, (2) the use of transcription as a “textual artefact,” and (3) joint rewriting. This model provides significant value in terms of process and outcomes. As a process, it embodies a collaborative care framework that minimises epistemic asymmetry and promotes patient agency. As an outcome, it helps clarify the patient’s lived experience, including its prereflective dimensions, thereby enriching shared psychopathological knowledge with a first-person perspective. Key Message: Phenomenological cowriting should be understood not as a mere technique but as a comprehensive and integrated model of care. Grounded in clinical phenomenology and the coproduction of a text, it provides a structured method for constructing therapeutic pathways that foreground an active role for the patient, ultimately generating clinical knowledge rooted in the subjective experience of suffering.

The editors and Karger Publishers would like to thank the following reviewers for their ongoing support in reviewing manuscripts for Psychopathology:June Andrews Horowitz, North Dartmouth, MA, USALudovica Aquili, Padua, ItalyArnoud R. Arntz, Amsterdam, The NetherlandsAli Bahari, Tehran, IranJ.M. Barnby, London, UKGabriel Engel Becher, Sao Paulo, BrazilKristin Bernard, Stony Brook, NY, USAValeria Bizzari, Leuven, BelgiumJuan Diego Bogotá, Jyväskylä, FinlandAlexa Bonacquisti, Philadelphia, PA, USAPavan Brar, Torrance, CA, USAEleanor Byrne, Nottingham, UKMichel Cermolacce, Marseilles, FranceSimone Cheli, Rome, ItalyDaniel Collerton, Newcastle, UKHenry R. Cowan, East Lansing, MI, USAKarin Dannecker, Berlin, GermanyAlexander Daros, Windsor, ON, CanadaKim de Jong, Leiden, The NetherlandsMarco Di Sarno, Milan, ItalyGiancarlo Dimaggio, Rome, ItalySigne Düring, Copenhagen, DenmarkÖmer Erdoğan, Kastamonu, TurkeyCecilia Maria Esposito, Pavia, ItalyRenaud Evrard, Nancy, FranceElena Faccio, Padua, ItalyIstván Fazakas, Wuppertal, GermanyJasper Feyaerts, Ghent, BelgiumMaria Luísa Figueira, Lisbon, PortugalAlberto Figueiras Rodríguez, Corme-Porto, SpainChristine Firk, Aachen, GermanyPeter Fonagy, London, UKEduardo Fonseca-Pedrero, Logroño, SpainFrancesca Forlè, Milan, ItalyAndrew Frazer, Knoxville, TN, USATom Froese, Tancha, JapanMaría Isabel Gaete, Vina del Mar, ChileS. Nassir Ghaemi, Boston, MA, USAAnne Giersch, Strasbourg, FranceGerrit Glas, Wijhe, The NetherlandsRossetos Gournellis, Athens, GreeceJonathan Green, Manchester, UKShannon Grogans, College Park, MD, USATill Grohmann, Leuven, BelgiumN.H. Grootendorst-van Mil, Rotterdam, The NetherlandsEnzo Grossi, Tavernerio, ItalyFabian Guénolé, Caen, FranceHanne Haavind, Oslo, NorwayUte Habel, Aachen, GermanyStephanie M. Hare, Baltimore, MD, USAMads Gram Henriksen, Copenhagen, DenmarkRachel Hershenberg, Atlanta, GA, USALea Kassandra Hess, Bern, SwitzerlandRoger C. Ho, Singapore, SingaporeTiffany Ho, Los Angeles, CA, USAClara Humpston, York, UKGeorge Ikkos, London, UKSevim Berrin Inci Izmir, Istanbul, TurkeyHenry James Jackson, Melbourne, VIC, AustraliaNattinee Jantaratnotai, Bangkok, ThailandNatalia Jimeno, Valladolid, SpainTim Kaiser, Berlin, GermanyJoachim Klosterkötter, Cologne, GermanyTobias Kockler, Karlsruhe, GermanyDeniz Konac, London, UKAllan Køster, Copenhagen, DenmarkLeonhard Kratzer, Prien am Chiemsee, GermanyAnurag Kuhad, Chandīgarh, IndiaFranziska Lechner-Meichsner, Utrecht, The NetherlandsMarcelo Vieira Lopes, Santa Maria, BrazilKevin B. Meehan, Brooklyn, NY, USAJosé Miguel Mestre, Cadiz, SpainJohannes Michalak, Witten, GermanyIda-Marie Mølstrøm, Copenhagen, DenmarkMarcin Moskalewicz, Heidelberg, GermanyAndrew Moskowitz, Alexandria, VA, USAAlexandra Moussa-Tooks, Bloomington, IN, USAInes Mürner-Lavanchy, Basel, SwitzerlandIvan Nenchev, Berlin, GermanyDaniel Nischk, Reichenau, GermanyJulie Nordgaard, Roskilde, DenmarkGeorg Northoff, Ottawa, ON, CanadaAleš Oblak, Ljubljana, SloveniaErcan Ozdemir, Edinburgh, UKAngelo Picardi, Rome, ItalyMarek Pokropski, Warsaw, PolandMichele Poletti, Reggio Emilia, ItalyHolly Prigerson, New York, NY, USAJannis Puhlmann, Heidelberg, GermanyAndrea Raballo, Lugano, SwitzerlandAndreas Rosén Rasmussen, Copenhagen, DenmarkKatrina Rbeiz, Nashville, TN, USAJack Reynolds, Geelong, AustraliaAlessandro Rodolico, Munich, GermanyJenny Ann Rydberg, Metz, FranceMarsal Sanches, Houston, TX, USAVedat Sar, Istanbul, TurkeyMichael Saraga, Lausanne, SwitzerlandLeonhard Schilbach, Munich, GermanyPhilipp Schmidt-Boddy, Heidelberg, GermanyKnut Schnell, Göttingen, GermanyPeter Schofield, Waratah, AustraliaElmira Shayegh, Tehran, IranSebastian Simonsen, Copenhagen, DenmarkBorut Skodlar, Ljubljana, SloveniaLine I. Stänicke, Oslo, NorwayGeorg Starke, Munich, GermanyYueYi Sun, Nanjing, ChinaSamuel Thoma, Berlin, GermanyJenna M. Traynor, Belmont, CA, USARudolf Uher, Halifax, NS, CanadaSalome Vanwoerden, Pittsburgh, PA, USAMartin Voss, Berlin, GermanySebastian Walther, Bern, SwitzerlandHéloise Young, Rouen, FranceLucy Zhang, Melbourne, VIC, Australia

Background: Felt presence (FP) – the sensation of someone nearby without sensory evidence – is common in healthy adults and related to psychosis risk. FP may arise from a misattribution of internal signals to an external source and often occurs when people are alone. Interoception, the ability to perceive one’s own bodily signals, may help distinguish oneself from others. FP could relate to interoception across several dimensions: through altered signal perception (interoceptive accuracy), insight into their perception (interoceptive insight), and/or self-reported beliefs (interoceptive beliefs). This is the first study that investigates this potential relationship. Method: A total of 55 healthy adults completed the heartbeat counting task to assess interoceptive accuracy and insight under three “social” conditions: self-view (observing oneself on a screen), other view (being observed by the experimenter on a screen), and baseline (no viewing). Participants completed the Prodromal Questionnaire-16 to screen for psychosis risk, the Inclusion of Other in the Self Scale as a measure of self-other overlap, the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), and indicated whether they ever had a “felt- or sensed-presence experience” (Y/N). Results: Psychotic experiences were elevated in individuals with FP, and it was experienced more often in solitude. Overall, the other-view condition reduced both interoceptive accuracy and insight. Distinct interoceptive patterns emerged for FP and psychosis risk. High risk was related to lower interoceptive accuracy, particularly when perceived self-other overlap was low. In contrast, individuals with FP showed intact interoceptive insight when the self-other overlap was low. Both FP and psychosis risk were associated with lower trust in bodily signals and tendency to not distract oneself from bodily sensations. Only FP group reported attending to bodily sensations to calm oneself. Conclusion: Interoceptive accuracy was preserved in those with FP regardless of their psychosis risk, but their trust of and insight into their own bodily signals were reduced. This mismatch may lead to misattributing internal signals to external sources, contributing to FP. However, preserved interoceptive accuracy may support self-regulation, potentially offering a protective effect. These results highlight the potential of interoceptive training to enhance resilience in individuals at risk for psychosis.

Background: Self-injury has become increasingly prevalent among adolescents and young adults over the past decades, reflecting the intersection between individual vulnerability and sociocultural transformations. Understanding this phenomenon requires not only a clinical perspective but also a broader reflection on how current social dynamics – such as digital hyperconnectivity and weakened interpersonal bonds – shape subjectivity and emotional regulation. Summary: This article offers an integrative and interpretive study based on the authors’ previous empirical research conducted in 2022, which included semi-structured clinical interviews with 20 young people (19 females and 1 male) aged between 13 and 28 years who engaged in skin-cutting. The analysis considered four dimensions: family dynamics, identity, symptom onset and context, and the function of the symptom. The findings revealed that self-injury is associated with difficulties in identity formation, emotional regulation, and family relationships, which were interpreted in light of contemporary sociocultural changes. To enrich this perspective, theoretical contributions from sociology and philosophy were incorporated to link individual experience with the broader cultural framework. Key Messages: Self-injury reflects not only intrapsychic conflict but also the impact of sociocultural transformations characteristic of postmodernity. Understanding its meaning requires integrating clinical, familial, and sociocultural levels of analysis. The proposed therapeutic approach combines evidence-based strategies for emotion regulation with interventions that address the patient’s identity and social context. This work aims to provide clinicians with conceptual and practical tools to better understand and treat self-injury as a phenomenon rooted in contemporary culture.