Based on contemporary witness statements, the study examines how employees in the psychiatric institutions of the German Democratic Republic (GDR) dealt with mentally ill people at social events. In this study 63 contemporary witnesses who worked in psychiatric institutions in the GDR were interviewed. The interviews were evaluated qualitatively. The interviews show that there were restrictions and admissions for certain social events, such as national holidays or state visits, that were not medically indicated. These instructions were handled differently. Noncompliance with these instructions was largely not reported as having serious consequences. People with mental illnesses were supposed to be kept away from public events during certain social events. The staff in psychiatric institutions dealt with this differently. This indicates acertain degree of flexibility. The removal from society represents astigmatization of mentally ill people. Psychiatry in the GDR was also instrumentalized for political purposes.

Construction and validation of a predictive model for suicidal attempts in patients with mood disorders after discharge based on machine learning methods: A two-year follow-up study.

Poor engagement with Early Intervention Services (EIS) for first-episode psychosis threatens program effectiveness, yet research often reduces engagement to a binary measure (engaged/disengaged), limiting understanding of those who disengage and re-engage. This study examined demographics, clinical characteristics, and health service utilisation patterns among engaged, intermittently engaged, and disengaged patients of the Nova Scotia Early Psychosis Program (NSEPP). A retrospective cohort comprised of 331 individuals enrolled in NSEPP between July 22, 2005, and October 9, 2015, was constructed by linking clinical and administrative datasets. Engagement types (engaged, intermittently engaged, disengaged) were characterised in terms of baseline demographics and clinical factors, along with patterns of health service utilisation before, during, and after program enrollment. Crude and adjusted associations between program engagement and post-program health service utilisation (emergency department (ED) use and mental health-related hospital admissions) were assessed using negative binomial regression models. During program enrollment, the intermittently engaged group had the greatest illness severity (35% spent 30+ days in hospital), and the highest proportion of individuals with at least one ED visit (85%) and one hospital admission (55%). These during-program health service use factors were the strongest predictors of post-program health service use outcomes. The three engagement types show distinct health service utilisation patterns, which may reflect differences in need, access, or program effectiveness. These results provide evidence that dichotomisation of engagement may mask important heterogeneity. Further characterisation of the engagement continuum to include intermittent engagement may provide insights to reducing barriers and improving access to and uptake of EIS.

Adolescence is a critical period for the onset of major depressive disorder (MDD), during which emotional symptoms frequently co-occur with environmental adversity and maladaptive behavioral coping. In China, these processes may be further shaped by left-behind experience (LBE) - a prevalent structural vulnerability in which children grow up separated from migrating parents. To clarify these relationships, we applied network analysis in a clinical sample of 2341 adolescents (Mage = 14.99 years,77.92% female) with MDD. Participants were recruited from 14 psychiatric outpatient clinics across China. The networks examined associations among mental health symptoms (depression, anxiety, stress, sleep problems, self-esteem, loneliness), ecological factors (childhood trauma, peer victimization, social support), and problematic smartphone use (PSU). We further examined whether network topology differed by LBE (19.99% of the sample). In the full sample network, depression and loneliness demonstrated the highest strength centrality, while sleep exhibited the lowest. Loneliness and PSU acted as bridges between mental health symptoms and ecological factors. Network comparison tests revealed no significant between-group global structural differences. Although childhood trauma and PSU appeared more centrally positioned in the left-behind group and social support showed slightly higher centrality in the non-left-behind network, these subtle trends need further confirmation. These findings underscore critical psychological-ecological-behavioral interaction pathways in adolescents with MDD, and suggest loneliness and PSU as promising targets for bridge-informed clinical intervention.

Kratom exposure cases reported to United States Poison Centers: 2016-July 2025.

Cognitive flexibility in adults with schizophrenia: A scoping review.

Sleep disorders are frequently reported in individuals with anorexia nervosa (AN). Autism spectrum disorder (ASD) is strongly associated with both anorexia nervosa and sleep disturbances. We study the possible influence of the association of ASD to AN to the development of sleep disorders. A retrospective cohort study design was used, including all patients followed for AN or ASD in the child and adolescent psychiatric unit at the Salvator hospital, Marseille, between January 2019 and January 2024. We had included 491 patients, mean age was 15.16years±3.11years. Sleep was assessed with the PSQI, ESS and ISI; autistic traits with the Autism-Spectrum Quotient (AQ). Sleep disorders were significantly more prevalent in the anorexia nervosa binge/purge subtype group than the Anorexia nervosa restrictive subtype or the ASD groups with pathological scores in the PSQI in 78% (p<10-3), ISI in 46.3% (p=0.035) and in the ESS in 58.5% (p=0.017). The prevalence of sleep disorders was significantly higher in AN patients having pathological AQ score. However, when controlling for confounding factors, this association was no more significant. Our findings were inconclusive in establishing a clear association between autistic traits and sleep disorders in individuals with anorexia nervosa. However, a potential influence cannot be ruled out.

Schizophrenia in migrants and natives: clinical presentation, treatment patterns, and outcomes in a Spanish acute inpatient unit.

ObjectiveThe present study investigated ADHD comorbidity and clinical features, including hyperfocus, in women with depressive or anxiety disorders, addressing the diagnostic complexities arising from symptom overlap and the underdiagnosis of ADHD in this population.MethodsFemale patients from outpatient psychiatric clinics (n = 170) were assessed using the Beck Depression Inventory and Beck Anxiety Inventory. Participants meeting threshold scores underwent further evaluation with the Wender-Utah Rating Scale, Hyperfocus Scale and Adult ADHD DSM-IV-Based Diagnostic Screening Scale, complemented by structured clinical interviews.ResultsADHD was identified in 19.6% (n = 33) of patients, 45.5% (n = 15) of whom were previously undiagnosed. ADHD was most prevalent in patients with social anxiety disorder (46.4%) and double depression (40.6%). In non-ADHD participants, (a) attention deficit scores correlated positively with depression (r = 0.236, p = 0.005), (b) hyperactivity with anxiety (r = 0.187, p = 0.029), and (c) hyperfocus with ADHD scores (r = 0.434, p < 0.001; r = 0.292, p = 0.001); no such correlations were seen in the ADHD group.ConclusionADHD is common and frequently overlooked in women presenting with depression or anxiety. While hyperfocus is a relevant clinical feature, it is not diagnostic alone and correlates with ADHD symptoms in the absence of ADHD. Clinicians should conduct thorough screenings for ADHD and carefully interpret hyperfocus within the broader clinical context to ensure accurate diagnosis and timely, appropriate treatment.

Aim: To examine the relationship between the ethical attitudes of psychiatric nurses and their knowledge, attitudes, and practices regarding physical restraintMethod: This study has employed a descriptive cross-sectional design. The researchers recruited 146 nurses who work in psychiatric units. Convenience sampling method was used to collect data. "Sociodemographic Questionnaire," "The Scale of Nurses' Knowledge Level, Attitudes, and Practices Regarding Physical Restraint," and "The Ethical Attitude Scale for Nursing Care." used as a measurement.Results: The nurses' mean scores of knowledge, attitude, practices regarding physical restraint, and ethical attitudes were [7.09±1], [30.1±3], [38.3±2] and [156.1±13], respectively. The ethical attitudes of nurses and practices regarding physical restraint scores were found to be positively correlated. It was further found that the ethical attitudes of nurses contributed 9.1% to predicting their practices regarding physical restraint.Conclusion: This study is essential to understand how ethical attitudes affect physical restraint practices among psychiatric nurses. Healthcare institutions can work towards enhancing the ethical attitudes of psychiatric nurses by addressing barriers, providing targeted education, and promoting a supportive ethical environment.

Safety planning is recognized as one of the most effective interventions for reducing suicidal behaviors. The quality of safety plans strongly depends on professional training, and traditional methods, such as role-playing, are time-consuming and offer limited opportunities for repetition across diverse patient profiles. Generative artificial intelligence (GenAI) may provide innovative solutions by offering accessible, flexible, and realistic training environments. This pilot study aimed to evaluate the acceptability and feasibility of a GenAI-based simulator designed to train mental health professionals in safety planning. Twenty nurses and nursing assistants from psychiatric units in a French university hospital participated in a pre-post, single-session evaluation. After self-rating their ability, competence, and willingness to manage patients experiencing suicidal ideation, participants interacted individually with the text-based simulator for 20 minutes to perform a safety plan with a chatbot, then completed postsimulation acceptability items, and open-ended feedback. Composite scores were computed: acceptability (eg, helpfulness; 0-40), realism (eg, looking like real interaction with patient; 0-20), and challenge (eg, emotional challenge; 0-30). Pre-post changes were tested (Wilcoxon signed-rank test), and age-group comparisons were performed. Acceptability was high (mean 31.9/40, SD 5.3; median 32, IQR 7), realism moderate-to-high (mean 15.1/20, SD 4.1; median 15, IQR 5.25), and challenge manageable (mean 17.0/30, SD 8; median 18, IQR 12.5). Participants rated usefulness (mean 7.65/10, SD 1.57; median 8, IQR 1.57), perceived learning (mean 7.6/10, SD 1.79; median 8, IQR 2), recommendation to use the chatbot for training (mean 8.3/10, SD 1.59; median 9, IQR 2.25), and feedback quality (mean 8.35/10, SD 1.27; median 8.5, IQR 1.25) favorably. Willingness to actively manage patients experiencing suicidal ideation significantly increased postsimulation (P=.03). Younger participants reported higher acceptability (P=.04) and realism (P=.03). Participants reported minimal concerns regarding the simulator's use. This pilot study demonstrates that a GenAI-based simulator for safety planning is feasible and highly acceptable among experienced mental health professionals. The findings are promising and warrant larger, controlled trials to assess impacts on training effectiveness and patient outcomes.

To explore the experiences of individuals with mental disorders participating in a nurse-led group yoga practice in an acute psychiatric inpatient setting. A descriptive qualitative design was used. The study sample comprised patients with mental disorders hospitalized in a psychiatric unit of a university hospital in Türkiye; 26 patients participated in the yoga program, and interviews were conducted with 14 participants who attended at least eight sessions over 4 weeks. Data were collected through semi-structured interviews and analyzed using reflexive thematic analysis informed by a analytic framework. Four main themes emerged: Emotional and Mental Well-Being, Reflecting Relaxation, Emotional Regulation, and Enhanced Self-Awareness; Physical Effects and Body Awareness (including increased bodily awareness and breath control); The Power of Shared Experience (highlighting motivation and social connectedness fostered through group practice); and Challenges and Recommendations (addressing physical strain, environmental limitations, and suggestions for structured and supportive implementation). Nurse-led group yoga appears to be a holistic and supportive intervention for psychiatric inpatients, improving psychological well-being, physical awareness, and social connectedness. Integrating structured, nurse-led yoga sessions into psychiatric wards can promote recovery-oriented, holistic care.

Background: Schizophrenia is a chronic mental disorder that becomes one of the biggest burdens for health services. The main therapy for schizophrenia is antipsychotics. The use of these antipsychotics resulted in several side effects, especially extrapyramidal syndrome. To treat the side effects ofantipsychotics, trihexyphenidyl is used. This research aims to determine the description of schizophrenia and the use of trihexyphenidyl in HB Saanin Mental Hospital, Padang City. Objective: This study aims to determine the description of schizophrenia and the use of trihexifenidil in HB Saanin Mental Hospital Padang City. Methods: This study was a retrospective descriptive study and used a cross sectional method through medical record observation. The sampling technique was purposive sampling with a total sampling of 96 patients. This research was conducted in the medical record installation of HB Saanin Mental Hospital Padang City on patients who were hospitalized on June 1 to June 30, 2022. Results: The results of this study were that 74% of the patients were male. The most age group of patients ranged from 36-45 years of age is 32.3%. The most age of onset is 21-25 years is 33.3%. Most of the history of patient education level was SMA, which is 45.8%. Most of the patients did not work as much as 80.2%. More than half of the patient's marital status is not married which is 59.4%. The highest frequency of patients with a disease course of 11-15 years was the highest is 21.9%. The most common classification of schizophrenia found is paranoid schizophrenia, which is 36.5%. Almost all schizophrenic patients are given risperidone, which is equal to 99%. Two-thirds of schizophrenic patients were given trihexyphenidyl, which is 63.5%. Conclusions: This study found that many schizophrenia patients were given trihexyphenidil

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often require long-acting or pro-drug stimulants, but telehealth prescribing is constrained by the Ryan Haight Act's in-person requirements. While pandemic-era waivers temporarily lifted these mandates, their permanent status remains uncertain. Assess long-acting or pro-drug stimulant medication adherence using proportion of days covered (PDC) in adolescents with ADHD (12-17) receiving telehealth or hybrid care (2022-2024), comparing rates to post-pandemic (April 2020-June 2022) adherence rates in urban pediatric populations. Examine symptom scores on the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screening (GAD-2), and ADHD Symptom and Side Effect Tracking (ASSET). Compare visit attendance between telehealth and hybrid care. Program evaluation consisting of retrospective chart reviews, pre-visit surveys, and prescription data on 49 adolescents (21 telehealth and 28 hybrid) in a psychiatric clinic were evaluated. The total sample mean PDC was .381. Hybrid group adherence was .448 and .313 for the telehealth group. PDC was the same as the post-pandemic adherence rate (.310-.440). Paired t-tests comparing GAD-2 scores were (p < .001), PHQ-9 (p < .001), and ASSET (p = .010). Telehealth attendance was lower than hybrid attendance. The hybrid care model showed better adherence and attendance than telehealth for adolescents with ADHD. PDC from this program evaluation was statistically similar to national trends in pediatric ADHD management. Future research must prioritize geographic and digital determinants, understand the impact of polypharmacy, and establish evidence-based strategies to enhance long-term adherence in telehealth care models.

BackgroundPsychiatric inpatients in China may experience threats to dignity and self-expression within ward environments shaped by stigma, safety concerns, and institutional routines. However, how they navigate these challenges and restore dignity through everyday interactions during hospitalization remains underexplored in psychiatric nursing.AimTo develop a substantive theoretical framework explaining how Chinese psychiatric inpatients experience dignity challenges and navigate pathways toward dignity empowerment and restoration during hospitalization, and what role therapeutic relationships with mental health nurses play in facilitating this process.Research designConstructivist grounded theory following the Charmaz tradition, informed by relational autonomy theory.Participants and research context11 psychiatric inpatients were recruited from the psychiatric ward of a tertiary general hospital in China between March and June 2025, using maximum variation purposive sampling to ensure demographic diversity.Ethical considerationsEthical approval was obtained from the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Reference 2025-2245-01).FindingsThe theoretical model "Finding Voice in Vulnerability" suggests that psychiatric inpatients may navigate dignity challenges through four interconnected relational processes: Cognitive Liberation and Conceptual Reconstruction, Relational Dignity Empowerment, Relational Reconstruction of Valued Identity, and Participatory Treatment Negotiation. The model further suggests that vulnerability may become a relational resource through dignity-affirming interactions that support autonomy and participation in treatment decisions.ConclusionsDignity empowerment may emerge through relational recognition rather than individual autonomy, suggesting a potential reorientation toward relationally informed psychiatric care. The findings suggest that everyday nursing interactions may be important contexts for empowerment, with implications for relational competency training and future longitudinal research across diverse psychiatric settings.

This article describes the federal Medicaid Institutions for Mental Diseases (IMD) exclusion and compares legislative proposals introduced in the 119th Congress-House of Representatives Bill (H.R.) 5662 and H.R. 6727-that seek to repeal this policy. A descriptive policy analysis was conducted using publicly available legislative texts, related federal policy documents, and earlier reviews examining potential impacts of the repeal of the IMD exclusion. The analysis summarizes the statutory basis of the IMD exclusion, reviews existing workarounds, and compares the key mechanisms proposed in H.R. 5662 and H.R. 6727. Potential implications for Medicaid financing and inpatient psychiatric capacity are discussed. The IMD exclusion prohibits federal Medicaid reimbursement for most inpatient psychiatric facilities with more than 16 beds for adults aged 21-64 years, contributing to reliance on state financing and temporary waiver programs. Both H.R. 5662 and H.R. 6727 propose repealing this exclusion. H.R. 5662 would repeal the policy without additional requirements, while H.R. 6727 would also require the U.S. Department of Health and Human Services to establish standards for participating facilities. Repeal would expand eligibility for federal Medicaid funding but would not mandate changes in state utilization or capacity. Recent legislative efforts to repeal the IMD exclusion reflect a growing concern regarding inpatient psychiatric bed shortages and mental health system strain. Understanding the differences between proposed repeal strategies is essential for evaluating how changes in Medicaid financing could affect inpatient psychiatric care and broader behavioral health systems.

Haaken Bergh spent eleven years as a patient in psychiatric institutions in Norway and Sweden in the early twentieth century. Following his discharge from Dikemark Asylum in 1921, he devoted the rest of his life to seeking redress and campaigning for reform of the mental health service. Bergh published two books, brought legal proceedings against Oslo local authority, petitioned the Norwegian parliament (the Storting) for ex-gratia compensation and held lectures throughout Norway. He attracted considerable public attention during his lifetime but was largely forgotten after his death. This article is based on Bergh's books Levende begravet (buried alive) (1925) and Jo galere, jo bedre (the crazier, the better) (1928), searches in the National Library of Norway's digital collections, a review of Bergh's medical records from Solna Hospital outside Stockholm and Dikemark Asylum in Norway, and archival material from the Office of the Municipal Finance Director in Oslo relating to Bergh's damages claim. Bergh was a prominent critic of psychiatry, and his books and lectures reached a wide audience. He ultimately received a token ex-gratia payment from the Storting, but the authorities largely ignored him. His criticism mainly concerned the inadequate safeguards governing involuntary admission, the limited expertise in asylums and the need to revise the Insanity Act of 1848. The solitary nature of his campaign and his polemical style probably contributed to his lack of impact.

Violent behavior remains prevalent in psychiatric settings and has serious negative impacts on the physical and mental well-being of health care professionals. Although evidence suggests that systematic risk assessment, patient engagement, and individualized care plans are effective preventive measures, a significant gap persists between such evidence-based prevention strategies and clinical practice in adult psychiatric inpatient units in China. This project aimed to promote evidence-based practices for the prevention and management of violence among psychiatric adult inpatients in five psychiatric hospitals in China. This project applied the JBI Evidence Implementation Framework. Using an audit-feedback strategy, we conducted a baseline audit using six evidence-based audit criteria. Identified barriers informed tailored implementation strategies. A follow-up audit then measured changes in clinical practice compliance. The baseline audit showed that families' ability to recognize and manage aggressive behavior was poor and the use of individualized care plans was 0%. The follow-up audit revealed improvements, with three indicators reaching 100%. Moreover, the implementation rate of individualized care plans increased from 14.67% to 86% and was successfully integrated into the clinical pathway. This evidence implementation project produced beneficial shifts. A standardized prevention protocol for aggression is now active; personalized care plans and the level of family involvement have both improved to varying degrees; and staff members' knowledge and skills have been strengthened. Future efforts are needed to sustain these achievements and further enhance adherence to best practices. http://links.lww.com/IJEBH/A607.

Mental health is now recognised as a major global concern affecting people from diverse backgrounds. There is growing evidence that the gut microbiota plays a crucial role by producing metabolites that significantly influence a person's mood and behaviour. Despite its importance, there is a significant gap in the profiling and understanding of the gut microbiota's influence on mental health among Malaysians. Therefore, this study aims to determine gut microbiome profiles among patients with major depressive disorders (MDD) of different treatment groups attending psychiatric clinics in the state hospitals and compare them to healthy individuals in the community of Klang Valley, Malaysia. This cross-sectional study will be carried out in Klang Valley, Malaysia. Eligibility of the patients will be assessed by the psychiatrists prior to recruitment of patients. Patients with MDD will be categorised into monotherapy and polypharmacy while healthy individuals will be used as a comparison group. Demographic data will be recorded. Stool samples will be subjected to DNA extraction and 16S rRNA gene-sequencing analysis to determine the microbial compositions of the gut microbiome. This study will be conducted following the procedure set by the National Medical Research Register Malaysia. The Medical Research Ethics Committee (MREC), Ministry of Health Malaysia, has ratified this study and granted ethical approval to conduct this study (NMRR ID-22-00893-JVW). All the participants will be given an information sheet and will sign a consent form to participate. Participants have the right to withdraw from the study at any time without an explanation. All information gathered will be used for research purposes only and treated as confidential. The results will be submitted to peer-reviewed journals for publication as well as presented at national and international conferences. Informing policy makers at all levels is a crucial aspect of the dissemination and will be done from local to international levels. This study was registered under National Medical Research Register Malaysia (NMRR ID-22-00893-JVW), a mandatory procedure of the Ministry of Health Malaysia before the start of a research.

Cardiometabolic conditions-including cardiovascular disease, type 2 diabetes, and obesity-are highly prevalent among individuals with psychotic disorders. These conditions contribute substantially to reduced life expectancy, diminished quality of life, and increased societal and economic burdens. Thus, effective, individualized interventions are urgently needed. Outpatient psychiatric clinics offer an ideal setting for such efforts owing to regular patient contact and access to multidisciplinary care. We have developed a comprehensive, clinically integrated trial aimed at improving cardiometabolic health, promoting healthier lifestyles, and enhancing quality of life for individuals with psychotic disorders receiving care in the Greater Gothenburg region. LAGOM is a multicenter, naturalistic, quasi-experimental case‒control trial conducted across six geographically separate outpatient psychosis clinics within the Department of Psychotic Disorders at Sahlgrenska University Hospital, a multi-site university hospital in the Greater Gothenburg region. A total of 650 adults with psychotic disorders will be recruited from these clinics. Two clinics will implement the LAGOM intervention, whereas four will serve as control sites delivering usual care. The intervention is embedded within routine psychiatric care and grounded in behavioral science. It includes comprehensive cardiometabolic risk assessments, two visual motivational tools (QRISK3 and a body composition analyzer), personalized follow-up plans, risk-oriented referrals to primary care, and structured education for patients, relatives, and staff. The intervention is designed to be scalable, sustainable, and tailored to individual patient needs. If proven superior to usual care, this pragmatic, multicomponent intervention-delivered within routine psychiatric care-could improve cardiometabolic health and quality of life for individuals with psychotic disorders. Embedding the intervention within existing clinical structures enhances its scalability and feasibility and, if effective, could serve as a model for wider implementation. ClinicalTrials.gov (NCT06781801; date registered: 16 January 2025). Trial status recruitment started on 27 February 2025 and will be completed on 31 December 2026. The current clinical investigation plan version is 3.1, dated 21 October 2025.