Psychiatric disorder diagnoses and adverse psychiatric outcomes among pregnant and postpartum adolescents in Ontario, Canada: a retrospective, population-based cohort study.

Polyallergy, a condition characterized by multiple non-immune-mediated reactions, has been associated with somatic symptom disorder (SSD), a psychiatric diagnosis characterized by excessive anxiety and preoccupation with physical symptoms without objective physical findings. SSD has been linked to a higher incidence of migraines and poorer surgical outcomes. Given these associations, this study examined whether polyallergy could serve as a preoperative marker for predicting outcomes after headache surgery involving peripheral nerve decompression. A retrospective cohort study was conducted of patients who underwent headache surgery between 2012 and 2017 with a single plastic surgeon. Patient-reported outcomes assessed with the Headache Impact Test-6, Migraine-Specific Quality of Life Questionnaire, and Migraine Disability Assessment; psychiatric diagnoses; and allergy history were collected. Polyallergy was defined as 2 or more allergies without immune-mediated confirmation or anaphylaxis. Subgroup analyses were performed based on polyallergy and psychiatric history. Patients with polyallergy experienced significantly less improvement in Headache Impact Test-6 (11.9% versus 56.3%; P = 0.002) and Migraine Disability Assessment (29.8% versus 93.7%; P = 0.010) scores, with Migraine-Specific Quality of Life Questionnaire scores approaching significance (44.0% versus 138.0%; P = 0.056). Polyallergy was associated with a roughly 50% to 70% lower likelihood of achieving clinically significant improvement. Patients with an anxiety disorder had less improvement, but the differences were not statistically significant. There were no differences in improvement between those with or without a mood disorder. Polyallergy is associated with poorer outcomes after headache surgery and may serve as a chart-accessible marker to identify individuals at risk for suboptimal improvement. These findings offer a novel application of polyallergy as a behavioral proxy for SSD in migraine surgical care and may aid patient selection and preoperative counseling.

When discharging patients, identifying those with a high risk of short-term readmission is crucial, as these readmissions may disrupt patient recovery and increase healthcare costs. The READMIT risk index has been developed to address this need across all psychiatric diagnoses. However, a broad model might not be applicable to specific diagnoses, e.g., major depressive disorder. We aimed to investigate the predictive validity of the READMIT risk index in a cohort of Danish patients suffering from major depression, and to develop an alternative prediction model for the risk of readmission within 30 days. Based on national register data, we included 24,984 patients discharged from a Danish psychiatric hospital after treatment for major depression. The proportions of patients who experienced readmission within 30 days were 8% (n=1969) with major depression, 13% (n=3343) with any psychiatric diagnosis, and 19% (n=4718) with all-cause readmission. For readmission related to major depression, the predictive performance of the READMIT index, defined as area under the receiver operating characteristic curve (AUC), was 0.48 (95% CI:0.47; 0.49), whereas the prediction model developed in this study showed an AUC of 0.58 (95% CI:0.57; 0.59). Neither the READMIT risk index nor a newly developed alternative prediction model based on individual-level variables, achieved an acceptable AUC, i.e., 0.70 or above, and were therefore not able to appropriately predict the risk of readmission within 30 days for patients with major depressive disorder. However, organizational factors and factors related to capacity in the Danish psychiatric system could potentially improve the results.

Mental health conditions in Mexico: Diagnosis trends based on hospital records.

This article discusses the diagnosis and conceptualization of suicide. Addressing suicide and related phenomena is a top priority in mental health care but is not adequately reflected in the current categorical diagnostic system, the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, Text Revision. Suicide demonstrates the pitfalls of categorical conceptualization of psychopathology and should be thoroughly examined within dimensional frameworks. This is particularly relevant as development of the newest iteration of the DSM-and renewed discussion of diagnosis and conceptualization of psychopathology-begins. The categorical nature of diagnosis has been critiqued at length, with the proposed alternative positing transdiagnostic dimensions that account for overlaps across and variations within diagnoses. Suicide and related phenomena do not appear as a distinct psychopathology/diagnosis in the DSM, Fifth Edition, Text Revision, instead comprising a symptom/criterion for only two of the almost 300 disorders. A transdiagnostic conceptualization of suicide aligns with historical and modern theories of suicide, none of which focus on psychiatric diagnoses as primary explanatory factors in suicide, and most of which emphasize transdiagnostic patterns of distress and biopsychosocial processes that better explain suicidal behavior. Discussion to date about limitations of the current diagnostic system regarding suicide has focused on adding suicide-related diagnoses or even positing an additional suicide-related axis when the DSM previously used an axial structure. Based on the characteristics of suicide and related phenomena described previously, the author hypothesizes that suicide-related processes comprise higher level dimensions-including a range of nonpathological (e.g., developmental changes in acceptance of death) to pathological phenomena and factors aligned with suicide theory (e.g., capability)-that interact with cross-cutting psychopathological and biopsychosocial factors to lead to varying phenotypes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Cognitive impairment in intensive care unit (ICU) survivors is multifactorial and can affect especially memory, attention, and executive functions. This study aimed to determine the cognitive functioning of patients with circulatory shock immediately after ICU discharge and 3 months later. This study, ASSESS-SHOCK 2, is a preplanned sub-study of the observational ASSESS-SHOCK study conducted at Helsinki University Hospital ICU. We included adults with circulatory shock, defined as hypotension requiring vasopressor infusion and concomitant signs of hypoperfusion. We excluded patients with severe neurological or psychiatric diagnoses, impairment of hearing or vision, developmental disability, and language barriers. Cognitive functioning of patients was assessed within 3 days of ICU discharge and 3 months thereafter with the Montreal Cognitive Assessment (MoCA) test. We defined cognitive impairment as MoCA score < 26 points. We also included data of 48 volunteer controls, tested once, to analyses. Fifty-five patients underwent an assessment within 3 days of ICU discharge, and 36 of them completed a follow-up assessment at 3 months. At discharge median MoCA-score was 22 (IQR 17-25). At the 3 months follow-up, the median MoCA-score was 26.5 points (IQR 24.25-28) showing improvement from discharge to follow-up (p < 0.001). The prevalence of cognitive impairment at discharge was 78.2%, and, at the 3-month follow-up 44.4%. In the control group, the median MoCA score was 27 points (IQR 25-28) and the prevalence of cognitive impairment 33%. We found cognitive impairment in more than three out of four ICU survivors immediately after ICU treatment for circulatory shock. We observed an improvement in cognitive functioning between ICU discharge and 3 months follow-up. These results have importance considering the optimal timing of information given to patients and when involving patients in decision-making. This study used the MoCA score to investigate the change in cognitive impairment in patients who survived circulatory shock, from the time of discharge from intensive care to 3 months after discharge. Scores indicated more severe cognitive dysfunction compared to controls at the time of discharge, but these improved to match control scores 3 months later. The findings have important implications for strategies to inform and support newly discharged ICU survivors who have experienced circulatory shock.

This study evaluated internalizing and externalizing problems, as well as psychiatric comorbidities, in children with hereditary spherocytosis (HS). The study cohort comprised children followed at the Department of Pediatric Hematology at Gaziantep City Hospital (n=27). Psychiatric diagnoses were assessed using a semi-structured interview, and parents completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate internalizing and externalizing symptoms in their children. Based on the semi-structured interview, 29.6% of patients (n=8) met diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), followed by enuresis (22.2%, n=6). Compared with the control group, children with HS demonstrated higher parent-reported SDQ scores for both internalizing ( P =0.042) and externalizing problems ( P =0.017). Among the SDQ subdomains, children with HS had significantly higher hyperactivity/inattention scores than controls ( P =0.004). No significant between-group differences were identified in other domains, including emotional symptoms, conduct problems, and peer relationship problems. These findings suggest that children with HS may experience a greater burden of internalizing and externalizing difficulties than their healthy peers and may also be at increased risk of psychiatric comorbidities, particularly ADHD. Larger multicenter studies are warranted to confirm and extend these findings.

Attention Deficit/Hyperactivity Disorder (ADHD) is increasingly diagnosed in adults, including women of childbearing age. However, limited research exists on how maternal ADHD and psychotropic medication use during pregnancy impact early child development. This study aimed to assess developmental outcomes in children of mothers with ADHD during the first 4years of life. A retrospective cohort study using data from a pilot study, supplemented with data from Isala Hospital Zwolle (ageneral teaching hospital) and regional child health clinics. The exposed group comprised mothers diagnosed with ADHD, aged ≥18years at term, with a gestation of ≥24weeks. A subgroup used psychotropic medication during pregnancy (including SSRIs, methylphenidate, benzodiazepines and antipsychotics). The reference group included mothers without psychiatric diagnosis. Relevant somatic and socioeconomic confounders were documented. Child development was assessed using the Van Wiechen Onderzoek (VWO), a validated Dutch screening tool for early childhood developmental disorders, routinely used in child health clinics. Seventy-two children born to mothers with ADHD were included, of whom 36 were exposed to psychotropic medication in utero. Thirty-two children formed the reference group. Univariate analysis revealed no significant differences in total VWO-scores between children of mothers with and without ADHD, nor between those exposed and unexposed to psychotropic medication. Maternal ADHD and associated medication use during pregnancy did not appear to adversely affect early childhood development. However, findings are limited by the small sample size and should be interpreted with caution.

Clinical characterization of bipolar disorder in adults with autism without intellectual disability: a cross-sectional study.

Detection of psychiatric comorbidity is essential given its high burden and frequent under-recognition. The DSM-5 Level 1 Cross-Cutting Symptom Measure (DSM-XC) is a multidimensional screener designed to capture relevant psychopathological domains, yet its ability to detect comorbid conditions remains unclear. In this study, we evaluated the DSM-XC's capacity to screen additional psychiatric comorbidity in individuals with an existing psychiatric diagnosis. Cross-sectional data from 796 individuals aged 22 years (60.8% female) from the 1993 Pelotas birth cohort in Brazil were analysed. Participants were included if they met criteria for at least one of seven psychiatric diagnoses based on structured clinical interviews. Screening accuracy metrics were calculated for targeted DSM-XC domains in identifying secondary diagnoses (e.g., depression domain for major depressive disorder [MDD]), using standard and Youden-optimized thresholds. Non-targeted performance assessments (e.g., anxiety domain for MDD) were also performed. Additionally, all 13 domains and the total score were evaluated for detecting any comorbidity. For the targeted domain assessment, high sensitivity and negative predictive values were observed using original thresholds, supporting rule-out utility, but specificity and positive likelihood ratios were low. The application of optimized thresholds increased specificity, with positive likelihood ratios reaching ~2 across domains. Non-targeted domains frequently outperformed targeted domains. Good discrimination for detecting any comorbidity was achieved using the DSM-XC total score (AUC = 0.75), with a cutoff of ≥ 21 providing the best balance between sensitivity (0.71) and specificity (0.69) and acceptable likelihood ratios. DSM-XC domains are useful for excluding comorbidities but have limited confirmatory value. The total score provides a global indicator of comorbidity. These findings support the DSM-XC primarily as a rule-out transdiagnostic triage tool for improving comorbidity detection in community settings.

Who's getting care? Acute treatment utilization following an emergency department visit among adults with major psychiatric disorders and suicidal thoughts and behaviors.

An empirically derived system for classifying psychopathology has long been a goal in psychiatric research. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been criticized for high comorbidity and heterogeneous symptom presentations among DSM diagnoses. Competing alternative models include the Hierarchical Taxonomy of Psychopathology, a quantitative, dimensional alternative, and network theories, which conceptualize mental disorders as emergent from dynamic interactions of symptoms and mechanisms. Fisher (see record 2026-72441-001) introduced a set-theoretic framework to identify minimally sufficient symptom sets that are statistically predictive of outcomes such as psychopathology-related distress or impairment. Using analyses of symptoms of major depression, generalized anxiety, and posttraumatic stress disorder, Fisher demonstrated how specific features (e.g., uncontrollable worry) emerge as necessary within sufficient sets that predict validators. In essence, these analyses suggest that a lot of the heterogeneity in DSM disorders can be reduced by a set-theoretic approach. The analysis has several limitations (e.g., validators, skip-logic in interviews). Nonetheless, the method has several desirable properties: It is empirically grounded, accommodates individual variability in symptoms, and retains categorical features for clinical application. Conceptually, it exemplifies how mathematical tools from outside psychology can enrich nosological research. We recommend methodological pluralism to study the classification of psychopathology and also caution readers to test assumptions about the relative merits of diagnostic systems that compete with the DSM. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Childhood emotional maltreatment and psychosocial functioning in adulthood: Associations with generalized interpersonal trust, life satisfaction, and self-reported psychiatric morbidity in a representative German sample.

Use of a relevance assessment tool in therapeutic residential care: A real world study.

Attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional problems frequently co-occur. Longitudinal data provide opportunities to understand how and why they co-develop. Data were drawn from the Twins Early Development Study, which included 27,890 participants. Emotional problems and ADHD symptoms were parent-reported using the Strengths and Difficulties Questionnaire and Conners' Parent Rating scales. We modeled the co-development of ADHD symptoms and emotional problems from ages 4 to 21 using joint trajectory analysis. The predictors included polygenic scores (PGSs) for multiple psychiatric symptoms, maternal depression, family chaos, and socioeconomic status (SES). The outcomes included SES, lifetime psychiatric diagnoses, undergraduate diploma attainment, and entry into parenthood at age 26. A four-class joint trajectory model was selected as best fitting and included: 'Low ADHD, Low emotional problems', 'High-decreasing ADHD, Low emotional problems', 'Mid-decreasing ADHD, Increasing emotional problems', and 'Increasing ADHD, Increasing emotional problems'. The consistently low-symptom group reported lower ADHD and had lower externalizing PGSs, lower maternal depression, higher SES, and less home chaos at baseline, and higher educational attainment and fewer lifetime depression/anxiety diagnoses at 26 than groups with higher symptom levels. Those with high ADHD symptoms in childhood or increasing ADHD symptoms from childhood to adulthood had the lowest educational attainment and SES in adulthood. Groups characterized by increasing ADHD symptoms also tended to show increases in emotional problems, whereas increases in emotional problems did not necessarily coincide with increases in ADHD symptoms. The trajectories had distinct early-life predictors and adult outcomes, highlighting potential intervention targets.

Emphysema is defined by progressive alveolar destruction and impaired tissue repair, with diminished Wnt/β-catenin signaling implicated in its pathogenesis. Preclinical studies suggest that lithium, a pharmacologic activator of Wnt/β-catenin signaling, may attenuate emphysema. However, its effects in humans remain unknown. To investigate whether lithium use is associated with less emphysema compared to users of other neuropsychiatric medications. We analyzed cross-sectional data from two large cohorts-the U.K. Biobank and COPDGene-comprising over 800 individuals using oral lithium. Lithium users were compared to individuals using other neuropsychiatric medications. In the U.K. Biobank, outcomes included spirometry and self-reported physician-diagnosed emphysema. In COPDGene, outcomes included spirometry and quantitative CT measures of emphysema. Multivariable regression and propensity score matching accounted for demographics, smoking history, and psychiatric diagnoses. In the U.K. Biobank, lithium use was associated with higher FEV1 and FVC (% predicted) and ∼50% lower adjusted odds of emphysema diagnosis. In COPDGene, lithium users exhibited significantly higher FEV1, FVC, and FEV1/FVC ratios, lower CT-measured emphysema (LAA %F950), and higher lung density. These associations persisted after multivariable adjustment and across sensitivity analyses. Lithium use is associated with less emphysema in two independent cohorts. These findings align with preclinical evidence supporting Wnt/β-catenin activation as a protective mechanism and warrant further investigation of lithium as a potential therapy for emphysema.

To systematically synthesize evidence on the psychobiological effects of music therapy and structured musical interventions on biomarkers in individuals with mental disorders, within a psychoneuroimmunological framework. This systematic review and meta-analysis followed PRISMA 2020 guidelines. Searches were performed in PubMed, LILACS, PsycINFO, and Cochrane Library up to October 2025. Studies with individuals aged ≥16 years, psychiatric diagnoses, and both psychological and biomarker outcomes were eligible. Ten studies met inclusion criteria. Random-effects meta-analysis was conducted for sufficient, comparable data. Cortisol was the only biomarker with sufficient data for meta-analysis (n=4). Results showed no significant effect on cortisol levels (SMD = -0.18; 95% CI = -0.96 to 0.59), with substantial heterogeneity (I² = 88.7%). Exploratory analyses indicated more consistent responses in autonomic and inflammatory biomarkers than endocrine markers. Psychological outcomes showed greater improvement consistency across studies, even without short-term physiological changes. Findings must be interpreted cautiously due to the limited number of studies and high heterogeneity. Psychobiological effects of music therapy and musical interventions vary by intervention, design, and population. Despite heterogeneity and limited quantitative data, findings support the clinical relevance of these interventions. More standardized, biomarker-informed research is needed to clarify underlying mechanisms.

To determine the prevalence of malnutrition among older adults with chronic wounds. A prospective cohort study was conducted to assess the nutrition status of adults over the age of 65 with a chronic wound. Participants who met inclusion criteria were recruited at the Sheldon Chumir Wound Clinic in Calgary, Alberta, Canada, from April 1, 2022, to March 31, 2023. The primary outcome was the diagnosis of malnutrition. Secondary outcomes included other nutrition diagnoses and identified diet barriers. Patient demographic and characteristic information were also collected. A total of 78 patients were included in the study, with a mean age of 75.9±7.7 years. A clinical diagnosis of malnutrition was made in 24.4% of participants, with more than two-thirds of the participants diagnosed with inadequate protein intake (69.2%) and knowledge deficiency (67.9%). Common dietary barriers included loss of appetite (46.2%), eating meals alone (30.2%), and constipation (19.2%). Older age increased the odds of malnutrition (odds ratio, 1.20; P=.004). In contrast, being male was associated with a lower likelihood of malnutrition (odds ratio, 0.07; P=.030). Patients with a psychiatric diagnosis had markedly higher odds of malnutrition (odds ratio, 76.89; P=.006), as did those with hypothyroidism (odds ratio, 20.55; P=.046). Previously, 34.2% of community-dwelling older adults in Canada were estimated to be at risk of malnutrition. The present study clinically diagnosed malnutrition in 24.4% of older adults with chronic wounds. This finding reinforces the importance of malnutrition screening in multidisciplinary wound clinics and advocates for establishing nutrition assessments as standard of care for geriatric patients with chronic wounds.

Major psychiatric disorders are associated with increased risk of dementia but establishing whether psychiatric disorders causally increase dementia risk is challenging because dementia pathology can precede clinical diagnosis by decades. Prodromal psychiatric symptoms may arise long before cognitive decline, leaving open the possibility of reverse causation. We aimed to determine whether non-affective psychosis or depression credibly causally influence dementia risk using a design robust to reverse causation. We tested whether people with psychiatric disorders who later develop dementia show reduced genetic liability to Alzheimer's disease (AD) compared with dementia cases without such history. We compared AD genetic liability, measured by polygenic risk scores (PRS) among dementia cases (N=7936) with and without prior non-affective psychosis (N=56) or depression (N=937) in the UK Biobank. We examined whether schizophrenia or major depressive disorder (MDD) PRS correlates with dementia liability to assess whether shared trait liability contributes to the association. Dementia cases with prior non-affective psychosis or depression had lower AD genetic liability than those without a psychiatric history (psychosis: B=-0.29, 95% CI (-0.54 to -0.05), p=0.036; depression: B=-0.12, 95% CI (-0.18 to -0.05), p=0.0004), which is inconsistent with the hypothesis that the association between psychiatric disorders in dementia is explained by prodromal dementia effects. After excluding people with psychiatric diagnoses, neither schizophrenia nor MDD liability showed the negative correlations with AD liability in people with dementia expected if trait liability to those disorders per se contributed to dementia risk. Our findings instead are consistent with exposure to the disorders themselves as being associated with dementia. Our findings are consistent with the hypothesis that psychiatric disorders are associated with increased vulnerability to dementia. Identification of potentially modifiable mechanisms for the association and optimal management of non-affective psychosis and depression may help reduce long-term dementia risk and inform prevention strategies.

Neuroimaging is prevalent in psychiatric research, but there is limited evidence that it improves clinical outcomes. Functional connectivity neuroimaging was recently used to target individualized brain circuits with accelerated transcranial magnetic stimulation (aTMS), with rapid antidepressant effects and US Food and Drug Administration clearance, but the importance of connectivity-based targeting remains unclear. To estimate the effect size of connectivity- vs scalp-based targeting of aTMS for treatment-resistant depression. This randomized clinical trial comparing connectivity- to scalp-based aTMS treatment was conducted between July 2023 and March 2025 with the primary outcome assessed at 1 month posttreatment and follow-up every 3 months for 1 year. Participants, TMS technicians, and study physicians were blinded. The study took place at the Center for Brain Circuit Therapeutics at Mass General Brigham and Harvard Medical School in Boston, Massachusetts. Forty adults aged 22 to 80 years with a primary diagnosis of major depressive disorder with moderate to severe depression per Montgomery-Åsberg Depression Rating Scale (MADRS) score and moderate to severe treatment resistance per Maudsley Staging Method were included. Key exclusion criteria included contraindications to TMS or magnetic resonance imaging, primary psychiatric diagnoses other than major depressive disorder or anxiety disorders, recent rapid-acting antidepressant treatments, and significant neurological or substance use disorders. All participants underwent a 41-minute multiecho resting-state functional connectivity scan prior to aTMS, and half of them received treatment guided by these data. The connectivity-based target was defined as the left dorsolateral prefrontal cortex region with the greatest correlation to a published and publicly available convergent depression circuit. This circuit includes multiple brain regions linked to depression, including negative connectivity to the subgenual cingulate cortex. The scalp-based target was identified with the Beam F3 method. MADRS score 1 month after treatment, adjusted for baseline. In total, 40 participants (22 female [55%]; mean [SD] age, 45.7 [15.2] years) were randomized and treated. The median (IQR) MADRS score reduction was 24 (19-28) vs 18 (10-23) points with connectivity- vs scalp-based targeting, respectively (P = .02). Connectivity-based targeting had an effect size of 0.8 (Cohen d analog) and 95% CI of 0.26-1.54, with a number needed to scan of 5 individuals. Individualized targets were reproducible within an individual (4.47 mm split-half distance) and different between individuals (12.97 mm) (P < .001). In this randomized clinical trial, individualized, connectivity-based targeting of the convergent depression circuit enhanced the antidepressant effects of high-dose aTMS. These results could facilitate cost-effectiveness analyses and help to power a confirmatory efficacy trial. ClinicalTrials.gov Identifier: NCT05680727.