Exploring the burden of care: A model for understanding caregiver burden in children with psychosis.

Use measurement-based care to assess symptom change across diagnostic categories for adolescents receiving acute-care psychiatric inpatient treatment including both psychopharmacology and dialectical behavior therapy. Adolescents were aged 12-17 and hospitalized on a coeducational, acute-care inpatient unit within a psychiatric hospital in New York City. We conducted a retrospective chart review to analyze symptoms across two or more timepoints from the first 15 days of admission using mixed effects regression models to estimate linear change on five outcome measures including Generalized Anxiety Disorder-7 (GAD-7), General Behavior Inventory-Mania subscale (GBI-10M), Patient Health Questionnaire-9 (PHQ-9), Prodromal Questionnaire Brief-21 (PQB-21), and Schwartz Outcome Scale-10 (SOS-10). There were improvements on all five measures. For the GAD-7, GBI-10M, PHQ-9, and PQB-21, the change is negative, indicating a decrease in symptoms. For the SOS-10, the change is positive, suggesting an increase in well-being. The covariance parameters indicate that there is generally significant individual variation around the adolescent's initial assessment as well as significant individual variation around the slope, suggesting that patients change at different rates. The Days × Intercept covariance parameter is generally negative, indicating that adolescents who started with higher symptom severity showed greater symptom reduction. For well-being, the negative change indicates that adolescents with higher well-being on the first assessment showed smaller increases in well-being over time. Adolescents experienced improvements in their symptoms of anxiety, mania, depression, psychosis, and well-being during acute psychiatric inpatient treatment. These are notable findings, particularly for demonstrating the impact of psychiatric inpatient treatment on improving symptoms/diagnoses.

Factors associated with employment and hospitalizations in early-onset psychosis: a clinical study with register-based follow-up.

To evaluate whether postpartum domperidone use is associated with new-onset psychosis and other severe mental health outcomes. We conducted a retrospective cohort study of people who filled a prescription for domperidone within 56 days of delivery between March 1, 2006, and March 1, 2022, in Ontario, Canada. Those who filled a domperidone prescription were matched 1:1 based on propensity score to an equal number of those who did not. The primary outcome was any health care contact for incident psychosis in the subsequent 365 days, with a secondary outcome of any psychiatric emergency department (ED) visit or hospitalization. Cox proportional hazards regression was used to compare outcome risk between people who initiated domperidone and those who did not. We identified 2,237,806 births, and 7,096 (0.3%) were followed by the individuals filling a publicly funded domperidone prescription within 56 days postpartum. After exclusions, 4,629 domperidone-exposed and 116,644 unexposed individuals remained. Overall, 4,585 domperidone-exposed individuals were propensity score matched to an equal number who were unexposed, resulting in good balance across all measured baseline characteristics. Compared with matched postpartum individuals who did not initiate domperidone, domperidone use was not associated with psychosis (6.4/1,000 person-years vs 6.4/1,000 person-years; hazard ratio [HR] 1.00, 95% CI, 0.60-1.67) in the postpartum period. We found no association between domperidone use and ED visits or hospital admissions with mental health diagnoses (38.0/1,000 person-years vs 43.4/1,000 person-years, HR 0.88, 95% CI, 0.71-1.08). Initiation of domperidone postpartum was not associated with an increased risk of new-onset psychosis or ED visits or hospital admissions with mental health diagnoses.

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

This study assessed associations of motivation factors and precursor health behaviors with weight loss in the CoachToFit program for adults with mental illness. This is a secondary analysis of a randomized trial comparing CoachToFit and usual care over 6 months at a Veterans Affairs medical center. Inclusion criteria were body mass index ≥30 kg/m2 and diagnosis of major depressive disorder, bipolar disorder, or schizophrenia. Exclusion criteria were history of bariatric surgery or recent psychiatric hospitalization. The sample (N=256) had a mean±SD age of 53.5±13.0 years; 176 (69%) were male, 178 (70%) were White, and 199 (78%) were diagnosed as having major depressive disorder. Participants were assessed at baseline and at 6 months (postintervention) on weight, motivation factors (efficacy for healthy eating and exercise, confidence to improve health, importance assigned to weight loss, and stage of change for weight control), and precursor health behaviors (daily cups of sugary drinks consumed and physical activity days per week and minutes per day). The study assessed the relationships between study group and multiple motivation factors and precursor health behaviors and associations between weight loss and change over time on those factors. Compared with usual care, CoachToFit significantly improved efficacy for eating healthily, exercising, and making healthy changes. CoachToFit (vs. usual-care) participants reported nearly 1 additional day of physical activity per week and had nearly twice the odds of being in a higher category of exercise minutes. Physical activity and confidence for health improvement are important factors for weight loss programs among adults with mental illness.

To investigate antidepressant treatment changes following transitioning to secondary care for depression in older adults and examine their associations with social determinants. This Danish register-based cross-sectional study included all older adults with a first outpatient visit to psychiatric hospitals (referred by general practitioners or private psychiatrists) for depression within the first year after initiating antidepressant treatment during 2006 and 2016. Treatment changes were assessed using three outcomes based on antidepressant prescriptions redeemed before and within 90days after the outpatient visit: (i) antidepressant switching, (ii) discontinuation, and (iii) dose changes. Social determinants included education, occupation, income, marital status, household type, urbanicity, and ethnicity. Multiple logistic regression and generalized linear regression were employed for association analyses. Of 792 individuals referred to outpatient care after starting antidepressants (61% female; mean age 79), 25% discontinued treatment. Among those who continued (n=594), 47% switched antidepressants. Of those who stayed on the same antidepressant (n=315), only 46% had recorded dose information, and 38% of these had dose adjustments. Among social determinants, low income was associated with a higher likelihood of discontinuation compared to higher income (odds ratio: 2.10; 95% confidence interval: 1.14-3.87). Short education was associated with an average dose reduction of 15units (beta-coefficient, 95% CI: -15, -25 to -4.4) compared to long education. Prescribers' information was not available and >50% of prescriptions had missing dose information. Noticeable changes in antidepressant treatment occurred after secondary care contact, with some differences across social determinants, mainly related to income and education.

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.

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

Blended therapy (BT) combines digital applications with face-to-face treatment and has become an increasingly important component of psychiatric care. Evidence indicates that BT can achieve outcomes comparable to or even superior to those of traditional face-to-face therapy. Despite certain advantages, routine implementation of BT remains challenging, and clinical practice suggests that while some inpatients engage with BT, many either discontinue early or do not initiate its use at all. To better understand these patterns, this multicentric, retrospective observational study investigates factors associated with noninitiation and dropout among inpatients who are offered BT. In this study, data from 278 inpatients were analyzed to examine the influence of sociodemographic variables, comorbidities, and symptom severity on the uptake and continued use of BT. The objective was to identify predictors of noninitiation and dropout. Multivariable logistic regression models were conducted to identify significant predictors of noninitiation and dropout among inpatients using the transdiagnostic, cognitive behavioral therapy-based electronic mental health platform Minddistrict, which offers modules targeting psychoeducation, cognitive restructuring, and behavioral activation. Data were collected from 2 psychiatric hospitals between January 2020 and May 2024. The sample consisted predominantly of patients diagnosed with depression (182/278, 65.7%) and posttraumatic stress disorder (61/278, 21.9%), alongside various comorbid conditions. The findings indicate distinct patterns of association for noninitiation and dropout. Of the 278 patients, only 5 (1.8%) completed all the assigned modules, and one-third of the patients never initiated the platform at all. Specifically, increasing age was linked to a lower risk of noninitiation (odds ratio [per year age difference] 0.98, 95% CI 0.96-1.00; P=.01), while the presence of a comorbid anxiety disorder was associated with a reduced risk of dropout (odds ratio 0.23, 95% CI 0.08-0.66; P=.007). Several variables showed no association with either noninitiation or dropout across all analyses, including sex, overall symptom severity, and certain comorbidities such as personality disorders and depression. In this preselected inpatient sample, uptake of BT was very limited. Older age was associated with lower noninitiation, and comorbid anxiety disorders were associated with a lower likelihood of dropout. These findings may help inform future prospective studies on how BT can be introduced and supported more effectively in inpatient psychiatric care. As access to BT was granted selectively by therapists, the results should be interpreted as predictors of engagement within a selected sample rather than general predictors of BT uptake among all psychiatric inpatients.

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.

Diabetes, obesity and bipolar disorder often co-occur and may have shared pathophysiology. Glucagon-like peptide 1 receptor agonists (GLP-1RA) treat diabetes and obesity but their impact on bipolar disorder is unknown. In this era of stagnated pharmacotherapy, we examined psychiatric hospitalisation and absence from work due to sick leave as potential measures of relapse in people diagnosed with bipolar disorder who were also prescribed antidiabetic medications, including GLP-1RA. The study cohort was derived from the National Swedish Registers and included all people with a diagnosis of bipolar disorder who used any antidiabetic medication, between the years 2009 and 2024. GLP-1RA individually and as a group were compared with non-use of GLP-1RA, and directly with other second-line antidiabetic medications. A within-individual design was utilised for all comparisons to reduce confounding. The main outcome was psychiatric hospitalisation for any reason, with secondary outcomes being psychiatric hospitalisation after a relapse of bipolar disorder, and sick leave due to psychiatric reasons. Within-individual stratified Cox models with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were used. 14,694 people were included in the study, of whom 5200 used GLP-1RA. Semaglutide was associated with a 21% (aHR 0.79, 95% CI 0.69-0.91) lower risk of psychiatric hospitalisation compared with non-use of GLP-1RA in that same individual. Liraglutide and dulaglutide were not specifically associated with a lower hospitalisation risk. Semaglutide was also linked to a 17% (aHR 0.83, 95% CI 0.69-0.99) lower risk of relapse of bipolar disorder. Absences from work due to sick leave were not significantly associated with the specific antidiabetic medications studied. In people with both bipolar disorder and diabetes and/or obesity, the use of semaglutide was linked to lower rates of psychiatric hospitalisation compared with time periods when GLP-1RA were not used by that individual. Liraglutide and dulaglutide were not associated with reduced psychiatric hospitalisation, implying this is not a class effect. This finding with semaglutide should be further tested in a randomised controlled trial.

The Crisis Intervention Ward relocated from a general hospital to a psychiatric hospital in Basel, Switzerland, on May 26, 2023. We hypothesize that this relocation influenced patient demographics, frequencies of main diagnoses, involuntary admissions, transfer rates, clinical outcomes, patient satisfaction, and clinician perceptions of the treatment setting. We compared two patient cohorts: one from a 12 month period pre-relocation and the other from a 12 month period post-relocation. Two outpatient clinician surveys-one conducted pre- and one post-relocation-assessed location ratings, treatment satisfaction, and the perceived benefits and disadvantages of each location. Prior to relocation, 625 cases were treated; after relocation, 686 cases. Patient's age and gender showed no differences. The frequency of affective disorders (F3) was lower (Φ = - 0.124) at the psychiatric hospital. Clinical outcomes, involuntary patient admissions, and transfer rates to other psychiatric wards were comparable. Patient-reported satisfaction was lower at the psychiatric hospital (mean 4.6 vs. mean 5.2, r = 0.23). Outpatient clinicians favored the general hospital setting strongly (r = 0.78-0.81). Clinical outcomes remained stable, but patient satisfaction was lower after relocation, and clinicians perceived barriers related to accessibility and stigma at the psychiatric hospital.

This study evaluated four Mobile Response Teams (MRTs), providing 24/7 behavioral health crisis intervention services, using retrospective administrative records of calls made to an MRT hotline between May 1, 2024, and April 30, 2025. The sample included 2,300 eligible calls representing 1,960 unique individuals (Mage = 30.01 years, SD = 19.92, Range = 5-89). Programmatic descriptives examined call and final dispositions, method of response, and response times, while chi-square tests assessed bivariate associations and binary logistic regression assessed predictors of final disposition, dichotomized as psychiatric hospitalization vs. diversion. Across the 12-month observational period, 64.8% of cases resulted in diversion, and the average in-person response time was within the State of Florida's 60-minute benchmark. Consistent with the program's "in-person first" model, 95.0% of calls were addressed face-to-face. Significant independent predictors of psychiatric hospitalization included age (adults 18 + years), higher suicide risk scores, presence of a specific suicide plan, law enforcement involvement, call source (school setting), and call reason (suicide attempt/ideation). Findings from this large, ethnically diverse, naturalistic sample demonstrate that MRTs not only divert a substantial proportion of crisis cases from hospitalization but also consistently meet state standards for timely and "in-person first" response, with implications for behavioral health policy and crisis service delivery.

Sierra Leone is confronting an escalating polydrug epidemic centered on Kush, a synthetic cannabinoid compound whose proliferation has produced a 4000% rise in drug-related psychiatric hospitalizations since 2020 in a context of acute mental health resource scarcity. Dominant policy responses have privileged punitive containment over rehabilitative and harm-reduction frameworks, recapitulating victim-blaming discourses that obscure the structural antecedents of polydrug use. This commentary establishes why the polydrug crisis is an epidemic rooted in structural violence and situates its emergence within Sierra Leone’s intersecting legacies of civil war, recurrent epidemic shocks, and entrenched poverty. Drawing on critical pragmatism and the culture-centered tradition in critical health communication, we demonstrate how community mobilizations from past public health crises can provide insights for global health communication practitioners. We extract five health communication insights from Sierra Leone’s 2014 Ebola response: centering community engagement and trust building; investing in youth livelihoods; decriminalizing and reintegrating people who use drugs; integrating mental health into primary care; and galvanizing coordinated international support. Leaning on these theoretical and experiential insights can guide communication interventions toward addressing the sociopolitical conditions in which the polydrug crisis emerges, as well as the individuals that use Kush.

Rates of adolescent psychiatric hospitalization have increased significantly over the last decade. Despite heightened risk for life-threatening behavior and readmission in the year following hospitalization, mental health service use has varied. Parental burden and youth externalizing behavior have been associated with service use in community samples, with most research focused on children and their parents. The present study explored longitudinal relations between parental burden, externalizing symptoms, and mental health service use in a high-risk clinical adolescent sample in the year following hospitalization. The sample included 252 mothers with an adolescent recently discharged from psychiatric hospitalization. Mothers completed measures of parental burden (Child and Adolescent Impact Assessment), youth externalizing symptoms (Achenbach Child Behavior Checklist), and youth mental health service use (Child and Adolescent Services Assessment) at 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months following adolescent discharge from psychiatric hospitalization. Bidirectional relations between variables were examined with a cross-lagged autoregressive model. Controlling for baseline levels, greater externalizing symptoms were positively associated with parental burden and negatively associated with recommended use of individual psychotherapy over time. Recommended use of youth individual psychotherapy at M3 predicted lower externalizing symptoms at M6. No other longitudinal relations were found. Findings enhance our understanding of the experience of adolescents and families and inform service use patterns during the posthospitalization period. Recommendations for discharge practices and postdischarge care are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Certified Peer Specialists provide optional peer support services (PSS) to individuals with mental health disorders. In this effectiveness study, we describe changes in behavioral health service utilization in Medicaid-enrolled adults receiving PSS compared to propensity-score matched controls. Individuals receiving PSS (n = 2,156) in 2021-2024 were successfully matched 1:2 to individuals receiving outpatient mental health services without PSS (comparison; n = 4,312). Service rates were compared between groups over time (90days before, during, and 90days following the PSS or outpatient episode of care. Rates of services were higher for PSS; utilization for the majority of services declined over time. PSS versus the Comparison was associated with a steeper decline in psychiatric hospitalization, β = -.0190, t(2,932) = -2.61, p = .0090, and crisis service, β = -.0269, t(2,932) = -3.49, p = .0005 following discharge from the episode of care. PSS may successfully maintain recovery-oriented care through diversion from psychiatric hospitalization and increase community tenure resulting in a utilization pattern that is not observed with outpatient mental health service alone.

Discontinuation, Medication Switching, and Augmentation After SSRI in Pediatric Depression.

Body procurement at The University of Sydney has a long history. Anatomy legislation (1881 Anatomy Act) modeled on the British Anatomy Act 1832 legalized procurement of unclaimed bodies from public institutions for anatomical dissection at licensed Schools of Anatomy, effectively conferring the University of Sydney an exclusive license until the 1960s. This study documents the procurement of 7609 bodies between 1883 and 1983, of which 4084 were unclaimed. Until the 1930s, bodies were predominantly from public asylums, with a small number from psychiatric asylums, hospitals and morgues. Donors were uncommon as were female bodies, reflecting prevailing societal antipathy toward anatomical dissection, the characteristics of asylum residents, and academic attitudes to the dissection of the female body. The individuals whose bodies sustained medical education were diverse in origin and circumstances: ex-convicts, immigrants, miners, Chinese indentured laborers, Indigenous Australians and locally born individuals. Although the law provided a limited right of objection, asylum residents were poorly positioned to exercise it. Mirroring practice across the Western World, their classification as "unclaimed" reflected legal procedure and poverty, institutionalization, separation from family, discriminatory and inaccurate record-keeping, and Colonial-era assumptions of social worth. Little consideration was given to their cultural beliefs, preferences and rights. The University shifted to a body donation program in the 1940s as the availability of unclaimed bodies diminished. This shift was rapid; the last unclaimed body was received in 1961.

Mood disorders and related suicidal ideation among adolescents are pressing global health concerns. Although negative life events (NLEs) are recognized risk factors, the psychological mechanisms underlying the transition from adversity to suicidal ideation (SI), particularly in clinically depressed adolescents, remain unclear. This study is grounded in the vulnerability‒stress framework and investigates the developmental and psychological pathways linking NLEs and suicidal ideation in a clinical sample of depressed adolescents. A total of 341 adolescents (aged 10-19) with clinically diagnosed depression were recruited from five psychiatric hospitals in China via a multicenter design. The participants completed self-report questionnaires assessing NLEs, resilience, and suicidal ideation. A moderated chain mediation model was used to test whether resilience and depressive symptoms sequentially mediate the relationship between NLEs and SI and whether age moderates this pathway. NLEs were associated with lower resilience, which predicted greater depressive symptoms and ultimately higher SI. Furthermore, age significantly moderated the relationship between depressive symptoms and SI. Simple slope analysis confirmed that depressive symptoms had a stronger predictive effect on SI in younger adolescents. Our findings reveal a critical chain of vulnerability: negative life events were associated with lower resilience and higher depressive symptoms, which in turn predicted suicidal ideation. The significant moderating role of age suggests that this pathway is sensitive to development and is especially potent in younger adolescents. This multicenter study provides compelling evidence of the importance of fostering resilience and treating depressive symptoms as key targets in suicide prevention efforts, especially through interventions tailored to different age groups. Not applicable.