Understanding national trends and regional variations in mental health disorders among older adults is essential for improving mental health services and guiding evidence-based policy. This study examined national and regional trends in major mental health disorders, including anxiety (ANXD), trauma and stressor (TSRD), bipolar (BIPD), depressive (DEPD), and schizophrenia or other psychotic (SOPD) disorders, among U.S. older adults (≥60years) treated in the State Mental Health System. Ten years (2013-2022) of Mental Health Client-Level Data were analyzed for 4,195,615U.S. adults. Unadjusted and adjusted logistic regression models, controlling for age, sex, and race/ethnicity, were used to assess temporal trends in each disorder nationally and by U.S. Census region. Nationally, ANXD and TSRD showed increasing trends, with ANXD prevalence rising from 13.29% to 22.62% (adjusted odds ratio (AOR): 1.90, 95% CI: 1.26-2.88) and TSRD from 8.73% to 14.30% (AOR: 1.70, CI: 1.30-2.23). In contrast, BIPD (17.03% to 14.23%; AOR: 0.79, CI: 0.68-0.92) and SCOD (27.19% to 24.29%; AOR: 0.78, CI: 0.70-0.87) declined. Regional variations were pronounced: the Midwest and South showed steep increases in ANXD and TSRD; the Northeast exhibited rising TSRD; and in the West, ANXD and TSRD rose while BIPD and DEPD declined. Anxiety and trauma-related disorders increased nationally and across most regions, whereas bipolar and psychotic disorders declined, with depressive disorders remaining persistently prevalent. These patterns highlight the need to investigate underlying drivers such as diagnostic, demographic, and service-related factors and to develop targeted interventions for each disorder.

Identifying patients with first-episode psychosis (FEP) at high mortality risk may facilitate personalized treatment regimen development and reduce the mortality gap between individuals with psychotic disorders and the general population. Following validation studies in Sweden and Finland, we aimed to externally validate the recently developed mortality risk prediction machine learning model, MIRACLE-FEP, with a new Norwegian national cohort. We analyzed a Norwegian national register-based cohort of patients with FEP (N=4632), with follow-up extending to 8years. The performance of MIRACLE-FEP was evaluated via the area under the receiver operating characteristic curve (AUROC) and calibration. In addition to all-cause mortality (primary outcome), we assessed the model's discrimination performance for specific causes of death. Finally, we examined whether the model demonstrates any bias toward gender, education level, or immigration status. MIRACLE-FEP demonstrated an AUROC of 0.71 (95% CI 0.63-0.79) for the prediction of 2-year all-cause mortality. Calibration was relatively good, with a calibration slope of 1.04 (95% CI 0.68-1.47) and a calibration-in-the-large value of 0.31 (-1.93-1.26). Among specific causes of death, the model showed the highest discrimination for deaths due to accidents (AUROC 0.86, 95% CI 0.79-0.93) and the lowest for suicide (AUROC 0.47, 95% CI 0.35-0.59). No evidence of bias was observed in discrimination accuracy by gender, education level, or immigration status. The performance metrics of this external validation study aligned with those reported in the development study. Efforts to enhance MIRACLE-FEP's performance in suicide prediction are needed.

Within clinical environments and empirical research, discussions of atypical perceptual experiences (APE; i.e., hallucination) tend to centre on voice-hearing (auditory-verbal hallucinations) in psychotic disorders, with other sensory modalities and psychiatric conditions often neglected. Similarly overlooked are lived experience (LE) perspectives of APE, despite valuable insights that may be gleaned to advance research and clinical practice. The present paper presents a participatory collaboration between a panel of five people with lived experience of APEs and seven APE researchers who worked together on a review of the literature on APEs. LE perspectives were synthesised by researchers with thematic analysis of material generated in five LE consultation sessions held during the course of the project. This revealed six primary themes: (i) challenges during diagnosis and treatment; (ii) what is missing in clinical environments; (iii) underacknowledged cultural and subcultural factors; (iv) stigma; (v) priority areas for developing treatments and; (vi) priority areas for advancing research. Overall, a common sentiment emerged, in that the perception and treatment of APE within the mental health system can often be highly stigmatising, disempowering and distressing. It is hoped that recommendations outlined here may forge more positive and productive treatment experiences for persons distressed by their APE, irrespective of diagnosis.

Associations between PTSD and psychotic symptoms: A network analysis of patients with psychotic disorders in Uganda

Genetic predisposition to inflammation and psychopathology: A transdiagnostic network analysis.

Artificial intelligence-associated delusions and large language models: risks, mechanisms of delusion co-creation, and safeguarding strategies.

Hypnotics are frequently used in depressed patients, but factors determining long-term use remain uncertain. Using national health registers, we included patients aged ≥18years in Sweden 2007-2018 who filled a prescription for any drug indicated for sleep within three months after a diagnosis of depression in psychiatric specialist care. We excluded patients with dementia, bipolar or psychotic disorders, and those who had been Swedish residents for <12months. Patients were followed for one year. Long-term use was defined as >180 defined daily doses of hypnotics across ≥3 prescription fills, including ≥1 fill in the second half of the year. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs, aORs) with 95% confidence intervals (CI) to identify factors associated with long-term hypnotic use. We included 78,383 patients (mean age 39.4years, 58.4% women). The most commonly initiated drug was a benzodiazepine-like hypnotic (Z-drug; n=40,008; 51.0%), followed by the phenothiazine propiomazine (n=30,940; 39.5%), melatonin (n=6415; 8.2%), and benzodiazepine hypnotics (n=1020; 1.3%). Overall, 23,476 of 78,383 patients (30.0%) met the criteria for long-term hypnotic use. In the adjusted model, older age was strongly associated with long-term hypnotic use (≥70 vs. 18-29years: aOR 2.27, 95%CI 2.08-2.47), as was higher number of antidepressants in the past year (≥3 vs. 0: aOR 3.23, 95%CI 2.97-3.53). In this large cohort of patients with unipolar depression initiating hypnotic treatment, long-term use was more likely in older patients and those with multiple prior antidepressant trials, highlighting the need for careful clinical attention in these groups.

Evidence of phenotypes indexing cognitive resilience and vulnerability in the early course of mood and psychosis spectrum illness; mapping the latent structure, characteristics, and longitudinal stability of cognitive heterogeneity.

There are indications that motivational deficits in psychotic and mood disorders are related to differences in functional connectivity. However, the literature is mixed, partly due to the limitations of traditional methods in accounting for individual variability. Ecological momentary assessment (EMA) and individual-specific techniques can account for such variability. By leveraging these methods, this study aims to elucidate transdiagnostic relationships between motivational deficits and resting-state functional connectivity. 144 participants (29 schizophrenia/schizoaffective; 38 bipolar, 37 major depressive, 40 controls) completed EMA on motivation and pleasure (MAP) and resting-state BOLD scans. Individual-specific network connectivity matrices were calculated with an empirically validated template-matching technique. Bayesian hierarchical regression models assessed relationships between anticipatory and consummatory MAP and within-network connectivity, participation coefficient, and number of vertices for eight networks (default mode, cingulo-opercular, dorsal attention, ventral attention, salience, fronto-parietal, dorsal somato-motor, ventral somato-motor). Analyses demonstrated intact MAP for bipolar and major depressive disorders, and elevated MAP for schizophrenia/schizoaffective disorder. Moreover, MAP was positively related to within-network connectivity of the dorsal attention network, positively related to participation coefficient of the ventral attention network in schizophrenia/schizoaffective disorder, negatively related to within-network connectivity of the salience network in schizophrenia/schizoaffective disorder, and positively related to spatial extent of the salience network in controls. Overall, the findings highlight the role of attentional processes in MAP and suggest that underlying neural mechanisms vary by diagnosis. The results emphasize the complexity of MAP deficits and underscore the need for research to consider inter-individual variability to fully understand their phenomenology and neural basis.

Self-beliefs and other-regarding beliefs are related to attachment experiences and may contribute to paranoid beliefs and social functioning difficulties in psychosis. However, their relationships have not been examined jointly from an ecological perspective, while considering different degrees of psychosis risk. Relationships between avoidant and anxious attachment, self-beliefs and other-regarding beliefs, paranoia, and social functioning in daily-life were examined across the psychosis continuum of familial risk. The sample comprised 29 patients with non-affective psychotic disorders (Mage = 39.07, SD = 9.91, 20.68% female), 17 first-degree relatives (Mage = 37.36, SD = 13.86, 64.71% female) and 26 controls (Mage = 36.15, SD = 8.1, 34.6% female). Avoidant and anxious attachment were assessed with the Psychosis Attachment Measure. Self-beliefs, beliefs about others, paranoia, and time spent alone were assessed for one week in participants' daily lives using the Experience Sampling Method. Multilevel models were used to investigate cross-sectional and temporal relationships between the variables. Less positive self-beliefs and beliefs about others were related to paranoia, but only self-beliefs mediated the association between attachment insecurity and paranoia. People who were alone more frequently held less positive self-beliefs and beliefs about others, and being alone at a specific point in time was related to less positive self-beliefs. Attachment insecurity was unrelated to the amount of time spent alone. Less positive self-beliefs and beliefs about others were related to higher paranoia levels and fewer social interactions in daily-life. These associations were present in all groups, supporting their utility as cognitive treatment targets in diverse therapeutic contexts.

Taking care of psychotic disorders globally, beyond clinical management.

New onset psychosis following cannabis discontinuation: A case report

Nitrous oxide (N2O) has been linked to several neuropsychiatric complications. This paper aims to systematically review reported cases of psychosis associated with N2O use. Additionally, five new cases of N2O-related psychosis are presented. A systematic search was conducted in MedLine for cases of psychosis associated with N2O use, from database inception to April 2025. The five new cases are thoroughly analyzed, and the Naranjo criteria were applied to assess causality in both the new cases and those identified in the systematic review. A total of 15 articles were included, encompassing 15 patients. Including these and the five newly reported cases, the current manuscript analyzes 20 individuals (17 men and 3 women) aged 20 to 45 years. Most cases reported a history of substance use disorder (mainly alcohol) and escalating N2O use prior to the psychotic episode. Clinical manifestations included psychotic symptoms (delusions and hallucinations) as well as other psychopathological features. Neurological complications were also commonly described. Laboratory tests showed vitamin B12 abnormalities in some cases. All patients were hospitalized; abstinence from substance use was the first intervention, and most received antipsychotic treatment. N2O may be associated with psychotic episodes, particularly among young, heavy users with underlying vulnerabilities. Psychiatric and neurological symptoms are frequently observed. Although outcomes vary, treatment involving abstinence, vitamin B12 supplementation, and antipsychotic medication typically leads to improvement. Further research is warranted on this topic.

Age-related eye conditions, including cataract, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and dry eye disease (DED), are prevalent and have been linked to mental health disorders, though findings are mixed. This study systematically examines associations between these ocular diseases and mental health conditions using a large real-world dataset. A retrospective cohort study was conducted using the Global TriNetX database. Five cohorts (aged ≥ 40 years) with diagnoses of cataract, glaucoma, AMD, DR, and DED were propensity score matched 1:1 with controls without these eye diseases based on demographic and clinical covariates. Outcome measures were the incidence of mood, anxiety, and psychotic disorders, identified using ICD-10 codes. Hazard ratios (HRs) and 95% confidence intervals (95% CI) from the Cox proportional hazards models were used to assess associations. Study included patients with cataract (N = 121,060), glaucoma (N = 122,663), AMD (N = 39,915), DR (n = 43,495), DED (n = 148,221), and their median follow-up ranging 1263-2191 days. Cataracts, glaucoma, DR, and DED were each associated with mildly increased risks of mood (HR range: 1.05-1.10), anxiety (HR range: 1.04-1.12), and psychotic disorders (HR range: 1.18-1.36). When accompanied by visual impairment, risks were higher: mood (HR range: 1.22-1.57), anxiety (HR range: 1.16-1.32), and psychotic disorders (HR range: 1.54-2.15). Age-related ocular diseases, particularly when presented with vision impairment, are independently associated with elevated risks of mental health disorders. These findings underscore the need for integrated ophthalmic-psychiatric care and early intervention before vision loss to address the complex needs of affected patients.

Recent efforts to clarify the structure of the genetic risks for psychiatric disorders have been limited to disorders with large molecular samples. These heterogeneous samples have typically been ascertained from diverse sources and use a widening range of diagnostic approaches including single-item self-reports. To assess the structure of genetic risk factors for 18 diverse psychiatric and substance use disorders in a single population, using high-quality population-based registries. This cohort study included individuals born between 1960 and 2000 in Sweden to Swedish-born parents who were followed up to a mean (SD) age of 40.9 (10.5) years in 2018. Registries included the Swedish Multigeneration Register and Swedish National Patient Register. Data were analyzed from September to December 2025. The family genetic risk scores (FGRSs) for 18 disorders in all individuals calculated from first- through fifth-degree relatives, controlling for cohabitation. Exploratory and confirmatory factor analysis (EFA and CFA, respectively) of these FGRSs performed on split-half samples. Among 3 021 948 individuals (1 549 159 [51.3%] male), EFA found a 6-factor structure consisting of psychotic disorders, externalizing disorders, anxiety disorders, neurodevelopmental disorders, mood disorders, and eating disorders. The mean (SD) interfactor correlation was 0.29. The CFA fit well and set 70.3% of the loadings to 0. Interesting features included identification of separate mood and anxiety disorder factors, with major depression loading on both; bipolar disorder, schizoaffective disorder, and acute psychoses all loading on the mood and psychotic disorder factors, with loadings on the mood disorder factor stronger for bipolar disorder than the psychotic disorder factor and the reverse seen for schizoaffective and acute psychotic disorder; posttraumatic stress disorder having the most diverse loadings on the mood, anxiety, and externalizing disorder factors; and attention-deficit/hyperactivity disorder loading on both the neurodevelopmental and externalizing factors. Because FGRSs are skewed, especially for rare disorders, a range of transformations was performed to reduce skewness, which produced results similar to those obtained on the original data. Using a complete epidemiological ascertainment frame for treated psychiatric disorders in a large population sample with high-quality registries, this cohort study uncovered a structure of genetic risks that, compared to prior efforts, was similar in many ways but also had important differences.

Epilepsy and risk of psychiatric disorders in later life: a population-based cohort study of 38,173 older men.

Enhancing inpatient services for children and adolescent mental illness is a primary goal of medical systems, yet knowledge of child and adolescent psychiatric hospitalization utilization is limited. This study aimed to characterize hospitalizations and rehospitalizations over a decade and to identify factors associated with rehospitalizations. In this retrospective analysis, we obtained data from the Beijing Hospital Electronic Record Database from January 1, 2013, to December 31, 2022. We analyzed an admission-level dataset (n = 20215 admissions) to describe overall trends and established a patient-level cohort (n = 5048 unique patients) to evaluate rehospitalization risk. Modified Poisson regression models, with variables selected using the Andersen Behavioral Model, were used to identify factors associated with psychiatric rehospitalizations at 30-day, 180-day, and 365-day intervals. From 2013 to 2022, 20215 hospitalizations (involving 17175 unique patients) were analyzed. Mood disorders (50.6%), behavioral and emotional disorders (27.8%), and psychotic disorders (13.3%) were the most prevalent diagnoses. Specialized hospitals served a higher proportion of adolescents (≥ 14 years: 78.6%) and females (60.5%) than general hospitals (P < 0.05). In the readmission cohort(n = 5048), cumulative rehospitalization rates were 9.7% at 30 days, 16.8% at 180 days, and 20.3% at 365 days. Multivariable analysis showed that the psychotic disorders (30-day RR:1.57; 365-day RR: 1.27) and eating disorders (30-day RR:1.91; 365-day RR: 1.56) were associated with significantly elevated risks compared to depressive disorders. Older age (12-17 years) was consistently associated with a higher rehospitalization risk of rehospitalization (P < 0.05). Female patients faced a significantly higher risk of 365-day rehospitalization (RR: 1.15, P = 0.03), sex showed no significant association with shorter-term readmission. Residence status and insurance type did not have significant independent effects in the adjusted models. Psychiatric hospitalizations for children and adolescents in Beijing increased substantially from 2013 to 2022. Rehospitalization risks were primarily driven by diagnostic categories and age. These findings highlight the need for targeted post-discharge monitoring for high-risk diagnostic groups and provide a basis for optimizing pediatric mental health resource allocation in urban settings.

Seasonal and climatic variations are known to influence patterns of mental illness presenting to emergency departments; however, few studies-particularly in Saudi Arabia and the Eastern Mediterranean region -have examined these effects. This study investigates whether seasonality and gender differences are associated with variations in the number of emergency department visits for mental health disorders at Eradah Complex for Mental Health in Dammam, Saudi Arabia. We analyzed data from patients presenting to the emergency room (ER) between January 2024 and December 2024 with mental health diagnoses according to ICD-10 criteria. Data were categorized into four consecutive quarters (Q1 = January-March; Q2 = April-June; Q3 = July-September; Q4 = October-December) and analyzed by sex. Chi-square analysis was used to assess seasonal variation. Seasonal time-series assessment demonstrated significant variation across all disorders studied, including personality disorders, mixed anxiety-depressive disorder, obsessive-compulsive disorder (OCD), and psychotic disorders. Most patients with psychotic disorders were male, whereas most patients with the other diagnoses were female. There was a significant seasonal variation (P ≤ 0.01) in emergency department visits for psychotic disorders and mixed anxiety-depressive disorder in both males and females. Significant seasonal variation exists in ED visits for psychotic disorders, mixed anxiety-depression, OCD, and personality disorders, with the highest volume occurring in Q4 (October-December). Females accounted for most non-psychotic disorders. Therefore, emergency and outpatient psychiatric services should enhance winter/autumn preparedness, and further research should examine underlying climatic drivers.

Cortical brain morphology in early-onset psychosis (EOP; age of onset <19 years) is poorly understood, partly due to recruitment constraints linked to its low incidence. We pooled T1-weighted magnetic resonance imaging (MRI) data from 387 adolescents with EOP (mean age=16.1 ± 1.5; 49.6% female) and 338 healthy controls (CTR; mean age=15.8 ± 1.9, 54.4% female) from nine research sites worldwide. Using harmonized processing protocols, we extracted cortical brain metrics from 34 bilateral regions. Univariate regression analyses revealed widespread lower bilateral cortical thickness (left/right hemisphere: d = -0.36/-0.31), surface area (left/right: d = -0.42/-0.41), cortical volume (left/right: d = -0.58/-0.56), and Local Gyrification Index (LGI; left/right: d = -0.39/-0.52) in EOP relative to CTR. Diagnostic subgroup analyses showed broader and more pronounced case-control differences in early-onset schizophrenia for area, volume, and LGI. We found no associations with antipsychotic medication use, illness duration, age of onset, or positive symptoms. Negative symptoms were related to smaller left lingual volume (partial r = -0.21; pFDR = 0.014) and antidepressant users had smaller area (d = -0.43; pFDR = 0.034) and volume (d = -0.50; pFDR = 0.003) of the right rostral anterior cingulate compared to non-users. Cortical thickness alterations in EOP showed a similar pattern to those observed in prior studies on adults with schizophrenia (SCZ; r = 0.62) and bipolar disorders (BD; r = 0.61). However, surface area alterations were overall 1.5 times greater for EOP than adult SCZ and 4.6 times greater than adult BD. In the largest study of its kind, we observed a widespread pattern of cortical alterations in adolescents with psychotic disorders, highlighting the potential impact of aberrant neurodevelopment on cortical morphology in this clinical group.

This study aimed to examine the causal effect of adiposity on mental illnesses by summarizing and assessing evidence from Mendelian randomization (MR) studies. Searches were conducted on Embase, Medline, and Web of Science from database inception to September 22nd, 2025. Studies using MR study designs that estimated adiposity measures including body mass index, abdominal adiposity, peripheral adiposity, or body composition in relation to mental illnesses were included. Outcomes were the presence or severity of depression, anxiety, eating disorders, bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, schizophrenia, and related psychotic disorders. Study quality was assessed with a scoring system reflecting MR study guidelines. Data were pooled in meta-analyses using random-effects models. Subgroup analyses were conducted by sex. Fifty-seven studies with 215 MR estimates were included in the systematic review, and 23 studies with 44 MR estimates were included in meta-analyses. Pooled estimates suggested that general adiposity was causally associated with depression (OR: 1.09, 95% CI, 1.02-1.15, p < 0.001; I2 = 94%), but the effect size was modest and there was high heterogeneity. Subgroup differences by sex in the causal relationship were not observed (p = 0.318). There was suggestive evidence for causal associations of adiposity with schizophrenia and OCD; however, these analyses were characterized by high imprecision and heterogeneity. The evidence for other mental illnesses remains unclear. General adiposity appears to be causally associated with depression, suggesting psychological benefits of weight management. Evidence for causal associations between adiposity and other mental illnesses remains suggestive or uncertain.