J Psychiatr Res [JOURNAL]
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200 papers
Duration of untreated psychosis and long-term outcomes: A systematic review examining the critical window hypothesis.
Ricci V, De Berardis D, Martinotti G … +1 more , Maina G
J Psychiatr Res · 2026 Jun · PMID 42365845 · Publisher ↗
BACKGROUND: The "critical window hypothesis" posits that prolonged duration of untreated psychosis (DUP) causes irreversible neurobiological damage during a time-sensitive period, leading to worse long-term outcomes. Whi...
BACKGROUND: The "critical window hypothesis" posits that prolonged duration of untreated psychosis (DUP) causes irreversible neurobiological damage during a time-sensitive period, leading to worse long-term outcomes. While widely accepted as justification for early intervention psychiatry, empirical evidence supporting this hypothesis remains contentious. This systematic review evaluates DUP-outcome relationships across symptomatic, functional, cognitive, and neurobiological domains. METHODS: Following PRISMA guidelines, we searched five databases through December 2025 for longitudinal studies examining DUP and outcomes at ≥12 months in first-episode psychosis. Study quality was evaluated using Newcastle-Ottawa Scale; findings were synthesized narratively due to substantial heterogeneity. RESULTS: From 8011 citations, 30 studies encompassing approximately 9800 first-episode psychosis patients were included. Longer DUP consistently associated with worse symptomatic outcomes at 1-2 years (median r = 0.20-0.35), but associations weakened substantially at 5-10 years. Functional outcomes showed modest associations (r = 0.15-0.25), primarily in social domains. Cognitive effects were minimal and inconsistent. Neuroimaging revealed gray matter reductions, though directionality unclear. Critical threshold analyses suggested inflection points at 6-12 months but varied considerably. Major limitations included retrospective DUP assessment, variable definitions, survivor bias, and inadequate confounder control (only 37% controlled premorbid functioning), substantially limiting causal inference. CONCLUSIONS: While DUP shows consistent short-term associations, evidence for irreversible damage through critical window mechanisms remains inconclusive. Temporal attenuation suggests DUP may reflect illness severity and premorbid vulnerability rather than neurotoxicity. The field requires prospective studies with standardized measurement, adequate confounder control, and extended follow-up. Early intervention remains clinically justified through humanitarian principles, even if the critical window hypothesis lacks robust empirical support.
To the Editor: Comment on Silvestre et al., "Supply, demand, and adequacy of the adult psychiatry workforce in the United States: Projecting a shortage to 2038".
Dotson S
J Psychiatr Res · 2026 Jun · PMID 42364374 · Publisher ↗
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Emotional dysfunction as a predictor of reported current, but not childhood, ADHD symptoms among adults with and without ADHD.
Turchmanovych-Hienkel N, Dykins M, Abalos SA … +9 more , Shapiro G, Wang Y, Finley JA, Robinson AD, Cerny BM, Phillips MS, Ulrich DM, Soble JR, Ovsiew GP
J Psychiatr Res · 2026 Jun · PMID 42361594 · Publisher ↗
INTRODUCTION: The cardinal symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are highly nonspecific, and are shared with other prevalent neuropsychiatric disorders. Moreover, rates of psychopathological co-occu...
INTRODUCTION: The cardinal symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are highly nonspecific, and are shared with other prevalent neuropsychiatric disorders. Moreover, rates of psychopathological co-occurrence are high with ADHD. Given symptom non-specificity may confound differential diagnosis of ADHD, this study assessed the effect of elevated emotional dysfunction on endorsement of current and childhood ADHD symptoms. METHOD: Study sample included 527 adults referred for neuropsychological evaluation of suspected or known ADHD. The Clinical Assessment of Attention Deficit-Adult (CAT-A) assessed severity of self-reported childhood and current ADHD symptoms. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Emotional/Internalizing Dysfunction (EID) scale indexed severity of self-reported emotional dysfunction. EID T-scores ≥65 were classified as clinically elevated (n = 238), and T-scores <65 non-elevated. Childhood, current, and overall ADHD symptom endorsement was examined by EID status among those with and without ADHD. RESULTS: Invariably, elevated EID significantly predicted greater current, but not childhood, ADHD symptoms with small effects (η 0.021-0.045). The greatest effects of EID elevation were found among those without ADHD (η 0.045-0.046). Among those without ADHD, elevated EID predicted greater overall ADHD symptoms and raised overall ADHD classification from Normal Range to Mild Clinical Risk. DISCUSSION: Emotional dysfunction among adults presenting for differential diagnosis of ADHD predicts greater current, but not childhood, ADHD symptom endorsement, regardless of ADHD status. Results indicate that convincing ADHD complaints may emerge from nosologically unrelated conditions. Findings underscore the need to assess childhood symptom report, which was resistant to current emotional dysfunction.
Autism-like features in individuals at clinical high risk for psychosis: a longitudinal research using the PANSS Autism Severity Score (PAUSS).
Pelizza L, Picone TF, Leuci E … +7 more , Quattrone E, Palmisano D, Pupo S, Paulillo G, Pellegrini C, Pellegrini P, Menchetti M
J Psychiatr Res · 2026 Jun · PMID 42349013 · Publisher ↗
PURPOSE: The PANSS Autism Severity Score (PAUSS) is a widely used measure of autism-like features in early psychosis, including mental states at "Clinical High Risk for Psychosis" (CHR-P). However, evidence regarding its...
PURPOSE: The PANSS Autism Severity Score (PAUSS) is a widely used measure of autism-like features in early psychosis, including mental states at "Clinical High Risk for Psychosis" (CHR-P). However, evidence regarding its relevance to long-term outcomes and treatment response is very scarce. Thus, the main aim of this investigation was to compare baseline clinical characteristics and longitudinal outcomes/treatment response between CHR-P subjects with or without autistic features recruited into a specialist early intervention service during a 2-year follow-up period. METHODS: CHR-P participants completed the Social and Occupational Functioning Assessment Scale (SOFAS) and the Positive And Negative Syndrome Scale (PANSS) at baseline and over the follow-up. Kaplan-Meyer survival analysis, mixed-design ANOVA, and binary logistic regression analysis were performed. RESULTS: Thirty-six (16.8%) of the 214 enrolled CHR-P individuals scored above the PAUSS cut-off of 30 (PAUSS + subgroup). At baseline, they showed higher PANSS and SOFAS scores, as well as higher prevalence rates of substance abuse and individuals not engaged in education, employment, or training. Over the follow-up period, they showed worse clinical and functional outcomes, including higher incidence rates of hospital re-admission (28.7% vs. 11.6%; Hazard Ratio [HR] = 3.38) and conversion to psychosis (26.0% vs. 12.0%; HR = 2.71), as well as lower likelihood of both functional (Hazard Risk [HR] = 4.23) and symptomatic (HR = 6.50) remission. However, our specialist intervention has proven effective in improving psychopathological and functional parameters over time even in the PAUSS + subgroup. CONCLUSIONS: Our findings suggest that the PAUSS specifically identifies a CHR-P subgroup with greater clinical and functional severity at presentation and worse longitudinal outcomes.
Adaptation under fire: The effect of updating flexibility during cumulative trauma.
Porat-Butman S, Levy-Gigi E
J Psychiatr Res · 2026 Jun · PMID 42341413 · Publisher ↗
Direct and indirect traumatic exposure during ongoing continuous trauma often leads to increased anxiety symptoms, which may cause distress and disrupt daily functioning. Previous research has shown that updating flexibi...
Direct and indirect traumatic exposure during ongoing continuous trauma often leads to increased anxiety symptoms, which may cause distress and disrupt daily functioning. Previous research has shown that updating flexibility can attenuate the positive association between levels of exposure and the tendency to develop clinical symptoms. Here, we suggest that in line with the predictive-processing framework, this can be done by updating prior beliefs based on new relevant, but not irrelevant, information. Such ability is especially important during an ongoing war, where extensive exposure to traumatic events may destabilize prior beliefs and lead to information overload. The current study tested for the first time the moderating role of belief updating in the relationship between trauma exposure and anxiety during the first month of an ongoing war while differentiating between the possible effects of direct and indirect exposure. Participants were assessed for trauma exposure and clinical symptoms and completed a well-validated performance-based paradigm to evaluate belief updating. The results revealed that belief updating moderated the relationship between indirect, but not direct, trauma exposure and anxiety. Specifically, for individuals with impaired belief updating, there was a positive association between levels of indirect traumatic exposure and anxiety symptom severity. In contrast, those with flexible belief updating maintained lower levels of symptoms independent of their exposure. Interestingly, direct exposure increased anxiety symptoms regardless of flexibility in belief updating. The results highlight the need for developing tailored interventions that consider belief updating and exposure type to reduce clinical symptoms and improve well-being during ongoing crises.
Time to diagnosis and treatment for borderline personality disorder - opportunities and pitfalls during the consumer mental health journey.
Broadbear JH, Ng I, Lee J … +3 more , Crowley S, Schembri E, Rao S
J Psychiatr Res · 2026 Jun · PMID 42341412 · Publisher ↗
Borderline personality disorder (BPD) typically begins in adolescence, however diagnosis and treatment are often delayed, contributing to suffering, frequent service contact for consumers, and distress for families. The...
Borderline personality disorder (BPD) typically begins in adolescence, however diagnosis and treatment are often delayed, contributing to suffering, frequent service contact for consumers, and distress for families. The aim of this cross-sectional study was to: (1) examine key events in the mental health journeys of consumers with BPD, (2) identify factors contributing to delays in diagnosis and treatment, and (3) explore lived experiences of diagnosis and care. One hundred and seventy participants (average age 34.6 years), most identifying as female (89.9%), completed an anonymous online survey that included questions about symptom onset, diagnosis, treatment, and lived experiences of diagnosis. Univariate and multivariate analyses as well as inductive thematic analysis were utilised. The median time to receiving a BPD diagnosis following initial onset of symptoms was 13.5 years (IQR = 8-20). This was longer for males (p < 0.001) and shorter for non-binary participants (p = 0.047) than for females, both of which were explained by participant age. The delay between symptom onset and diagnosis increased with participant age at time of survey completion (p < 0.001). Once age was taken into account, neither prior mental health diagnoses nor number of prescription medications delayed diagnosis. Post diagnosis, the median time to receive treatment was more than a year (IQR=0-3). Treatment delays and negative perceptions regarding recovery were more likely for participants who reported negative healthcare experiences at the time of diagnosis. These findings suggest improvements have occurred in the identification and diagnosis of BPD nationally, while highlighting the need for ongoing education for mental health professionals to enable them to communicate the diagnosis effectively and facilitate access to evidence-based treatment.
Dissociable roles of frontal electroencephalography markers in depression: Predictive value of frontal alpha asymmetry and responsive changes in beta power following home-based brain stimulation.
Ahn JS, Kim WJ, Jhung K … +3 more , Roh D, Park J, Park JY
J Psychiatr Res · 2026 Jun · PMID 42341411 · Publisher ↗
BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising intervention for major depressive disorder; however, electroencephalographic (EEG) predictors of treatment response remain incompletely understood...
BACKGROUND: Transcranial direct current stimulation (tDCS) is a promising intervention for major depressive disorder; however, electroencephalographic (EEG) predictors of treatment response remain incompletely understood. Therefore, this study aimed to identify EEG predictors of treatment response in this population. METHODS: In this study, a subsample (n = 108) of individuals included in a multicenter, double-blind randomized controlled trial (N = 198) with baseline and week 6 EEG data was analyzed. Participants received either 6 weeks of active tDCS (6W-active; n = 65) or 3 weeks of active stimulation followed by sham stimulation (3W-active-sham; n = 43). Resting-state EEG features, including frontal alpha asymmetry (FAA) and relative alpha and beta power at F3/F4, were analyzed. Pearson correlation and hierarchical regression analyses were conducted to assess associations with week 6 depressive symptoms (measured using the Beck Depression Inventory-II [BDI-II]), while adjusting for baseline severity. RESULTS: In the 6W-active group, greater left-lateralized FAA at baseline was significantly associated with lower BDI-II scores at endpoint. In contrast, no significant FAA-depression association was observed in the 3W-active-sham group; however, higher F3 relative alpha power was associated with greater symptom severity. Regression analyses identified FAA as a significant predictor of treatment outcome after controlling for baseline symptoms and other covariates. CONCLUSIONS: Baseline FAA may serve as a clinically relevant EEG predictor of antidepressant response to tDCS. Moreover, EEG-symptom associations differed by stimulation duration, supporting the potential of EEG biomarkers to guide personalized neuromodulation strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05539131.
Prevalence and associated factors of postpartum depression at 5-8 weeks postpartum in a developed district of South China: a retrospective cross-sectional study.
Peng Y, Cheng J, Wang M … +13 more , Rehman S, Xiong J, Qin X, Peng Z, Mao W, Chen Q, Zhang L, Ju Y, Liu J, Liu B, Zhang Y, Yu Y, Zhang Q
J Psychiatr Res · 2026 Jun · PMID 42341410 · Publisher ↗
BACKGROUND: Postpartum depression (PPD) induces adverse maternal and infant outcomes. Identifying and understanding the associated factors of PPD are crucial for effective screening and intervention strategies. Consequen...
BACKGROUND: Postpartum depression (PPD) induces adverse maternal and infant outcomes. Identifying and understanding the associated factors of PPD are crucial for effective screening and intervention strategies. Consequently, this study assesses the prevalence and associated factors of PPD in a large Chinese population. METHODS: A retrospective cross-sectional study was conducted among women attending routine care at 5-8 weeks postpartum at Shenzhen Baoan Women's and Children's Hospital, China, between January 1, 2020 and January 31, 2024. Data on participants' sociodemographic, obstetric, and psychological characteristics were collected during pregnancy and postpartum. The Edinburgh Postnatal Depression Scale was used to measure probable PPD, with a score of ≥10 indicating a probable case. Descriptive, univariate, multivariate analyses, and restricted cubic spline (RCS) were performed to identify the associated factors. RESULTS: A total of 20,121 postpartum women were enrolled in this survey, among whom 1729 (8.6%) had probable PPD. Age< 30 years (OR = 1.40, 95% CI = 1.26-1.55), lower economic status (OR = 1.13, 95% CI = 1.01-1.27), antenatal depression (OR = 2.94, 95% CI = 2.31-3.74), antenatal anxiety (OR = 3.00, 95% CI = 2.55-3.52), non-breastfeeding (OR = 1.24, 95% CI = 1.12-1.37), and abnormal gestational age (OR = 1.26, 95% CI = 1.01-1.58) were the factors associated with probable PPD. RCS analyses revealed nonlinear associations for gestational age and birth weight with PPD. Premature delivery and lower birth weight were associated with probable PPD, while maternal age showed a linear relationship with PPD. CONCLUSIONS: Approximately one in twelve women experiences probable PPD in a developed district of South China. These findings highlight the need for early identification and targeted support for vulnerable groups.
Calibrated clinical judgment in psychiatric drug trials: Beyond psychometric scales.
Pani L, Sachs GS, Schooler NR
J Psychiatr Res · 2026 Jun · PMID 42335497 · Publisher ↗
Psychiatric randomised controlled trials increasingly privilege psychometric rating scales, yet bedside clinical training, remains the clinician's primary integrator of meaning, context, and change. Recent reconceptualis...
Psychiatric randomised controlled trials increasingly privilege psychometric rating scales, yet bedside clinical training, remains the clinician's primary integrator of meaning, context, and change. Recent reconceptualisations describe clinical judgment as a three-stage process encompassing data collection through clinical interviewing, interpretationviaclinical reasoning, and decision making (Fava and Guidi, 2026; Fava et al., 2026). We provide a historically informed, conceptually focused analysis of the transition from narrative clinical impression to operationalised criteria and multi-item scales, and examine the emergence of clinician-judgment outcomes, particularly the Clinical Global Impressions (CGI) scales, as a hybrid bridge between these traditions. We argue that modern outcome assessment comprises two dominant families: multi-item symptom scales (e.g., PANSS, MADRS, HAM-A) and global clinician-judgment scales (CGI-Severity, CGI-Improvement). Global ratings can capture clinically salient information not fully represented by item totals, but only if their use preserves independent judgment. We propose "CGI 2.0": minimum standards for rater qualification, construct-focused training, structured justification, calibration/monitoring, and prespecified concordance/discordance analyses with primary symptom-scale endpoints, while cautioning against "industrialised" practices such as deriving CGI scores from multi-item totals. A clinimetric integration of psychometric methods that re-legitimises calibrated clinical judgment alongside rigorous measurement could improve interpretability, clinical relevance, and signal detection in psychopharmacology trials.
Intrinsic links between obsessive-compulsive symptoms and other psychopathological symptoms: A network analysis of clinical and community populations.
Suo X, Zhang Y, Wang H … +5 more , Li X, Cao H, Zeng L, Gao J, Hu M
J Psychiatr Res · 2026 Jun · PMID 42335496 · Publisher ↗
BACKGROUND: The interconnectedness of core mental health features is associated with more severe illness impairment and less effective treatment outcomes. This study aimed to evaluate the network of relationships between...
BACKGROUND: The interconnectedness of core mental health features is associated with more severe illness impairment and less effective treatment outcomes. This study aimed to evaluate the network of relationships between obsessive-compulsive symptoms and other psychopathological symptoms in both obsessive-compulsive disorder (OCD) patients and community populations, identifying symptom interconnections. METHODS: A cross-sectional study was conducted from January 1, 2020, to June 30, 2024. The Chinese versions of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Symptom Checklist-90 (SCL-90) were used to measure obsessive-compulsive symptoms and other psychopathological symptoms, respectively. Measurement invariance testing was performed using Mplus software (version 8.11). Network structure, centrality, stability, and network comparisons were analyzed using R software (version 4.4.1). RESULTS: The study included 4223 OCD patients and 5253 community participants. In the symptom networks of both groups, SCL3 ("Depression") and SCL4 ("Anxiety") were common core symptoms. SCL10 ("Psychoticism") was a specific core symptom for OCD patients, while SCL2 ("Interpersonal sensitivity") was specific to the community group. Additionally, SCL8 ("Obsessive symptoms") and YBOCS3 ("Distress caused by obsessions") served as bridge symptoms in both groups. LIMITATIONS: The cross-sectional design limited causal inferences; self-report measures were subject to recall bias and other confounding factors; sample representativeness and the range of variables included in the analysis were limited. CONCLUSION: Depressive and anxiety symptoms emerged as common core symptoms in both OCD patients and community populations. Psychoticism was specifically identified as a core symptom in OCD patients, while obsessive symptoms and obsession-related distress served as bridging symptoms linking OCD with other psychopathological symptoms, highlighting important targets for clinical assessment.
Transcranial magnetic stimulation and 180-day risk of recurrent suicidal ideation in adults with moderate-to-severe major depressive disorder: A TriNetX propensity-matched cohort study.
Asay C, Espiridion E
J Psychiatr Res · 2026 Jun · PMID 42335495 · Publisher ↗
INTRODUCTION: Major depressive disorder (MDD) is strongly associated with suicidal ideation, a major predictor of suicide attempts and completed suicide. Transcranial magnetic stimulation (TMS) has shown promise in impro...
INTRODUCTION: Major depressive disorder (MDD) is strongly associated with suicidal ideation, a major predictor of suicide attempts and completed suicide. Transcranial magnetic stimulation (TMS) has shown promise in improving suicidal ideation, though the generalizability of these findings to routine clinical practice remains uncertain. This study evaluated whether TMS exposure was associated with recurrent suicidal ideation among adults with moderate-to-severe MDD using real-world electronic health record data. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Adults with moderate-to-severe MDD and documented suicidal ideation who received TMS were compared with matched patients not exposed to TMS. Propensity score matching and Kaplan-Meier and Cox proportional hazards analyses were performed. A landmark sensitivity analysis excluding outcomes within the first 30 days after index was conducted to address potential immortal time bias. RESULTS: After matching, 1193 patients per cohort were included. Recurrent suicidal ideation occurred in 22.5% of TMS-exposed patients versus 33.9% of controls (HR 0.584, 95% CI 0.500-0.681; p < 0.001). In the landmark sensitivity analysis, recurrent suicidal ideation occurred in 17.5% of the TMS cohort and 14.5% of controls, and the association was no longer statistically significant (HR 1.203, 95% CI 0.954-1.516; p = 0.118). CONCLUSION: The initially observed association between TMS exposure and lower recurrent suicidal ideation attenuated substantially after landmark sensitivity analysis addressing potential immortal time bias. These findings do not provide robust evidence that TMS independently reduces recurrent suicidal ideation in adults with moderate-to-severe MDD.
Intrinsic reward sensitivity drives internet gaming disorder through striatal-thalamic hyper-synchronization.
Li MH, Jiang AH, Xu XF … +3 more , Li S, Luo X, Dong GH
J Psychiatr Res · 2026 Jun · PMID 42335494 · Publisher ↗
BACKGROUND: Internet gaming disorder (IGD) is a behavioral addiction characterized by compulsive gaming and impaired control over gaming behavior. Although the reward system is central to addiction, the specific neural m...
BACKGROUND: Internet gaming disorder (IGD) is a behavioral addiction characterized by compulsive gaming and impaired control over gaming behavior. Although the reward system is central to addiction, the specific neural mechanisms through which IGD affects intrinsic and extrinsic rewards processing remain poorly understood. METHODS: We recruited 21 individuals with IGD and 23 recreational gaming users (RGU). Participants underwent functional magnetic resonance imaging (fMRI) while performing a cue-craving task with four types of stimuli: intrinsic reward, extrinsic reward, neutral, and gaming cues. Behavioral data (reaction time, subjective craving) were analyzed using repeated-measures ANOVA (stimulus type × group), and neural responses were analyzed using a general linear model and seed-based functional connectivity analysis. RESULTS: Compared to RGU, individuals with IGD exhibit faster responses to gaming cues, stronger cravings, and altered evaluations of intrinsic rewards. Neuroimaging analysis revealed excessive synchronization in the striatum-thalamus functional connectivity during processing of intrinsic rewards in the IGD group, particularly enhanced connectivity from the left thalamus to the right caudate nucleus. Furthermore, distinct patterns of brain connectivity emerged across stimulus conditions: under gaming cues, the IGD group exhibited significantly stronger connections between the default mode network and core nodes of the reward network (e.g., nucleus accumbens-prefrontal cortex) than the RGU group. CONCLUSIONS: Our findings indicate that IGD is associated with aberrant neural reward processing, including striatal-thalamic hyper-synchronization, which may underlie the hijacking of intrinsic reward mechanisms. These results support a 'self-efficacy-sensory drive' model of IGD, providing a neurobiological basis for targeted interventions.
Testing the mediating role of negative affect, affect intolerance, and dissociation in the relationship between sleep loss and psychotic experiences.
Johnson MR, Bower JL, Reeve S
J Psychiatr Res · 2026 Jun · PMID 42335493 · Publisher ↗
BACKGROUND AND HYPOTHESIS: Sleep disturbances are known to causally contribute to psychotic experiences, with negative affect indicated as a mediator in previous research. However, other plausible related mechanisms such...
BACKGROUND AND HYPOTHESIS: Sleep disturbances are known to causally contribute to psychotic experiences, with negative affect indicated as a mediator in previous research. However, other plausible related mechanisms such as affect intolerance and dissociative experiences have not been tested. We hypothesised that sleep restriction would increase psychotic experiences, with effects mediated by increases in negative affect, affect intolerance and dissociative experiences. STUDY DESIGN: A within-subjects, cross-over experimental study was conducted with 58 undergraduate participants, comparing sleep restriction (≤4 h sleep for one night) to standard sleep. STUDY RESULTS: In comparison to standard sleep, one night of sleep restriction resulted in significant increases in all psychotic experiences except grandiosity, as well as significant increases in all proposed mediators. Dissociative experiences (46.2%), and combined mediators (89.1%), substantially mediated the effect of reduced sleep on paranoia. Dissociative experiences also partially mediated the effect of reduced sleep on hallucinations (38.5%). No significant mediation effects were identified for cognitive disorganisation, anhedonia or distress from psychotic experiences. CONCLUSIONS: These findings extend the causal relationship between sleep loss and psychotic experiences as occurring after only one night of sleep restriction. They also identify a novel mechanism - dissociative experiences - as contributing towards both paranoia and hallucinations. Negative affect was supported as a mediating mechanism for paranoia, in line with existing research, however there was limited identification of mediating mechanisms for other psychotic experiences. The results emphasise the importance of further experimental research investigating the relationship between affective processes, particularly dissociative experiences, and specific symptoms of psychosis.
Effect of a digital mindfulness intervention for mild-to-moderate late-life depression: A randomized controlled trial.
Zhu K, Hu M, Liu C … +7 more , Wang Y, Guo C, Shen H, Ding N, Wang X, Ren L, Zhang Q
J Psychiatr Res · 2026 Jun · PMID 42335492 · Publisher ↗
BACKGROUND: Late-life depression (LLD) is a growing public health concern in aging populations. Although digital mindfulness interventions show promise for depression, anxiety, and insomnia, their efficacy and electroenc...
BACKGROUND: Late-life depression (LLD) is a growing public health concern in aging populations. Although digital mindfulness interventions show promise for depression, anxiety, and insomnia, their efficacy and electroencephalogram (EEG) correlates in older adults with LLD remain unclear. This study evaluated the FocusZen Mindfulness Stress Reduction System, a digital mindfulness intervention with EEG feedback, in mild-to-moderate LLD. METHODS: Fifty-four participants with mild-to-moderate LLD were randomly assigned to a 6-week intervention group (n = 27; daily FocusZen sessions) or a control group (n = 27; general health education). The primary outcome was the change in HAMD-17 score. Secondary outcomes included anxiety, sleep quality, cognition, and frontal EEG spectral activity. Data were analyzed using mixed-effects models and intention-to-treat principles. RESULTS: The intervention group demonstrated significant reductions in depressive symptoms [HAMD-17: F(3, 132.69) = 8.83, P < 0.001], anxiety [HAMA: F(3, 129.95) = 8.34, P < 0.001], and sleep disturbances [PSQI: F(3, 128.91) = 5.55, P = 0.01], alongside improved cognition [MOCA: F(3, 133.19) = 5.14, P = 0.01]. Response and remission rates were higher in the intervention group. Exploratory EEG analysis showed increased frontal theta [F(1.96, 43.12) = 25.28, P < 0.001] and alpha activity [F(1.44, 31.73) = 22.92, P < 0.001]. CONCLUSIONS: FocusZen-based digital mindfulness reduced depressive, anxiety, and sleep symptoms and improved cognition in mild-to-moderate LLD, potentially accompanied by enhanced frontal theta and alpha activity. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2400086063; https://www.chictr.org.cn/.
Adiposity and inflammation mediate altered metabolic profile in individuals with opioid use disorder.
Li X, Manza P, Wang GJ … +8 more , Giddens N, Belcher A, Schwandt M, Diazgranados N, Lynch KG, Volkow ND, Shi Z, Wiers CE
J Psychiatr Res · 2026 Jun · PMID 42335491 · Publisher ↗
Previous studies have linked opioid use to altered metabolic profiles, but findings have been inconsistent and mechanisms remain unclear. One potential mechanism involves increased adiposity, leading to chronic low-grade...
Previous studies have linked opioid use to altered metabolic profiles, but findings have been inconsistent and mechanisms remain unclear. One potential mechanism involves increased adiposity, leading to chronic low-grade inflammation that elevates metabolic risk. Here, we examined metabolic profiles in individuals with opioid use disorder (OUD) and matched non-OUD controls, focusing on the sequential mediating roles of BMI and inflammation. Data from individuals with OUD (n = 281) and non-OUD (n = 246) were drawn from a natural history screening protocol from the National Institute on Alcohol Abuse and Alcoholism intramural program. Groups were matched on age, sex, race, ethnicity, socioeconomic status, and education via propensity score matching. Metabolic measures included body mass index (BMI), hemoglobin A1c (HbA1c), and lipid profiles, with lipid imbalance indexed by the atherogenic index of plasma (AIP). Inflammatory markers included C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Individuals with OUD had significantly higher BMI (F = 12.9, p < 0.001), higher HbA1c (F = 10.5, p = 0.001), lower high-density lipoprotein cholesterol (HDL-C; F = 46.2, p < 0.001), higher low-density lipoprotein cholesterol (LDL-C; F = 11.9, p < 0.001), and higher AIP (F = 20.7, p < 0.001) compared to non-OUD. Inflammatory markers were also elevated in individuals with OUD, including CRP (F = 9.4, p = 0.002) and ESR (F = 7.4, p = 0.007),and statistically mediated group differences in AIP and HbA1c, respectively. Our results are consistent with prior evidence of metabolic dysfunctions in individuals with OUD and suggest inflammation as a contributing mechanism. Targeting metabolic health and inflammation may offer new avenues for improving long-term health outcomes in OUD.
Depressive and anxiety symptoms in mothers and fathers and child socioemotional outcomes: A nationwide Canadian study.
Wade M, Li LM, Wright E … +8 more , Marini F, Shiri R, Vigod S, Brown HK, Grigoriadis S, Prioreschi A, Matthews S, Dennis CL
J Psychiatr Res · 2026 Jun · PMID 42335490 · Publisher ↗
OBJECTIVE: This study examined associations between single-versus dual-parental depressive and anxiety symptoms during the antenatal and postpartum period with child socioemotional problems from 12 to 24 months of age. M...
OBJECTIVE: This study examined associations between single-versus dual-parental depressive and anxiety symptoms during the antenatal and postpartum period with child socioemotional problems from 12 to 24 months of age. METHOD: In this nationwide Canadian longitudinal cohort study of women and their cohabitating partners, generalized estimating equations were used to examine associations between antenatal maternal and paternal depressive (Edinburgh Postnatal Depression Scale) and anxiety (State-Trait Anxiety Inventory) symptoms measured retrospectively within 3 weeks postpartum, and postnatal symptoms measured prospectively at 3, 6, 9, 12, and 18 months postpartum and their children's socioemotional development (Brief Infant-toddler Social and Emotional Assessment) from 12 to 24 months of age. RESULTS: The study included 3217 cohabitating couples. Adjusting for covariates, mother-only (range of ORs = 1.50 [95% CI, 1.08-2.10] for antenatal anxiety symptoms to 2.03 [95% CI, 1.13-3.65] for antenatal comorbid symptoms), father-only (range of ORs = 1.57 [95% CI, 1.18-2.09] for postpartum anxiety symptoms to 2.44 [95% CI, 1.33-4.47] for antenatal comorbid symptoms), and dual-parental (range of ORs = 1.78 [95% CI, 1.00-3.15] for antenatal anxiety symptoms to 4.34 [95% CI, 1.83-10.29] for antenatal depressive symptoms) depressive and anxiety symptoms in both the antenatal and postpartum periods were associated with increased child socioemotional problems. CONCLUSION: Maternal and paternal depressive and anxiety symptoms during the antenatal and postpartum periods are associated with increased child socioemotional problems in early childhood, with roughly equal magnitude. Dual-parental mental health conditions and comorbid conditions have the strongest associations with socioemotional problems. Findings underscore the importance of considering the well-being of mothers and fathers in promoting healthy socioemotional development.
Machine learning model based on spontaneous brain activity and functional connectivity for identifying patients with internet gaming disorder.
Yu M, Xiao Z, Liu S … +5 more , Zhang D, Cui N, Lu X, Lei W, Chen G
J Psychiatr Res · 2026 Jun · PMID 42335489 · Publisher ↗
OBJECTIVES: Internet gaming disorder (IGD) has been identified as a significant global mental health concern, emphasising the necessity for early diagnosis and intervention. This study aims to integrate multiple brain fu...
OBJECTIVES: Internet gaming disorder (IGD) has been identified as a significant global mental health concern, emphasising the necessity for early diagnosis and intervention. This study aims to integrate multiple brain function metrics and machine learning algorithms to develop an advanced model for identifying IGD patients. METHODS: The amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), degree centrality (DC), regional homogeneity (ReHo) and voxel-mirrored homotopic connectivity (VMHC) from functional magnetic resonance imaging were extracted according to the anatomical automatic labelling (AAL) atlas from 244 IGD patients and 212 healthy controls (HCs). Combinations of 4 feature selection methods (analysis of variance (ANOVA), Kruskal‒Wallis (KW), Relief, and recursive feature elimination (REF)) and 10 classification algorithms were used to determine the most robust combinatorial model. Furthermore, a nomogram integrating functional metric features derived from the optimal model with independent clinical predictors was developed and evaluated via calibration curve and decision curve analyses (DCAs). RESULTS: The DC model derived from the bilateral olfactory cortex, bilateral insula and left orbitofrontal cortex (OFC), which combines the KW selector and Gaussian process (GP) classifier, and the ReHo model derived from the bilateral OFC, left olfactory cortex, left insula and left rectus, which combines the Relief selector and GP classifier, demonstrated superior performance in identifying IGD patients. The areas under the 0.971 and 0.989, respectively; corresponding AUCs for the ReHo model were 0.985 and 0.980. The internet addiction test (IAT) score was identified as an independent clinical predictor. The calibration curve and DCA demonstrated that the nomogram integrating DC with the IAT exhibited excellent reliability and significant net benefit (C index: 0.994). CONCLUSIONS: The nomogram based on DC and the IAT yields satisfactory classification performance and provides an effective tool for identifying IGD patients.
Balancing burden and resolution: Effects of EMA survey schedule on compliance and study evaluation in suicide-focused research.
Blacutt M, O'Brien CM, Jacobucci R … +1 more , Ammerman BA
J Psychiatr Res · 2026 Jun · PMID 42330698 · Publisher ↗
INTRODUCTION/BACKGROUND: Ecological momentary assessment (EMA) enables fine-grained, real-time prediction and monitoring of suicidal ideation and related experiences, but participant burden and declining compliance pose...
INTRODUCTION/BACKGROUND: Ecological momentary assessment (EMA) enables fine-grained, real-time prediction and monitoring of suicidal ideation and related experiences, but participant burden and declining compliance pose challenges. This study examined how EMA survey schedules influence EMA compliance, response likelihood, and participant burden. METHODS: Participants (N = 137) with recent suicidal ideation completed 28 days of EMA under one of three schedules: fixed (six surveys/day), 4+burst (four/day with one week of 10/day), or randomly varying (3-15 surveys/day). Bayesian mixed-effects and logistic regression models examined the effects of schedule type and time on overall and momentary compliance. Associations between compliance and schedule type with perceived burden, emotional reactions, and satisfaction were examined. RESULTS: Schedule type was not associated with overall compliance; however, time-by-schedule interactions showed that 4+burst and randomly varying conditions exhibited less decline over time than the fixed condition. Prior survey completion increased momentary response likelihood, while time in study decreased the likelihood of responding. Higher compliance was associated with fewer perceived drawbacks; no other effects of compliance or study schedule were found. DISCUSSION: Although overall compliance did not differ across schedules, those that incorporated some variability in survey frequency showed more sustained compliance over time. Responding to the previous survey increased response likelihood, indicating a momentum effect, whereas longer study participation reduced momentary compliance, consistent with cumulative survey fatigue. CONCLUSION: Incorporating variability in survey frequency sustained greater compliance over time without increasing perceived burden, suggesting that varying EMA schedules may help mitigate study fatigue.
The state urge to be physically active in anorexia nervosa: a systematic review of mechanisms and clinical implications.
Boltri M, Gabutti C, Pignattai L … +8 more , Brusa F, Apicella E, Castelnuovo G, Sapuppo W, Mendolicchio L, Hanachi M, Hebebrand J, Paslakis G
J Psychiatr Res · 2026 Jun · PMID 42314357 · Publisher ↗
OBJECTIVE: Anorexia nervosa (AN) is a severe eating disorder, leading to life-threatening complications and psychosocial impairment. Among its complex clinical features, a prominent but poorly understood feature is the i...
OBJECTIVE: Anorexia nervosa (AN) is a severe eating disorder, leading to life-threatening complications and psychosocial impairment. Among its complex clinical features, a prominent but poorly understood feature is the intense State Urge to be Physically Active (SUPA), which may not always manifest as observable physical activity. This systematic review followed PRISMA guidelines to synthesize current empirical evidence regarding the characteristics, biological underpinnings, assessment methods and clinical implications of SUPA in AN across varying illness severity levels. METHODS: A systematic search of PubMed, Scopus, and EBSCOhost databases identified 1165 records, of which 17 studies met the inclusion criteria and were included in the final review. These studies employed both objective and subjective assessments of the SUPA. RESULTS: Findings suggest that the SUPA may persist regardless of BMI changes, including during recovery, and may function as a maladaptive emotion regulation strategy, rather than reflect a dispositional feature. Higher SUPA levels during weight restoration seem to predict poorer post treatment weight maintenance. DISCUSSION: In clinical settings, SUPA may signal illness severity and resistance to weight restoration, warranting its proactive inclusion in diagnostic and treatment frameworks. To advance understanding and management of SUPA in AN, future research should address confounding factors such as illness duration, validate standardised assessment tools and procedures, and explore targeted interventions to improve outcomes in AN.
Network intervention analysis of a school-based gaming disorder prevention program in Hong Kong primary school students.
Zhang H, Chow CH, Cheng C
J Psychiatr Res · 2026 Jun · PMID 42309022 · Publisher ↗
BACKGROUND AND AIMS: The growing prevalence of gaming disorder has prompted the emergence of early prevention programs. While previous evaluations assessed overall efficacy, the specific symptom-level changes following p...
BACKGROUND AND AIMS: The growing prevalence of gaming disorder has prompted the emergence of early prevention programs. While previous evaluations assessed overall efficacy, the specific symptom-level changes following program participation remain unknown. This study addressed the gap using network intervention analysis (NIA) to investigate how a newly validated prevention program, the Digital Netizen Alliance, was associated with changes in the network components of gaming disorder symptoms. METHODS: In a school-clustered design, a sample of 600 Chinese Primary 4 to 6 students (48% female, age range: 9-12) was randomly assigned to either the intervention or waitlist condition. Participants completed validated questionnaires at baseline and three-month follow-up. RESULTS: Within this school-clustered intervention context, the NIA revealed that program participation was related to reductions in three symptoms: gaming-driven affirmation dependence, craving, and jeopardizing relations. The analysis further showed reductions in three other symptoms: loss of interest, social escapism, and impaired control. DISCUSSION: This study presents the first application of NIA to examine patterns of symptom change following a gaming disorder prevention program. Unlike conventional approaches that evaluate effectiveness through overall outcome comparisons, our findings highlight which specific symptoms were greatly reduced and how these changes were associated with improvements in other symptoms. These insights demonstrate the value of NIA as a complementary evaluation approach for elucidating the cognitive-behavioral processes related to preventive change.
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