Annals Of General Psychiatry[JOURNAL]
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200 papers
Correction: Prevalence of suicidal thoughts and attempts in the transgender population of the world: a systematic review and meta‑analysis.
Kohnepoushi P, Nikouei M, Cheraghi M … +6 more , Hasanabadi P, Rahmani H, Moradi M, Moradi G, Moradpour F, Moradi Y
Ann Gen Psychiatry · 2026 Jul · PMID 42393700 · Full text
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Cardiovascular fitness of forensic psychiatric patients: a longitudinal clinical study.
Fernqvist A, Andiné P, Thomeé R … +3 more , Degl'Innocenti A, Nilsson T, Gutke A
Ann Gen Psychiatry · 2026 Jul · PMID 42387560 · Full text
BACKGROUND: Forensic psychiatric patients have a reduced life expectancy, largely due to cardiovascular diseases. Low maximal oxygen uptake is a risk factor for cardiovascular diseases in the general population and may a...
BACKGROUND: Forensic psychiatric patients have a reduced life expectancy, largely due to cardiovascular diseases. Low maximal oxygen uptake is a risk factor for cardiovascular diseases in the general population and may also be essential to the cardiovascular risk among forensic psychiatric patients. The purpose of this study was to verify previous results of very low estimated maximal oxygen uptake levels in a larger group of forensic psychiatric patients and investigate the impact of the length of inpatient forensic psychiatric care on estimated maximal oxygen uptake. Further, we examined the extent to which BMI, level of physical activity, and smoking status were associated with estimated maximal oxygen uptake. METHODS: We evaluated estimated levels of maximal oxygen uptake based on clinical testing of 115 forensic psychiatric patients and the development of these levels during inpatient care for those who underwent retesting (two tests, n = 66, three tests, n = 30). RESULTS: Mean estimated levels of maximal oxygen uptake were remarkably low, confirming previous findings. Levels correlated negatively with higher body mass index, lower physical activity, and older age; however, no change was observed during forensic psychiatric inpatient care. Estimated physical activity levels tended to increase between tests one and two, but decreased significantly between tests two and three. CONCLUSIONS: This Swedish forensic psychiatric cohort had very low cardiovascular fitness. The strongest associated factors were a high BMI and a low level of physical activity. These results make essential contributions to the planning of future studies on treatment strategies aimed at improving metabolic health in forensic psychiatric patients. The importance of aerobic exercise, as well as means to encourage patients to reach and maintain recommended levels of physical activity, needs to be further explored.
Association between changes in sleep quality and serum pro-inflammatory cytokine levels in patients with major depressive disorder following duloxetine treatment.
Xu Y, Gao W, Shan F … +2 more , Xia Q, Liang J
Ann Gen Psychiatry · 2026 Jun · PMID 42366392 · Full text
OBJECTIVE: Major depressive disorder (MDD) is accompanied by prominent physiological abnormalities, notably sleep disturbances and immune-inflammatory dysregulation. As a serotonin-norepinephrine reuptake inhibitor, anti...
OBJECTIVE: Major depressive disorder (MDD) is accompanied by prominent physiological abnormalities, notably sleep disturbances and immune-inflammatory dysregulation. As a serotonin-norepinephrine reuptake inhibitor, antidepressant duloxetine exhibits both anti-inflammatory effects and therapeutic benefits in improving sleep architecture. This study aimed to investigate the effects of duloxetine on objective sleep parameters and serum pro-inflammatory cytokine levels in patients with MDD, and further to explore the correlation between treatment-related improvements in sleep quality and dynamic changes in inflammatory cytokine profiles. METHODS: This study included 74 patients with MDD who met the DSM-5 criteria, had a baseline 24-item Hamilton Depression Rating Scale score ≥ 20, and no prior use of antidepressants or anti-inflammatory drugs within 3 months. All patients were administered duloxetine at a daily dose of 40-60 mg for 4 consecutive weeks. Objective sleep parameters, including total sleep time (TST), sleep efficiency (SE), wake time after sleep onset (WASO), and rapid eye movement (REM) latency, were evaluated using polysomnography (PSG). Serum levels of 6 pro-inflammatory cytokines, including interleukin‑1β (IL‑1β), IL‑6, IL‑8, IL‑12, tumor necrosis factor‑α (TNF‑α), and interferon‑γ (IFN‑γ), were measured by enzyme-linked immunosorbent assay. Changes from baseline to post-treatment were analyzed using paired t-tests or Wilcoxon signed-rank tests based on data distribution. Correlation analyses were performed using Pearson or Spearman tests, followed by partial correlation analysis adjusting for potential confounders. RESULTS: After 4 weeks of duloxetine treatment, significant improvements in sleep parameters were observed, characterized by increased TST (t = -6.614, P < 0.001) and SE (t = -6.631, P < 0.001), as well as decreased WASO (t = 6.331, P < 0.001). Moreover, serum concentrations of IL‑1β (t = 4.759, P < 0.001), IL‑8 (t = 6.327, P < 0.001), IL‑12 (t = 6.194, P < 0.001), and IFN‑γ (t = 8.713, P < 0.001) were significantly reduced following treatment. Furthermore, at baseline, TST was negatively correlated with serum IL-12 levels (r = -0.306, P = 0.016) in patients with MDD. Similarly, SE was negatively correlated with serum levels of IL‑1β (r = -0.343, P = 0.006), IL‑8 (r = -0.297, P = 0.019), and IL‑12 (r = -0.279, P = 0.028). Additionally, following treatment, the change in TST was negatively correlated with the change in IL-12 levels (r = -0.285, P = 0.025). Likewise, the change in SE was negatively correlated with changes in IL-8 levels (r = -0.263, P = 0.039) and IL-12 levels (r = -0.294, P = 0.020). CONCLUSIONS: Four-week duloxetine treatment was associated with improved sleep disturbances and reduced peripheral pro-inflammatory cytokine levels in patients with MDD. The baseline correlations between sleep parameters and pro-inflammatory cytokines, as well as the concurrent changes in these indicators following duloxetine treatment, reveal a potential relationship between sleep improvement and altered inflammatory profiles during duloxetine intervention. These preliminary findings suggest a possible link between duloxetine-related therapeutic effects on sleep and inflammatory regulation in MDD, which warrants further verification in future studies.
Timing of childhood adversity and cognitive profiles in adults with autism spectrum disorder.
Ishida R, Yamamuro K, Toritsuka M … +6 more , Takeda T, Tamakoshi H, Kashida N, Okada T, Iwata N, Makinodan M
Ann Gen Psychiatry · 2026 Jun · PMID 42332821 · Full text
BACKGROUND: This study examined whether the timing of adverse childhood experiences (ACEs) is associated with differences in intellectual ability in adults with autism spectrum disorder (ASD) without intellectual disabil...
BACKGROUND: This study examined whether the timing of adverse childhood experiences (ACEs) is associated with differences in intellectual ability in adults with autism spectrum disorder (ASD) without intellectual disability. METHODS: A total of 161 adults with ASD were categorized into three groups based on ACE onset: no ACEs (Group 0), early childhood ACEs (≤ 10 years; Group 1), and adolescent ACEs (11-18 years; Group 2). Intellectual ability was assessed using the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). RESULTS: Findings revealed that Group 1 outperformed Group 2 on the picture completion and figure weights subtests, suggesting that early ACE exposure may be linked to distinct cognitive profiles in ASD. To account for the higher severity of post-traumatic stress disorder (PTSD) symptoms, including hypervigilance, in Group 1 compared to Group 2, we conducted multivariate analyses of covariance and logistic regression to control for potential confounders such as years of education and PTSD symptom severity, given that hypervigilance may influence cognitive task performance. However, the observed differences remained significant. CONCLUSION: These results suggest a potential association between the timing of ACE exposure and specific cognitive subdomains in adults with ASD. Furthermore, WAIS-IV subtests, particularly picture completion and figure weights, may serve as potential markers for identifying cognitive adaptations associated with early adversity in ASD individuals. CLINICAL TRIAL REGISTRATION: Since this study was not a clinical trial, this section does not apply.
Examining clinical relevance of interpretation inflexibility in social contexts.
Deng W, Zabag R, Narain S … +2 more , Cannon TD, Joormann J
Ann Gen Psychiatry · 2026 Jun · PMID 42321778 · Full text
Growing research highlights interpretation inflexibility as a key transdiagnostic mechanism across psychopathologies. Yet, few studies have examined its role in everyday socio-emotional processing. This review bridges th...
Growing research highlights interpretation inflexibility as a key transdiagnostic mechanism across psychopathologies. Yet, few studies have examined its role in everyday socio-emotional processing. This review bridges that gap by exploring how interpretation inflexibility contributes to psychopathology-particularly depression and psychosis-in social contexts. Evidence suggests disrupted interpersonal processes, including rigid interpretations of social scenarios and impressions of others, are central to understanding depressive and psychotic symptoms. Depression is marked by valence-specific, context-dependent inflexibility, with difficulty disengaging from negative biases. In contrast, psychosis shows a broader inflexibility across emotional valences. The review also outlines evolving measures of interpretation inflexibility, emphasizing the need to account for social context in interpretation revision. Current findings highlight the value of examining inflexibility within social frameworks to better understand its role in adaptive functioning and psychopathology. Future research on interpretation inflexibility in social contexts could inform novel interventions and improve clinical outcomes.
Demoralization in patients with obsessive-compulsive disorder: results from an exploratory cross-sectional report.
Maraone A, Panfili M, Roselli V … +6 more , D'Agostini D, Pinucci I, Accinni T, Tarsitani L, Bersani FS, Pasquini M
Ann Gen Psychiatry · 2026 Jun · PMID 42288816 · Full text
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, early-onset condition often associated with high rates of treatment resistance, and affective disturbances are frequent comorbidities and linked to poorer the...
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, early-onset condition often associated with high rates of treatment resistance, and affective disturbances are frequent comorbidities and linked to poorer therapeutic outcomes. Recently, the concept of "demoralization syndrome" has been proposed as not fully overlapping with major depressive episodes. Given the disabling nature of OCD, it is relevant to specifically evaluate the states of demoralization, considering that this condition may have treatment implications partially different from those related to other forms of affective disturbances. The aim of the present exploratory study was to evaluate demoralization in subjects with OCD and its relationship with the severity of OCD-related symptoms. METHODS: Adults with a primary diagnosis of OCD were consecutively recruited from the OCD outpatient clinic of Azienda Ospedaliero-Universitaria Policlinico Umberto I (Rome, Italy). Participants were assessed with clinical interviews as well as with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for OCD severity, the Demoralization Scale (DS) for demoralization, and the Patient Health Questionnaire (PHQ) and Hamilton Depression Rating Scale (HAM-D) for depressive symptoms. Descriptive and correlational analyses have been performed. RESULTS: A total of 43 adults with OCD were included. Both depressive and demoralization symptoms were highly prevalent, with clinically-significant demoralization observed in 88% of patients. A subset of individuals exhibited clinically-significant demoralization without clinically-relevant depression. Demoralization severity showed significant associations with the severity of obsessions. CONCLUSION: Demoralization was highly prevalent in our sample, and it was significantly associated with the severity of obsessions. Recognizing demoralization states in OCD may improve diagnostic precision and guide tailored therapeutic interventions, complementing standard treatments for the diseases. Further research, including longitudinal studies, is needed to clarify its impact on the course of the disorder.
Associational pathway analyses of depression and impulsivity in the relationship between internet addiction and non-suicidal self-injury among adolescents: a cross-sectional case-control study.
Abdalla AA, Fahmy M, Anwar K … +3 more , Hendi AE, Cullen KR, Ibrahim O
Ann Gen Psychiatry · 2026 Jun · PMID 42277886 · Full text
BACKGROUND: Adolescents undergo important developmental changes, characterized by profound biological and psychosocial changes. This period is also associated with increased vulnerability to mental health challenges and...
BACKGROUND: Adolescents undergo important developmental changes, characterized by profound biological and psychosocial changes. This period is also associated with increased vulnerability to mental health challenges and engagement in risky/problematic behaviors. Non-suicidal self-injury (NSSI) and internet addiction (IA) are increasingly recognized as prevalent and interconnected behavioral concerns among adolescents, particularly those with depressive disorders. Impulsivity has also been identified as a key psychological factor in both IA and NSSI. This study aimed to investigate the cross-sectional interrelationships among depression, impulsivity, IA, and NSSI in adolescents. METHODS: A total of 110 adolescents (55 diagnosed with major depressive disorder [MDD] and 55 healthy controls) were recruited from the Child and Adolescent Psychiatry Outpatient Clinic at Suez Canal University Hospital. The severity of depression was assessed using the Children's Depression Inventory (CDI). All participants completed the Internet Addiction Test (IAT), Deliberate Self-Harm Inventory (DSHI), and Barratt Impulsiveness Scale (BIS-11). Statistical analyses included group comparisons, correlation analyses, logistic regression. Cross-sectional pathway analyses using structural equation modeling (SEM) was conducted to examine indirect associations between IA and NSSI through depression and impulsivity. RESULTS: Adolescents with MDD reported significantly higher levels of NSSI, IA, and impulsivity compared to controls. Significantly positive correlations between IAT, BIS-11, and CDI scores and lifetime NSSI frequency were demonstrated among the depression group. IA and NSSI were significantly associated by indirect pathways through both depression and impulsivity. In serial associational models, the cross-sectional indirect pathway from impulsivity to depression (B = 0.370) was stronger than the reverse direction (B = 0.310). CONCLUSION: Our findings highlighted the interrelated roles of IA, impulsivity, and NSSI among adolescents with MDD. Impulsivity may be a critical factor linking IA to emotional dysregulation and self-injurious behavior. These results highlight the need for integrated screening and prevention strategies targeting impulsivity and these risk behaviors.
Analysis of gut microbiota and intestinal mucosal neurotransmitter changes and their correlation in adolescent depression mice.
Xing J, Jiang Z, Jing X … +5 more , Li Y, Guo F, Liu P, Liu Z, Sun N
Ann Gen Psychiatry · 2026 Jun · PMID 42271469 · Full text
BACKGROUND: Adolescent depression is a major mental health disorder with increasing prevalence and substantial long-term consequences. Although growing evidence suggests that the gut-brain axis is involved in depression,...
BACKGROUND: Adolescent depression is a major mental health disorder with increasing prevalence and substantial long-term consequences. Although growing evidence suggests that the gut-brain axis is involved in depression, the relationships among gut microbiota, intestinal mucosal neurotransmitters, and adolescent depression remain insufficiently understood. This knowledge gap limits a better understanding of the pathophysiological mechanisms underlying adolescent depression and the identification of potential microbiota-related targets. Therefore, this study aimed to investigate alterations in gut microbiota and intestinal mucosal neurotransmitters, as well as their correlations, in an adolescent mouse model of depression. METHODS: We established an adolescent depression mouse model using chronic unpredictable mild stress (CUMS), and collected data with the Smart video tracking system. We collected intestinal contents and mucosal tissues from mice. We analyzed gut microbial composition using metagenomic sequencing and quantified mucosal neurotransmitters with liquid chromatography-tandem mass spectrometry (LC-MS/MS). We analyzed correlations among gut microbiota, intestinal mucosal neurotransmitters, and behavioral indicators. RESULTS: Mice in the CUMS group exhibited a significantly reduced sucrose preference rate in the sucrose preference test (P < 0.001); a significantly prolonged immobility time in the forced swim test (P < 0.01); and a significantly decreased total movement distance in the open field test (P < 0.01). No significant intergroup difference was observed in the tail suspension test. Regarding the gut microbiome, the CUMS group showed significantly lower Simpson index (P = 0.018) and Pielou's evenness index (P = 0.022). Beta diversity analysis indicated a statistically significant but modest between-group difference in community structure (ANOSIM R = 0.145, P = 0.03); this finding was supported by PERMANOVA (Bray-Curtis; pseudo-F = 1.675, R² = 0.0897, P = 0.033). LEfSe (Linear discriminant analysis Effect Size) analysis suggested 27 candidate taxa with discriminatory signals between groups (nominal P < 0.05; exploratory). Neurotransmitter analysis demonstrated that levels of 5-HIAA (5-hydroxyindoleacetic acid), 5-HT (serotonin), 5-HTP (5-hydroxytryptophan), and Kyn (kynurenine) in the colon were significantly decreased in the CUMS group, whereas levels of PA (phenylethylamine) and NE (norepinephrine) were significantly elevated (P < 0.05). Spearman correlation analysis found that Lactobacillus and Lactobacillus acidophilus correlated positively with sucrose preference and negatively with immobility in the forced swim test. Lactobacillus acidophilus also showed a positive correlation with 5-HT pathway metabolites: 5-HIAA, 5-HT, 5-HTP, and Kyn. CONCLUSION: Adolescent mice exposed to CUMS showed depression-relevant behavioral alterations, shifts in gut microbiota composition, and changes in 5-HT pathway metabolites. Gut microbiota dysbiosis was significantly associated with alterations in 5-HT pathway metabolites. Because this study is correlational, causal relationships require validation in future interventional studies.
Association between generalized anxiety disorder and health-related quality of life.
Kim J, Lee Y, Park S
Ann Gen Psychiatry · 2026 Jun · PMID 42251434 · Full text
BACKGROUND: The objective of this study was to examine the association between generalized anxiety disorder (GAD) and health-related quality of life (HRQOL) in the general Korean population, and whether this relationship...
BACKGROUND: The objective of this study was to examine the association between generalized anxiety disorder (GAD) and health-related quality of life (HRQOL) in the general Korean population, and whether this relationship differed by multimorbidity profiles and household income. METHODS: We included 5,542 participants aged 19 years or older from the data of the 2021 Korean National Health and Nutrition Examination Survey. The GAD was assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). Participants with a GAD-7 score ≥ 10 were classified as having GAD. HRQOL was measured using the Health-related Quality of Life Instrument with 8 Items (HINT-8). Multimorbidity profiles were derived using latent class analysis. Survey-weighted regression models were used to evaluate associations and interaction effects. RESULTS: The weighted prevalence of GAD was 4.23%, with a mean GAD-7 score of 1.99. The mean HINT-8 index was 0.80. Higher GAD-7 scores and the presence of GAD were consistently associated with lower HINT-8 index values. GAD was associated with increased odds of problems across all HINT-8 domains, with particularly strong associations for depression (odds ratio [OR] = 34.43) and moderate associations for memory (OR = 4.88) and sleep (OR = 4.68). Three multimorbidity profiles (Healthy, Geriatric Disease, and Cardiometabolic Disease groups) were identified, and the association between GAD-7 scores and HRQOL differed by multimorbidity profile and household income, with similar patterns observed for GAD status. CONCLUSIONS: Higher GAD-7 scores and GAD were associated with substantially poorer HRQOL across both physical and psychological domains. The strength of this relationship varied according to multimorbidity profile and socioeconomic context.
The combined discriminative value of LHR, NLR, and platelet count in distinguishing first-episode schizophrenia.
Shi C, Zhang G, Wang Z … +4 more , Chang X, Yang Z, Xue H, Guo Y
Ann Gen Psychiatry · 2026 Jun · PMID 42237380 · Full text
OBJECTIVE: To investigate the discriminative value of the combination of lymphocyte-to-high-density lipoprotein ratio (LHR), neutrophil-to-lymphocyte ratio (NLR), and platelet count for patients with first-episode schizo...
OBJECTIVE: To investigate the discriminative value of the combination of lymphocyte-to-high-density lipoprotein ratio (LHR), neutrophil-to-lymphocyte ratio (NLR), and platelet count for patients with first-episode schizophrenia (FES). METHODS: A retrospective analysis was performed on 181 antipsychotic-naïve inpatients with FES admitted to Zhenjiang Mental Health Center between January 2015 and February 2025.189 participants, including staff members who underwent health check-ups at the same center from July 2024 to November 2025, were prospectively recruited as the healthy control group. Both groups underwent fasting blood cell analysis. Univariate analysis, binary Logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to assess the diagnostic performance of the combined use of LHR, NLR, and platelet count for FES. RESULTS: Univariate analysis revealed that white blood cell count, neutrophil count, monocyte count, platelet count, high-density lipoprotein (HDL), neutrophil-to-high-density lipoprotein ratio (NHR), LHR, platelet-to-lymphocyte ratio (PLR), NLR, and systemic immune-inflammation index (SIRI) were statistically significant influencing factors associated with FES (all P < 0.05) when comparing the FES group with the healthy control group. Binary Logistic regression analysis further identified platelet count, LHR, and NLR as independent predictors of FES relative to healthy controls (all P < 0.05). The ROC curve analysis demonstrated that the combination of platelet count, LHR, and NLR yielded an area under the curve (AUC) of 0.863 for distinguishing FES. CONCLUSION: The combination of LHR, NLR, and platelet count is significantly elevated in antipsychotic-naïve FES patients compared with healthy controls. These findings highlight immune-metabolic dysregulation in acute-phase FES, but do not establish diagnostic specificity. Comparative studies with other acute psychiatric disorders are needed.
Correction: A narrative review on trazodone as a multimodal and multifunctional antidepressant: clinical relevance of formulations, dosing, and pharmacokinetic/pharmacodynamic targets.
Cuomo A, Pompili M, Vita A … +3 more , Spina E, Caraci F, Fagiolini A
Ann Gen Psychiatry · 2026 Jun · PMID 42237136 · Full text
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Loneliness despite social integration: subjective loneliness without social isolation as a risk factor for psychotic-like experiences.
Sugawara N, Tabuchi T, Tokumitsu K … +1 more , Yasui-Furukori N
Ann Gen Psychiatry · 2026 Jun · PMID 42231387 · Full text
BACKGROUND: Psychotic-like experiences (PLEs) are associated with subjective loneliness, as well as social isolation. However, few studies have examined how different combinations of loneliness and social isolation relat...
BACKGROUND: Psychotic-like experiences (PLEs) are associated with subjective loneliness, as well as social isolation. However, few studies have examined how different combinations of loneliness and social isolation relate to overall PLEs and specific psychotic symptom domains. The aim of this study was to examine the associations between combinations of loneliness and social isolation and PLEs in a population-based sample in Japan. METHODS: Data were derived from the 2025 wave of the Japan Society and New Tobacco Internet Survey (JASTIS), including 25,424 adults aged 15-84 years. PLEs were assessed using the Japanese version of the PRIME Screen-Revised (PS-R). Loneliness was measured using the University of California, Los Angeles Loneliness Scale version 3, Short Form 3-item (UCLA-LS3-SF3), and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). Logistic regression analyses with inverse probability weighting were conducted to examine associations between four categories of loneliness/social isolation and overall PLEs as well as six psychotic symptom domains. RESULTS: The weighted prevalence of PLEs was 4.3%. Compared with participants with both loneliness and social isolation, those with neither loneliness nor social isolation showed lower odds of overall PLEs (OR = 0.51, 95% CI 0.42-0.63), as did those with social isolation without loneliness (OR = 0.62, 95% CI 0.51-0.74). In contrast, participants with loneliness without social isolation had higher odds of overall PLEs (OR = 1.46, 95% CI 1.24-1.71). Symptom-domain analyses indicated heterogeneous patterns across domains. CONCLUSIONS: These findings demonstrate that loneliness without social isolation is particularly associated with PLEs, highlighting the importance of subjective loneliness as a correlate of PLEs. This suggests that reliance on objective indicators of social isolation alone may overlook individuals at elevated risk, emphasizing the importance of attending to subjective loneliness in population-based mental health research.
Efficacy and safety of repetitive transcranial magnetic stimulation in anorexia and bulimia nervosa: a systematic review and meta-analysis.
Ewis DK, Sabet H, Hawas Y … +8 more , Hassan W, Abouelmagd ME, Jader A, Abo-Elnour DE, Abbas A, Elsayed MEG, Schönfeldt-Lecuona C, Raslan AM
Ann Gen Psychiatry · 2026 Jun · PMID 42226264 · Full text
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusi...
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusing on its impact on psychological, psychopathological, neurocognitive, and behavioral outcomes. METHODS: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to May 2025. Eligible studies included clinical trials involving adult patients with AN or BN treated with rTMS. Data were pooled using fixed or random-effects models depending on heterogeneity. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using Cochrane RoB 2.0 and NIH tools. RESULTS: Thirteen studies were included, yielding a total of n = 195 active rTMS treatments and n = 132 sham treatments. Compared to sham, rTMS did not significantly improve BMI in AN patients (MD: 0.19; 95% CI: -0.50, 0.88; P = 0.59). A significant moderate reduction in eating disorder severity was found in single-arm analysis (31 patients, SMD: -0.50, 95% CI [-0.90, -0.10], p = 0.01). Depression improved with rTMS over sham (105 patients, SMD: -0.41, 95% CI [-0.81, -0.02], p = 0.04), while anxiety, binge frequency, and vomiting frequency did not. Urge to eat increased in AN (30 patients, MD: 1.20, 95% CI [0.20, 2.21], p = 0.02) and decreased in BN (25 patients, MD: -10.25, 95% CI [-15.88, -4.62], p = 0.0004). No serious adverse events were reported. CONCLUSIONS: rTMS shows potential in improving eating disorder severity and depressive symptoms in AN, with disorder-specific modulation of food-related urges. Its effects on BMI and behavioral symptoms remain inconclusive. rTMS was well tolerated.
Initiation of aripiprazole once-monthly via a two‑injection start in adult patients diagnosed with schizophrenia: real-world experiences of healthcare professionals from five European countries.
Beckham C, Yildirim M, Fagiolini A … +5 more , Leopold K, Cottam WJ, Hickey J, Rogerson O, Pappa S
Ann Gen Psychiatry · 2026 May · PMID 42226249 · Full text
BACKGROUND: The aripiprazole once-monthly 400 mg two-injection start (AOM 400-TIS) enables treatment initiation at a single clinic visit, without the need for 14 days of concurrent oral aripiprazole supplementation. Prev...
BACKGROUND: The aripiprazole once-monthly 400 mg two-injection start (AOM 400-TIS) enables treatment initiation at a single clinic visit, without the need for 14 days of concurrent oral aripiprazole supplementation. Previously, results from a survey outlined the views and experiences of healthcare professionals (HCPs) with the AOM 400-TIS in a real-world setting in Europe. The current work extends these findings to include a broader pool of participants from more European countries. METHODS: This was a non-interventional, cross-sectional survey of HCPs from Germany, Italy, the United Kingdom, Denmark, and Sweden. Participants were licensed nurses/physicians with experience prescribing and/or administering the AOM 400-TIS to patients diagnosed with schizophrenia. Two waves of survey data were pooled and analysed using descriptive methods. RESULTS: Data from 229 HCPs were evaluated. Poor treatment adherence (88.6%), relapse (51.1%), and patient preference (47.6%) were common reasons for using the AOM 400-TIS, while patients not wanting two injections at the same time (52.4%) and concerns about safety (34.1%) and tolerability (33.6%) were common barriers. Among HCPs, 86.0% agreed/strongly agreed they were satisfied with outcomes of patients treated with the AOM 400-TIS, with most agreeing/strongly agreeing that patients appeared satisfied in general (73.4%) and with sustained quality of life and functioning (66.4%). CONCLUSIONS: This survey provides a pan-European account of HCPs' views and experiences with the AOM 400-TIS in adults diagnosed with schizophrenia. Initiatives to overcome barriers to AOM 400-TIS use include providing clearer evidence and education on its efficacy and safety and consideration of how the regimen is presented in patient-provider discussions.
Long-term trends in age at psychiatric admission (2006-2022): influence of sex, diagnosis, and admission type in a single Italian catchment.
Barlattani T, Salfi F, Socci V … +7 more , Renzi G, Bologna A, Tamanti S, Trebbi E, Rossi A, Romano F, Pacitti F
Ann Gen Psychiatry · 2026 May · PMID 42219509 · Full text
AIMS: Following Italy's psychiatric reform, national inpatient numbers declined, but how the age at admission has changed across sex, diagnostic, and admission-type subgroups remains unclear. This study examined 17 conse...
AIMS: Following Italy's psychiatric reform, national inpatient numbers declined, but how the age at admission has changed across sex, diagnostic, and admission-type subgroups remains unclear. This study examined 17 consecutive years (2006-2022) of psychiatric admissions to the sole ward serving L'Aquila, assessing temporal trends in age at admission by diagnosis, sex, and admission status (voluntary vs. compulsory). METHODS: All adult admissions (≥ 18 years) were extracted from hospital discharge records (Schede di Dimissione Ospedaliera, SDO). Analyses were conducted at the admission-episode level. Primary diagnoses were grouped into four ICD-9 categories: schizophrenia spectrum, major depressive disorder, bipolar disorder, and alcohol/substance use disorder. Multiple linear models tested time-related changes in mean age at admission, including interactions for time × diagnosis × sex × admission type. RESULTS: Across 5,207 admission episodes, the Trimester × Diagnosis interaction showed a marked decline in age at admission for major depression (B = - 0.20 per trimester, p < 0.001) and bipolar disorder (B = - 0.09, p = 0.03), equivalent to approximately - 0.80 and - 0.36 years per year, yielding total reductions of ~ 13.6 and ~ 6.1 years over 2006-2022. The Trimester × Diagnosis × Sex interaction indicated that the decline in depression was driven by men (B = - 0.32, p < 0.001; ≈ -1.28 years/year; -21.76 over 17 years), while in bipolar disorder it was driven by women (B = - 0.14, p = 0.03; ≈ -0.56 years/year; -9.52 over 17 years). The Trimester × Admission type interaction showed the reduction was specific to voluntary admissions (B = - 0.10, p < 0.001; ≈ -0.40 years/year), while compulsory admissions were stable (B = - 0.01, p = 0.87). No significant age change occurred in schizophrenia spectrum disorders or in alcohol/substance use disorders. CONCLUSIONS: Between 2006 and 2022, we observed a progressive rejuvenation of voluntary and affective-disorder inpatient admissions, with the clearest subgroup-specific reductions detected in men with major depression and women with bipolar disorder, while remaining stable in schizophrenia spectrum, alcohol/substance use disorder, and compulsory admissions. These findings underscore the need to balance youth-focused outreach with adequate capacity for chronic psychosis and substance use disorder.
Risperidone long-acting in-situ microimplant following a brief oral risperidone lead-in in the acute inpatient management of manic episodes with psychotic symptoms in non-adherent patients with schizoaffective disorder: a retrospective, uncontrolled real-world study.
Barillà G, Fagiolini A, Bussolotti D … +2 more , Venco C, Cuomo A
Ann Gen Psychiatry · 2026 May · PMID 42210281 · Full text
BACKGROUND: Nonadherence is a major cause of relapse in patients with schizophrenia, schizoaffective disorder, or bipolar disorder who have achieved remission. However, it is also a significant challenge during manic epi...
BACKGROUND: Nonadherence is a major cause of relapse in patients with schizophrenia, schizoaffective disorder, or bipolar disorder who have achieved remission. However, it is also a significant challenge during manic episodes. Risperidone in-situ microimplant (ISM) releases the drug early and in a sustained manner once a month, eliminating the need for daily administration, which can be difficult during a manic episode. In this study, we described symptom trajectories and tolerability of a brief oral risperidone lead-in followed off-label initiation of risperidone ISM within multimodal inpatient care in nonadherent inpatients with schizoaffective disorder experiencing a manic episode with psychotic symptoms. METHODS: This retrospective, observational, single-centre study included 50 consecutive adults admitted after discontinuation/marked non-adherence and with prior response to risperidone who received ≥ 6 days of oral risperidone to confirm tolerability, then risperidone ISM (75 or 100 mg) and were followed for 6 weeks. Mania severity was assessed with the Young Mania Rating Scale (YMRS). RESULTS: Fifty patients were included; most received concomitant mood stabilisers and benzodiazepines. Median YMRS decreased from 32 at admission (Tx) to 26 at the first injection (T0, after the oral lead-in), 8 by day 8, and remained low at day 28 (5) and day 42 (6). Activation/behavioural items improved earlier, whereas psychotic thought content improved more gradually, predominantly between days 8 and 28. Side-effect burden at weeks 4 and 6 was minimal, and no discontinuations due to adverse events occurred. CONCLUSIONS: In this exploratory uncontrolled cohort, an oral risperidone lead-in plus monthly risperidone ISM within multimodal inpatient care was associated with with rapid and sustained improvement in symptom trajectories and favourable short-term tolerability. Findings reflect multimodal inpatient care and cannot be attributed to ISM alone. Prospective, controlled studies are warranted.
The effect of metacognitive therapy on depressive symptoms from a transdiagnostic perspective: a systematic review, meta-regression and meta-analysis.
Torabi Z, Nikfarjam M, Dorcheh AK
Ann Gen Psychiatry · 2026 May · PMID 42178556 · Full text
BACKGROUND: Metacognitive therapy (MCT) is a modern therapeutic approach gaining wider use for psychological problems. This review evaluates the efficacy of MCT on depressive symptom severity. METHOD: This review followe...
BACKGROUND: Metacognitive therapy (MCT) is a modern therapeutic approach gaining wider use for psychological problems. This review evaluates the efficacy of MCT on depressive symptom severity. METHOD: This review followed Cochrane and PRISMA-2020 guidelines. A comprehensive literature search revealed 51 studies on the efficacy of MCT, of which 33 were trials. A random-effects model was used to assess treatment efficacy. We calculated effect sizes using (Hedge's g) SMD for the percentage change index. (PROSPERO registration (CRD420251024202)). RESULTS: Within-group aggregate effect sizes for the depression outcome measure, mean change for studies was Hedge's g = (-2.29), 95% CI (-2.75 | -1.83), (P < 0.001). Between-group analyses combined effect size for depression outcome, the mean change of aggregate effect size for the studies comparing MCT to the control group was Hedge's g =(-1.28), 95% CI (-1.71 | -0.86). Both effect sizes were highly significant (Ps < 0.000). CONCLUSIONS: Findings indicate that metacognitive therapy appears to be an efficacious intervention for depressive disorders and is superior to waitlist control conditions. However, interpretation is limited by small sample sizes and the lack of active comparison groups. Future investigations should employ larger samples and include head-to-head comparisons with other evidence-based psychotherapies.
Systematic review exploring the quality of life of patients undergoing mental disorders treatment in the kingdom of Saudi Arabia.
Althemery AU
Ann Gen Psychiatry · 2026 May · PMID 42177573 · Full text
BACKGROUND: According to the World Health Organization, approximately one in eight people is diagnosed with mental disorders globally. Patient-reported outcomes and quality of life assessments are essential tools for eva...
BACKGROUND: According to the World Health Organization, approximately one in eight people is diagnosed with mental disorders globally. Patient-reported outcomes and quality of life assessments are essential tools for evaluating patient outcomes. This study aimed to identify, characterize, and summarize the literature focusing on quality of life or patient-reported outcomes among patients with mental disorders in the Kingdom of Saudi Arabia undergoing pharmacological treatment. METHODS: This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 item checklist applicable for Systematic reviews. Searches were run in the following databases: PubMed, MEDLINE via Ovid, MEDLINE via EBSCO, and ProQuest. Databases were searched from January 1, 2000, to July 31, 2025. RESULTS: Ten articles that explored the quality of life of patients undergoing mental disorders treatment in the Kingdom of Saudi Arabia since 2000 met the inclusion criteria. A total of 3,773 patients included, and fifteen different quality of life questionnaires and patient-reported outcome measures were used. One-third of the reviewed articles used the Morisky Medication Adherence Scale (MMAS) and consistently reported low to moderate levels of adherence. CONCLUSIONS: This study highlights the need for further research in the mental health field, with a focus on enhancing patients' quality of life and reporting outcomes.
Patterns of suicidal ideation disclosure among acute psychiatric inpatients.
Garagiola ER, Bhatt Y, Lawrence H … +4 more , Witerska V, Rosen T, Galynker I, Bloch-Elkouby S
Ann Gen Psychiatry · 2026 May · PMID 42169029 · Full text
Prior literature has explored disclosure of suicidality to formal and informal sources, identifying reasons for nondisclosure (e.g., fear of rejection, shame, and hospitalization); however, existing research is limited t...
Prior literature has explored disclosure of suicidality to formal and informal sources, identifying reasons for nondisclosure (e.g., fear of rejection, shame, and hospitalization); however, existing research is limited to retrospective data, often collected months or years after suicide attempts have occurred. The present study seeks to address this gap by identifying patterns of nondisclosure among recent suicide attempters within a one-week period following the attempt, shortening the temporal distance from event to recall. Adult psychiatric inpatients (N = 39, 38.5% female, 61.5% White) who had attempted suicide within the past seven days were recruited from a large urban hospital system in New York. At intake, patients completed a self-report questionnaire, which included two questions on suicidal ideation (SI) disclosure. Consensual Qualitative Research (CQR) methodology was used to extract and categorize reasons for nondisclosure. Nearly half of the patients (46.2%) reported not disclosing their suicidal intentions prior to their suicide attempt. Four key themes emerged as reasons for nondisclosure: fear of stigma (27.8%), fear of consequences such as involuntary hospitalization (22.3%), social isolation and lack of confidants (22.3%), and impulsivity (16.7%). Future research should examine targeted interventions to improve disclosure and explore how different disclosure patterns influence treatment outcomes.
Smoking and depressive symptoms: the mediating role of systemic inflammation in a US nationally representative sample.
Chen X
Ann Gen Psychiatry · 2026 May · PMID 42151976 · Full text
BACKGROUND: Smoking and depressive symptoms are strongly associated, but the underlying biological mechanisms remain incompletely understood. Systemic inflammation has been proposed as a potential mediator linking smokin...
BACKGROUND: Smoking and depressive symptoms are strongly associated, but the underlying biological mechanisms remain incompletely understood. Systemic inflammation has been proposed as a potential mediator linking smoking behavior to depressive symptoms. However, few studies have simultaneously examined multiple inflammatory biomarkers in large, nationally representative samples. OBJECTIVE: This study aimed to investigate whether systemic inflammation, measured by C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), mediates the association between current smoking and depressive symptoms in a US nationally representative sample. METHODS: I analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, including 28,456 adults aged 20 years and older. Smoking status was categorized as current, former, or never smoker. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Serum CRP levels and NLR were used as inflammatory biomarkers. Mediation analysis was performed using the Baron and Kenny approach with bootstrap methods to estimate indirect effects. RESULTS: Current smokers had significantly higher prevalence of depressive symptoms. compared to never smokers (12.8% vs. 7.2%, p < 0.001). Both CRP levels and NLR were significantly elevated in current smokers compared to never smokers (CRP: 3.2 ± 0.1 vs. 2.1 ± 0.1 mg/L; NLR: 2.4 ± 0.1 vs. 2.0 ± 0.1, both p < 0.001). In mediation analysis, CRP mediated 15.3% (95% CI: 12.1-18.7%) and NLR mediated 8.7% (95% CI: 6.2-11.4%) of the association between current smoking and depressive symptoms. The combined mediation effect of both inflammatory markers was 21.2% (95% CI: 17.8-24.9%). CONCLUSIONS: Systemic inflammation, as measured by CRP and NLR, partially mediates the association between smoking and depressive symptoms in US adults. These findings support the inflammatory hypothesis of depression and suggest that anti-inflammatory interventions may be beneficial for smokers with depressive symptoms.
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