Search Results (189)

The rapid integration of artificial intelligence (AI) into mental healthcare presents opportunities and ethical challenges, particularly for complex conditions like obsessive–compulsive disorder (OCD). In this perspective, we argue for a Dual Imperative: establishing safety architectures for AI-powered therapeutic tools to prevent algorithmic sycophancy (symptom accommodation), while mandating explainable AI (XAI) in prognostic models to ensure clinical auditability. In therapeutics, we propose a Guardian Angel architecture that utilizes patient-specific fear hierarchies and linguistic stance detection to distinguish compulsive reassurance-seeking from legitimate patient questions. This approach transforms potential therapeutic ruptures into opportunities for distress tolerance via the Digital Ulysses Pact, a patient-authorized, algorithmically enforced response prevention protocol. In diagnostics, we address the black box problem in precision psychiatry. We argue that as AI evolves from detection to high-stakes treatment selection, safety and accountability become a prerequisite for clinical application. Although distinct in implementation, these architectures form an integrated framework for aligning therapeutic and diagnostic AI. These architectures are not parallel tracks but a unified ecosystem: A patient’s XAI-audited profile can inform the Guardian Angel’s configuration, while the longitudinal data gathered during therapy enriches diagnostic precision. Grounded in ethical principles and best practices in OCD, this suggests a path toward AI that is auditable in its diagnostic logic, firm in its therapeutic boundaries, and enforceable through emerging regulatory frameworks. Full article

Standard diagnostic categories (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)) were developed as a pragmatic compromise between competing theoretical schools in psychiatry and psychotherapy. Focused on recognizable patterns of symptoms, they produce reliable descriptions and facilitate clinical communication, research, and reimbursement. Such a focus, however, necessarily falls short of the etiological complexity of bodily, personal, interpersonal, and cultural processes that shape human suffering. This article argues that beneath the diversity of approaches seeking to address this gap, a fundamental complementarity emerges—one constitutive of human existence itself: the complementarity between two irreducible ways of being in the world. The first is the organismic–biological dimension, elaborated in Jakob von Uexküll’s biosemiotics: sign-governed, evolutionarily pre-formed processes of meaning-attribution that operate prior to and independent of language. The second is the symbolic–cultural dimension, developed in Ernst Cassirer’s philosophy of symbolic forms: the embedding of human beings in socially created, intersubjectively shared symbol systems through which the world is seen and understood. Although both approaches were published nearly a century ago, this article is not primarily a historical contribution. Rather, it argues that psychopathology and therapy can be understood more fully—and clinical practice enriched—when both dimensions are taken into account as genuinely complementary perspectives. Full article

Sex differences are increasingly recognized as key determinants of vulnerability, clinical presentation, and treatment response in depression. Rather than arising from a single mechanism, these differences emerge from the interplay of multiple biological and non-biological factors. Converging evidence points to the hippocampus as a central region where these processes intersect, with adult neurogenesis and astrogliogenesis representing a potential mechanistic link between sex-specific biological factors and behavioral outcomes in depression. In this review, we integrate findings from human studies and preclinical models to examine how sex impacts depression while considering the multiple origins of sexual differentiation in the central nervous system. We discuss the importance of studying sex as a biological variable and acknowledge current limitations in the field. Finally, we highlight how cytogenic processes in the adult hippocampus are modulated in a sex-dependent manner, how their disruption may contribute to the pathophysiology of depression, and their potential role in precision psychiatry. Adult cytogenesis provides a promising target for developing therapeutic strategies aimed at promoting the integration of these cells in neural circuits, which may counterbalance the cellular impairments observed in stress-induced depression, representing a therapeutic avenue for this disorder. Full article

Growing evidence indicates that the gut microbiota is not a static ecosystem but a rhythmic metabolic organ whose oscillatory activity is tightly coordinated with host circadian biology. Disruption of this temporal alignment, through irregular diet, sleep disturbance, shift work, or social jet lag, may profoundly alter microbial composition and the production of neuroactive metabolites. These alterations have emerged as potential contributors to the pathophysiology of mood disorders. This review introduces the concept of chrono-metabolic psychiatry, a framework integrating circadian rhythms, gut microbiota dynamics, and host metabolic signaling in the development and course of depressive and bipolar disorders. In this framework, the term “chrono-metabolic” refers to the integration of biological timing, host metabolic regulation, and microbiota-derived metabolic signaling. Chrono-metabolic psychiatry therefore shifts the focus from static dysbiosis or neurotransmitter imbalance alone to the time-dependent interactions among circadian misalignment, microbial rhythmicity, immune regulation, metabolite production, and affective instability. Diurnal fluctuations in short-chain fatty acids, tryptophan–kynurenine metabolites, bile acids, and microbial-derived neurotransmitters interact with clock gene regulation, hypothalamic–pituitary–adrenal axis activity, neuroinflammation, and synaptic plasticity. Chrono-disruption may represent a transdiagnostic vulnerability factor and may confirm the bidirectional relationship between mood instability and microbiota rhythmicity. Emerging therapeutic implications, including chrono-nutrition, time-restricted feeding, targeted probiotic administration (“chronobiotics”), and the microbiota-modulating effects of psychotropic medications are discussed. By shifting from a compositional to a temporal–metabolic perspective, this model highlights the importance of microbial oscillations rather than static dysbiosis alone. Integrating circadian biology into microbiota research may enable metabolomic stratification and pave the way for precision psychiatry approaches grounded in host–microbe metabolic crosstalk. Future longitudinal and time-resolved multi-omics studies are needed to validate this framework and to translate it into clinically actionable interventions. Full article

Glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed for type 2 diabetes and obesity, have recently attracted interest as potential modulators of addictive behavior. This narrative review summarizes current knowledge on the neurobiological basis, randomized controlled trials, and psychiatric relevance of GLP-1 analogs in substance use disorders. English-language articles available at the time of the search were reviewed between February and April 2026, with emphasis on topics most relevant to psychiatric practice. The literature suggests that GLP-1 signaling influences reward processing, cue reactivity, stress responses, relapse vulnerability, and executive control through actions in the gut–brain axis and mesocorticolimbic circuitry. Early clinical findings are most encouraging in alcohol-related outcomes, including reductions in alcohol cue reactivity, craving, alcohol self-administration, and some measures of heavy drinking, whereas evidence in nicotine dependence is mixed and appears more consistent for limiting post-cessation weight gain than for improving abstinence itself. Evidence for other substance use disorders remains preliminary. Across randomized controlled trials, interpretation is limited by small sample sizes, short follow-up, heterogeneous endpoints, and selective populations. In addition, psychiatric and behavioral safety requires careful attention, particularly regarding rapid weight loss, excessive appetite suppression, restrictive eating, dehydration, and psychological destabilization in vulnerable individuals. At present, GLP-1 receptor agonists should be regarded as promising but unproven adjunctive candidates in addiction psychiatry, warranting further rigorous trials, structured monitoring, and interdisciplinary collaboration. Full article

Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Materials and Methods: A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Results: Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusions: Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them. Full article

Severe mental disorders, including schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD), are leading causes of global disability, yet current treatments remain largely symptomatic and fail to alter disease trajectories. Converging evidence from genetics, longitudinal studies, and systems neuroscience supports a dimensional and transdiagnostic architecture of psychopathology, involving shared polygenic risk and overlapping neurodevelopmental and circuit-level alterations. Traditional approaches—such as post-mortem brain analysis, neuroimaging, and animal models—have delineated core molecular perturbations (e.g., dopaminergic, glutamatergic, and GABAergic dysfunction), as well as informed translational frameworks for mechanistic investigation, but remain constrained by restricted access to dynamic processes and incomplete recapitulation of human-specific biology. The advent of human-derived cellular models, particularly human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), has partially addressed these limitations, enabling the study of patient-specific neurodevelopment and synaptic function in vitro. Within this evolving landscape, the olfactory neuroepithelium (ONE) has emerged as an accessible source of neural progenitors, obtainable through minimally invasive procedures, providing a window into living human neurobiology. ONE-derived cells retain donor-specific genetic and epigenetic signatures while recapitulating disease-relevant phenotypes across major psychiatric disorders, including altered neurodevelopmental dynamics, synaptic gene expression, and inflammatory profiles. Here, we present a narrative review of the principal cellular and tissue models used in biological psychiatry, examining their respective strengths, limitations, and translational relevance across experimental contexts. By situating these approaches within a unified framework, we aim to clarify their complementarity, identify current gaps, and outline future directions, highlighting the emerging potential of ONE-based models to bridge genetic risk, cellular dysfunction, and clinical phenotype, thereby advancing precision psychiatry. Full article

Daylight Saving Time (DST) creates abrupt, externally imposed circadian disruptions that can impair sleep regulation, hormonal balance, cognitive performance, and emotional stability. Although these effects are known in the general population, individuals with chronic mental illness, whose circadian systems are often intrinsically dysregulated, may face increased neuropsychological consequences. This comprehensive review synthesizes evidence from chronobiology, psychiatry, neuroscience, and population health to examine how DST-related circadian misalignment impacts cognitive functioning, mood regulation, suicidality risk, and symptom exacerbation across psychological disorders such as depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, and psychotic disorders. Following the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, a search of PubMed, PsycINFO, Scopus, and Google Scholar was conducted to identify studies published from 2000–2026 examining DST, circadian rhythm disruption, neuropsychological outcomes, and chronic mental illness. Empirical, theoretical, and mechanistic studies were included to ensure comprehensive synthesis. Across conditions, DST, particularly spring forward transitions, is associated with increased sleep disturbance, impaired executive functioning, reduced attention and working memory, heightened emotional reactivity, increased depressive symptoms, elevated risk of manic episodes, and short-term increases in suicidality. Neurobiological mechanisms include altered melatonin secretion, cortisol dysregulation, Hypothalamus Pituitary Axis (HPA-axis) activation, and clock-gene desynchrony. DST may function as a modifiable negative environmental influence capable of affecting neuropsychological functioning in vulnerable populations. These findings underscore the need for clinical awareness, preventive strategies, and policy reconsiderations, including calls to eliminate seasonal time changes. Standardizing DST-related research outcomes and expanding longitudinal, multi-site studies will be essential for advancing this emerging field. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background/Objectives: Adolescents admitted for emergency psychiatric hospitalization frequently present with severe and heterogeneous psychopathology. In clinical practice, some adolescent inpatients appear to present a broader symptom pattern suggestive of emotional dysregulation. However, it remains unclear whether they can truly be distinguished in this population and whether they differ meaningfully from adolescents with predominantly depressive presentations. Methods: We conducted a retrospective cross-sectional chart review with subgroup analysis based on the medical records of patients aged 11–17 years hospitalized on an emergency basis at the Department of Child and Adolescent Psychiatry in Poznań, Poland, between January and December 2024. Patients were assigned either to an emotional dysregulation group, defined by affective dysregulation and behavioral dyscontrol, or to a depressive presentations group, comprising adolescents with depressive presentations who did not meet criteria for the emotional dysregulation profile. Broader clinical characteristics, adverse childhood experiences, and prior treatment history were compared between groups. Results: A total of 139 adolescents were included (85 in the emotional dysregulation group and 54 in the depressive presentations group). The median age was 13 years [Q1–Q3: 13–14] in the emotional dysregulation group and 14 years [Q1–Q3: 12.25–14] in the depressive presentations group; girls comprised 77.6% and 83.3% of the groups, respectively. The emotional dysregulation group more often presented with conflict-ridden relationships, a more frequent history of suicide attempts (72.9% vs. 50.0%, p = 0.006), and a higher number of suicide attempts (median 1 [Q1–Q3: 0–2] vs. 0.5 [Q1–Q3: 0–1], p = 0.012), as well as more frequent exposure to adversity-related experiences. Furthermore, this group had a higher number of previous psychiatric hospitalizations (median 1 [Q1–Q3: 1–2] vs. 1 [Q1–Q3: 1–1], p = 0.001) and a longer history of psychiatric treatment. In contrast, social withdrawal was more characteristic of the depressive presentations group. Conclusions: Routinely collected clinical records may capture a clinically meaningful subgroup of adolescents with a symptom profile suggestive of emotional dysregulation. Compared with the depressive presentations group, these adolescents showed greater interpersonal difficulties, more recurrent suicide attempts, greater adversity burden, and a longer history of psychiatric treatment. Further prospective studies using standardized measures are needed. Full article

Stock market investors and traders operate in high-pressure environments marked by volatility, uncertainty, financial risk, and intense performance demands. These conditions lead to substantial psychological distress, increasing vulnerability to psychiatric disorders and suicidal behavior. Key psychological risk factors in this population include acute financial loss, chronic stress, impulsivity, perfectionism, and identity fusion with professional performance. Evidence from behavioral psychology and clinical psychiatry indicates elevated rates of mood disorders, anxiety, and burnout in trading environments. Resilience—including emotional regulation, effective stress-coping mechanisms, strong social support, and cognitive flexibility—emerges as a critical protective factor that mitigates suicide risk and promotes adaptive functioning. Strengthening psychological resilience and implementing evidence-based mental-health strategies may help reduce suicide risk and support overall well-being. The medico-legal dimensions of this issue encompass duty of care within high-stress financial workplaces, clinical obligations related to suicide risk assessment and documentation, confidentiality and safety considerations, and questions of foreseeability of suicide in cases involving severe or catastrophic financial loss. Despite growing awareness of mental health challenges in financial professions, the intersection of suicide risk, resilience, and medico-legal responsibilities in this population remains underexplored. Further research is needed to refine assessment frameworks and develop targeted suicide prevention interventions for this at-risk group. Full article

Background: Agentic artificial intelligence (AI) systems, characterized by autonomous goal-directed behavior, multi-step reasoning, task decomposition, and tool use, are increasingly proposed for healthcare applications. However, their autonomy raises concerns regarding transparency, accountability, and human oversight. While explainable AI (XAI) has been widely studied in traditional predictive models, less is known about how explainability is implemented within agentic architectures. Objective: To map the emerging literature on explainable agentic AI (XAAI) in healthcare and characterize the types, scope, and forms of explainability used in these systems. Methods: A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Embase, IEEE Xplore, and ACM Digital Library were searched through November 2025. Eligible studies described healthcare-related agentic AI systems incorporating explicit explainability mechanisms. Data were extracted on system architecture, explainability type (intrinsic, post hoc, hybrid), explanation scope (local, global), explanation form, and reported clinical outcomes. Results: Nine studies met the inclusion criteria. All systems demonstrated core agentic features, including autonomy, task decomposition, and tool integration, often within multi-agent frameworks. Explainability was predominantly intrinsic and workflow-native, typically delivered through textual reasoning traces and example-based grounding in retrieved clinical evidence. Feature-based and global explanations were comparatively rare and largely confined to hybrid architectures. Across domains including radiology, neurology, psychiatry, and biomedical research, XAAI systems were reported to improve performance and interpretability relative to baseline models in the included studies. However, these findings were derived from heterogeneous, predominantly experimental or retrospective studies, and structured human-in-the-loop oversight was infrequently described. Conclusions: Current XAAI systems appear to emphasize process transparency and evidence grounding rather than mechanistic model-level attribution. The available evidence remains limited and heterogeneous, and findings should be interpreted as early trends rather than established characteristics. Further progress will require standardized evaluation frameworks, clearer reporting of oversight mechanisms, and validation in real-world clinical settings to support safe and trustworthy integration of agentic AI into healthcare practice. Full article

Major depressive disorder (MDD) affects over 330 million people globally, yet up to 30% of patients fail initial pharmacotherapy due to genetic variability in drug metabolism. This narrative review synthesizes evidence on pharmacogenomic (PGx) guided approaches for MDD, emphasizing their integration with POC diagnostics and engineering solutions. Approximately 40–50% of patients carry actionable variants in CYP2C19 or CYP2D6, which govern the metabolism of selective serotonin reuptake inhibitors. Landmark trials (GUIDED, PRIME Care, GAPP-MDD) and meta-analyses demonstrate that PGx-informed prescribing modestly but significantly improves remission and response rates, particularly in treatment-resistant depression. Established guidelines from CPIC and the Dutch Pharmacogenetics Working Group provide actionable recommendations for CYP2D6 and CYP2C19 phenotypes. Emerging POC platforms, including Genomadix Cube and Genedrive, now deliver CYP2C19 results within one hour, supporting rapid clinical decisions. However, psychiatric-specific implementation data remain limited compared to cardiology; current POC devices lack multi-gene capabilities, and most studies underrepresent diverse populations. Persistent barriers include variable reimbursement, limited clinician education, and fragmented electronic health record integration. Future directions include pre-emptive genotyping, expanded multi-gene panels, and embedded clinical decision support. With continued engineering innovation and rigorous validation, PGx-guided care holds promise for reducing the trial-and-error burden and advancing precision psychiatry. Full article

Background/Objectives: Previous research has shown that mental disorders are common in the general population in Latvia, while access to specialised psychiatric services is limited, particularly in rural areas. General practitioners, therefore, have a crucial role in the early detection and management of these conditions. Previous studies and national initiatives have highlighted an unmet need for continuing education in psychiatry tailored to the Latvian primary care context. In response, the first Latvian telementoring programme, the “ECHO School of Psychiatry” (Extension for Community Healthcare Outcomes, ECHO), was launched in 2023 to enhance general practitioners’ competencies and decision-making in mental healthcare. This study explored general practitioners’ experiences and perceptions of participation in the programme and its perceived impact on their practice, using a qualitative approach. Methods: Thirteen women general practitioners who had participated in the programme between October 2023 and February 2025 were recruited using voluntary response sampling, via email invitations from programme coordinators. Individual semi-structured interviews were conducted remotely between May and September 2025, audio-recorded, transcribed verbatim, and the resulting transcripts were analysed thematically using an inductive approach, supported by NVivo software. Data collection continued until no new themes emerged. Results: Four main themes emerged from the thematic analysis: (1) participants’ perceptions of the structure and educational value of the programme; (2) perceived impact of the programme on clinical practice and decision-making; (3) programme limitations in addressing professional isolation and fostering collaboration; (4) suggestions for programme improvement. Themes illustrate participants’ perceptions of the programme’s value, its impact on practice, and recommendations for further development. Conclusions: This study provides insights into the strengths and areas for improvement of the “ECHO School of Psychiatry” as perceived by general practitioners. It also acknowledges current challenges in primary care, such as limited access to specialists and professional isolation. Full article

Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder that has been receiving more research attention lately. Nonetheless, there is a lack of systematic bibliometric overviews tracing the conceptual evolution, knowledge structure, and emerging research frontiers within this field. The utilization of bibliometric and visualization analyses can enhance the understanding of trends and central themes in PPPD research, offering valuable insights for future studies. Methods: Data were retrieved from the Web of Science Core Collection, yielding a final dataset of 370 bibliographic records (“DATA”). We employed CiteSpace, HistCite, the Alluvial Generator, and R software to conduct multi-dimensional statistical and visualization analyses on publication trends, collaborative networks (countries/institutions/authors), disciplinary distribution, citation bursts, and the evolution of keyword clusters. Results: Starting from 2005, there has been a notable increase in publication volume, reaching its peak in 2024. The United States and Germany are at the forefront of national collaboration, with the University of Munich and the Mayo Clinic being key research institutions. The research focus has transitioned from a primary emphasis on Psychiatry to a broader scope encompassing Neurosciences, Otorhinolaryngology, and General Medicine. Keyword analysis reveals a shift towards standardized terminology, transitioning from “phobic postural vertigo” to “diagnostic criteria” and “consensus documents”. Current research trends are centered around comorbidity mechanisms like “vestibular migraine”, therapeutic approaches such as “vestibular rehabilitation”, and quality of life assessments using the “dizziness handicap inventory”. The 2017 consensus document by the Bárány Society is highlighted as a pivotal publication with significant citation impact. Conclusions: The intellectual structure of the field, as revealed by this bibliometric analysis, has transitioned from a phenomenological description to a conceptual unification. The bibliometric analysis indicates that the field is currently in a conceptually stabilized stage characterized by a research focus on refining diagnostic precision and comorbidity exploration, while scholarly attention remains biologically exploratory regarding objective biomarkers and pathophysiological mechanisms. Full article