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24 pages, 751 KB  
Article
A Comparative Analysis of Psychiatric Consultations Across Emergency, Hospital, and Community Mental Health Settings
by Rosaria Di Lorenzo, Carolina Bottone, Isabella Riguzzi, Paola Ferri and Sergio Rovesti
J. Clin. Med. 2026, 15(9), 3476; https://doi.org/10.3390/jcm15093476 - 1 May 2026
Viewed by 516
Abstract
Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) [...] Read more.
Background/Objectives: A psychiatric consultation is a professional evaluation aimed at establishing a diagnosis, a prognosis, and developing a treatment plan. The objective was to assess psychiatric consultations (PCs) at the Community Mental Health Center (CMHC), Emergency Room (ER) and General Hospital (GH) to highlight differences across settings. Methods: With a retrospective design, we examined all PCs performed between 1 January 2024 and 31 December 2024 at the CMHC, ER and GH of Baggiovara in Modena. Descriptive statistical analysis and a multivariate logistic regression were performed. Results: We collected a total of 3174 PCs for 1801 patients, performed in the three settings: 52% in ER, 30% in CMHC and 18% in GH. In ER, PCs were most frequently requested for suicide risk (26%), psychomotor agitation (14%) and substance intoxication (14%). In CMHC, the most common diagnoses were depressive disorders (22%), acute anxiety (20%) and acute psychotic episodes (13%). In GH, consultations mainly addressed psychiatric symptoms associated with medical and eating disorders. The overall rate of psychiatric hospitalization after PCs was 16.2%, reaching 23.4% for consultations in ER. Discontinuation of pharmacological therapy was significantly associated with an increased risk of hospitalization (p < 0.001), which rose to 17% when therapy had been interrupted for more than one year. Conclusions: PCs at ER were the access point for most hospitalizations. Therapeutic discontinuation, acute psychosis and substance use represented the main predictors of hospitalization. Strengthening shared care pathways among CMHC, ER and GH represents an effective model of integration between hospital and community services, ensuring continuity of care. Full article
(This article belongs to the Special Issue Clinical Advances in Personalized Psychiatry)
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19 pages, 905 KB  
Review
Rehabilitation in Adults with Complex Psychosis: A Clinician-Oriented Narrative Review of Multidimensional Approaches to Functional Recovery
by Mario Pinzi, Andrea Fagiolini, Giacomo Gualtieri, Maria Beatrice Rescalli, Caterina Pierini, Alessia Santangelo, Benjamin Patrizio and Alessandro Cuomo
Medicina 2026, 62(5), 841; https://doi.org/10.3390/medicina62050841 - 28 Apr 2026
Viewed by 480
Abstract
Complex psychosis is a clinically relevant rehabilitation construct rather than a formal diagnostic category and refers to psychotic illness associated with treatment-resistant symptoms, functional impairment, and additional cognitive, psychiatric, neurodevelopmental, or physical health complexity. In this clinician-oriented narrative review, we synthesised current evidence [...] Read more.
Complex psychosis is a clinically relevant rehabilitation construct rather than a formal diagnostic category and refers to psychotic illness associated with treatment-resistant symptoms, functional impairment, and additional cognitive, psychiatric, neurodevelopmental, or physical health complexity. In this clinician-oriented narrative review, we synthesised current evidence on rehabilitation interventions for adults with complex psychosis, integrating direct evidence from specialist rehabilitation settings with indirect evidence from schizophrenia-spectrum studies when clinically informative. We searched major clinical databases, prioritised guidelines, systematic reviews, meta-analyses, and controlled studies, and organised the synthesis by functional domain and pathway relevance. Evidence was strongest for cognitive remediation, particularly when combined with broader psychiatric rehabilitation or vocational support, for family interventions in relapse prevention, and for individual placement and support in competitive employment. Social–cognitive and metacognitive interventions appear clinically valuable, although transfer to real-world functioning is more variable. Community-based rehabilitation, supported accommodation, illness self-management, and ecological adaptation strategies remain central to functional recovery when embedded within multidisciplinary pathways. Digital and virtual interventions are promising adjuncts, but their efficacy remains heterogeneous and implementation challenges include engagement, privacy, and service integration. Overall, rehabilitation in complex psychosis is most convincing when it is personalised, measurement-based, and delivered through integrated service models linking assessment, intervention selection, supported living, and recovery-oriented care. Full article
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28 pages, 550 KB  
Systematic Review
Physical Restraints and Seclusion in Psychiatric Settings in the Eastern Mediterranean Region: A Systematic Review of the Perspectives of Nurses and Individuals with Mental Illness
by Asrar Salem Almutairi, Owen Price, Abdullah Hassan Alqahtani, Antonia Marsden and Karina Lovell
Healthcare 2026, 14(9), 1161; https://doi.org/10.3390/healthcare14091161 - 26 Apr 2026
Viewed by 338
Abstract
Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has [...] Read more.
Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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18 pages, 300 KB  
Review
Beyond Principles: A Reflective-Cognitive Framework for Ethical Decision-Making in Anorexia Nervosa
by Evdoxia Tsigkaropoulou, Fragiskos Gonidakis and Ioannis Michopoulos
Healthcare 2026, 14(8), 1047; https://doi.org/10.3390/healthcare14081047 - 15 Apr 2026
Viewed by 546
Abstract
Anorexia nervosa is a clinically complex and ethically challenging psychiatric disorder. Clinicians are frequently confronted with ethical dilemmas arising from conflicts between core ethical principles in everyday clinical practice. Professional codes of ethics and legal frameworks often fail to provide a stable basis [...] Read more.
Anorexia nervosa is a clinically complex and ethically challenging psychiatric disorder. Clinicians are frequently confronted with ethical dilemmas arising from conflicts between core ethical principles in everyday clinical practice. Professional codes of ethics and legal frameworks often fail to provide a stable basis for resolving these dilemmas due to the fluctuating medical risk and the ego-syntonic nature of anorexia nervosa. Under conditions of heightened responsibility and medical risk, clinicians’ cognitive and emotional responses may be activated and may mediate ethical decision-making. Although such internal processes have been described in the literature, limited attention has been paid to their role in shaping ethical judgment in routine clinical care. The aim of this article is to conceptualize the decision-making processes that unfold in response to ethical dilemmas in the clinical context of anorexia nervosa and propose a sequential multi-level framework. A focused conceptual literature review was conducted to develop a reflective framework for clinical practice, drawing on selected studies in clinical ethics, healthcare law, anorexia nervosa care, and cognitive theory. Clinicians’ internal cognitive and emotional processes play a significant role in ethical decision-making in complex clinical contexts such as anorexia nervosa and should be explicitly recognized and brought into reflective awareness through supervision and reflective practice. Ethical decision-making is therefore conceptualized as a dynamic process linking clinical events, clinicians’ internal responses, ethical and legal considerations, and reflective clinical judgment. Incorporating structured reflection into clinical, educational, and supervisory settings may support more ethically informed and context-sensitive clinical judgment within multidisciplinary eating disorder services. Full article
27 pages, 331 KB  
Article
Incidence of Using Physical, Mechanical Restraints and Seclusion in Saudi Mental Health Settings: A Prospective Cohort Study
by Asrar Salem Almutairi, Antonia Marsden, Owen Price, Abdullah Hassan Alqahtani, Abdullelah Waleed Almulhim, Saleh Alsaidan, Modhi Alanazi and Karina Lovell
Healthcare 2026, 14(8), 1011; https://doi.org/10.3390/healthcare14081011 - 12 Apr 2026
Viewed by 472
Abstract
Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have [...] Read more.
Background/Objectives: The use of physical and mechanical restraints and seclusion in psychiatric facilities to manage violent and aggressive behaviours has long been a contentious issue, balancing patient safety with ethical considerations. With advancements in psychiatry and increased understanding of mental illness, there have been expectations that such interventions would no longer be required; however, their use persists in clinical practice. Management policies differ across countries and are largely influenced by legal frameworks. This study aimed to identify the factors influencing the incidence of these interventions across two psychiatric facilities in Saudi Arabia and to examine associations among inpatient variables. Methods: A prospective cohort study was conducted over six months (September 2021–March 2022) across two psychiatric facilities in Saudi Arabia (Eradah Complex, n = 1120; King Fahd University Hospital (KFUH), n = 268). Data from 333 restriction events were analysed using descriptive statistics, chi-square tests, and negative binomial regression to calculate incidence rates and explore associated factors. Results: The findings revealed a complex interplay of factors related to patient characteristics and clinical and environmental conditions within the facilities. Key contributing variables included symptom deterioration and the duration of observation required. Longer observation periods were associated with certain diagnoses, particularly schizophrenia and mood disorders. Conclusions: Restraints and seclusion remain influenced by multiple interacting factors within psychiatric settings. These findings highlight the need to reduce their use and ensure they are applied cautiously, with greater emphasis on minimising patient trauma and promoting safer, person-centred care. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
28 pages, 572 KB  
Article
Factors Associated with Reduced Clinical Response in Adult ADHD: The Role of Alcohol and Cannabis Use Disorders and Autism Spectrum Disorder
by Manuel Glauco Carbone, Beniamino Tripodi, Irene Matarese, Alessandro Bellini, Roberta Rizzato, Claudia Tagliarini, Filippo Della Rocca, Francesco De Dominicis, Icro Maremmani, Giulio Perugi and Angelo G. I. Maremmani
J. Clin. Med. 2026, 15(7), 2688; https://doi.org/10.3390/jcm15072688 - 2 Apr 2026
Viewed by 1179
Abstract
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is frequently associated with complex psychiatric comorbidity, including high rates of Substance Use Disorders (SUDs), which may influence treatment outcomes. Although pharmacological treatments are effective for core ADHD symptoms, real-world response remains heterogeneous, and the contribution of [...] Read more.
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is frequently associated with complex psychiatric comorbidity, including high rates of Substance Use Disorders (SUDs), which may influence treatment outcomes. Although pharmacological treatments are effective for core ADHD symptoms, real-world response remains heterogeneous, and the contribution of specific substance-related and neurodevelopmental factors to treatment response is not fully understood. Methods: This retrospective observational study examined a real-world cohort of 67 adults with ADHD treated pharmacologically in a specialized outpatient setting. ADHD was diagnosed according to DSM-5-TR criteria using the Diagnostic Interview for ADHD in Adults (DIVA-5). Autism spectrum disorder (ASD) was recorded based on documented pre-existing specialist diagnoses and confirmed clinically at baseline. Psychiatric comorbidities and substance use disorders, including alcohol and cannabis use disorders, were assessed according to DSM-5-TR criteria. Clinical response was defined using the Clinical Global Impression–Improvement scale (CGI-I; responders = scores 1–3). Exploratory binary logistic regression analyses were used to identify clinical factors associated with treatment response. Given the limited sample size, revised multivariable models were specified parsimoniously on the basis of a priori clinical relevance. Results: At follow-up, 48 of 67 patients (71.6%) met criteria for clinical response. In revised parsimonious multivariable models, alcohol use disorder (OR ≈ 0.08–0.10, p = 0.010–0.026) and cannabis use disorder (OR ≈ 0.20–0.24, p = 0.014–0.028) were consistently associated with reduced odds of clinical response. Autism spectrum disorder showed a descriptive trend toward lower response rates but did not retain statistical significance after adjustment (p ≈ 0.11–0.15). Conclusions: In adults with ADHD treated in routine clinical practice, alcohol and cannabis use disorders were associated with a reduced likelihood of achieving clinically meaningful improvement under routine pharmacological care, whereas autism spectrum disorder showed a trend toward lower response that was not stable enough to support firm conclusions. These findings should be considered exploratory given the retrospective design, limited sample size, and lack of systematic treatment exposure measures. Full article
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13 pages, 27423 KB  
Article
LLMs Underperform on Classifying Anxiety and Depression Using Therapy Conversations: A First-Step Benchmark
by Junwei Sun, Siqi Ma, Yiran Fan and Peter Washington
Appl. Sci. 2026, 16(7), 3388; https://doi.org/10.3390/app16073388 - 31 Mar 2026
Viewed by 918
Abstract
Anxiety and depression are among the most prevalent mental health conditions worldwide. Early and accurate automated detection from naturalistic conversations (e.g., those recorded with a remote chatbot) could eventually improve screening and, in turn, access to timely care. As a first step towards [...] Read more.
Anxiety and depression are among the most prevalent mental health conditions worldwide. Early and accurate automated detection from naturalistic conversations (e.g., those recorded with a remote chatbot) could eventually improve screening and, in turn, access to timely care. As a first step towards this goal, we aim to evaluate the efficacy of both traditional machine learning and large language models (LLMs) in classifying anxiety and depression from psychotherapy sessions using labels derived from clinician-annotated session metadata reflecting the primary presenting psychiatric concerns. While psychotherapy transcripts do not reflect the real-world domain of remote naturalistic conversation, we conduct this analysis as an “easy” starting point towards the eventual goal of building generalizable, clinician-assistive models that can infer mental health status from unstructured, non-directive conversations captured in the home setting as part of a remote digital assessment process. LLM underperformance on a psychotherapy benchmark would indicate that LLMs are most likely not yet ready to advance towards mental health classifications in more complex and less structured contexts, such as from remote conversations with a chatbot or family member. To study whether LLMs can classify anxiety and depression from psychotherapy transcripts, we fine-tuned both established transformer models (BERT, RoBERTa, Longformer) and more recent large models (Mistral-7B), trained a Support Vector Machine using engineered features, and assessed prompting GPT chatbots. We observe that (1) all machine learning approaches perform poorly and (2) state-of-the-art models fail to improve multi-label classification performance relative to traditional machine learning methods, indicating the current limitations of using LLMs for classification of psychiatric diagnoses from unstructured patient text as of 2026. Full article
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17 pages, 745 KB  
Article
The Shift in Delivery of Care from Hospital to Community Care Settings: What Changes in Terms of Healthcare Workers’ Exposure to Violence
by Ettore Minutiello, Pietro Marraffa, Manuela Martella, Alessia Pascarella, Stefano Savigni, Gianfranco Politano and Maria Michela Gianino
Healthcare 2026, 14(7), 896; https://doi.org/10.3390/healthcare14070896 - 31 Mar 2026
Viewed by 497
Abstract
Background: Despite the general interest in WPV against healthcare workers, there is evidence that this topic has comparatively fewer studies conducted in the context of community settings than in hospital settings. Given the current general transition of care from hospital to community, [...] Read more.
Background: Despite the general interest in WPV against healthcare workers, there is evidence that this topic has comparatively fewer studies conducted in the context of community settings than in hospital settings. Given the current general transition of care from hospital to community, this study aims to analyze whether community settings present different characteristics in comparison with hospital settings on this topic in Italy. Methods: A retrospective observational study was conducted from 2020 to 2024 on aggressions reported by HCWs in hospitals and community settings belonging to a Local Health Authority of Turin in Piedmont. For physical and non-physical aggressions, a monthly time trend series was constructed. A Mantel–Haenszel fixed-effect meta-analysis was performed to obtain the odds ratio (OR) in two settings. Variables relative to aggressions included the gender of victims, their professional category (medical doctors, nurses, other HCWs), the type and gender of perpetrators (relative, patient, or unknown person), age groups of perpetrators (under 30, 30–49, ≥50), the nature of aggression (physical, non-physical), recidivism, involvement of law enforcement, and time of occurrence (morning, afternoon, or evening/night). Events within hospitals were further classified into emergency department, psychiatric ward, and other wards, while events within community settings were classified as drug addiction service units (serDs), long-term care (including specialist outpatient services, home services, and nursing homes) (LTC), mental health centres, and penitentiary assistance. Results: The results highlighted that fewer WPV incidents were reported in community settings than in hospital settings, even though reported incidents showed a more pronounced increase over time. Differences were observed in a few characteristics of WPV (age classes of aggressors, recidivism, time of aggression, profession of the assaulted worker, and specific location). Only the gender of the assaulted (female workers) (OR = 3.11, 95% CI: 1.27–7.61; p = 0.013; OR = 0.32, 95% CI: 0.13–0.79; p = 0.013 for non-physical and physical violence, respectively, compared to male workers) was identified as a specific risk factor for community settings. Conclusions: Modern health systems are experiencing a transition from hospital-centred to community-centred care settings. This study suggested that WPV is a significant concern, even outside the hospital. Community-based services often involve direct interaction with frail and chronically ill patients and their caregivers, as well as care delivery in diverse and sometimes less controlled environments, which may influence exposure to aggressive behaviours. The identification of setting-specific risk patterns in both hospital and community contexts provides valuable insights into workplace violence and may support the planning and implementation of targeted interventions aimed at mitigating the frequency and burden of WPV. Full article
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15 pages, 831 KB  
Article
Care Settings, Autonomy, and Costs in Severe Mental Illness: A Cross-Sectional Comparison of Hospital, Residential, and Community Care in Romania
by Elena Tanase, Ion Radu, Adrian Cosmin Ilie, Dan-Alexandru Surducan, Adina Bucur, Alina Tischer, Felicia Marc, Ion Papava and Sorin Ursoniu
Healthcare 2026, 14(7), 884; https://doi.org/10.3390/healthcare14070884 - 30 Mar 2026
Viewed by 516
Abstract
Background and Objectives: Romania’s transition from long-stay psychiatric care to more balanced community-oriented care remains incomplete, and comparative patient-level data are limited. The primary objective was to compare mental health-related quality of life, autonomy, perceived coercion, and direct mental health costs across [...] Read more.
Background and Objectives: Romania’s transition from long-stay psychiatric care to more balanced community-oriented care remains incomplete, and comparative patient-level data are limited. The primary objective was to compare mental health-related quality of life, autonomy, perceived coercion, and direct mental health costs across hospital, residential, and community care settings. Secondary objectives were (i) to compare hospital care with deinstitutionalized care taken together (residential + community), and (ii) to examine whether autonomy and perceived coercion were associated with mental health-related quality of life. Methods: In this cross-sectional study, 128 adults with severe mental illness (42 hospital, 43 residential, 43 community) completed the Romanian SF-36 v2.0 and two brief study-specific rating scales for autonomy and perceived coercion. Service-use and cost data for the previous 12 months were extracted from records. Results: Community participants had higher SF-36 mental scores than hospital patients (63.3 ± 7.6 vs. 52.8 ± 9.1) and higher autonomy (72.1 ± 10.0 vs. 53.0 ± 8.6), with lower perceived coercion (4.2 ± 1.3 vs. 6.4 ± 1.5; all p < 0.001). Mean combined direct costs in residential and community settings were approximately USD 1000 lower than in hospital care (USD 2671.6 vs. 3666.2; p < 0.001). When residential and community participants were analyzed together as a deinstitutionalized group, they also had higher SF-36 mental scores (59.7 ± 8.9 vs. 52.8 ± 9.1; p < 0.001). In multivariable models (R2 = 0.316), each 10-point higher autonomy score was associated with a 2.8-point higher SF-36 mental score, whereas each 1-point higher coercion score was associated with a 1.3-point lower score. Exploratory mediation analysis suggested that autonomy statistically attenuated the association between deinstitutionalized care and mental quality of life. Conclusions: In this sample, residential and community arrangements outside hospital wards were associated with better mental health-related quality of life, higher autonomy, lower perceived coercion, and lower direct costs than long-stay hospital care. These findings support the study objective of comparing Romanian care settings and suggest that autonomy is an important correlate to target in future service reconfiguration and longitudinal research. Full article
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13 pages, 500 KB  
Review
Psychiatric–Mental Health Nurse Practitioners: Addressing the Growing Mental Health Needs of the Population—A Narrative Review
by Yael Sela, Keren Grinberg and Rachel Nissanholtz Gannot
Healthcare 2026, 14(7), 878; https://doi.org/10.3390/healthcare14070878 - 29 Mar 2026
Viewed by 1936
Abstract
Background: Mental health needs are rising globally, while workforce shortages constrain access to timely care. Israel launched formal training for Psychiatric–Mental Health Nurse Practitioners (PMHNPs) in 2023 as part of broader efforts to strengthen the public mental health system. This narrative review provides [...] Read more.
Background: Mental health needs are rising globally, while workforce shortages constrain access to timely care. Israel launched formal training for Psychiatric–Mental Health Nurse Practitioners (PMHNPs) in 2023 as part of broader efforts to strengthen the public mental health system. This narrative review provides a focused synthesis of international and Israeli literature on PMHNP roles, models of practice, outcomes, and implementation considerations relevant to the Israeli context. Methods: We conducted a narrative, non-systematic literature review of international and Israeli literature on Psychiatric–Mental Health Nurse Practitioners (PMHNPs). Searches were conducted in PubMed/MEDLINE, CINAHL, PsycINFO, and Scopus (January 2000–December 2024), alongside targeted policy and regulatory documents. Eligible sources addressed NP/PMHNP roles, scope of practice, clinical and service outcomes, implementation processes, workforce implications, or policy considerations in high-income health systems. Findings were synthesized thematically. Results: Across the reviewed literature, particularly in primary care and community-based settings, PMHNP/NP-delivered care was generally associated with comparable outcomes on selected quality and safety indicators, alongside improved accessibility, continuity, and high patient satisfaction. Successful implementation depended on regulatory clarity, organizational readiness, interprofessional collaboration, and the development of a clear professional identity. In Israel, the role is emerging within a cautious regulatory framework and may face early barriers related to role ambiguity, variable organizational support, and limited stakeholder awareness. Conclusions: PMHNP implementation may offer an important strategy for strengthening mental health service capacity in Israel. However, the extent of its contribution will depend on regulatory clarity, organizational support, implementation quality, and future empirical evaluation in the Israeli context. Full article
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11 pages, 230 KB  
Article
Physical Rehabilitation Patterns and Clinical Categorization in a Japanese Psychiatric Hospital: A Retrospective Content Analysis
by Shoko Edo, Kyoko Goda, Eiji Takigawa, Ryuichi Tanioka, Kazuyuki Matsumoto, Hirokazu Ito, Yoshihiro Mifune, Kaito Onishi, Krishan Soriano, Allan Paulo Blaquera, Leah Bollos, Seiji Kaganoi, Yueren Zhao, Kazushi Mifune and Tetsuya Tanioka
Psychiatry Int. 2026, 7(2), 62; https://doi.org/10.3390/psychiatryint7020062 - 11 Mar 2026
Viewed by 554
Abstract
The rising prevalence of physical comorbidities among patients with mental illness has increased the relevance of physical rehabilitation within psychiatric care. However, specific physical rehabilitation practices in specialized psychiatric hospitals in Japan remain insufficiently documented. This exploratory and descriptive study aimed to characterize [...] Read more.
The rising prevalence of physical comorbidities among patients with mental illness has increased the relevance of physical rehabilitation within psychiatric care. However, specific physical rehabilitation practices in specialized psychiatric hospitals in Japan remain insufficiently documented. This exploratory and descriptive study aimed to characterize the rehabilitation content provided and to categorize patient characteristics and comorbidities in a single specialized psychiatric hospital using an expert-led consensus approach. Clinical data from 150 patients (median age 71.0 years) who received physical rehabilitation were retrospectively analyzed. Patient categorization was conducted through a multidisciplinary consensus-building process involving an expert panel of physical therapists, occupational therapists, psychiatrists, and nurses, each with over 10 years of clinical experience. Using a hierarchical rule set based on International Classification of Diseases, 10th Revision (ICD-10) codes and clinical referral data, five distinct categories were identified: Disuse Syndrome (41%), Neurologic Disorders (20%), Lower Limb Lesions (18%), Parkinson’s Syndrome (15%), and Upper Limb Lesions (6%). Across all categories, rehabilitation interventions focused on foundational motor therapies, such as range of motion (27%) and strength training (23%). Mobility-oriented interventions were selectively provided to patients with high bedridden status based on clinical potential. Overall, practices in this setting primarily targeted disuse syndrome and maintenance of basic motor function and were delivered with input from multiple professional disciplines; such practices may inform future research on structured multidisciplinary rehabilitative approaches, especially for aging psychiatric populations. Full article
11 pages, 546 KB  
Article
Artificial Intelligence in Mental Health Care: Task-Specific Perspectives of Professionals in Saudi Arabia
by Zaenb Alsalman
Healthcare 2026, 14(6), 701; https://doi.org/10.3390/healthcare14060701 - 10 Mar 2026
Viewed by 539
Abstract
Background: Artificial intelligence (AI) is increasingly integrated into healthcare systems worldwide, including mental health services. While AI holds promise for improving efficiency and addressing workforce shortages, its role in psychiatry remains complex due to the central importance of empathy, clinical judgment, and [...] Read more.
Background: Artificial intelligence (AI) is increasingly integrated into healthcare systems worldwide, including mental health services. While AI holds promise for improving efficiency and addressing workforce shortages, its role in psychiatry remains complex due to the central importance of empathy, clinical judgment, and ethical responsibility. Understanding clinicians’ perceptions is essential for guiding responsible AI implementation, particularly in culturally specific settings such as Saudi Arabia. Material and Methods: A cross-sectional survey was conducted among psychiatrists and family medicine physicians in Saudi Arabia between October and December 2025. The survey questionnaire was adapted from previously published instruments to assess perceptions of AI’s impact on mental health professions, the likelihood that AI could fully replace clinicians in ten core psychiatric tasks, expected timelines for replacement, and views on the balance between AI’s benefits and risks. Descriptive statistics, subgroup comparisons, and multivariable linear regression were used to analyze factors associated with higher perceived AI replacement likelihood. Results: A total of 100 physicians participated (mean age, 43.3 ± 8.9 years; 47% female). Most respondents anticipated that AI would lead to slight (45.0%) or substantial (43.0%) changes in professional roles. Perceptions varied by task: administrative tasks were most replaceable (clinical documentation, 4.03 ± 0.95; 79% likely), diagnostic/assessment tasks showed mixed perceptions (40–58%), high-risk diagnostics (suicidal/homicidal thoughts) were largely resistant (2.73–2.82; 8–30%), and relational tasks including empathetic care were least replaceable (24% likely). Physicians currently using AI tools reported significantly higher AI replacement likelihood scores, a finding that remained significant after adjustment. Overall, 64.0% of participants believed that the benefits of AI in mental health care outweighed its potential risks. Conclusions: Mental health professionals in Saudi Arabia largely view AI as a supportive tool rather than a replacement for clinicians. Clear boundaries remain around tasks requiring empathy and ethical judgment. These findings underscore the need for culturally sensitive, clinician-led, and ethically grounded AI integration strategies that strengthen, rather than undermine, the human foundations of mental health care. Full article
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12 pages, 779 KB  
Article
An Action-Based Psychosocial Group Intervention in Psychiatric Inpatient Care: A Pragmatic Add-On Study to Talk-Based Psychotherapy
by Jyu-Ming Hu, I-Fei Chen, Chun-Chu Lin, Li-Ting Huang, Nien-Hwa Lai and Ming-Wei Lin
Healthcare 2026, 14(5), 687; https://doi.org/10.3390/healthcare14050687 - 9 Mar 2026
Viewed by 636
Abstract
Background/Objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined [...] Read more.
Background/Objectives: Psychiatric inpatient care emphasizes pharmacological stabilization, yet psychosocial interventions remain essential for addressing complex emotional, interpersonal, and behavioral needs. While talk-based psychotherapy (TBP) is standard inpatient psychosocial care, some patients face barriers to exclusively verbal engagement during acute crises. This study examined the feasibility and implementation of psychodrama as a pragmatic add-on to routine inpatient TBP under real-world ward conditions. Methods: A quasi-experimental pragmatic add-on design was used (N = 84). All participants received routine TBP; the experimental group (n = 47) additionally participated in psychodrama co-facilitated by a multidisciplinary team (MDT). Outcomes were assessed using the ASEBA-ASR. Non-parametric tests with effect sizes and 95% confidence intervals were used to evaluate pre–post symptom changes over four weeks, and between-group differences were assessed using change-score comparisons. Results: Both groups demonstrated significant within-group symptom reductions following the intervention. However, between-group comparisons of change scores showed no statistically significant differences (all p > 0.05), with small effect sizes and confidence intervals including zero. Conclusions: Psychodrama appears feasible to implement as an action-based psychosocial add-on in acute inpatient settings. Although statistical superiority over TBP alone was not demonstrated, the intervention allowed for the characterization of symptom trajectories under real-world constraints, suggesting that psychodrama may represent an action-based option to diversify psychosocial pathways within MDT-delivered care. Future adequately powered studies are needed to examine how action-based modalities may fit within multidimensional, complexity-informed inpatient care pathways. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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15 pages, 255 KB  
Article
Exploring the Interpretive Clarity of the TCCNI-RePract and Identifying Conceptual Barriers Encountered by Japanese Psychiatric Nurses: A Concurrent Mixed-Methods Study
by Yoshiyuki Takashima, Gil Platon Soriano, Allan Paulo Blaquera, Hirokazu Ito, Yuko Yasuhara, Kyoko Osaka and Tetsuya Tanioka
Nurs. Rep. 2026, 16(3), 77; https://doi.org/10.3390/nursrep16030077 - 24 Feb 2026
Viewed by 694
Abstract
Background/Objectives: Integrating technology with caring is essential in modern healthcare, yet the clinical applicability of nursing theories remains underexplored. Locsin’s Technological Competency as Caring in Nursing (TCCN) theory emphasizes the competent use of technology to address patients holistically, rather than focusing solely [...] Read more.
Background/Objectives: Integrating technology with caring is essential in modern healthcare, yet the clinical applicability of nursing theories remains underexplored. Locsin’s Technological Competency as Caring in Nursing (TCCN) theory emphasizes the competent use of technology to address patients holistically, rather than focusing solely on health concerns. Here, we explored the interpretive clarity of the TCCN Instrument–Revised for Practice (TCCNI-RePract) items and identified the conceptual barriers encountered by psychiatric nurses when engaging with its theoretical constructs. Methods: This concurrent mixed-methods study surveyed 291 psychiatric nurses across five large hospitals in the Kansai region of Japan. Quantitative data on the TCCNI-RePract perception dimension were examined using descriptive statistics and normality testing. Qualitative open-ended responses were analyzed using reflexive thematic analysis. To ensure rigor and integration, a joint display was utilized to bridge both data strands. Results: Quantitative findings indicated that nurses strongly endorsed core values of caring (high agreement) but perceived theoretical constructs (wholeness and technological knowing) as significantly more difficult to interpret than concrete, behavior-oriented items. Qualitative analysis revealed four major themes: (1) fragmented understanding of “technology and caring,” (2) struggles with abstract and philosophical language, (3) moral and emotional tensions in caring relationships, and (4) contextual barriers to integrating caring and technology. We found a “semantic gap,” where the professional endorsement of caring values was not automatically translated into the mastery of theoretical lexicon. Conclusions: While psychiatric nurses identify with the moral core of TCCN, a substantial gap exists between abstract theory and clinical practice. For effectiveness, middle-range theories require “clinical translation” that resonates with the moral, emotional, and organizational realities of psychiatric settings. Full article
(This article belongs to the Special Issue Psychiatric Nursing and Mental Health Service)
17 pages, 479 KB  
Article
Sociodemographic and Clinical Predictors of Chronic Disease Outcomes in a Colombian Population: A Cross-Sectional Analysis of 2495 Patients
by Adriana Guzmán Sánchez, Lilibeth Sánchez-Guette, Armando Monterrosa-Quintero, Yaneth Herazo-Beltrán, Narledis Núñez-Bravo and Carlos Andrés Collazos Morales
Med. Sci. 2026, 14(1), 74; https://doi.org/10.3390/medsci14010074 - 7 Feb 2026
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Abstract
Objectives: This study sought to identify sociodemographic and clinical predictors associated with the absence versus presence of alterations in mental, neurological, cardiovascular, osteomuscular, and pulmonary conditions, to provide information towards targeted interventions for non-communicable diseases (NCDs) in urban Colombian populations. Methods: [...] Read more.
Objectives: This study sought to identify sociodemographic and clinical predictors associated with the absence versus presence of alterations in mental, neurological, cardiovascular, osteomuscular, and pulmonary conditions, to provide information towards targeted interventions for non-communicable diseases (NCDs) in urban Colombian populations. Methods: A cross-sectional analysis was performed on 2495 patients (70.1% women) from public health facilities in Bogotá, using the Colombia Open Data “Enfermedades Crónicas” dataset collected between January and December 2023. Associations between sociodemographic variables (sex, age groups, education, and ethnicity) and clinical variables (BMI, type of disability, COVID-19 vaccination status, psychiatric risk, and the modified Medical Research Council dyspnea scale) were examined in relation to health outcomes. Data cleaning involved the exclusion of 107 outliers identified by z-scores >|3| using Microsoft Excel 365. Categorical variables were summarized using frequencies and proportions, and Pearson’s chi-square tests were applied to assess bivariate associations (e.g., BMI–health conditions, and sex–disability associations). Multivariable Firth’s penalized logistic regression models (implemented in Python 3.14 and Jamovi 2.3) were used to predict the absence of alteration (reference category: presence), adjusting for multicollinearity (variable inflation factor, VIF) and events-per-variable ratios. Odds ratios (ORs), 95% confidence intervals (CIs), and two-tailed p-values were estimated, with statistical significance set at p < 0.05. Results: Women predominated in obesity (81% vs. 19% in men, p < 0.001) and in unaltered conditions (e.g., 71% of cases without pulmonary alterations) but exhibited a lower crude prevalence of disability (6% vs. 16% in men, p < 0.001). Men represented higher proportions of alterations (e.g., 53.8% of pulmonary cases vs. 46.2%, p = 0.006) and mental disabilities (70%, p < 0.001). Firth regression models identified the following predictors: for mental alteration, a single COVID-19 vaccine dose (OR = 2.39, 95% CI 1.12–5.09, p = 0.024), occupation (OR = 1.07, 95% CI 1.05–1.10, p < 0.001), BMI (OR = 0.96, 95% CI 0.93–0.98, p < 0.001), and disability (inverted OR = 4.35, 95% CI 2.56–7.69, p < 0.001); for neurological alteration, occupation (OR = 1.15, 95% CI 1.10–1.21, p < 0.001) and disability (inverted OR = 3.45, 95% CI 1.43–8.33, p = 0.006); for cardiovascular alteration, BMI (OR = 1.02, 95% CI 1.00–1.03, p = 0.042); for osteomuscular alteration, occupation (OR = 1.03, 95% CI 1.01–1.06, p = 0.011); and for pulmonary alteration, occupation (OR = 1.07, 95% CI 1.03–1.11, p = 0.001). The models demonstrated a moderate to excellent goodness-of-fit (R2 = 0.25–0.72). Conclusions: Sex, BMI, disability status, occupation, and COVID-19 vaccination status emerged as key predictors of NCD-related alterations, highlighting specific vulnerabilities such as partial immunization for mental health risk, and disability for mental and neurological outcomes. Targeted interventions, including completion of vaccination schedules, mitigation of occupational exposure, BMI management, and disability-inclusive care, may reduce health disparities and support PAHO/WHO 2025 targets. Longitudinal studies are recommended to establish causal relationships in the context of Colombia’s fragmented subnational NCD evidence base. Full article
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