Search Results (442)

Background/Objectives: Depression, anxiety disorders, and substance use disorders frequently coexist in clinical settings and are main factors that worsen a patient’s prognosis. However, traditional artificial intelligence-based mental health studies have limitations in capturing the complex symptoms that occur in actual counseling situations by relying on social media data or focusing on binomial classification of single diseases. This study proposes a multi-label classification model that simultaneously detects the coexistence of depression, anxiety, and substance use disorder in actual counseling dialogue texts, and applies the Shapley Additive Explanatory (SHAP) method to explain the clinical basis of model prediction. Methods: We retrospectively analyzed 1661 de-identified Korean-language counseling session transcripts obtained from the publicly available AI Hub “Mental Health Counseling Dialogue” dataset (Republic of Korea; sessions collected between 2021 and 2023 from accredited domestic mental health counseling centers). Each session averaged 30 min (≈5000 Korean characters). Labeling was performed by two licensed clinical psychologists (inter-rater Cohen’s κ = 0.82). A Hierarchical Attention Network with Bidirectional LSTM (HAN-BiLSTM) was constructed; performance was compared with six baselines (Flat LSTM, TextCNN, KR-BERT, KoBERT, KoELECTRA, KLUE-RoBERTa) using stratified 5-fold cross-validation, paired t-tests with Bonferroni correction, and McNemar’s test. Top-ranked SHAP tokens were independently rated for clinical face validity by three psychiatrists. Results: The proposed model outperformed the baseline model not only for the labels of depression (F1 = 0.90) and anxiety (F1 = 0.85) but also for substance use disorder (F1 = 0.78) with poor data, achieving a macro-averaged F1 of 0.84 (95% CI 0.82–0.86; all p < 0.001 versus baselines). As a result of the SHAP analysis, clinically significant keywords such as “I want to die,” “anxiety,” and “drink” were identified as the model’s main basis for judgment, accurately tracking the client’s state, which dynamically changed as the dialogue progressed; three independent psychiatrists rated 88.7% of the top-15 SHAP tokens per label as clinically meaningful (Fleiss’s κ = 0.76). Conclusions: This study demonstrated that a deep learning-based multi-label approach is effective in early screening of complex mental health problems. In particular, the introduction of explainable AI (XAI) increases clinicians’ trust and suggests that it can be used as an AI-based clinical decision support system (CDSS) in the future. Full article

Background/Objectives: Adolescence is a crucial stage of development, in which life skills are essential for promoting psychological well-being. Social and Emotional Learning (SEL) interventions aim to develop social–emotional and relational skills that foster resilience and adaptation. Short-term effects may be nonlinear and influenced by gender differences, with possible fluctuations in self-assessments due to increased social–emotional awareness (response shift). Methods: This action research study involved 179 preteens (ages 11–17) from educational settings in Aosta Valley. The SEL program consisted of three experiential sessions on key life skills, led by psychologists and psychiatrists and including group activities and role-playing. Quality of life was assessed before and after the intervention using the Q-LES-Q, which measures satisfaction and well-being in the areas of social relationships, physical health, academic performance, leisure activities, and subjective feelings. Subscale scores were calculated as the mean of the corresponding items. Results: The results revealed nonlinear patterns: a decline in satisfaction with social relationships, which may reflect a response shift. Males reported higher initial levels and greater perceived positive effects, while females reported lower post-intervention scores, likely due to greater self-reflection and self-criticism. Conclusions: The data highlight the complexity of the short-term effects of SEL interventions and the importance of considering developmental trajectories and gender differences when evaluating their effectiveness. Full article

Background: Insomnia is common among people with mental health conditions and can exacerbate symptoms, impair functioning and negatively impact treatment outcomes. Community mental health services require practical data to quantify the burden of insomnia in routine care and to identify groups at a higher risk of experiencing clinically significant insomnia. Methods: We conducted a retrospective analysis of anonymized routinely collected clinical data from adult psychiatric outpatients attending the Community Mental Health Center in Bra (Department of Mental Health, Asl Cuneo 2, Italy). Consecutive patients were included over a three-month period (1 September to 30 November 2025). Insomnia severity was assessed using the Insomnia Severity Index (ISI). Diagnoses were established by psychiatrists using the Structured Clinical Interview for DSM-5 (SCID-5). Results: The sample included 506 patients (mean age: 45.1 ± 16.7 years; 265 women, 52.4%). The mean ISI total score was 12.18 ± 6.99. Clinically significant insomnia (ISI ≥ 15) was present in 205 out of 506 patients (40.5%), while severe insomnia (ISI ≥ 22) was present in 55 out of 506 patients (10.9%). The ISI score differed across diagnostic groups (ANOVA, F(8, 497) = 2.82, p = 0.0046, η² = 0.043). Post hoc comparisons revealed higher ISI scores in patients with depressive disorders than in those with anxiety disorders (Tukey, p = 0.0056). In a multivariable logistic regression model (outcome: ISI score of at least 15), adjusted for age, sex, education and the complexity of concurrent psychotropic medication (number of medication classes), depressive disorders were associated with clinically significant insomnia (OR: 1.99; 95% CI: 1.07–3.73). Attention deficit hyperactivity disorder (ADHD) also showed higher odds (OR: 3.64; 95% CI: 1.26–10.55). Medication complexity was also associated with an ISI score of at least 15 (OR: 1.43 per additional class; 95% CI: 1.16–1.77). In a sensitivity model additionally adjusting for benzodiazepine prescription (yes/no), benzodiazepine prescription was associated with ISI ≥ 15 (OR 1.82; 95% CI 1.13–2.95), while the estimate for medication complexity was attenuated using this association (OR 1.17; 95% CI 0.90–1.53). The eating disorders group was excluded from multivariable models due to the very small sample size (n = 4). Conclusions: Clinically significant insomnia was prevalent among this sample of psychiatric outpatients, with modest differences in insomnia severity across diagnostic groups. Sensitivity analyses suggested that the signal of medication complexity may be partly accounted for by benzodiazepine prescribing, supporting the cautious interpretation of medication-related correlates in routine cross-sectional data. These findings support routine insomnia screening in psychiatric outpatient care, while prospective studies are needed to clarify directionality and clinical implications. Full article

Background/Objectives: Major depressive disorder (MDD) frequently coexists with chronic diseases and inflammatory processes, particularly in primary care. The primary aim of this study was to investigate the association between MDD and multimorbidity burden (≥2 chronic diseases), while the secondary aim was to examine the relationship between MDD and routinely available inflammatory biomarkers. Methods: This retrospective cross-sectional study used electronic medical records from a Family Health Center in Türkiye between 1 January 2025 and 31 December 2025. Individuals aged ≥18 years with accessible records, complete laboratory data, and recorded sociodemographic/lifestyle variables were included. Patients were considered to have MDD if a psychiatrist-diagnosed MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was recorded in the electronic medical system within the past year. Multimorbidity burden was defined as the total number of chronic diseases and was further dichotomized as ≥2 versus <2 for multivariable regression analysis. Inflammatory biomarkers were calculated from routine blood tests: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune–inflammation index (SII), and monocyte-to-HDL cholesterol ratio (MHR). Group comparisons and logistic regression were performed to evaluate associations with MDD. Results: A total of 3006 patients were analyzed; 375 (12.5%) had MDD. Participants with MDD were older and more frequently female, had higher body mass index and waist circumference, and exhibited a substantially higher burden of chronic comorbidities. PLR was higher in the MDD group (p = 0.019), whereas MHR was lower (p = 0.004); NLR, MLR, and SII did not differ significantly. In multivariable analysis, increasing age (OR 1.029, 95% CI 1.019–1.039, p < 0.001), female sex (OR 2.659, 95% CI 1.949–3.636, p < 0.001), and multimorbidity (OR 2.162, 95% CI 1.650–2.833, p < 0.001) were independently associated with MDD, whereas PLR and MHR were not independently associated after adjustment. Conclusions: In this large real-world primary care cohort, MDD was common and strongly linked to multimorbidity. Although PLR and MHR differed significantly between groups, they were not independently associated with MDD after adjustment, suggesting that these differences may be driven by multimorbidity and related clinical factors rather than independent disease-specific effects. Full article

Research on burnout has been a consistent and increasingly popular topic since the 1970s when it was first defined. The focus of publications regarding burnout spans studies of various occupations, countries, age groups, social groups, and effects. A recent development is the documenting of brain changes associated with burnout. This review aims to investigate the peer-reviewed publications on this topic published in 2025. Although not a scoping review because it is limited to one year and peer-reviewed reports, this study follows the standardized PRISMA-ScR guidelines for scoping reviews as the methodology. The search was of five relevant databases: Google Scholar, OVID, PubMed, Scopus, and Web of Science. Brain changes AND burnout AND 2025 are the keywords searched. The keywords were limited to these to identify those articles where researchers themselves connected a relationship between brain changes and burnout during 2025. The results were several perspectives that investigated burnout, and the brain changes were various. The findings differ depending on the measurement tools used for burnout assessment, as discussed. The purpose of conducting the review is to aid psychiatrists in identifying the most recent research to enhance patient treatment options by considering current information on this developing topic. Full article

Background/Objectives: Minor physical anomalies (MPAs) are subtle morphological markers of disrupted neuroectodermal development occurring during early gestation. Their increased prevalence has been reported in several neurodevelopmental and psychiatric conditions, including schizophrenia. However, data on MPAs in pediatric psychosis remain limited. This exploratory descriptive study aimed to characterize the occurrence of MPAs and congenital malformations in children presenting with early-onset psychotic symptoms and to illustrate the clinical heterogeneity through two representative cases. Methods: All participants underwent a comprehensive head-to-toe examination by a trained child and adolescent psychiatrist to identify MPAs. Key anatomical regions, including the face, hair vortex, palate, and extremities, were systematically photographed. Results were corroborated by MRI brain screening and consulted with a clinical geneticist. Anomalies were classified using the standardized Elements of Morphology terminology. Results: Among the 19 study participants, seven (37%) were diagnosed with very early-onset schizophrenia (VEOS). Identified minor physical anomalies included epicanthus (n = 5), café au lait spots (n = 2), and discoloured spots (n = 1). Furthermore, major congenital malformations were detected, specifically Arnold–Chiari malformation type I (n = 1), incomplete hippocampal inversion (n = 1), and a temporal cortex malformation (n = 1). Conclusions: MPAs and selected neuroanatomical anomalies were observed in a subset of children with early-onset psychotic symptoms. While the small sample size and absence of a control group limit interpretability, these exploratory findings suggest that systematic physical examination may provide supportive clinical information in the assessment of pediatric psychosis. Larger, controlled studies are needed to clarify whether specific MPAs may serve as early markers of neurodevelopmental vulnerability. Full article

Background: With the rising demand for psychiatric mental health services and the development of online technology, telemental health services are gaining popularity. Psychiatrists and psychologists differ significantly in service patterns and ethical models. This study investigated their ethical patterns and used the technology acceptance model (TAM) to explore how professionals’ attitudes influence their ethical and regulatory use of telemental health services. Methods: The online survey included their basic information, telemental health service patterns, attitudes toward telemental health services, and ethical norms. This cross-sectional online survey was conducted among psychiatrists and psychologists in China between April and October 2022. Of the 1071 respondents in the parent survey, 690 professionals who reported using telemental health services were included in the present subgroup analysis. Results: In some instances, practitioners offering telemental health services may not adhere to ethical standards, particularly in the case of psychologists. A significant proportion of respondents expressed concerns including potential emergencies, technical issues, and security, suggesting the need for a re-evaluation of the ethical framework. The TAM showed higher behavioral intention was associated with lower ethical compliance scores. Conversely, elevated subjective norms and perceived behavioral control have the potential to encourage ethical compliance. Conclusions: Telemental health services are widely used in China, but important gaps remain in ethical compliance and regulatory implementation. Future efforts should focus on strengthening professional training, improving platform security and emergency response procedures, and developing clearer institutional and professional guidelines for ethical telemental health practice. Full article

Objective: This study examines the potential of natural language processing and text mining to automate the systematic review process in clinical psychiatry, a field that traditionally relies on domain experts and can be time-consuming, prone to human bias and errors. The study compares the classification of review articles by domain experts with that facilitated by machine algorithms. Methods: Using data from PubMed, 160 abstracts related to “transcranial magnetic stimulation” and “autism” were classified into “treatment” and “non-treatment” categories by both human reviewers and a computer algorithm. The computer algorithm, employing topic modeling in text mining, was compared to human reviewers, including two psychiatrists, a biostatistician, and a medical student. Results: The accuracy of human classifications ranged from 68% to 85%, with inter-rater reliability (Kappa statistic) between 0.40 (fair to moderate) and 0.64 (substantial). Intra-rater reliability, tested by reclassification after three months, varied from 0.38 to 0.82. Conclusions: The findings highlight the consistency and reproducibility of computational approaches compared to human classification, which exhibited both inter-rater and intra-rater variability. Differences in reviewer performance were observed; however, these patterns should be interpreted cautiously, as the study was not designed to directly assess cognitive or decision-making processes. Full article

Background: Distinguishing functional dystonia (FD) from idiopathic dystonia (ID) remains a major clinical challenge because both conditions are diagnosed primarily on clinical grounds and may be accompanied by non-motor psychiatric symptoms. Although personality abnormalities have been described in functional neurological disorders, their relevance in the differential diagnosis of dystonia remains insufficiently studied, and comparative data on FD and ID are lacking, particularly in the Russian population. Patients and Methods: A total of 178 patients with idiopathic dystonia (focal and segmental dystonia, ID) and 32 patients with functional dystonia (FD) were observed. A clinical interview by a psychiatrist was conducted; the SCID-II-PD questionnaire and the Five-Factor Personality Questionnaire (5-PFQ) were used to assess PD. Results: Patients with FD more often than patients with ID had such PD as dependent, paranoid, passive–aggressive, borderline, schizoid and schizotypal (p < 0.001), as well as obsessive–compulsive (p < 0.013) and avoidant (p < 0.049) according to SCID-II-PD. In FD, personalities of the eccentric cluster A predominate; patients with FD are characterized in personality terms by significantly greater introversion, detachment, naturalness (irresponsibility, impulsivity, carelessness), emotional restraint and practicality (conservatism, low sensitivity, rigidity) according to 5-PFQ. Conclusions: Patients with FD differ from patients with ID in both categorical and dimensional personality characteristics. The predominance of cluster A personality pathology and the identified pattern of personality-related variables may have potential value as adjunctive markers in the clinical differentiation of FD from ID. Further external validation is required before these findings can be incorporated into diagnostic algorithms. Full article

The concept of the overvalued idea (OVI) has been debated since German psychiatrist Karl Wernicke coined the term in the late nineteenth century, describing it as an emotionally exaggerated yet psychologically comprehensible belief arising from normal cognitive processes that becomes central to an individual’s mental life. Since that time, the construct has been variably reinterpreted through competing theoretical lenses, ranging from Kraepelin’s biological nosology to contemporary cognitive-behavioral and multidimensional models. Despite its clinical relevance across disorders (e.g., anorexia nervosa, body dysmorphic disorder, obsessive–compulsive disorder), overvalued ideas remain inconsistently and insufficiently defined, having been alternately treated as attenuated delusions, markers of poor insight, or disorder-specific severity indicators—interpretations that have limited theoretical coherence, measurement precision, and clinical utility. This review traces the historical evolution of the overvalued idea, clarifies enduring theoretical misinterpretations, and proposes a comprehensive, practical definition. Integrating historical and contemporary perspectives, we define an overvalued idea as a psychologically intelligible, ego-syntonic belief held with disproportionate emotional significance that dominates cognition and behavior without meeting criteria for an obsession or a delusion. We further propose that overvalued ideation is best conceptualized as a transdiagnostic mechanism through which emotionally reinforced beliefs acquire pathological dominance across disorders, a formulation that both honors Wernicke’s original insight and can be operationalized for future research, measurement, diagnosis, and treatment. Full article

Background: Youth mental health needs are critically undertreated. Access and engagement remain challenging, particularly for disadvantaged youth, due to barriers such as limited clinic hours, insurance, transportation, bias, and stigma. School-focused collaborative approaches may reduce mental health care inequities. In this study, we illustrate a pilot intervention by process documentation, participant feedback, and two case studies. Method: To address local service gaps, a virtual collaborative care process was piloted with a child and adolescent psychiatrist (CAP) and psychologist from Project TEACH, a New York State Office of Mental Health funded Child Psychiatry Access Program (CPAP), primary care representatives, and multiple school mental health teams. Demographic data, participant feedback and the collaborative process is reviewed with two case studies created to highlight the collaborative process. Results: Most participants report utility and felt supported. The majority also report a positive impact on communication and collaboration between teams serving students; challenges with family follow up persist. Streamlined communication and consent was helpful. Demographic data suggests that this model can help reach disadvantaged youth. Conclusions: School-focused collaborative mental health requires regular communication and coordination between youth-serving providers. This pilot implementation study shows promise for reaching disadvantaged youth and providing multidisciplinary support. Full article

Objectives: This study aimed to assess the validity of aphasic depression and anxiety rating scales (Signs of Depression Scale [SODS], Hospital version of Stroke Aphasic Depression Questionnaire [SADQH-10], Behavioural Outcomes of Ansxiety scale [BOA]) in the local setting and describe clinical outcomes of a local aphasic stroke population. Methods: Records of 236 aphasic stroke patients from an existing database of a proactive post-stroke depression screening service in a tertiary stroke centre in Singapore with rehabilitation facilities met review criteria for having available data for the SODS, SADQH-10 and carer-rated version of BOA (BOA-C). The reference standard was a psychiatrist’s diagnosis of post-stroke mood disorder. Clinical outcomes at 1-year post-stroke were analysed. Results: The areas under the Receiver Operator Characteristic curve (AUC) compared against the psychiatrist’s diagnosis of post-stroke mood disorder were 0.805, 0.844 and 0.780 for the SODS, SADQH-10 and BOA-C respectively. Optimal cut-off scores were found for the SODS (four and above) and SADQH (seven and above), with a sensitivity of 60.00% and 55.56%, respectively, and a specificity of 94.62% and 96.17%, respectively. No appropriate cut-off score was found for the BOA-C. Of the patients, 58.6% were found to have poor outcomes at 1-year post-stroke, and recurrent and haemorrhagic strokes were significant predictors of poor outcomes. Conclusions: The SODS and SADQH-10 are appropriate tools for assessing post-stroke depression in hospitalised aphasic stroke patients in Singapore based on their predictive values and likelihood ratios. The BOA-C has poor validity. At 1-year post-stroke, more than 50% of aphasic stroke patients have poor clinical outcomes not associated with clinician-diagnosed depression status, but predicted by recurrent and haemorrhagic strokes. Full article

Background: In the Philippines, studies have shown that availability and access to healthcare varies widely. Although the shortage of psychiatrists in the country has been recognized for many years, no published study to date has described their distribution across the regions. This study aimed to describe the distribution of psychiatrists in the country using publicly available data on the Internet. Methods: This was a cross-sectional study, analyzing publicly available data from the Philippine Psychiatric Association (PPA) web directory, the Philippine Health Insurance Corporation (PhilHealth) web database of accredited psychiatrists, and the Philippine Statistics Authority. Information on location of practice, sex, PPA membership, PhilHealth accreditation, regional gross domestic product (GDP), and regional population were collated. Results: Information on 409 psychiatrists was available online, with 68% being female and 53% holding PhilHealth accreditation. There were a total of 417 declared locations of practice, with six psychiatrists practicing in more than one location. The National Capital Region accounted for 53.5% of the declared practice locations, while no psychiatrist declared practicing in the Bangsamoro region. Conclusions: This study highlights the maldistribution of psychiatrists across the Philippines. Policies to incentivize and encourage practice in low-access regions and investment in technology, such as telemedicine, may help reduce the access gap. Full article

Menin, the product of the Multiple Endocrine Neoplasia type 1 (MEN1) gene, is a scaffold protein, the lack of which leads to the development of a tumor syndrome primarily affecting endocrine organs. Although it is classified as an oncosuppressor, menin is a ubiquitous protein whose expression is also abundant in non-endocrine tissues such as the central nervous system, where knowledge of menin’s role still remains limited. In this article, we aim to draw attention to an underestimated clinical aspect of MEN1 syndrome, i.e., the psychological/psychiatric manifestations, in which menin deficiency could have an important function. Our aim is to highlight that a multidisciplinary team caring for patients with MEN1 throughout their lives should include professionals such as psychologists and psychiatrists in order to better manage any mental illness associated with the syndrome and to further improve the patient’s quality of life. Full article

Lithium remains endorsed as first-line treatment for bipolar disorders across major clinical guidelines, yet robust evidence demonstrates its progressive decline in use in psychiatric practice across numerous countries. To justify this decline, concerns regarding lithium’s efficacy, safety profile, and monitoring requirements are frequently cited. Yet these apprehensions largely stem from an insufficient understanding of lithium’s clinical uses. In fact, when patients are selected for lithium stabilization according to a characteristic clinical profile and not just a bipolar verdict, lithium continues demonstrating good efficacy compared to all other psychiatric medications currently available. Moreover, after sufficient clinician and patient education regarding lithium stabilization principles, monitoring requirements stop being burdensome. Furthermore, among lithium-responsive patients, adverse effects are typically mild and clinically manageable, except for glomerular filtration rate decline, which tends to develop after decades of continuous administration. Thus, it might be possible to reverse this unfortunate decline in lithium’s use by teaching clinicians to identify the patient profile responsive to lithium stabilization and by implementing educational programs regarding optimal lithium utilization for psychiatrists, patients, and their families. Furthermore, it is worth investigating intermittent lithium administration to mitigate renal complications. Full article