This study evaluated the efficacy and acceptability of Ireland’s National Clinical Programme for ADHD in Adults (NCPAA), providing public assessment and supports for adults with ADHD.

Overall, 249 adults (51% women, 42% men, 4% non-binary, 1% other gender) were recruited from three NCPAA services using consecutive sampling. Participants completed the Adult Self-Report Scale (ASRS) and the Weiss Functional Impairment Rating Scale (WFIRS-S) at baseline, 6, and 12 months; service satisfaction was measured with the Service Satisfaction Scale (SSS). Reflexive thematic analysis explored responses to two open-ended questions.

Service users presented with high baseline symptomatology and life challenges. Significant improvements were observed in ASRS and WFIRS-S (except education) in the first six months. Improvements were retained at 12 months in ASRS and WFIRS-S domains of work, life skills, self-concept and social. but not family, risk or education. Service satisfaction was high, particularly among those diagnosed with ADHD. Thematic analysis identified three positive themes: feeling affirmed, benefits of supports, and person-centred care; and three improvement areas: access barriers, resource gaps, and need for ongoing support.

Engagement with NCPAA services is associated with improvements in ADHD symptoms and life challenges and is acceptable to adults with ADHD in the short term. Service limitations, particularly staffing constraints, warrant attention. Recommendations include strengthening resources, improving communication and appointment systems, and enhancing links to external supports. Given the absence of a control group, findings should be considered preliminary.

Substance use is sustained partly through implicit associations toward drugs – i.e. automatic positive attitudes and motivational responses toward drug-related cues. Such implicit associations may be inferred by behavioral measures that capture the relative ease, speed, or priming of those associations. However, implicit opioid associations in patients with opioid use disorder (OUD) remain underexplored, and it is unknown whether mindfulness-based interventions such as Mindfulness-Oriented Recovery Enhancement (MORE) can modify implicit associations to support recovery.

We conducted secondary analyses of data from a clinical trial of adults with OUD (N = 154), randomized to either methadone treatment as usual (TAU) or TAU plus MORE. Participants completed an opioid implicit association test (IAT) at baseline. Days of opioid use were tracked over 16 weeks. Data were analyzed using logistic and zero-inflated negative binomial (ZINB) regressions to examine the impact of baseline IAT scores on future opioid use and MORE’s moderating effect.

In the TAU group, each 1-unit increase in IAT D score was associated with a 216% increase in the odds of opioid use (OR = 3.16, p = 0.049). However, in the MORE group, IAT scores were not significantly associated with future opioid use (OR = 0.58, p = 0.57). ZINB analysis revealed that each 1-unit increase in IAT D score predicted 0.96 fewer days of use in MORE relative to TAU (B = –1.25; SE = 0.58; p = 0.030).

Implicit attitudes toward opioids predicted higher opioid use among individuals receiving methadone. However, MORE attenuated this relationship and may counteract automatic cognitive biases that sustain opioid use.

Hypochondriasis, or health anxiety disorder, is associated with increased mortality, mainly from potentially preventable causes. Substance misuse is a well-known contributor to premature death, yet its relationship with hypochondriasis remains unclear. We assessed the risk of broadly defined substance-related problems in individuals diagnosed with hypochondriasis.

This Swedish register-based matched cohort study included 4,129 individuals diagnosed with hypochondriasis in specialist services between 1997 and 2020 and 41,290 demographically matched unexposed individuals. Stratified Cox proportional hazards models were fitted to estimate hazard ratios (HRs) for the association between hypochondriasis and substance-related problems – defined as alcohol and drug use disorders, dispensed medications for alcohol dependence and opioid use disorders, and alcohol- and drug-related accidental poisonings, deaths, and suspected criminal offenses. Models were adjusted for sociodemographic variables, parental substance-related problems, and personal psychiatric history.

Substance-related problems were identified in 504 (12.2%) individuals with hypochondriasis and 1,924 (4.7%) matched unexposed individuals. After adjustment for sociodemographic and parental covariates, hypochondriasis was significantly associated with an increased risk of substance-related problems (HR, 2.55; 95% confidence interval [CI], 2.30–2.84). Similar results were observed in individuals without preexisting substance-related problems (HR, 2.85; 95% CI, 2.48–3.27). Further adjustment for psychiatric comorbidity, particularly anxiety and depression, reduced the risk estimates, but the associations remained statistically significant. In an additional analysis including primary care diagnoses of hypochondriasis (presumably reflecting less complex cases), the risk of substance-related problems remained elevated (HR, 1.61; 95% CI, 1.39–1.86).

Improved recognition of, and clinical awareness of substance misuse may help reduce long-term adverse outcomes in individuals with hypochondriasis.

Cognitive fatigue is a prevalent and disabling symptom in neurological and post-viral conditions, including multiple sclerosis (MS) and Long COVID. Assessment relies largely on self-report, and no validated objective biomarker exists, limiting reliable diagnosis and treatment monitoring. The aperiodic exponent of the Electroencephalogram (EEG) power spectrum, reflecting the excitation/inhibition (E/I) balance, is a promising candidate biomarker. We examined whether aperiodic exponent values can objectively identify pathological fatigue and assessed their classification accuracy.

We conducted a cross-sectional study, including 119 participants: 36 healthy controls, 33 with Long COVID-related fatigue (LCOF), and 50 with MS (23 fatigued and 27 nonfatigued). Resting-state EEGs were analyzed, and associations with fatigue ratings and group differences were assessed. Logistic mixed-effects regression models evaluated classification accuracy for fatigue status.

Lower frontal aperiodic exponents were associated with higher cognitive fatigue across participants. Fatigued individuals, regardless of diagnosis, showed reduced frontal exponent values compared with nonfatigued groups, while no differences emerged in occipital regions. Logistic regression confirmed that frontal exponent values significantly predicted fatigue status, improving classification accuracy beyond age and depression, with good sensitivity and specificity.

The frontal aperiodic exponent is a regionally specific biomarker of cognitive fatigue across MS and LCOF. Mechanistic interpretation suggests an altered prefrontal E/I balance, which could inform the development of targeted interventions to alleviate cognitive fatigue. It offers a clinically accessible tool to complement self-report, support trial stratification, and enable objective treatment monitoring. Importantly, its presence across distinct disorders highlights its value as a transdiagnostic marker of fatigue.

Confidence exhibits systematic individual differences across mental health, gender, and age. However, it remains unknown whether these distinct sources of metacognitive bias have common or distinct computational origins.

To address this question, we developed a novel dynamic computational model of metacognition to study the temporal evolution of underconfidence associated with individual differences in transdiagnostic anxiety symptoms and gender in samples of online participants (total N = 1,447).

We found that underconfidence associated with anxiety symptoms became more prominent the longer individuals took to make metacognitive judgments – suggesting that it is exacerbated by additional time for introspection. In contrast, gender-related underconfidence decreased with greater metacognitive judgment time – suggesting that additional time for introspection is able to remediate prepotent biases. Our computational model of confidence explained these effects – while both gender and anxiety symptoms involved shifts in confidence criteria, only anxiety symptoms involved a temporal accumulation of negatively biased evidence about one’s ability.

Our study reveals multiple computational pathways to the formation of underconfidence, in turn highlighting specific potential mechanisms for its remediation.

To prevent power lines from igniting wildfires, utility companies in California are authorized to conduct Public Safety Power Shutoffs (PSPS), de-energizing, or shutting off power to equipment during periods of high wildfire risk. This study assessed the association between PSPS and emergency department visits.

The study quantified the extent to which counties in California experienced PSPS each day between September 15 and November 30, 2019. Linear mixed models were used to estimate the rate of emergency department encounters per 100,000 county residents based on quartiles of PSPS exposure, compared to no PSPS exposure at the county-day level. Analyses examined all emergency department encounters as well as age- and diagnosis-specific visits.

There was an increase of 15 emergency department visits per 100,000 persons aged 65 years and older on days with the highest levels of PSPS exposure compared to days without PSPS. The highest level of PSPS exposure was associated with increased rates of emergency department visits for respiratory, cardiovascular, injury, and mental or behavioral diagnoses.

Despite advanced notification, PSPS events are associated with negative health consequences. Older adults are particularly vulnerable to the unintended adverse health effects of PSPS and should be prioritized in mitigation efforts.

Early diagnosis of amyotrophic lateral sclerosis (ALS) is essential for treatment initiation and symptom management, yet it remains challenging due to nonspecific symptoms and the lack of reliable diagnostic biomarkers. Although conventional MRI sequences such as T2* weighted and fluid-attenuated inversion recovery (FLAIR) have shown potential in identifying upper motor neuron abnormalities, their diagnostic utility in ALS is not well established. This study aimed to evaluate the sensitivity and specificity of brain T2* weighted and FLAIR MRI sequences in diagnosing ALS using prospectively collected data and to assess associations with disease severity.

Data were analyzed from 20 patients with ALS and 20 healthy controls enrolled at the Edmonton site of the Canadian ALS Neuroimaging Consortium 1 (CALSNIC-1) study. Single-slice 2D axial susceptibility-weighted echo planar imaging (SWEPI) and FLAIR images were independently rated by a blinded neurologist and radiologist for signs of corticospinal tract and motor cortex abnormalities. Sensitivity and specificity were calculated, and linear regression was used to examine associations with ALS Functional Rating Scale-Revised (ALSFRS-R) scores.

T2* weighted and FLAIR MRI sequences showed high specificity (0.95 and 0.85, respectively) but low sensitivity (both 0.25) for ALS diagnosis. No significant correlation was found between imaging abnormalities and ALSFRS-R scores. Inter-rater reliability was poor (κ = 0.25 for SWEPI; κ = 0.14 for FLAIR).

While T2* weighted and FLAIR MRI sequences may have some specificity for ALS, our study suggests they are not sufficiently sensitive to be used as reliable diagnostic tools for ALS.