The COVID-19 pandemic presented significant challenges to infectious disease management and mental health services (MHS). Service demand and delivery changed due to fear of infection, economic hardships, and the psychological effects of protective measures. This systematic review with meta-analysis aims to quantify these impacts on different mental health service settings.

Comprehensive searches were conducted in PubMed, Embase, and PsycINFO, focusing on studies published from the initial outbreak of COVID-19, starting in November 2019. Studies were included comparing the utilization of mental health inpatient, emergency department (ED), and outpatient services (including telemedicine and medication prescriptions) before and during the COVID-19 pandemic. A random-effects model was employed to estimate pooled effects, with study quality assessed using a modified Newcastle-Ottawa Scale.

Among 128 studies, significant decreases in utilization were observed during the initial phase of the pandemic for inpatient services (RR: 0.75, 95% CI: 0.67 to 0.85) and ED visits (RR: 0.87, 95% CI: 0.69 to 1.10). Outpatient services showed a similar decline (RR: 0.78, 95% CI: 0.66 to 0.92), while no significant change was found in psychotropic medication prescriptions (RR: 0.90, CI: 0.77 to 1.05). In contrast, telemedicine utilization increased significantly (RR: 7.57, 95% CI: 3.63 to 15.77).

The findings reveal substantial shifts in mental health service utilization during the pandemic, with the largest reductions in inpatient services and significant increases in telemedicine use. These results emphasize the need for flexible healthcare models. Further research is essential to evaluate the consequences of reduced MHS utilization.

Tobacco smoking is highly prevalent in patients with psychosis, who also often experience negative affect (NA) and stress. The relationship between these factors remains unclear in this population. We aimed to investigate everyday life associations in 158 patients with psychosis, 136 unaffected siblings, and 117 controls from the Genetic Risk and Outcome of Psychosis (GROUP) study with Experience Sampling Method measurements.

Generalized linear mixed models were used to evaluate across time and within-subject associations. Across time analyses investigated the relationship between smoking status and overall NA and stress. Within-subject analyses assessed whether smoking between two measurements (t−1 and t0) was associated with changes in NA and stress at the measurement after smoking a cigarette (t0) and at the subsequent measurement (t+1).

Across assessments, smoking status was initially associated with NA in patients (B=0.26, p=0.036), but this association disappeared after controlling for psychotic symptoms and cannabis use. Within-subject analyses in smokers showed a decrease in NA in patients after smoking (t0: −0.23, p=0.016), which remained significant after correcting for confounders (t0: −0.20, p=0.015). Siblings showed a decrease in NA (t0: −0.22, p=0.009), also after controlling for confounders (t0: −0.14, p=0.018). No time-lagged effect was found at t+1 after correction for subsequent smoking.

Overall smoking behavior was not associated with NA in patients with psychosis. In the short term, smoking in the daily life context is associated with a reduction in NA in people vulnerable to psychosis, possibly due to alleviation of withdrawal symptoms, which may complicate smoking cessation.

Impairments in mentalizing, or theory of mind, occur across psychiatric disorders. Static illustrations are widely used to assess mentalizing due to their simplicity, and they allow assessment of specific cognitive processes. However, systematic comparisons of impairments between psychiatric disorders, neurodevelopmental disorders, and at-risk groups in mentalizing tasks with static illustrations are currently lacking.

A systematic review with pairwise and network meta-analyses (NMA) was conducted to evaluate mentalizing impairments using tasks with static illustrations across psychiatric disorders compared to healthy controls (HCs) and between groups. Subgroup analyses examined specific mentalizing domains (false belief, humor, and intentionality), and meta-regression analyses explored potential moderators. The ceiling effects of specific tasks were also examined.

Eighty-nine studies were included, involving 9,038 participants and 11 psychiatric conditions. Significant mentalizing deficits were observed across all conditions versus HCs, except for the familial risk for bipolar disorder group. NMA demonstrated that schizophrenia (g = −0.960) and early schizophrenia (g = −0.785) exhibited the most pronounced impairments, followed by borderline personality disorder (g = −0.612) and obsessive-compulsive disorder (g = −0.613). Particularly, schizophrenia showed significantly greater deficits than autism, bipolar disorder, clinical and familial high risk for schizophrenia, and depression. Domain-specific analyses highlighted differential impairment patterns. The presence of prominent ceiling effects suggests major limitations of tasks with static illustrations.

This review provides detailed insights into transdiagnostic and disorder-specific patterns of mentalizing impairments with tasks using static illustrations. Findings highlight the importance of domain-specific approaches, examining interindividual variability, refining assessment tools, and implementing targeted interventions.

Optimizing depression treatment intensity and duration is crucial, given an overburdened mental healthcare system. However, decision-making is challenged by heterogeneous treatment effects. We aimed to investigate these effects, accounting for confounders and population heterogeneity, in a real-world dataset from specialized mental healthcare.

The study included 36,946 participants from mental healthcare providers in the Northern Netherlands. We measured the effects of treatment duration and intensity on time to depression recurrence, using monthly costs as a proxy for treatment intensity. An accelerated failure time model was used, adjusting for confounding via entropy weighting. Non-linear effects were examined using restricted cubic splines to identify turning points, after which linear analyses were stratified. Population heterogeneity was explored through K-means clustering analyses, followed by cluster-specific analyses.

In the high-intensity group (above €360/month), a €1000/month increase in treatment intensity may reduce time to recurrence by 16% (acceleration factor [AF] 0.84, 95% CI 0.77–0.92). Conversely, the same increase in the low-intensity group might prolong recurrence-free time by 9.6-fold (AF 9.6, 95% CI 2.18–42.31). Extending treatment duration by 6 months may reduce time to recurrence by 7% (AF 0.93, 95% CI 0.89–0.97) in the long-duration group, with no significant effect in the short-duration group. Five clusters emerged, three of which comprised only women, with AFs of 0.67, 0.80, and 0.81, respectively, under high treatment intensity.

Increasing treatment intensity appears worthwhile only in the low-intensity group, though residual confounding remains possible.

Anorexia nervosa (AN) often persists for years, resulting in high morbidity and mortality. Hypoglycaemia, typically assessed from a single morning blood sample, is a critical severity indicator. Continuous glucose monitoring (CGM) provides more comprehensive information on glycaemic patterns. This study aimed to characterize glycaemia in patients with AN and identify its potential drivers among metabolic severity (current BMI), clinical severity (Eating Disorder Inventory-2 [EDI-2] score), and illness duration, in a real-world outpatient setting.

This cross-sectional study included female outpatients with restricting subtype AN. Participants underwent CGM for five days in their usual environment. Collected data comprised age, BMI, illness duration, EDI-2 score, and continuous glycaemic measurements. Glycaemic biomarkers (hypoglycaemic area under the curve [AUC], mean and minimum glycaemia, and coefficient of variation) were computed over 24-hour periods.

Three hundred and four female patients were monitored for a mean of 4.8 days. No significant correlations were observed between glycaemic biomarkers and BMI. Illness duration was significantly associated with mean and minimum glycaemia (r = 0.26 and 0.23, respectively, p < 0.001) and with hypoglycaemia AUC (r = −0.25, p < 0.001).

In female patients with restricting subtype AN, illness duration, rather than BMI, appears to significantly influence glycaemic profiles. This may reflect glycaemic adaptations, a hypothesis that warrants further investigation using CGM, a practical tool for exploring metabolic changes and their potential clinical significance in AN.

Negative symptoms (NS) represent an important unmet need in schizophrenia (SZ) assessment and management. Despite NS are strongly associated with poorer functioning and quality of life, they are frequently underrecognized, inconsistently evaluated, and show limited response to current treatments. Although specific assessment tools and European Psychiatric Association (EPA) guidance on NS have been developed, their impact on routine clinical practice appears limited. This study aimed to investigate the competence and confidence of European Early Career Psychiatrists (ECPs) in NS evaluation and management.

The CARE project was a cross-sectional online survey directed towards ECPs from European countries.

828 ECPs’ responses were collected from 19 countries. The majority of ECPs were trainees (65.8%), reported theoretical training in negative symptoms (NS) and placements in schizophrenia-specialized settings (67.9% and 70.3%), while about half reported extracurricular NS training (51.1%) and involvement in clinical research (46.1%). Only 11% correctly identified NS domains, despite 65.7% felt well-trained in NS assessment tools. Just 15.9% correctly answered questions based on the EPA guidance papers. 46.7% and 25.9% ECPs reported feeling competent in NS evaluation and management, respectively. Gender (men) specialist status, research involvement, theoretical NS training, and placements in specialized SZ services predicted perceived competence. However, in-depth NS knowledge was predicted only by specialist status, engagement in clinical research, and extracurricular NS training.

Despite reported exposure to NS training, ECPs demonstrated limited knowledge of NS. Actions need to be taken to ensure that ECPs receive the highest standard of training in NS.

Peripartum depression (PPD) is one of the most common pregnancy complications; nevertheless, it often goes underdiagnosed. Pinpointing important correlates is crucial for early risk identification and pathophysiology understanding. We aimed to investigate the association between self-reported mood swings during oral contraceptive (OC) use and peripartum depressive symptoms (PPDS).

We used data from the Swedish longitudinal cohort study Mom2B. 3829 women who had reported previous usage of OCs were included. Self-reported mood swings during OC use were assessed through a single question, and PPDS were evaluated using established cut-offs of the Edinburgh Postnatal Depression Scale (EPDS).

Self-reported mood swings during OC use were associated with PPDS at gestational weeks 12–22 (OR = 1.30, 95% CI, 1.01–1.66), 24–34 (OR = 1.37, 95% CI, 1.10–1.71) and 36–42 (OR = 1.39, 95% CI, 1.05–1.82) as well as at postpartum weeks 6–13 (OR = 1.46, 95% CI, 1.12–1.92) and 24–35 (OR = 2.07, 95% CI, 1.43–2.99). Interestingly, self-reported mood swings during OC use were associated with higher odds for newly developed PPDS in early postpartum (OR for weeks 6–13 = 1.92, 95% CI: 1.19–3.08).

Women with self-reported mood swings during OC use have higher risk of experiencing depressive symptoms across the peripartum period and twice the risk of newly developed PPDS during the early postpartum, adding to current evidence of a hormonal sensitive subgroup of women and the opportunity to use this simple question in future predictive efforts.