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.

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.

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.

In the ultra-high risk for psychosis (UHR) field, it is unknown whether understanding symptom relationships, beyond symptom severity alone, may hold prognostic value and inform preventive care. In this study, network analysis was performed to examine the interconnections between baseline symptoms in UHR youth who did and did not transition to psychosis over three years.

In a sample selected from the UHR1000+ cohort, positive and basic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States. Network analyses and network comparison tests were performed.

195 UHR youth transitioned to psychosis within three years and 346 did not. The two groups did not differ in the network structure, global strength (i.e., the overall level of connectivity between symptoms), or centrality of symptoms (i.e., their importance within networks). The transitioned group was characterized by unusual thought content not being connected to other symptoms; however, its centrality between networks was comparable. Across networks, impaired cognitive functioning connected disorganized speech to impaired emotional functioning, motor functioning, and tolerance to normal stress. Impaired bodily sensation connected perceptual abnormalities to other symptoms.

The networks of youth who transitioned and who did not transition were similar, indicating similar baseline symptom relationships. Across groups, unusual thought content, despite being traditionally associated with transition, had little to no interactions with other symptoms. Clinical manifestations that may need attention include impaired cognitive functioning, which connected several symptoms, and impaired bodily sensation. Future research using time series data may support progress toward individualized care.

Standard treatments for eating disorders (EDs) typically include nutritional rehabilitation, psychotherapy, and pharmacotherapy, often resulting in modest effectiveness. Neuromodulation has been proposed as a potential add-on strategy. This review aims to critically evaluate its effects on EDs.

The PICO framework was used to conduct a search according to the PRISMA guidelines for systematic reviews (PROSPERO Registration no. CRD42024559700). Descriptive and clinical data for each study, including comorbidity and safety, were tabulated by disorder. Quality assessment was performed using the RoB2 and ROBINS-I tools.

Fifty-eight studies examining rTMS, tDCS, DBS, ECT, iTBS, and dTMS in AN, BN, and BED met inclusion criteria. In AN, the effects of rTMS and tDCS on weight and BMI were modest, with notable benefits for adolescents. Conversely, in refractory AN, DBS produced significant and lasting increases in BMI and reductions in comorbid psychopathology. For BN, single-session rTMS reduced cravings acutely, while multisession results were mixed; tDCS enhanced self-control. In BED, right-DLPFC tDCS decreased cravings, food intake, and binge frequency, showing a dose-dependent effect, whereas early data on NAcc DBS were promising but limited.

Noninvasive stimulation methods effectively reduced cravings and impulsivity, showing more consistent improvements in BN and BED than in weight restoration for AN. Overall, this pattern replicates recent review reports. However, variations in study designs, stimulation protocols, and outcome measures may undermine the reliability of these conclusions and complicate comparisons across studies. Future studies should be adequately powered, multisession, with durability endpoints, and target and dose refinement.

As GLP-1 receptor agonists (GLP-1 RAs) are increasingly used worldwide, concerns about their association with mood disorders have grown. Yet real-world observational studies have produced conflicting findings. This study aims to fully examine the link between GLP-1 RAs and emotional/behavioral outcomes.

Disproportionality analysis of GLP-1 RA adverse events was conducted using FAERS data. Mendelian randomization (MR) employed GLP1R cis-eQTLs as instrumental variables to assess links with mood/behavior-related disorders. Summary-data MR (SMR) was then performed using GLP1R cis-eQTL data.

275,718 adverse events (AEs) associated with GLP-1 RAs were retrieved and analyzed. A mild signal for suicide-related AEs was observed only in the obesity indication subgroup (ROR:1.65, 95% CI: 1.28–2.12). Genetic evidence showed that GLP-1 RAs were likely associated with reduced risks of anxiety, depression, emotional lability, bipolar disorder, and suicide. Mediational analysis indicated that weight loss partially mediated the causal effects of GLP-1 RAs on depression and emotional lability, accounting for 18.28% (95% CI: 9.46–27.10%, P = 0.038) and 7.65% (95% CI: 5.66–9.64%, P < 0.001) of the total effects, respectively. SMR analysis showed that genetically predicted GLP1R expression was negatively associated with anxiety (OR: 0.79, 95% CI: 0.64–0.98, P = 0.031), with no significant associations for other emotional or behavioral outcomes.

Both observational and MR analyses showed that patients treated with GLP-1 RAs may have no increased risk of emotional and behavioral disorders. Instead, genetic proxy activation of GLP-1 RAs may reduce the risk of anxiety, depression, and emotional lability.

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.

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.

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.

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.

Existing research on post-traumatic stress disorder (PTSD) development over time covers brief periods predominantly among military personnel, rather than civilians, and baseline measurements from before traumatic experiences are rarely available. This longitudinal study examined PTSD trajectories among Israeli civilians before and after the October 7, 2023, terror attack, exploring their associations with current and previous trauma.

Data included 1,231 Israeli Jewish adults from a quasi-representative sample surveyed at four time points: January 2018, April 2022, December 2023, and March 2024. Participants completed self-report measures, including the PTSD Checklist for DSM-5 (PCL-5), exposure to the October 7 attack and subsequent war, and trauma in childhood and adulthood. Latent growth mixture modeling identified PTSD trajectories.

Four trajectories were identified: resilience (70.4%), trauma recovery (9.4%), trauma vulnerability (16.8%), and chronic PTSD (3.5%). The chronic PTSD group exhibited persistently high symptoms, associated with greater childhood trauma and war-related exposure. The trauma vulnerability group showed low-medium pre-attack PTSD levels that escalated post-attack, associated with higher war-related stressors. The trauma recovery group had high pre-attack PTSD severity related to high trauma exposure, but showed significant symptom reduction post-attack.

This study, the first to examine PTSD trajectories in civilians after large-scale trauma, highlights diverse impacts. Most participants demonstrated resilience, while some exhibited chronic symptoms. Two trajectories – trauma vulnerability and trauma recovery – were event-responsive, suggesting that collective trauma can both exacerbate and paradoxically alleviate symptoms. Findings emphasize the need for targeted interventions and suggest future research using machine learning to refine PTSD trajectory prediction.

The population with a serious mental illness (SMI) shows a high risk of premature mortality. Overexposed to multiple health risks throughout life, their main threat is physical illness, which starts earlier and is not diagnosed in time. Developing preventive actions is a public health priority.

This longitudinal prospective study evaluated the predictive value of lung function on all-cause mortality in patients with schizophrenia (SCHIZ) or bipolar disorder. Patients aged 40–70 years, active smokers, and without preexisting respiratory disease underwent spirometry following American Thoracic Society/European Respiratory Society 2021 standards. Mortality data were collected through December 2022. Cox proportional hazards models and Kaplan–Meier survival curves analyzed the association between lung function, specifically forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and mortality, adjusting for relevant confounders (age, gender, abdominal circumference, and comorbidities).

Of 107 participants (mean age 49.3 years, 63.3% male) with SMI (72% SCHIZ) and active smokers, 8 (7.5%) died during the 6-year follow-up (5 cardiovascular and 3 cancer). Mean z-scores were −1.41 (SD = 1.22) for FEV1 and −0.99 (SD = 1.16) for FVC. Lower FEV1 and FVC z-scores were significantly associated with increased mortality risk (p = 0.002 and p = 0.009, respectively). Kaplan–Meier analysis confirmed this association for FEV1 (p = 0.039) and FVC (p = 0.007) but not for gender, comorbidities (hypertension, diabetes, and dyslipidemia), or FEV1/FVC. A multivariate Cox regression model, adjusting for age and abdominal circumference, confirmed the independent predictive value of lower FEV1 z-score for mortality (hazard regression = 0.473, 95% confidence interval: 0.220–0.979, p = 0.044).

Poorer lung function, especially lower FEV1, was independently associated with all-cause mortality in SMI. Spirometry, an easily implementable technique, could help to detect at-risk individuals and favor prevention initiatives.

Bipolar disorder (BD) is associated with impairments in facial emotion recognition (FER), affecting social functioning and quality of life. Understanding FER deficits in BD is crucial for tailoring interventions and improving treatment outcomes. This systematic review and meta-analysis aims to evaluate FER differences among individuals with BD, unaffected first-degree relatives (FDRs), and healthy controls (HCs), exploring predictors related to patient and study characteristics.

We systematically searched PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO databases from inception to March 28, 2024. Random-effects meta-analyses were conducted to explore differences in accuracy and reaction time during FER identification and discrimination tasks.

A total of 100 studies were included, comprising 4920 individuals with BD (females = 56%, mean age = 34.1 ± 9.1), 676 FDRs (females = 55%, mean age = 36.1 ± 12), and 4909 HCs (females = 53.2%, mean age = 32.5 ± 9.5). Compared to HCs, adults with BD exhibited significantly lower accuracy (SMD = −0.47; 95% CIs = −0.56, −0.38) and higher reaction time (SMD = 0.57; 95%CIs = 0.33, 0.81) during facial emotion identification tasks. During facial emotion discrimination tasks, adults with BD had significantly lower accuracy than HCs (SMD = −0.59; 95%CIs = −0.78, −0.4), but similar speed. No significant differences were observed between BD and FDRs. Meta-regressions identified several predictors of FER performance, including manic symptom severity, stimulus duration, and presence of practice before task.

FER deficits appear to be a core feature of BD and require specialized, systematic assessment. Identifying these deficits may help guide interventions aimed at improving affective cognition and social outcomes in individuals with BD.

Major depressive disorder is a prevalent and debilitating mental health condition contributing to a growing global burden. Late-life depression (LLD), affecting individuals over 60 years of age, is further associated with elevated risks for cardiovascular diseases, cognitive decline, and dementia. Treatment responses vary widely, potentially due to underlying neurodegeneration and cellular senescence. We aimed to explore blood-based biomarkers related to Alzheimer’s disease and senescence-associated secretory phenotype (SASP) proteins, seeking to identify biological underpinnings of LLD and their association with response to psychotherapy.

We performed a secondary analysis of the Cognitive Behavioral Therapy for Late-Life Depression (CBTlate) trial in 228 participants aged 60 years and older with a diagnosis of LLD. Depression trajectories were compared using clustering. In participants with available plasma samples, biomarker data were generated post hoc. We assessed associations between biomarkers and depression trajectories, biomarker dynamics, and their ability to predict treatment response.

Two depression trajectories were identified: persistently high stable Geriatric Depression Scale (GDS) scores (hsGDS) and decreasing scores over time (dGDS). The hsGDS group had more severe baseline depression (p = 2.88 × 10−6), anxiety (p = 4.39 × 10−4), and sleep disorders (p = 1.09 × 10−3), and was more likely to have a history of major depression (p = 0.01) and mild cognitive impairment (p = 0.01). Biomarker analysis revealed elevated baseline plasma neurofilament light chain (NfL, p = 2.51 × 10−2) and reduced C-X-C Motif Chemokine Ligand 5 (CXCL5, p = 2.83 × 10−2) in the hsGDS group. Including CXCL5 in predictive models improved trajectory differentiation (p = 3.94 × 10−3).

Cellular aging biomarkers like CXCL5 may improve understanding of LLD and guide personalized therapeutic interventions.