Mental health is a global issue, and mobile applications, such as chatbots, offer a partial solution by providing improved services through various communication forms. This study aimed to identify chatbots and their technical features in mental health services. This study conducted a systematic review of mental health chatbots and their technical features from 2000 to 2025. A search was performed across databases such as PubMed, Scopus, ProQuest and the Cochrane database. The CASP (Critical Appraisal Skills Programme) appraisal checklist was used to assess the quality of the studies. In the next step, the Braun and Clarke’s approach was utilized for conducting thematic analysis on the data. The search yielded 2,921 records, of which 10 were duplicates and removed. After screening for relevance and eligibility, 33 papers met all the requirements. The mean quality score of the included studies was 13.36 (standard deviation = 1.36). The studies had a moderate risk of bias, as they mostly had a clear question, searched for the right type of papers, included all relevant papers and reported the results precisely. The research conducted an analysis of 138 mental health chatbots, categorizing them based on five distinct attributes: the disorder they target, their input and output modalities, the platform they operate on and their method of generating responses. The research emphasized the need for designing chatbots that suit patients’ preferences and needs, and also indicated that the digital divide within societies should be taken into account when designing and producing chatbots for mental health services. Although mental health chatbots can assist underserved communities, ethical concerns must be addressed before their deployment.

Long-acting injectable (LAI) antipsychotics are highly effective tools for managing serious mental illness, yet their clinical utility is often compromised by logistical and pharmacological complexities. This review serves as a practical guide to optimizing LAI therapy by addressing common clinical hurdles. Maintaining a consistent injection schedule is essential to successful treatment. To improve adherence, clinicians should implement proactive reminder systems—such as phone calls or text messages—and involve family or caregivers in the care plan. When injections are delayed, management strategies must be tailored to the specific medication and the length of the “dosing window”. For example, aripiprazole monohydrate (Abilify Maintena) allows a ±7 day window, whereas paliperidone palmitate (Invega Sustenna) provides a +14 day window. If these windows are exceeded, catch-up protocols may involve administering the next dose as soon as possible, utilizing supplemental oral antipsychotics for a bridge period (e.g., 14 days for aripiprazole or 21 days for risperidone), or restarting initiation loading regimens entirely. Clinically significant drug interactions, such as the reduction of aripiprazole or risperidone levels by carbamazepine, can lead to symptom breakthrough. Conversely, CYP450 inhibitors like fluvoxamine or fluoxetine may increase antipsychotic concentrations, necessitating dose reductions. Adverse effects, including drug-induced Parkinsonism and akathisia, should be managed by reducing the LAI dose or switching to agents with lower risk profiles, such as aripiprazole-based products. For akathisia, short-term adjunctive treatments like vitamin B6 or mirtazapine may be utilized until dose adjustments reach steady state. Patient-centered care requires a collaborative approach to substance use, which can exacerbate symptoms or interfere with LAI effectiveness. Clinicians must also engage in nonjudgmental discussions when patients request a return to oral therapy, carefully considering the pharmacokinetic properties of the LAI to time the transition safely. Ultimately, a proactive management plan that addresses these clinical variables is essential for reducing relapse risk and improving long-term quality of life.

We investigated the response of experienced amyotrophic lateral sclerosis physicians to patient-based evidence pertaining to health communication. Fifteen expert amyotrophic lateral sclerosis (ALS) physicians participated in an in-person focus group. Focusing on clinical feasibility and first-hand experience, participants discussed recommendations from people with ALS and caregivers for improving communication. Data were qualitatively analyzed using conventional content analysis. Findings demonstrated shared and differing perspectives, and communication challenges. Findings suggest a difference in perspective centered on how to achieve the shared goal of patient-centered communication. We discuss asymmetry between healthcare professional perspectives and patient-based evidence, and opportunities for alignment that will advance effective health communication.

Language is the primary technology clinical ethicists use as they offer guidance about norms. Like any other piece of technology, to use the technology well requires attention, intention, skill, and knowledge. Word choice becomes a matter of professional practice. The Brief Report offers clinical ethicists several reasons for rejecting the phrase “aggressive care.” Instead, ethicists should consider replacing “aggressive care” with the adjacent concept of a “recovery-focused path.” The virtues of this neologism include: the opportunity to set aside the emotion of “aggression,” the phrase’s accuracy when capturing the intention of the patient or their representative, and an unappreciated rhetorical force—and transparent logic—that arises when the patient’s recovery is unlikely.

Global mental health services face challenges such as stigma and a shortage of trained professionals, particularly in low- and middle-income countries, which hinder access to high-quality care. Mobile health interventions, commonly referred to as mHealth, have shown to have the capacity to confront and solve most of the challenges within mental health services. This paper conducted a comprehensive investigation in 2024 to identify all review studies published between 2000 and 2024 that investigate the advantages of mHealth in mental health services. The databases searched included PubMed, Scopus, Cochrane and ProQuest. The quality of the final papers was assessed and a thematic analysis was performed to categorize the obtained data. 11 papers were selected as final studies. The final studies were considered to be of good quality. The risk of bias within the final studies was shown to be in a convincing level. The main advantages of mHealth interventions were categorized into four major themes: ‘accessibility, convenience and adaptability’, ‘patient-centeredness’, ‘data insights’ and ‘efficiency and effectiveness’. The findings of the study suggested that mHealth interventions can be a viable and promising option for delivering mental health services to large and diverse populations, particularly in vulnerable groups and low-resource settings.

Physicians place significant weight on the distinction between acts and omissions. Most believe that autonomous refusals for procedures, such as blood transfusions and resuscitation, ought to be respected, but they feel no similar obligation to accede to requests for treatment that will, in the physician’s opinion, harm the patient (e.g., assisted death). Thus, there is an asymmetry. In this paper, we challenge the strength of this distinction by arguing that the ordering of values should be the same in both cases. The reason for respecting refusals is that, in such cases, autonomy outweighs well-being. We argue that the same should be true in request cases, which means that requests should not be denied only due to the treatment being too harmful in the physician’s opinion. Our strategy is to consider and reject a number of arguments for the asymmetrical view, including an appeal to the doing–allowing distinction and positive and negative rights. The duty to respect refusals is still greater than the duty to grant requests on our view, but, by arguing that the ordering of values is the same in both cases, we show that there is less of a distinction in healthcare between requests and refusals than many currently believe.

The field of clinical decision making is polarized by two predominate views. One holds that treatment recommendations should conform with guidelines; the other emphasizes clinical expertise in reaching case-specific judgments. Previous work developed a test for a proposed alternative, that clinical judgment should systematically incorporate both general knowledge and patient-specific information. The test was derived from image theory’s two phase-account of decision making and its “simple counting rule”, which describes how possible courses of action are pre-screened for compatibility with standards and values. The current paper applies this rule to clinical forecasting, where practitioners indicate how likely a specific patient will respond favorably to a recommended treatment. Psychiatric trainees evaluated eight case vignettes that exhibited from 0 to 3 incompatible attributes. They made two forecasts, one based on a guideline recommendation, the other based on their own alternative. Both forecasts were predicted by equally- and unequally-weighted counting rules. Unequal weighting provided a better fit and exhibited a clearer rejection threshold, or point at which forecasts are not diminished by additional incompatibilities. The hypothesis that missing information is treated as an incompatibility was not confirmed. There was evidence that the rejection threshold was influenced by clinician preference. Results suggests that guidelines may have a de-biasing influence on clinical judgment. Subject to limitations pertaining to the subject sample and population, clinical paradigm, guideline, and study procedure, the data support the use of a compatibility test to describe how clinicians make patient-specific forecasts.