Few studies have examined the relationship between anxiety and response to repetitive transcranial magnetic stimulation (rTMS) in patients with unipolar depressive disorder (UDD) and bipolar depressive disorder (BDD). The primary aim of this study was to investigate the correlation between anxiety symptoms and the response to rTMS in individuals with comorbid anxiety, in both UDD and BDD patients. The secondary aim was to evaluate the efficacy of rTMS in reducing depressive symptoms, anxiety, and different subtypes of anxiety disorder.

A total of 379 outpatients (214 UDD, 165 BDD) underwent 20 sessions of either right unilateral low-frequency rTMS or sequential bilateral rTMS targeting the dorsolateral prefrontal cortex (DLPFC). Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-II) were used for assessment.

Binary logistic regression analysis indicated that pre-treatment physical anxiety scores showed a negative correlation with rTMS response, while subjective anxiety scores were positively associated. Distinct and overlapping response profiles for UDD and BDD patients with comorbid anxiety were identified based on anxiety symptoms. Predictive values for the BDD group were more reliable than those for the UDD group (PPV: 75 %, NPV: 77 %). Moreover, both unilateral and bilateral rTMS significantly reduced depressive symptoms as well as physical, subjective, and panic-related anxiety symptoms.

The findings suggest that in both UDD and BDD, physical anxiety symptoms are linked to less response to rTMS, whereas subjective anxiety symptoms are associated with more response. Future prospective studies are required to confirm the predictive value of anxiety symptoms in UDD and BDD patients who suffer from comorbid anxiety.

This study evaluates whether neurofeedback training (NFT) to boost alpha wave activity in the central brain may effectively mitigate persistent insomnia in patients with remitted depression and anxiety. Thirty-two participants in clinical remission from depression or anxiety were enrolled and evaluated for insomnia severity. Individuals were randomly assigned in a single-blinded manner to either NFT or the sham treatment. The effectiveness of the intervention was measured using recognized scales for depression, anxiety and sleep quality. While subjective sleep quality, measured by the PSQI, showed significant improvements in the active group compared to the sham group at post training, 1-month, 3-month, and 6-month follow-up, objective measures of sleep quality largely remained within the normal range, with few significant changes observed. Specifically, the active group exhibited notable improvements in alpha amplitude and duration during NFT sessions, which were not seen in the sham group. This highlights the potential of NFT as a complementary approach for improving sleep perception in this population, but further research is needed to confirm its effects on actual sleep architecture and long-term outcomes.

Climate change is one of the greatest threats to human life, and news about it can significantly impact mental health. Furthermore, doomscrolling, that is habitual negative consumption, may further exacerbate these effects. Understanding the associated risks and protective factors is crucial for supporting the most affected groups. However, no research has examined the relationship between doomscrolling and climate change news.

We employed a cross-sectional design to investigate the relationship between general doomscrolling and climate change-specific doomscrolling in a sample of 365 participants. Furthermore, we examined the influence of demographic factors, risk factors (anxiety and depression), and protective factors (social support and coping skills) on both types of doomscrolling.

Analyses of the final sample revealed a significant positive correlation between general doomscrolling and climate change-specific doomscrolling. Additionally, the study suggests a gender difference, with females exhibiting a greater propensity for doomscrolling behavior. Risk factors for doomscrolling were explored, with both anxiety and depressive symptoms demonstrating positive associations. Depression correlated positively with doomscrolling for females, and it displayed a negative correlation for males. Anxiety consistently demonstrated a positive association with general and climate change-specific doomscrolling. Social support did not significantly protect against either form of doomscrolling. Conversely, the study identified coping skills as a potential protective factor, albeit with a modest effect size.

Given climate change's continued prominence within the news cycle, developing effective coping mechanisms becomes increasingly crucial. This study underscores the importance of designing interventions that empower individuals to navigate the negativity inherent in news consumption.

The primary aim was to investigate the relationship between serum growth differentiation factor-15 (GDF15) levels and non-motor symptom (NMS) in Parkinson's disease (PD) patients. The secondary aim was to explore the diagnostic value of GDF15 for specific NMS.

A total of 102 PD patients were enrolled in this study, including 47 males and 55 females. Doctors collected the clinical and demographic information of patients and detected the level of serum GDF15. Next, linear univariate and multivariate linear regression analyses were used to assess the correlation between GDF15 and NMS. Receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of GDF15 and evaluate its diagnostic value.

In PD patients, there was no significant difference in serum GDF15 levels between males and females (p = 0.831). Age of PD onset, pesticide use, depression, sexual dysfunction, Epworth Sleepiness Scale (ESS) and Hamilton Depression Scale (HAMD) were associated with serum GDF15. Serum GDF15 was negatively correlated with HAMD, depression and sexual dysfunction and positively correlated with ESS. Each 10 pg/ml increase in serum GDF15 levels was associated with a 4% lower risk of depression and a 5% lower risk of sexual dysfunction. Notably, serum GDF15 may be a biomarker for distinguishing depression and sexual dysfunction in PD patients.

Elevated serum GDF15 reduced the risk of PD with depression and sexual dysfunction. Serum GDF15 may be a biomarker for distinguishing depression and sexual dysfunction in PD patients.

Treating attention disorders is one of the hottest studies in the field of rehabilitation medicine. Stroke leads to the destruction of the functional network of the cerebral cortex and impairs the cognitive function of patients. Improvement of attention plays a pivotal role in the rehabilitation of patients who have had a stroke. Repetitive transcranial magnetic stimulation has achieved relatively positive efficacy in rehabilitation applications for patients who have had a stroke; however, its optimal parameters and mechanism of action regarding poststroke attention deficits are still elusive. Therefore, this will be an in-depth study exploring the mechanisms of high-frequency transcranial magnetic stimulation on cerebral functional connectivity in patients with poststroke attentional dysfunction.

This single-centre randomised controlled trial will involve 120 patients who have had a stroke. They will be randomly allocated to either a high-frequency transcranial magnetic stimulation group or a control group (sham stimulation group). The intervention will take place 5 days a week for 2 weeks. The primary outcome will be a comparison between and within the two groups from baseline to 2 weeks before and after the intervention, and will be based on quantitative electroencephalography to explore the connectivity of brain networks and to assess the efficacy of high-frequency transcranial magnetic stimulation on attentional functioning after stroke. Functional near-infrared spectroscopy imaging, a range of neuropsychological scales, activities of daily living, motor function scores and biological indicators will be used as secondary outcome indicators.

This study has been approved by the Ethics Committee of the First Hospital of Shanxi Medical University (NO. KYLL-2023-264 and NO.KYXZ-2024-005). All participants will sign the informed consent form. Findings will be published in peer-reviewed journals and presented at conferences.

ChiCTR2400082383.

The neuroelectrophysiology mechanisms of the connection between nonsuicidal self-injury (NSSI) and impairment of social decision-making function remain unknown. As the event-related potentials (ERPs) technique has been widely used in neurobiology research because of its advantage of high temporal resolution, we conducted this study to explore the ERPs of decision-making function among adolescents with NSSI.

This study was designed to compare patients with mood disorder plus NSSI with mood disorder patients without NSSI using a 2:1 ratio. Participants aged 12-18 years were recruited from the outpatient department of psychiatry at Nanfang Hospital. Sociodemographic and psychological data were collected. The Ultimatum Game, a task examining individuals' social decision-making, was conducted with the ERP technique to record participants' neural responses. The associations between ERPs characteristics and psychological factors were examined by using correlation analysis and regression analysis.

In total, 90 participants were eligible, with 60 in the NSSI group and 30 in the non-NSSI group. N1 latency in the unfair condition was positively correlated with Difficulties in Emotion Regulation Scale scores (r = 0.257), whereas P2 latency in the fair condition was correlated with agreeableness personality (r = 0.250). Regression analysis revealed that N1 latency in the unfair condition was positively associated with NSSI (ORs ranged 1.07-1.10), whereas P2 latency in the fair condition was negatively associated (ORs ranged 0.95-0.97).

NSSI patients tended to exhibit impairment in decision-making function including initial cognitive value judgment, attentional allocation, and working memory process. ERPs characteristics including N1 latency and P2 latency may be predictors of NSSI.

Citing nonresponse to conventional treatments, neuromodulation based treatments are needed in generalized anxiety disorder (GAD). Data regarding continuous TBS (cTBS) in GAD has been anecdotal. Citing right posterior parietal cortex (PPC) hyperconnectivity in GAD, we aimed to study the effect of intensive cTBS targeting PPC in a randomized rater-blinded placebo-control design.

Forty-four patients age range 18-59 years (baseline Hamilton Anxiety Rating Scale [HAM-A] score >18 or Clinical Global Impression Severity [CGI-S] score of ≥4) were randomly allocated to active cTBS (n = 22) and sham cTBS (n = 22) groups using block randomization method. They received 10 cTBS sessions, 2 sessions per day (total of 1200 pulses) for 5 days in a week at 80% motor threshold. HAM-A, World Health Organization's abbreviated quality of life assessment (WHOQOL-BREF), and CGI-S were assessed at baseline, after the last session, and at 2 weeks after cTBS with gender as covariate. Intention-to-treat analysis was conducted and missing values were replaced using the last observation carried forward method.

On repeated measures analysis of variance, a significant between-group time effect for HAM-A (F = 29.6; P = 0.001; ηp2 = 0.420), CGI-S (F = 24.7; P = 0.001; ηp2 = 0.376), and WHOQOL-BREF (F = 29.6; P = 0.001; ηp2 = 0.420). Logs of odds of response of >50% improvement in HAM-A between active and sham groups is 3.27 (95% CI [0.345, 6.20]). No major side effects were reported and none discontinued the trial because of side effects.

Our trial concludes that cTBS of posterior parietal cortex is safe, well-tolerated, and effective in GAD.

This study evaluates the effectiveness of a novel mindfulness-based intervention called RADO (Relaxation, Aromatherapy, and Prayer) for reducing anxiety and improving the quality of life in children with cancer.

A quasi-experimental pre- and post-control group design was used. Participants included 66 children with cancer aged 10-17 years, diagnosed with cancer for at least 3 months, currently undergoing treatment, and able to communicate verbally, and recruited from three hospitals in Bandung, Indonesia. The study used consecutive sampling. The intervention group received a seven-day RADO program involving mindfulness-based relaxation, aromatherapy, and prayer. Anxiety and QoL were measured using the Hamilton Rating Scale for Anxiety (HRS-A) and Pediatric Quality of Life Inventory (PEDQL 3.0), respectively. Data were collected at baseline (T0), day three (T1), and day seven (T3). Statistical analysis included repeated ANOVA and independent t-tests.

By day seven (T3), the intervention group showed a significant reduction in anxiety (p < 0.001) and improved QoL (p = 0.001) compared to the control group. Repeated ANOVA revealed significant within-group changes in the intervention group across time points, while no significant changes were observed in the control group. Following the intervention, males and a diagnosis of ALL demonstrated slightly higher anxiety scores and quality of life scores than female and those with other cancer types. Additionally, individuals who underwent fewer chemotherapy cycles (<10) showed better outcomes in anxiety and quality of life than those with 10 or more cycles.

The RADO intervention significantly reduced anxiety and enhanced QoL among pediatric cancer patients, demonstrating its potential as a culturally tailored MBI for children undergoing cancer treatment. Further research is needed to explore long-term effects and cross-cultural adaptability.

Anhedonia is psychopathological dimension conceptualized as loss of pleasure in several activities. Although typically viewed as a characteristic feature of depressive episodes, anhedonic experience is also seen in other mental disorders. We aimed to investigate the relationship between anhedonia, separation anxiety, and attachment style in a large cohort of outpatients with mood and anxiety disorders, also considering its ties to suicidality.

384 consecutively recruited outpatients with mood or anxiety disorders were recruited and assessed with the Structured Clinical Interview for Mood Spectrum-Self Report (MOODS-SR) for anhedonia and suicidality, the Adult Separation Anxiety-Checklist (ASA-27), the Assessment of Adult Attachment Style Questionnaire (ASQ), the Hamilton Rating Scale for Depression (HAMD) and for Anxiety (HAM-A). Anhedonia score was calculated using eight items of the MOODS-SR encompassing the definition of anhedonia.

84 patients were diagnosed with adult separation anxiety disorder only (A-SAD), 32 patients had separation anxiety disorder only during childhood (C-SAD), 77 had both A-SAD and C-SAD, and 191 had no A-SAD/C-SAD. No differences were found in HAM-A and HAM-D scores between the diagnostic groups. Anhedonia score was significantly worse in the two groups with A-SAD. Regression analyses showed that HAM-D (p < .024), ASA-27 (p < .002) total scores and the ASQ domains of Confidence (p < .001) and Discomfort with Closeness (p < .002) were significant predictors of anhedonia. Anhedonia score (p < .001) and ASA-27 (p < .041) total score were significant predictors of suicidal thoughts and behaviors.

Adult separation anxiety is associated with anhedonia and suicide risk in outpatients with mood and anxiety disorders.

In general, traditional antidepressants often have limited efficacy in patients with major depressive disorder (MDD). Agomelatine, as an antidepressant with a different mechanism of action, might have adjunctive effects on traditional antidepressants. This study aimed to investigate the augmentation effect of agomelatine versus placebo in treating MDD patients who failed to respond to selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs).

This is an 8-week, multi-centred, double-blinded, randomized, and placebo-controlled trial. Participants diagnosed with MDD and demonstrated inadequate response to SSRI or SNRI lasting at least 2 weeks were randomly allocated to receive either agomelatine or placebo in conjunction with SSRIs or SNRIs. The 17 items of the Hamilton Depression Scale (HAMD-17) were employed to assess depression severity. The primary outcome is the total score of HAMD-17 at week 8. Secondary outcomes included HAMD-17 scores at weeks 2 and 4 and clinical remission and response over 8 weeks. Adverse events (AEs) reported in both groups were recorded. A linear mixed model was established for both primary and secondary outcomes.

A total of 123 eligible participants were included, among which 60 were randomized into the agomelatine group, and 63 were randomized into the placebo group. The between-group difference in HAMD-17 score reduction from baseline to week 8 was not significant (difference = - 0.12, 95% CI = - 3.94 to 3.70, P = 0.90; Cohen's d = 0.022). In addition, we did not observe significant differences between the two treatment groups for secondary outcomes, including response remission, and AEs.

This study did not obtain significant findings in favour of the augmentation effect of agomelation for MDD patients. However, agomelatine was generally well tolerated and demonstrated a favourable safety profile when used in combination with SSRIs and SNRIs.

This trial is registered at ClinicalTrials.gov ( https://clinicaltrials.gov ), the registration number is NCT04589143.

Major depressive disorder (MDD) is associated with reduced heart rate variability (HRV), but its link to circadian rhythm modulation (CRM) of HRV is unclear. Given that depression disrupts circadian rhythms, assessing HRV fluctuations may better capture the CRM and the related autonomic nervous system (ANS) alterations, potentially enhancing our understanding of the pathophysiological mechanisms of MDD. This study aimed to explore the relationship between CRM of HRV and MDD, and to identify potential biomarkers for MDD using machine learning (ML). A total of 165 MDD patients and 60 healthy controls (HCs) were enrolled in the study, with each participant completing 24-h Holter electrocardiogram (ECG) monitoring and psychological scale assessments prior to receiving antidepressant treatment. The circadian rhythm of HRV was quantified using a cosine regression model, and seven typical ML models were employed to distinguish MDD from HCs. MDD patients exhibited a significant decrease in average diurnal HRV indices, particularly during night-time, along with reductions in the parameter M of HRV circadian rhythms compared to HCs. Depression severity was negatively associated with the parameters M of RMSSD, PNN50, HF, while positively associated with the parameter M of LF/HF ratio. Furthermore, the gradient boosting machine (GBM) model demonstrated the best performance in classifying MDD (accuracy 0.823, AUC 0.868), and a final GBM model was developed with 12 selected features. This study provides new insights into the relationship between circadian rhythm abnormalities and MDD, highlighting the potential of using CRM of HRV as novel biomarkers for MDD pathophysiology and clinical applications.

Hypoparathyroidism, sensorineural deafness, and renal dysplasia (HDR) syndrome is a rare autosomal dominant genetic disease associated with mutations in the GATA3 gene, which encodes GATA3 that plays essential roles in vertebrate development. This study aimed to identify and report the pathogenic mutation in GATA3 in a Chinese family diagnosed with HDR syndrome and determine its functional impacts in vivo.

The clinical features of a 25-year-old male patient with HDR syndrome and his parents were collected. GATA3 gene exome sequencing and Sanger sequencing were performed on the proband and his family, respectively. Functional analyses of GATA3 were performed using bioinformatics tools and zebrafish assays to determine pathogenicity and phenotype spectrum.

A novel, heterozygous, missense mutation in exon 4 of the GATA3 gene, c.863 G > A, p.Cys288Tyr, in the proband and his mother who presented the complete HDR triad, was predicted to be deleterious by in silico tools. 3D structure modeling showed that the variant caused significant structural changes. In vivo studies using a zebrafish animal model revealed the deleterious impact of the variant on the gill buds, otoliths, and pronephros.

We identified a novel missense mutation, GATA3 p.Cys288Tyr, within a family with HDR syndrome and delineated it as a loss-of-function variant in vivo. This expands the spectrum of GATA3 mutations associated with HDR syndrome in the Chinese population and mimics HDR-related changes in vivo.

Depression is the most common psychiatric disorder diagnosed in patients with Parkinson's disease (PD). A direct role in PD depression for loss of dopaminergic terminals and dopamine-transporter (DAT) expression in the striatum is revealed by many studies.

The objective was to discern the relationship between DAT neuroimaging and risk of depression in PD.

One hundred and ninety-eight PD patients (101 with depression, 97 without depression) were evaluated using an extensive protocol from 2015 to 2023. DAT availability at striatal terminals was assessed with single-photon emission computed tomography with 123I-Ioflupane. Specific binding ratio (SBR) of 123I-Ioflupane and the whole striatum asymmetry index (SASI) were calculated. Data were analyzed with univariate/multivariate models as well as receiver operating characteristic (ROC) curves.

A logistic regression model adjusting for confounding risk factors of depression indicates that SASI and PD duration are associated with the odds of having parkinsonian depression. SASI is the strongest predictor of risk of parkinsonian depression. Following ROC analysis, SASI is found to be an accurate factor for detecting parkinsonian depression because a cutoff value of 3.4895 of SASI shows good accuracy (0.813), sensitivity (81.1%), and specificity (80%). Higher SASI is also linked to more disease-related limitations in activities of daily living.

The whole SASI is the strongest predictor of risk of parkinsonian depression. The findings could be valuable in evaluating depression in PD patients.

Background and aims:Aframomum melegueta (A. melegueta) from the ginger family is appreciated for its pungent seeds widely used in African ethno-medicine. Among the several biological activities associated with the seed's preparations, some preclinical studies suggest a set of neuroactive properties that have not been tested in humans to date. We performed a clinical trial to investigate the effects of A. melegueta seed extracts on anxiety, stress, mood, and sleep in healthy subjects with moderate anxiety levels. In vitro pharmacological assays targeting the endocannabinoid, serotoninergic, and GABAergic systems were conducted to elucidate the underlying mechanism of action. Methods:A. melegueta standardized to 10% total vanilloids (primarily 6-gingerol, 6-shogaol, and 6-paradol) was obtained after hydroalcoholic extraction and the spray-drying microencapsulation process. Subjects consumed 50, 100, or 150 mg of the extract daily for two days. A set of validated psychometric test questionnaires was collected before and 48 h after the first intake. A. melegueta extract interaction with canonical endocannabinoid receptors (hCB1R and hCB2R), the serotonin receptor (5HT1AR) and gamma-aminobutyric acid receptor (GABAA1R) was evaluated by the radioligand binding assay. Additionally, receptor functional assays and enzyme inhibition assays were conducted to test the extract's functional activity on the non-canonical endocannabinoid receptor (TRPV1) and the cannabinoid fatty-acid amide hydrolase enzyme (FAAH), respectively. Results: In vitro pharmacological tests showed that the A. melegueta extract activated TRPV1, modulated both hCB2R and 5HT1AR and inhibited FAAH, which is the enzyme primarily responsible for hydrolyzing endogenous anandamide. After a 48 h intake period, the extract significantly reduced anxiety and tension related to stress, improved overall mood, and enhanced sleep quality in the participants at doses ranging from 50 to 150 mg, with no reported side effects. Conclusions: This study supports the potential of the A. melegueta extract for anxiety reduction, mood improvement, stress mitigation, and sleep enhancement. The in vitro tests suggest that the extract's primary mechanism of action may involve the inhibition of FAAH, which is a key target in anxiety management.

Somatic symptom disorder (SSD) exacerbates subjective cognitive decline (SCD). This association can be significantly impacted by the mental well-being of the SSD patients. However, the underlying mechanisms remain obscure.

A total of 525 elderly patients, who visited the Department of Neurology of Fujian Medical University Union Hospital between October 2017 and August 2024, and the Department of Neurology of Quanzhou First Hospital Affiliated to Fujian Medical University between August 2022 and August 2024, were included in the study. Data of sociodemographics, medical history, somatic symptom disorder, subjective cognitive decline, depression, and anxiety were analyzed by simple, serial and moderated mediation models to evaluate the impact of depression and anxiety on the linkage between SSD and SCD.

SSD significantly affected SCD. Simple mediation analysis showed that depression and anxiety significantly mediated the association between SSD and SCD (βdepression = 0.079, 95% CI: 0.030 to 0.132; βanxiety = 0.058, 95% CI: 0.031 to 0.093). Serial mediation analyses indicated that the worsening of SSD exacerbates anxiety, in turn aggravating depressive symptoms and SCD (β b  = 0.044, 95% CI: 0.026 to 0.069). Moderated mediation model revealed that the depressive symptoms-conferred mediation of the correlation between SSD and SCD was moderated by anxiety symptoms (β = -0.073, 95% CI: -0.131 to -0.014).

These findings provided new insights into possible avenues for prevention and intervention of SCD through SSD-based treatments with a multifaceted approach to psychiatric disorders.

Religious and spiritual (R/S) struggles, such as questioning of faith, existential and ethical concerns, and interpersonal conflicts, are associated with depressive symptoms. Neuroinflammation is critical in major depressive disorder (MDD) and is linked to stress associated with R/S problems. This study aimed to investigate whether the presence of DSM-5 R/S problems contributes to neuroinflammation. We recruited 93 MDD patients and 93 healthy controls with and without R/S problems. MRI-based restricted fraction (RF) values, an index of neuroinflammation, were measured in the hippocampus, amygdala, and neocortex. Depression and anxiety were assessed using the Hamilton Depression and Anxiety Rating Scales (HAM-D, HAM-A), while R/S problems were quantified using the Religious and Spiritual Struggles Scale (RSS-14). Results revealed elevated RF values in the amygdala and hippocampus of healthy individuals and MDD patients with R/S problems relative to those without R/S problems, with the highest values in MDD patients with R/S problems. Importantly, R/S problems and depressive symptoms were independent predictors of RF values in the amygdala and hippocampus but not in the cortex. Elevated cortical RF values were associated with MDD. These findings indicate that R/S struggles are not secondary manifestations of depression but may independently contribute to neurobiological changes.

Interpersonal problems are a transdiagnostic risk factor for the development and maintenance of various psychiatric disorders, including anxiety and depression. Interventions that address these interpersonal challenges could therefore play a crucial role in enhancing mental health. This study aims to evaluate the efficacy and feasibility of a transdiagnostic group intervention, the Kiesler Circle Training (KCT), in improving interpersonal skills.

In a prospective randomised controlled trial (RCT), 156 outpatients with a primary diagnosis of either depression or anxiety disorder according to DSM-5, and significant interpersonal problems, will be investigated. All patients will receive individual, state-of-the-art cognitive behavioural therapy (CBT) during the study. They will be randomly assigned to one of two conditions: the experimental group will receive the KCT in group sessions, in addition to individual CBT, while the control group will receive only individual CBT. The KCT intervention consists of 1 introductory individual session and 12 weekly group sessions, each lasting 100 min, with groups of up to 10 patients. KCT includes five sequential modules: the interpersonal circle, nonverbal communication, verbal communication, conflict resolution and empathy training. It is hypothesised that the experimental group will show (a) greater reduction in interpersonal problems from pre-assessment to post-assessment and (b) greater symptomatic improvement regarding the primary diagnosis. Child maltreatment is expected to moderate the trajectory of interpersonal problems. This study aims to provide evidence for the feasibility of KCT as a modular transdiagnostic add-on approach for patients with interpersonal difficulties.

This study obtained approval from the ethics committees at the Charité Berlin, the Medical School of Berlin and the University of Greifswald. All results will be disseminated through peer-reviewed articles in scientific journals and contributions to national and international conferences.

DRKS00032467, NCT06170801 (see Supplementary Material).

Generalized anxiety disorder (GAD) is a prevalent anxiety disorder often comorbid with major depressive disorder (MDD). Previous neuroimaging studies have shown that white matter (WM) microstructural alterations are critical for efficient communication between brain regions, and play an important role in the pathology of GAD. However, the exact profile of WM abnormalities in GAD with and without comorbid MDD remain unclear. This study aimed to uncover them using a novel global probabilistic tractography technology named Tracts Constrained by Underlying Anatomy (TRACULA), and to assess the correlations between fascicle integrity and symptom severity.

We recruited 20 pure GAD (p-GAD) patients, 14 GAD comorbid with MDD (GAD + MDD) patients, and 41 age- and sex-matched healthy controls (HCs). All participants underwent T1 magnetic resonance imaging and diffusion tensor imaging. For each subject, 42 WM fiber bundles of the whole brain were successfully tracked and calculated with five metrics including volume, fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD). Group comparison were firstly performed between the whole GAD patients and HCs. Then, we compared the differences among the three groups (the p-GAD, GAD + MDD patients and HCs) using the one-way ANCOVA and post hoc analysis with the Bonferroni correction. Furthermore, correlations between abnormal WM metrics and clinical symptom severity were examined using partial correlations analyses among patients.

Compare to HCs, both p-GAD and GAD + MDD patients exhibited decreased FA values in left superior longitudinal fasciculus (SLF) II, and right dorsal of cingulum bundle (CBD); Moreover, GAD + MDD patients showed decreased FA, increased MD and RD values in the central and temporal section of the body of the corpus callosum (CC-BODY), right SLF I and II compared to HCs. Within the GAD + MDD group, GAD-7 scores were negatively correlated with FA values (r = -0.75, p = 0.008) and positively correlated with RD values (r = 0.7, p = 0.017) in the right CBD.

This study identified both shared and distinctive changes in GAD patients with and without MDD. The shared WM disruption in the p-GAD and GAD + MDD groups located in the left SLF and right CBD, while only GAD + MDD patients showed distinctive changes in the central and temporal sections of the CC-BODY and right SLF. Current study gave a comprehensive characterization of WM abnormalities among these patients, and highlighted TRACULA's value in identifying critical WM changes.

This study investigates the impact of nursing interventions, guided by behavior change theory, on the recovery of cardiac function and quality of life in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

A total of 120 patients scheduled for CPB in the Department of Cardiology at our hospital, from February 2021 to May 2023, were enrolled. According to the study protocol, patients were randomly assigned to either a control group (n = 60) or an observation group (n = 60) post-surgery. The control group received routine nursing care, while the observation group received nursing interventions based on behavior change theory, including health education, psychological support, and behavioral incentives. Informed consent was obtained from all patients. General patient data were collected from clinical records. Cardiac function was assessed using echocardiography. The wall motion score index (WMSI) and 6-minute walk distance (6MWD) were evaluated post-care. Serum levels of inflammatory cytokines TNF-α, IL-6, and IL-10 were measured via ELISA. Quality of life was assessed using the WHOQOL-BREF questionnaire, while anxiety and depression levels were evaluated using the HAM-A and HAM-D scales, respectively.

The baseline clinical characteristics and biochemical data of both groups were comparable (P > 0.05). The observation group showed a significantly higher left ventricular ejection fraction (LVEF) compared to the control group (P < 0.05), while both left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) were significantly lower (P < 0.05). Additionally, the observation group had a significantly lower WMSI score and a longer 6MWD (P < 0.05). Regarding inflammatory markers, TNF-α and IL-6 levels were significantly reduced in the observation group, while IL-10 levels were significantly elevated compared to the control group (P < 0.05). In terms of quality of life, the observation group reported significantly higher scores in physical health, mental health, social relationships, and environmental factors (P < 0.05). Moreover, anxiety and depression levels were significantly lower in the observation group, as evidenced by reduced HAM-A and HAM-D scores (P < 0.05).

Nursing care guided by behavior change theory significantly improves cardiac function and overall quality of life in patients recovering from cardiac surgery with CPB. This approach enhances LVEF, reduces left intraventricular diameter, lowers inflammatory cytokine levels, and improves mental health and social functioning. These findings underscore the importance of behavior change theory-based nursing interventions in optimizing postoperative recovery.

Recent studies revealed the effect of valproate (VPA) on brain structural changes in idiopathic generalized epilepsy (IGE). We aimed to investigate the volume of the entire hippocampus and subfields in patients with IGE, and explored their associations with VPA use.

A total of 211 patients with IGE and 97 healthy controls (HCs) were enrolled in this study. All participants underwent T1-weighted images. Each hippocampus was segmented into seven subfields using HippUnfold. The volumes of bilateral hippocampi and each hippocampal subfield were evaluated. Spearman correlation analyses were performed to identify VPA use related abnormalities in IGE. Subgroup analyses for juvenile myoclonic epilepsy (JME), epilepsy with generalized tonic-clonic seizures alone (GTCA), and absence epilepsy (AE) were conducted.

The volumes of bilateral hippocampi were reduced in IGE compared with HCs. Subgroup analysis showed significant volume reductions in right hippocampus and its subfields in GTCA. Additionally, significant volume reductions were detected in bilateral hippocampal volumes and subfields in IGE patients currently taking VPA compared with HCs. A negative correlation was observed between the left CA2 volume and the age of onset.

Our study revealed volume reductions in bilateral hippocampi in IGE, as well as in the right hippocampus and its subfields in GTCA. Abnormalities in both subfields and the whole hippocampus were associated with VPA use. These findings suggest that VPA may have more extensive neuroanatomical effects in IGE, potentially accounting for the heterogeneity observed in neuroimaging studies.

Motor and non-motor symptoms can negatively affect quality of life (QoL) for people with Parkinson Disease (PD). Our purpose was to investigate the effects of group exercise (GE) compared to individual exercise (IE) and usual care (UC) on QoL for people with PD. A systematic review and meta-analysis were performed with randomized controlled trials that studied the effects of GE compared to IE and UC on QoL for people with PD.

The systematic search was performed in EBSCO, PubMed, and Science Direct databases. Quality of methodology was assessed using the Cochrane GRADE approach. Thirteen studies met all inclusion criteria and were included in the analysis.

No significant difference was found on QoL between GE and IE; however, QoL was significantly improved with GE compared to UC. Results were based on low to moderate quality of evidence.

Based on low to moderate quality of evidence, GE has a similar effect on QoL when compared to IE and has a small and statistically significant effect when compared to UC, regardless of the patient reported outcome measure used or the total volume of exercise prescribed. GE may be an appropriate option for people with PD to improve their QoL.

Craving is a core factor driving drug-seeking and -taking, representing a significant risk factor for relapse. This study aims to identify neuroanatomical biomarkers for quantifying and predicting craving.

The study enrolled 94 ketamine-dependent users and 103 healthy controls (HC). Utilizing support vector regression (SVR) with 10-fold cross-validated framework, we developed a neuroanatomical craving model based on measures of regional cortical thickness (CT), surface area (SA), and subcortical volume (SV) derived from T1 images. The generalizability of neuroanatomical craving model was examined in an independent set. Spatial correlation analysis was employed to assess the relationship between the regional contribution to craving and density maps of receptors/transporters from previous molecular imaging studies.

The neuroanatomical craving model identified neuroanatomical biomarkers that predicted self-report craving (r = 0.635). The most importance of predictors of craving included the SA of the left medial orbitofrontal cortex and the left supramarginal gyrus, CT in the left caudal anterior cingulate, the left cuneus, the right lateral occipital cortex and the right lingual gyrus, as well as the left amygdala GMV. Importantly, these predictors were generalized to an independent sample. Moreover, nodal contribution to predicted craving scores were associated with DA2, 5-HTa, 5-HTb receptor and serotonin reuptake transporter densities.

The results offer a key perspective on craving prediction among ketamine-dependent users, and identify neuroanatomical areas associated with craving in the frontal and parietal regions. Additionally, the underlying neuroanatomical structures involved in the craving process may be linked to the dopaminergic and serotonergic systems.

There has been a lack of clarity about the mechanisms of widespread network dysfunctions after stroke. This study aimed to reveal dynamic functional network alternations following stroke based on lesion and brain perfusion. We prospectively enrolled 125 acute ischaemic stroke patients (25 were transient ischemic attack (TIA) patients) and 49 healthy controls with assessed the severity of their depression, anxiety, fatigue, and apathy. We performed dynamic functional network connectivity (DFNC) analysis using the sliding window method. The common static FC biomarkers of stroke were used to define functional states and calculated stroke-specific changes in dynamic indicators. Next, ridge regression (RR) analyses were performed on the dynamic indicators using voxel-wise lesion maps, cerebral blood flow (CBF) difference maps (removal of voxels overlapping lesions) and a combination of both. Mediation analyses were used to characterize the effect of dynamic networks changes on the relationship between lesion, CBF, and neuropsychological scores. Our results showed that DFNC identified three functional states with three dynamic metrics extracted for subsequent analyses. RR analyses show that both CBF and lesions partially explain post-stroke dysfunction (CBF: dynamic indicator1: R2 = 0.110, p = 0.163; dynamic indicator2: R2 = 0.277, p = 0.006; dynamic indicator3: R2 = 0.125, p = 0.121; lesion: dynamic indicator1: R2 = 0.132, p = 0.109; dynamic indicator2: R2 = 0.238, p = 0.015; dynamic indicator3: R2 = 0.131, p = 0.110). In addition, combining the two can improve the efficacy of explanations. Finally, exploratory mediation analyses identified that dynamic functional network changes can mediate between CBF, lesion and neuropsychiatric disorders. Our results suggest that CBF and lesion can be combined to improve the interpretation of dynamic network dysfunction after stroke.

Major depressive disorder (MDD) is a recurrent and persistent mental illness. However, there is a lack of research that distinguishes the severity of comorbid anxiety disorders in MDD, and insufficient evidence exists regarding the prevalence of MDD patients with comorbid moderate-to-severe anxiety in the Chinese population.

The study included 1718 MDD patients (894 with moderate-to-severe anxiety symptoms and 824 without moderate-to-severe anxiety symptoms). Clinical symptoms and development were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale-14 (HAMA-14), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI). The blood pressure and thyroid hormone levels were measured.

We found that the incidence of MDD patients with moderate-to-severe anxiety symptoms was 52.04%. The prevalence of recent suicide attempts in MDD comorbid moderate-to-severe anxiety patients was 31.8%, which was 4.24 times higher than that in patients without moderate-to-severe anxiety. Additionally, suicide attempters had elevated levels of thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), thyroid peroxidases antibody (TPOAb), systolic blood pressure (SBP), and diastolic blood pressure (DBP) compared to non-suicide attempters. We further identified CGI score, TSH, TPOAb, and DBP as influential factors for recent suicide attempts in MDD individuals who had moderate-to-severe anxiety symptoms. These indexes could distinguish between suicide attempts and non-suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

Our findings mainly indicated a high prevalence of recent suicide attempts in MDD patients with moderate-to-severe anxiety. Several clinical correlates, thyroid hormones, and blood pressure might contribute to recent suicide attempts in MDD patients with moderate-to-severe anxiety symptoms.

The aim of the study was to evaluate the concomitant psychiatric disorders of anxiety and depression in patients with epilepsy caused by low-grade brain tumors (LBTs). We retrospectively reviewed the clinical data of patients who underwent preoperative neuropsychological evaluations of anxiety and depression and subsequent epilepsy surgery for LBTs. The univariate and multivariate analyses were conducted to analyze the risk factors of the occurrence of anxiety and depression. Of the 107 patients included in the study, 42 patients (39.3%) were female, and 28 patients (26.2%) were children. The median age at surgery was 22 years (interquartile range [IQR]: 17-27 years old), the median age of seizure onset was 12 years (IQR: 6-18 years old), and the median duration of epilepsy was 84 months (IQR: 42-180 months). In total, 21 patients (19.6%) had psychiatric disorders of anxiety, and 26 patients (24.3%) had psychiatric disorders of depression. Through univariate and multivariate analysis, discordant (vs. concordant) interictal electroencephalogram (EEG) findings were found to be related to the presence of anxiety (P = 0.035, odds ratio [OR] = 3.35). Discordant (vs. concordant) ictal EEG findings (P = 0.015, OR = 4.44) and temporal location of tumor (P = 0.015, OR = 13.52) were found to be associated with the presence of depression. Psychiatric disorders of anxiety and/or depression could frequently occur in patients with epilepsy caused by LBTs. Thus, early screening and mental intervention are necessary, especially for those with discordant or wider epileptic discharges and temporal invasion of tumors.

Background: Quantitative electroencephalography (qEEG) data can facilitate the monitoring of treatment progress and the evaluation of therapeutic responses in patients with Major Depressive Disorder (MDD). This study aims to compare the qEEG data of MDD patients and healthy controls, both before and after treatment, to assess the effect of treatment response on neural activity. Methods: A total of 72 patients, aged 18-60, who had not used any psychopharmacological medication for at least two weeks, were included in the study. Based on a minimum 50% reduction in scores on the Hamilton Depression Rating Scale (HDRS-17) and Hamilton Anxiety Rating Scale (HARS), the patients were divided into two groups: responders (n = 51) and non-responders (n = 21). qEEG data were recorded before and after treatment. Results: Responders exhibited a significant shift in cortical activity-particularly in theta, alpha, and high-beta power-toward patterns resembling those observed in the healthy control group (improvement range: 15% to 67%). In contrast, non-responders showed minimal changes in cortical activity (improvement range: 38% to 46%). These findings suggest that while qEEG spectral data reflect marked neural changes in responders, no significant alterations occur in non-responders. Conclusion: The use of qEEG spectral analysis to monitor MDD patients provides valuable insights into treatment efficacy. The distinct patterns of cortical activity observed across most brain regions before treatment, compared to healthy individuals, highlight the potential of qEEG to predict treatment outcomes.

The study aims to explore the effects of music therapy combined with hospice care on the quality of life and negative emotions of elderly patients with advanced breast cancer.

A retrospective analysis was performed on 240 elderly patients with advanced breast cancer who were treated at Yancheng Third People's Hospital and Yancheng First People's Hospital from January 2020 to June 2024. The patients were classified into the hospice care group and the music therapy group, with 120 cases in each group. The hospice care group received only hospice care, while the music therapy group received music therapy combined with hospice care. Quality of life [Functional Assessment of Cancer Therapy-Breast (FACT-B)], pain level [visual analog scale (VAS)], cancer-related fatigue symptoms [Brief Fatigue Inventory (BFI)], negative emotions [Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD)], and medication compliance were compared between the two groups.

After care, the FACT-B scores of the music therapy group were significantly higher than those of the hospice care group, whereas its VAS, BFI, HAMA, and HAMD scores were significantly lower in the music therapy group compared to the hospice care group (P < 0.05). The total compliance rate of the music therapy group was 96.67%, which was significantly higher than that of the hospice care group (80.00%, P < 0.05).

Music therapy combined with hospice care for elderly patients with breast cancer can effectively relieve their pain and cancer-related fatigue symptoms, reduce their negative emotions, and improve their therapy compliance and quality of life.

Electroconvulsive therapy (ECT) is a commonly used alternative for treatment-resistant depression (TRD). Although esketamine has a rapid pharmacological antidepressant action, it has not been studied as an ECT anesthetic. The objective of this study was to compare the efficacy and safety of esketamine with propofol when both are used as ECT anesthetic agents.

Forty patients with TRD were assigned to one of two arms in a double-blind, randomized controlled trial: esketamine or propofol anesthesia for a series of eight ECT sessions. Using a non-inferiority design, the primary outcome was the reduction in HAMD-17 depressive symptoms. The other outcomes were: rates of response and remission, anxiety, suicidal ideation, cognitive function, and adverse events. These were compared in an intention-to-treat analysis.

Esketamine-ECT was non-inferior to propofol-ECT for reducing TRD symptoms after 8 sessions (adjusted Δ = 2.0, 95 % CI: -1.2-5.1). Compared to propofol-ECT, esketamine-ECT also had higher depression response (80 % vs. 70 %; p = .06) and remission (65 % vs. 55 %; p = .11) rates but non-inferiority was not established. In four components of cognitive function (speed of processing, working memory, visual learning, and verbal learning) esketamine-ECT was non-inferior to propofol-ECT. The results for anxiety, suicidal ideation, and adverse events (all p's > .05) were inconclusive.

Esketamine was non-inferior to propofol when both are used as anesthetics for TRD patients undergoing ECT. Replication studies with larger samples are needed to examine the inconclusive results.

ChiCTR2000033715.

Malnutrition, post-stroke depression (PSD), post-stroke anxiety (PSA), and post-stroke fatigue (PSF) in stroke survivors have complex relationships and are associated with adverse stroke outcomes.

This research aims to explore the temporal and directional relationships between malnutrition, PSD, PSA, and PSF after stroke in older adults.

Patients aged 65 years and older with their first ischemic stroke from two centers were selected and assessed at baseline, 3 months and 12 months. Malnutrition was evaluated using the Controlling Nutritional Status (CONUT) score, the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI). PSD, PSA and PSF were measured with 24-item Hamilton Depression Scale (HAMD-24), 14-item Hamilton Anxiety Scale (HAMA-14) and Fatigue Severity Scale (FSS), respectively. The cross-lagged panel model (CLPM) was employed to investigate the temporal and directional relationships among these variables.

Among the 381 older patients included, 54.33%, 43.57%, and 7.87% were found to have malnutrition according to the CONUT, GNRI, and PNI scores, respectively. Significant bidirectional relationships were found between malnutrition and PSD, as well as between PSD, PSA, and PSF, but no significant bidirectional relationships between malnutrition, PSA and PSF were observed, irrespective of the malnutrition index used (CONUT, GNRI, or PNI).

Nutritional status and post-stroke neuropsychiatric disorders in older stroke survivors are worthy of attention. Specifically, early malnutrition after stroke can predict later PSD and vice versa. PSD, PSA, and PSF are mutually predictable. Further studies are required to investigate the mechanisms of these findings.

Prolonged grief disorder (PGD) is a multidimensional condition with adverse health consequences. We hypothesized that enhanced negative emotional bias characterizes this disorder and underlies its key clinical symptoms.

In a cross-sectional design, chronically grieving older adults (age 61.5 ± 8.9 years) experiencing probable PGD (n = 33) were compared with demographic- and time since loss-equated integrated (adaptive) grief participants (n = 38). To probe generalized negative affective reactivity, participants performed an emotional face-matching task during functional magnetic resonance imaging scanning and completed demographic and clinical assessments. Contrast maps (fearful + angry faces [-] shapes) were generated to determine group differences in brain activity within hypothesized affective and regulatory processing regions (amygdala, anterior insula, dorsal anterior cingulate, dorsolateral prefrontal cortex) and in exploratory whole-brain regression analyses.

The PGD group showed higher right amygdala activation to negative emotional stimuli than the integrated grief group (pcorrected < .05), which positively correlated with intrusive thoughts. Generalized psychophysiological interaction analysis revealed lower task-dependent functional connectivity (FC) between the right amygdala and posterior cingulate cortex/precuneus in PGD (pcorrected < .05), which negatively correlated with avoidance of loss reminders. Resting-state FC between the identified right amygdala and thalamus was higher in PGD (pcorrected < .05), which negatively correlated with loneliness.

Dysregulated amygdala-centric neural activity and FC during processing of negative affective stimuli and at rest appear to differentiate prolonged from integrated grief in older adults. Future investigations that use interventions to target amygdala-centric neural circuit abnormalities may provide new insights into the role of enhanced negative bias and related mechanisms that underlie PGD and support treatment efficacy.

To investigate the effects of depression on non-suicidal self-injury (NSSI) and related psychological conditions in adolescents with unipolar disorder (UD) and bipolar disorder (BD), and to provide a basis for accurate prevention and intervention of NSSI behaviors in adolescents.

This cross-sectional study collected data from adolescents aged 12-18 years with depressive episodes who exhibited NSSI behaviors and attended the psychiatric outpatient clinic of Huangshi City Psychiatric Specialized Hospital from 2018 to 2023. Depressive episodes were clinically diagnosed by two psychiatrists according to the ICD-10.

In terms of NSSI behavioral patterns and severity, adolescents with UD displayed more frequent behaviour of intentionally burning themselves with cigarettes and had more instances of self-inflicted suicidal thoughts that were not carried out compared to those with BD, and the differences between the two groups were statistically significant (P < 0.05). For psychological status, Nurses' Global Assessment of Suicide Risk (NGASR) scores were significantly higher in adolescents with BD than in those with UD (P < 0.05). There was a significant negative correlation between anxiety scores and the frequency of NSSI in adolescents with BD (P < 0.05); that is, the more anxious the adolescents with BD, the lower the frequency of NSSI. The NGASR scores of adolescents with UD and BD were significantly and positively correlated with the frequency of NSSI occurrences (P < 0.05); higher NGASR scores of adolescents with UD and BD corresponded with higher frequencies of NSSI.

The differences in NSSI behaviors between adolescents with UD and those with BD were statistically significant in terms of self-injury method and severity. Adolescents with UD experienced more severe consequences related to NSSI behaviors. Regarding psychological conditions, adolescents with BD are at a higher risk of suicide. An inverse relationship was observed between anxiety severity and the frequency of NSSI in adolescents with BD; severe anxiety was associated with lower NSSI frequency. Additionally, higher suicide risk was associated with a higher frequency of NSSI in adolescent patients with either UD or BD. Therefore, different prevention and intervention measures are needed to address NSSI behaviors in adolescents with UD and BD.

In people with schizophrenia, anxiety is highly prevalent and related to numerous negative outcomes; unfortunately, anxiety is both underreported and understudied in schizophrenia. The current review highlights the importance and utility of assessing anxiety in schizophrenia by addressing four main questions: (1) What does anxiety look like throughout the development of schizophrenia?; (2) How do we measure anxiety in schizophrenia?; (3) What are the mechanisms underlying anxiety in schizophrenia; (4) How do we treat anxiety in schizophrenia? We also provide take-home points and propose future directions for the field. We hope this emphasis on the critical role of anxiety in schizophrenia will help researchers appropriately identify the presence of anxiety, better address these symptoms, and improve the lives of people at risk for or experiencing psychosis.

Background: Adolescent treatment resistant depression (TRD) is increasing in recent years. While ketamine showed rapid antidepressant effects in adult TRD studies, research on its effectiveness in adolescents is limited. Methods: This study examines the effects of intravenous ketamine vs. midazolam on depressive and anxiety symptomatology assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Children's Depression Inventory (CDI) at two time points-2 h after initial infusion (T0+2h) and 24 h after the end of the treatment (Te+24h) in a sample of 55 adolescent TRD females (27 receiving ketamine, 28 midazolam). Results: At T0+2h, within-group comparisons revealed a significant reduction in MADRS and HAM-A scores compared to baseline in the ketamine and midazolam groups. At Te+24h, both groups demonstrated similar significant reductions in MADRS, HAM-A, and CDI scores compared to baseline. The MADRS assessment in the ketamine group showed 33% and 59% responders, and in the midazolam group, 14% and 46% responders at T0+2h and Te+24h, respectively. HAM-A evaluation in the ketamine group revealed 33% and 56% responders, and in the midazolam group, 11% and 39% responders at T0+2h and at Te+24h, respectively. CDI rating discovered 11% and 44% responders in the ketamine group and 4% and 21% responders in the midazolam group at T0+2h and Te+24h, respectively. Moreover, inner tension significantly decreased in ketamine compared to the midazolam group at Te+24h. Conclusions: Ketamine showed a reduction in depressive and anxiety symptoms during a short-term period with particular efficacy in alleviating inner tension over midazolam, suggesting its potential advantages in specific symptom relief in rarely studied adolescent TRD.

To explore the prevalence, trajectories, and predictors of poststroke fatigue in older adults after a first ischemic stroke.

A longitudinal observational cohort study.

Two hospitals.

A total of 381 patients aged ≥65 years with their first ischemic stroke were included. The mean (standard deviation) age was 71.1 (4.27) years, with 96 patients (25.2%) being women and 285 (74.8%) being men.

Not applicable.

Patients were assessed using the Fatigue Severity Scale at admission, 3 months, and 12 months. Growth mixture models were used to identify distinct fatigue trajectories, and baseline variables were analyzed to determine their association with these trajectories.

The prevalence of clinical fatigue was 39.11%, 33.33%, and 22.31% at admission, 3 months, and 12 months, respectively. Five distinct fatigue trajectories were identified: persistently low fatigue (class 1, 49.1%), persistently high fatigue (class 2, 21.5%), initial high but early decreasing fatigue (class 3, 15.0%), initial high but late decreasing fatigue (class 4, 8.7%), and increasing-then-decreasing fatigue (class 5, 5.8%). Multinomial logistic regression analysis revealed that several factors were significantly associated with high and persistent fatigue (class 2), including older age, lower social support, decreased physical activity, higher depression and anxiety scores, cognitive impairment, and greater stroke severity.

These findings indicate significant variability in the progression of fatigue among stroke survivors. Further research is necessary to determine the outcomes linked to these fatigue trajectory subgroups and to identify the most effective treatment strategies tailored to each specific subgroup.

Evidence-based assessment (EBA) is critical for successful diagnosis and treatment of adult anxiety disorders. First, diagnostic interviews are reviewed with emphasis on how these tools can be used inform clinical diagnoses. Second, clinician-rated measures and self-report scales used to characterize anxiety symptom severity in adults are discussed. Third, to further inform clinical care, rating scales that illustrate clinical profiles contributing to symptom maintenance and severity-namely accommodation and avoidance behaviors-are discussed. Lastly, a summary of recommendations for using EBA for the diagnosis and treatment of anxiety disorders in adults is shared.

Attention-deficit/hyperactivity disorder (ADHD) affects 4% to 5% of the general population. Homework sessions are frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lower family quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Poor academic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-based approaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, might offer an interesting alternative. We present our digital homework support program for children and adolescents, known as "Programme d'Aide Numérique aux Devoirs pour Enfant avec TDA-H" (PANDAH), along with the study protocol of our ongoing randomized controlled trial.

This study aims to test PANDAH's efficacy in improving homework performance and family quality of life.

Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is a multicenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomized controlled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2: PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access to the app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will be conducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the global Homework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the "intent-to-treat principle" (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQ score improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2) greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only; and (3) adherence to the PANDAH program, measured with in-app metrics.

Recruitment began in January 2024, and the trial is ongoing.

This study contributes to the digital transformation of health care. The use of smartphone apps in self-care and self-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-laden homework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven, it is crucial to have an academic conception and evaluation of such digital tools.

ClinicalTrials.gov NCT04857788; https://clinicaltrials.gov/ct2/show/NCT04857788.

PRR1-10.2196/44553.

Neurofilament light chain (NfL) levels were reliable biomarkers of neurodegeneration in Parkinson's disease (PD). Lipoprotein-related Phospholipase A2(Lp-PLA2) levels have also been increasingly studied in PD. We aimed to explore the association of plasma NfL and Lp-PLA2 with the diagnosis, motor subtypes and disease severity of PD. Plasma NfL and Lp-PLA2 were assayed separately in 106 participants (74 PD and 32 healthy controls, HC). The motor subtypes of PD were classified according to the MDS-UPDRS components, and motor and non-motor manifestations of patients were also evaluated. Subsequently, correlation analyses were performed. The plasma NfL levels were higher in the PD than HC, and were positively correlated with age, UPDRS II, UPDRS III and the modified Hoehn and Yahr staging scale (H&Y stage) in the PD. Moreover, plasma Lp-PLA2 levels were lower in the PD than HC, and were positively correlated with Parkinson's Disease Quality of Life Questionnaire (PDQ-39) in the PD. For further distinguishing tremor-dominant (TD) from postural instability and gait difficulty-dominant (PIGD), plasma Lp-PLA2 levels were higher in the TD than PIGD, but there was no significant difference in NfL. plasma Lp-PLA2 levels were positively correlated with UPDRS I, Hamilton Anxiety Rating Scale (HAMA) and PDQ-39 in the TD. These resultssuggest that NfL and Lp-PLA2 may be potential biomarkers for the diagnosis of PD. We first demonstrated the potential utility of plasma Lp-PLA2 in differentiating motor subtypes. These findings deserve further evidence in larger PD cohorts.

Non-suicidal self-injury (NSSI) behavior is a common issue in youth with depression while lacks a prognostic prediction model. This study aims to develop a nomogram for NSSI in youth with depression. A total of 701 patients were included in the analysis based a youth depression cohort. They were further divided into a training set and a validation set. The Lasso regression and binary logistic regression were used to select variables for the nomogram. The nomogram's discrimination, calibration, accuracy, clinical applicability, and generalization involved the use of metrics such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (HL) test, Brier score, calibration curve, decision curve analysis (DCA), and internal validation. The Delong test was employed to compare the ROC performance between the two models. These patients had an average age of 19.3+/-3.3 years, and 101 (20.6%) individuals reported NSSI. Five risk factors for NSSI were identified: age, age at first medication, previous instances of NSSI, academic stress score in the Adolescent Self-rating Life Events Check List (ASLEC), and somatic anxiety of the 14 item Hamilton Anxiety Rating Scale (HAMA-14). The training set and validation set of binary logistic regression-based model showed good discrimination (area under the curve (AUC) 0.781, 95% CI: 0.735 ~ 0.827; and 0.757, 95% CI: 0.682 ~ 0.831, respectively), calibration (P = 0.421 and 0.175, respectively), and accuracy (Brier score 0.119 to 0.155 and 0.109 to 0.168, respectively). A prognostic nomogram was developed and validated to assist clinicians in predicting NSSI of youth with depression.