European Journal of Psychiatry最新文献

{"title":"The role of 6-lead mobile ECG devices in monitoring QT interval in routine psychiatry clinics: A clozapine cohort survey","authors":"Leticia-Irene Muñoz-Manchado ,&nbsp;Natalia Jagodzinska ,&nbsp;Rudolf N. Cardinal ,&nbsp;Jose-Ildefonso Perez-Revuelta ,&nbsp;Julia B. Deakin ,&nbsp;Jose-María Villagrán-Moreno ,&nbsp;Emilio Fernández-Egea","doi":"10.1016/j.ejpsy.2026.100346","DOIUrl":"10.1016/j.ejpsy.2026.100346","url":null,"abstract":"<div><h3>Background and objetives</h3><div>Cardiovascular risk assessment is crucial to reduce excess mortality in schizophrenia. We aimed to evaluate the use of a recently developed portable electrocardiography (ECG) device to measure the corrected QT interval (QTc) in a United Kingdom National Health Service (UK NHS) clinical setting and to explore its relationship with clozapine plasma levels.</div></div><div><h3>Methods</h3><div>Electronic health records were reviewed over one year of routine clinical practice (Sep 2022–Sep 2023) in a cohort of clozapine-treated patients. Use of the portable ECG device and data from different QTc correction formulae were analysed. Correlations between QTc, clozapine dose, and plasma levels were tested.</div></div><div><h3>Results</h3><div>A total of 300 consecutive clinical appointments were included, covering 184 patients. QTc was recorded in 75% (<em>N</em> = 138) of patients. The prevalence of prolonged QTc varied by formula, ranging from 3% to 9.3% (<em>N</em> = 9–28 patients depending on the QTc used formula). In 63 patients with plasma clozapine concentrations measured within two months of ECG, no significant correlation was found between clozapine levels and QTc interval (<em>p</em> = 0.1).</div></div><div><h3>Conclusions</h3><div>Portable ECG devices provide a simple and accessible tool for cardiac monitoring in patients on antipsychotics in routine clinical care. Our findings indicate a non-significant trend towards an association between QTc duration and plasma clozapine levels, highlighting the value of integrated monitoring strategies.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100346"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors involved in working memory in patients with schizophrenia and bipolar disorder: The role of peripheral biomarkers","authors":"Gonzalo Paniagua ,&nbsp;Julia Rodríguez-Revuelta ,&nbsp;Leticia González-Blanco ,&nbsp;Manuel Couce-Sánchez ,&nbsp;Ainoa García-Fernández ,&nbsp;Francesco Dal Santo ,&nbsp;Pilar A. Sáiz ,&nbsp;M.Paz García-Portilla","doi":"10.1016/j.ejpsy.2025.100334","DOIUrl":"10.1016/j.ejpsy.2025.100334","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Cognitive impairment, especially working memory (WM) dysfunction, is a core feature of schizophrenia (SZ) and bipolar disorder (BD), influenced by various factors including lifestyle, psychopathology, pharmacological factors, inflammation, and metabolic dysfunction. This study aimed to investigate the role of metabolic, inflammatory, and intestinal permeability biomarkers in WM impairments in SZ and BD patients.</div></div><div><h3>Methods</h3><div>A cross-sectional, observational study included 146 outpatients (SZ=96, BD=50). We assessed sociodemographic, clinical, metabolic, and inflammatory markers. Cognitive performance was evaluated using the Screen for Cognitive Impairment in Psychiatry. Biomarkers included glycohemoglobin, C-reactive protein, and lipopolysaccharide-binding protein/soluble CD14. Multivariate analyses identified factors associated with WM dysfunction and, secondarily, with other cognitive deficits.</div></div><div><h3>Results</h3><div>WM impairment was present in 56.3 % of SZ and 52 % of BD patients, without inter-group differences. Independent predictors of WM dysfunction were antipsychotic polypharmacy (OR=2.415, <em>p</em> = 0.011), abdominal obesity (OR=2.884, <em>p</em> = 0.016), and elevated glycohemoglobin (OR=1.126, <em>p</em> = 0.020). While inflammatory and intestinal permeability markers correlated with metabolic parameters, they were not independent predictors of WM impairment.</div></div><div><h3>Conclusion</h3><div>WM deficits in SZ and BD are primarily associated with metabolic and pharmacological factors. Addressing modifiable metabolic factors, optimizing antipsychotic treatment, and exploring interventions such as metformin and lifestyle modifications may improve cognitive outcomes in these populations.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100334"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild motor signs in major depressive disorder: prevalence and clinical profile","authors":"Antonina Luca ,&nbsp;Alessandro Serretti ,&nbsp;Stefano Barlati ,&nbsp;Lisa Buson ,&nbsp;Valentina Menesello ,&nbsp;Anna Magistrali ,&nbsp;Rosana Carvalho Silva ,&nbsp;Giulia Perusi ,&nbsp;Gabriele Nibbio ,&nbsp;Stefano Bignotti ,&nbsp;Giovanni Battista Tura ,&nbsp;Raffaele Ferri ,&nbsp;Massimo Gennarelli ,&nbsp;Antonio Vita ,&nbsp;Alessandra Minelli ,&nbsp;PANDORA study group","doi":"10.1016/j.ejpsy.2026.100342","DOIUrl":"10.1016/j.ejpsy.2026.100342","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Motor abnormalities are recognized features of major depressive disorder (MDD). However, subtle forms of motor dysfunction are still largely unexamined in adults with MDD. The aims of the present study were to: 1) assess the prevalence of mild motor signs (MMS) in adults with moderate to severe depression, and 2) evaluate whether patients with MMS exhibit specific depressive symptom profiles.</div></div><div><h3>Methods</h3><div>Two-hundred forty-four participants (172 (70.5 %) women, mean age 46.8 ± 14.5, mean education 12.5 ± 3.6 years) from the PANDORA trial were enrolled. All the participants were assessed using the Hamilton Depression Rating Scale (HAM-D). MMS were assessed using the UKU Side Effects Rating Scale.</div></div><div><h3>Results</h3><div>Out of the 244 participants, 34 (13.9 %) were MMS+: 20 (58.8 %) had myoclonus, 11 (32.3 %) hyperkinesia, 7 (20.6 %) rigidity, 6 (17.6 %) tremor, and 3 (8.8 %) hypokinesia. The percentage of patients reaching <em>a</em> <strong>≥</strong> 20 % improvement in the HAM-D total score was higher in the MMS- group than in the MMS+ (95.1 % vs. 75.0 %, respectively). MMS+ participants had higher HAM-D total score and sub-items exploring work and abilities, psychomotor retardation, agitation, and hypochondriasis. These associations between MMS and depression severity, as well as the specific symptomatology profile, were confirmed in the multivariate analysis, adjusted for age and sex.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that MMS may reflect a distinct subgroup within MDD, potentially characterized by greater sensitivity to motor adverse effects and subtle differences in treatment response.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100342"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective and objective assessment of negative symptoms in patients with schizophrenia and their clinical and functional associations","authors":"Jozef Dragasek,&nbsp;Matus Hrebenar,&nbsp;Martina Ruzickova","doi":"10.1016/j.ejpsy.2025.100331","DOIUrl":"10.1016/j.ejpsy.2025.100331","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Negative symptoms significantly affect psychosocial functioning and prognosis in schizophrenia. While clinician-rated scales are standard practice, the clinical value of patient-reported subjective assessments remains underexplored. This study investigated associations between subjective (Self-evaluation of Negative Symptoms, SNS) and objective clinician-rated (modified Short Assessment of Negative Domain-negative subscale, m-SAND-N) assessments, their predictive relationships, and links with psychosocial functioning (Personal and Social Performance, PSP).</div></div><div><h3>Methods</h3><div>This cross-sectional analysis included 188 outpatients with schizophrenia from 20 psychiatric clinics in Slovakia. Participants completed the SNS, followed by structured clinical interviews assessing negative symptoms (m-SAND), clinical severity (CGI-S), PSP, insight, and adherence. Correlation analyses and hierarchical multiple regressions examined the relationships among demographic, clinical, subjective/objective negative symptoms, as well as psychosocial functioning.</div></div><div><h3>Results</h3><div>Clinician-rated negative symptoms (m-SAND-N) showed significant correlations with patient-reported negative symptoms (SNS; <em>r</em> = 0.38, <em>p</em> &lt; 0.001) and with poorer psychosocial functioning (PSP; <em>r</em> = 0.68, <em>p</em> &lt; 0.001). In hierarchical regression, objective negative symptoms were the principal factor associated with higher subjective ratings (β = 0.332, <em>p</em> &lt; 0.001). Conversely, higher SNS scores (β = 0.179, <em>p</em> &lt; 0.001), greater overall illness severity (CGI-S; β = 0.156, <em>p</em> &lt; 0.05) and poorer psychosocial functioning (PSP; β = 0.583, <em>p</em> &lt; 0.001) were jointly related to more severe clinician-rated negative symptoms, together accounting for 50.7 % of their variance. Subjective ratings of affective blunting did not correlate significantly with clinician assessments, highlighting a divergence between patient- and clinician-reported measures.</div></div><div><h3>Conclusions</h3><div>Integrating subjective patient assessments with objective clinician ratings provides a comprehensive understanding of negative symptoms, facilitating improved treatment approaches and psychosocial outcomes in schizophrenia. Clinicians should consider patient insight when interpreting discrepancies, especially in affective blunting.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100331"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discriminative utility and limitations of the strengths and difficulties questionnaire for ADHD in a referred clinical pediatric sample","authors":"Erica Fongaro ,&nbsp;Arnaud Carlier ,&nbsp;Alexandra Vauclare ,&nbsp;Judith Brisot-Dubois ,&nbsp;Damien Huzard ,&nbsp;Hervé Caci ,&nbsp;Hala Kerbage ,&nbsp;Diane Purper-Ouakil","doi":"10.1016/j.ejpsy.2025.100333","DOIUrl":"10.1016/j.ejpsy.2025.100333","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. However, access to diagnosis and treatment remains limited, requiring improved screening strategies. This study evaluates the discriminative utility of the Strengths and Difficulties Questionnaire (SDQ) for ADHD diagnosis in a clinical sample and explores group differences and the contribution of different informants.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 496 children aged 6–16 referred to a mental health clinic; 358 (72.2 %) received a clinical ADHD diagnosis. Baseline SDQ-Parent (SDQ-P) and SDQ-Teacher (SDQ-T) ratings were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the diagnostic performance of SDQ subscales against clinical ADHD diagnoses.</div></div><div><h3>Results</h3><div>ADHD diagnoses were more frequent in males (65.6 %) and in younger children (mean age = 9.53 ± 2.59). Hyperactivity/Inattention showed the highest discrimination (AUC = 0.806 for SDQ-P; 0.883 for SDQ-T). Sensitivity was high but specificity low (.21 (95 % CI [.09, .43]) for SDQ-P; .30 (95 % CI [.07, .65]) for SDQ-T), limiting differential diagnosis. Teacher ratings outperformed parent ratings (higher AUC and specificity), underscoring informant complementarity.</div></div><div><h3>Conclusion</h3><div>The SDQ—especially Hyperactivity/Inattention—offers useful screening discrimination in referred youth, with teacher ratings outperforming parent ratings; however, low specificity limits differential diagnosis, so confirmation requires structured clinical interviews using multiple informants.</div><div>Future work should test calibrated subscale thresholds and local norms to boost discrimination and clarify context effects on SDQ ratings.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100333"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145876950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The paradox of empathy for pain: Personality, adversity, and affective resonance in psychiatry","authors":"Mathilde Souchon ,&nbsp;Raffaella Calati ,&nbsp;Lissa Garcia Segui ,&nbsp;Madison Roopchand ,&nbsp;Adriana Foster ,&nbsp;Marta Maisto ,&nbsp;Daniele Romano ,&nbsp;Giuseppe Delvecchio ,&nbsp;Paolo Brambilla ,&nbsp;Fabio Madeddu ,&nbsp;Jorge Lopez-Castroman","doi":"10.1016/j.ejpsy.2026.100343","DOIUrl":"10.1016/j.ejpsy.2026.100343","url":null,"abstract":"<div><div>Empathy for pain (EfP) refers to the capacity to experience and understand others’ pain and represents a fundamental process for psychosocial functioning. Psychiatric literature on EfP remains at times paradoxical, reflecting both intra- and interindividual variability. Notably, EfP appears either diminished or heightened across various psychiatric conditions. This scoping review aims to synthesize current findings to identify unifying patterns, focusing specifically on the influence of early life adversity (ELA), adulthood stressors, and personality traits on EfP processes. The literature was reviewed across two core domains: the neurobiological mechanisms underlying EfP and psychiatric diagnoses characterized by empathic dysfunction. Therapeutic implications are also discussed.</div><div>EfP consistently recruits the anterior insula and anterior cingulate cortex. Exposure to stressors results in differential patterns of activation in this core network, depending on the nature and severity of the experienced stress. Severe ELA heightens sensitivity to negative emotional cues and disrupts the balance between emotional and cognitive components of empathy, while moderate ELA induces a global decrease in both. Stressors encountered in adulthood tend to blunt empathic responses overall. Personality traits and disorders show specific EfP patterns: individuals with borderline personality disorder tend to display heightened emotional responses to others’ pain, while those with psychopathic traits exhibit reduced emotional signal processing. Mentalization-based treatment has shown promising results in improving empathy deficits in personality disorders. Other approaches, such as mindfulness-based interventions and behavioral empathy training, may also support empathic functioning but remain under-investigated.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100343"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Onset ADHD symptoms in the general population: A scoping review of longitudinal trajectories in population-based cohorts","authors":"Sophie Bayard ,&nbsp;Clarisse Madiouni ,&nbsp;François Radiguer ,&nbsp;Maëva Roulin ,&nbsp;Sébastien Henrard","doi":"10.1016/j.ejpsy.2025.100337","DOIUrl":"10.1016/j.ejpsy.2025.100337","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The developmental validity of late-onset ADHD remains debated. This scoping review aimed to synthesize evidence from longitudinal trajectory studies in the general population to (1) examine the existence and characteristics of late-onset ADHD symptom trajectories, and (2) identify associated factors.</div></div><div><h3>Methods</h3><div>Following PRISMA-ScR guidelines, we systematically reviewed longitudinal studies published up to May 2025 that applied person-centered trajectory modeling to ADHD symptoms in population-based cohorts. Twelve eligible studies were included.</div></div><div><h3>Results</h3><div>Among the twelve studies included in this scoping review, ten identified at least one symptom trajectory consistent with late-onset ADHD, with prevalence estimates ranging from 3 % to 17.5 %, and were analyzed to examine associated factors. These late-onset trajectories were predominantly inattentive and less disruptive than persistent profiles, but consistently observed across cohorts but were reported in the majority of cohorts (10/12), not all. The most robustly supported associated factors included higher childhood cognitive functioning, fewer early externalizing problems, emerging internalizing psychopathology during adolescence, lower family socioeconomic status, female gender, and polygenic liability for ADHD. However, methodological variability, particularly in informant source, symptom measurement and model specification, significantly influenced identification. Notably, no study assessed sleep-wake disturbances, treatment history, contextual supports or neurological antecedents.</div></div><div><h3>Conclusion</h3><div>Late-onset ADHD trajectories are commonly identified in general population cohorts (10/12 studies). Their interpretation calls for a dimensional, developmentally sensitive framework. Future studies should incorporate overlooked domains such as sleep-wake functioning, treatment exposure, and neurological risk factors to refine clinical characterization and diagnostic criteria.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100337"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of benzodiazepines in primary care: prescriptions from 2010 to 2019 in Catalonia","authors":"Maria Antonieta Also Fontanet ,&nbsp;Sandra Murgui ,&nbsp;Elisenda Sant ,&nbsp;Mireia Sans-Corrales ,&nbsp;Antoni Sisó-Almirall ,&nbsp;Ariadna Mas ,&nbsp;Clàudia Valenzuela-Pascual ,&nbsp;Gerard Anmella ,&nbsp;Jordi Blanch ,&nbsp;Myriam Cavero ,&nbsp;Eduard Vieta ,&nbsp;Diego Hidalgo-Mazzei","doi":"10.1016/j.ejpsy.2026.100341","DOIUrl":"10.1016/j.ejpsy.2026.100341","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Benzodiazepine (BZD) consumption has increased globally, with Spain among the highest-use countries. This study examines factors associated with intensive BZD in Catalonia’s primary care (PC) from 2010–2019.</div></div><div><h3>Methods</h3><div>Analyzed data from 713,196 adults attending PC without mental health service contact, excluding children, adolescents, and individuals with alcohol use disorders. Intensive BZD use was defined as &gt;56 Defined Daily Doses within an 8-week period. A hurdle model with a negative binomial distribution assessed factors influencing initiation and duration of intensive prescriptions. Multiple imputation addressed missing covariates.</div></div><div><h3>Results</h3><div>Of the study population, 67,184 adults (9.4%) received intensive BZD prescriptions in at least one year. Persistent users—those with prescriptions in all 10 follow-up years—numbered 6,767 and were predominantly female (81.6%) and Spanish nationals (99.2%). After adjustment, 54 of 92 associations (58.7%) remained significant. The strongest for sex, hypertension, and nationality:Females showed a 39% increase in the odds of heavy BZD use, while non-Spanish nationality was associated with a 45% reduction. Hypertension increased the odds by 57%, constituting comorbidity with the greatest impact on heavy use.Among persistent users, the most frequent diagnoses were anxiety (15.1%), insomnia (13.3%), and depression (8.5%).</div></div><div><h3>Conclusions</h3><div>Findings show initiation and persistence of intensive BZD use are influenced by different factors: initiation relates to sociodemographic characteristics, while persistence is driven by medical complexity. Women, Spanish nationals, and patients with hypertension are at highest risk of long-term use, underscoring the need for targeted interventions and deprescribing strategies.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100341"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma and personality disorders in Danish treatment-seeking veterans","authors":"Ask Elklit ,&nbsp;Signe Fauerholdt Sørensen","doi":"10.1016/j.ejpsy.2025.100327","DOIUrl":"10.1016/j.ejpsy.2025.100327","url":null,"abstract":"<div><h3>Background &amp; objectives</h3><div>50.000 Danish soldiers have been deployed abroad during the last three decades. A recent study reported that 24 % were registered with either a psychiatric diagnosis or receiving psychotropic medication. We want 1) to explore the relationship between ICD-11 PTSD and complex PTSD (CPTSD), and severe personality pathology as well as clinical syndromes, and 2) to assess the mediating impact of social support, secondary trauma symptoms, and aggression for the two trauma diagnoses.</div></div><div><h3>Method</h3><div>142 male war veterans were assessed at intake to the outpatient services of a specialized trauma treatment facility. The participants completed an assessment battery. In addition to descriptive statistics, two multiple regression analyses were performed: one for PTSD and one for CPTSD.</div></div><div><h3>Results</h3><div>While less than half of the personality disorders and the clinical syndromes were associated with PTSD, almost all personality disorders and all the clinical syndromes were associated with CPTSD and to a much higher degree. 52 % of the variation of PTSD could be explained in the regression analysis with three significant factors in the final model: Anxiety, schizotypal personality disorder, and dissociation. In the similar analysis for CPTSD, 61 % of the variation was explained in the final model with Avoidant personality disorder and Negative Affectivity as significant factors. Social support and aggression were not significant predictors in either analysis.</div></div><div><h3>Conclusion</h3><div>The study supports the more severe sequelae associated with CPTSD compared to PTSD. The relationships between trauma disorders and personality pathology deserve more attention to inform the treatment of veterans.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 4","pages":"Article 100327"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health law in Europe: Structures, standards, and ethical dilemmas a comparative analysis of 38 national frameworks in light of international guidelines, regarding involuntary measures in mental healthcare services","authors":"João Cortes Cardoso ,&nbsp;Cíntia Águas Pereira ,&nbsp;Silvana Galderisi ,&nbsp;Mariana Pinto da Costa ,&nbsp;Meryam Schouler-Ocak ,&nbsp;Thomas Pollmächer ,&nbsp;Luís Madeira","doi":"10.1016/j.ejpsy.2025.100326","DOIUrl":"10.1016/j.ejpsy.2025.100326","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>In recent years, tensions have risen between the legislative context of Mental Health Laws (MHL) across Europe and the provisions set forth by the UN Convention on the Rights of Persons with Disabilities, pointing to ongoing discussions about autonomy and the conditions under which involuntary measures may occur.</div></div><div><h3>Methods</h3><div>A comparative analysis of national Mental Health Laws (MHL) across 44 European countries was conducted, focusing on legal frameworks for involuntary psychiatric care. It identifies 38 countries with MHL, excluding six without national legislation or where mental health is governed by regional frameworks. Data were collected from official sources and verified through the WHO Mental Health Atlas 2020. A total of 38 MHLs were analysed across four key domains: general definitions, formal procedures for involuntary admission, emergency procedures, and best practices in involuntary care.</div></div><div><h3>Results</h3><div>All MHLs require the presence of a mental disorder for involuntary admission, with 92 % also citing dangerousness. However, only 45 % provide a legal definition of mental disorder, and 29 % reference international diagnostic criteria (e.g., ICD, DSM). Procedures for involuntary admission are typically initiated by healthcare professionals (66 %), with courts serving as the primary deciding authority in 76 % of cases. Emergency detention durations vary, with many countries lacking clear limits. Best practices—such as distinguishing admission from treatment, allowing outpatient commitment, and requiring periodic legal review—are applied inconsistently. Only 14 countries explicitly prohibit controversial practices like psychosurgery or non-consensual ECT. While most laws emphasize protection of rights, the study highlights ethical tensions with the UN Convention on the Rights of Persons with Disabilities (CRPD), particularly around involuntary measures. Limitations include reliance on translated texts, the omission of subnational laws, and the lack of enforcement analysis.</div></div><div><h3>Conclusions</h3><div>These findings highlight the need for harmonized legal standards, enhanced procedural safeguards, and stronger rights-based frameworks in mental health legislation across Europe. Reforms should aim for standardized legal definitions, clearer procedures, and alignment with international norms, while remaining sensitive to clinical and cultural contexts.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 4","pages":"Article 100326"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}