Pub Date : 2026-01-01Epub Date: 2026-01-22DOI: 10.1016/j.ejpsy.2025.100340
Dian-Jeng Li , Shih-Jen Tsai , Ya-Mei Bai , Tung-Ping Su , Tzeng-Ji Chen , Mu-Hong Chen , Chih-Sung Liang
Background and objectives
The medical comorbidities associated with bipolar disorder (BD) impose a heavy burden on society. We aimed to investigate the association between parental BD and severe bacterial infection among their offspring.
Methods
We used data from the Taiwan National Health Insurance Research Database. Individuals whose parents were diagnosed with BD were identified as the index group, and a demographically matched control group was also selected. The primary outcome was hospitalization due to bacterial infection, and the bacterial pathogens were recorded. Cox regression models with multiple adjustments were used to estimate the hazard ratios (HRs) with 95 % confidence intervals (CIs).
Results
The study included 8707 offspring of parents with BD and 87,070 offspring of parents without severe mental disorders. After adjustments, the offspring of parents with BD had higher risks of severe bacterial infection (HR: 1.2, 95 % CI: 1.03–1.39), meningitis (HR: 1.45, 95 % CI: 1.02–2.06), and Klebsiella infection (HR: 3.76, 95 % CI: 1.58–8.94) than the controls. In addition, the offspring of fathers with BD had higher risks of severe bacterial infection, repeated severe bacterial infection, and septicemia than the offspring of fathers without a severe mental disorder.
Conclusions
We identified an association between parental BD and an increased risk of bacterial infection in their offspring. Further research is warranted to better clarify the detailed mechanisms behind it.
{"title":"Risk of severe bacterial infection among offspring of patients with bipolar disorder: A family-linkage study","authors":"Dian-Jeng Li , Shih-Jen Tsai , Ya-Mei Bai , Tung-Ping Su , Tzeng-Ji Chen , Mu-Hong Chen , Chih-Sung Liang","doi":"10.1016/j.ejpsy.2025.100340","DOIUrl":"10.1016/j.ejpsy.2025.100340","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The medical comorbidities associated with bipolar disorder (BD) impose a heavy burden on society. We aimed to investigate the association between parental BD and severe bacterial infection among their offspring.</div></div><div><h3>Methods</h3><div>We used data from the Taiwan National Health Insurance Research Database. Individuals whose parents were diagnosed with BD were identified as the index group, and a demographically matched control group was also selected. The primary outcome was hospitalization due to bacterial infection, and the bacterial pathogens were recorded. Cox regression models with multiple adjustments were used to estimate the hazard ratios (HRs) with 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>The study included 8707 offspring of parents with BD and 87,070 offspring of parents without severe mental disorders. After adjustments, the offspring of parents with BD had higher risks of severe bacterial infection (HR: 1.2, 95 % CI: 1.03–1.39), meningitis (HR: 1.45, 95 % CI: 1.02–2.06), and Klebsiella infection (HR: 3.76, 95 % CI: 1.58–8.94) than the controls. In addition, the offspring of fathers with BD had higher risks of severe bacterial infection, repeated severe bacterial infection, and septicemia than the offspring of fathers without a severe mental disorder.</div></div><div><h3>Conclusions</h3><div>We identified an association between parental BD and an increased risk of bacterial infection in their offspring. Further research is warranted to better clarify the detailed mechanisms behind it.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"40 1","pages":"Article 100340"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034313","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}
Pub Date : 2026-01-01Epub Date: 2026-01-02DOI: 10.1016/j.ejpsy.2025.100334
Gonzalo Paniagua , Julia Rodríguez-Revuelta , Leticia González-Blanco , Manuel Couce-Sánchez , Ainoa García-Fernández , Francesco Dal Santo , Pilar A. Sáiz , M.Paz García-Portilla
Background and objectives
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.
Methods
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.
Results
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, p = 0.011), abdominal obesity (OR=2.884, p = 0.016), and elevated glycohemoglobin (OR=1.126, p = 0.020). While inflammatory and intestinal permeability markers correlated with metabolic parameters, they were not independent predictors of WM impairment.
Conclusion
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.
背景与目的认知功能障碍,尤其是工作记忆功能障碍是精神分裂症(SZ)和双相情感障碍(BD)的核心特征,受生活方式、精神病理、药理因素、炎症和代谢功能障碍等多种因素的影响。本研究旨在探讨代谢、炎症和肠通透性生物标志物在SZ和BD患者WM损伤中的作用。方法采用横断面观察性研究,纳入146例门诊患者(SZ=96, BD=50)。我们评估了社会人口学、临床、代谢和炎症指标。使用精神病学认知障碍筛查评估认知表现。生物标志物包括糖蛋白、c反应蛋白和脂多糖结合蛋白/可溶性CD14。多变量分析确定了与WM功能障碍相关的因素,其次是与其他认知缺陷相关的因素。结果56.3%的SZ和52%的BD患者存在swm损伤,组间差异无统计学意义。WM功能障碍的独立预测因子为抗精神病药物多药(OR=2.415, p = 0.011)、腹部肥胖(OR=2.884, p = 0.016)和糖蛋白升高(OR=1.126, p = 0.020)。虽然炎症和肠通透性标志物与代谢参数相关,但它们并不是WM损伤的独立预测因子。结论SZ和BD的wm缺陷主要与代谢和药理因素有关。解决可改变的代谢因素,优化抗精神病药物治疗,探索干预措施,如二甲双胍和生活方式的改变,可能会改善这些人群的认知结果。
{"title":"Factors involved in working memory in patients with schizophrenia and bipolar disorder: The role of peripheral biomarkers","authors":"Gonzalo Paniagua , Julia Rodríguez-Revuelta , Leticia González-Blanco , Manuel Couce-Sánchez , Ainoa García-Fernández , Francesco Dal Santo , Pilar A. Sáiz , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-20DOI: 10.1016/j.ejpsy.2026.100342
Antonina Luca , Alessandro Serretti , Stefano Barlati , Lisa Buson , Valentina Menesello , Anna Magistrali , Rosana Carvalho Silva , Giulia Perusi , Gabriele Nibbio , Stefano Bignotti , Giovanni Battista Tura , Raffaele Ferri , Massimo Gennarelli , Antonio Vita , Alessandra Minelli , PANDORA study group
Background and objectives
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.
Methods
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.
Results
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 a≥ 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.
Conclusions
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.
{"title":"Mild motor signs in major depressive disorder: prevalence and clinical profile","authors":"Antonina Luca , Alessandro Serretti , Stefano Barlati , Lisa Buson , Valentina Menesello , Anna Magistrali , Rosana Carvalho Silva , Giulia Perusi , Gabriele Nibbio , Stefano Bignotti , Giovanni Battista Tura , Raffaele Ferri , Massimo Gennarelli , Antonio Vita , Alessandra Minelli , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-30DOI: 10.1016/j.ejpsy.2026.100343
Mathilde Souchon , Raffaella Calati , Lissa Garcia Segui , Madison Roopchand , Adriana Foster , Marta Maisto , Daniele Romano , Giuseppe Delvecchio , Paolo Brambilla , Fabio Madeddu , Jorge Lopez-Castroman
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.
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.
{"title":"The paradox of empathy for pain: Personality, adversity, and affective resonance in psychiatry","authors":"Mathilde Souchon , Raffaella Calati , Lissa Garcia Segui , Madison Roopchand , Adriana Foster , Marta Maisto , Daniele Romano , Giuseppe Delvecchio , Paolo Brambilla , Fabio Madeddu , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-15DOI: 10.1016/j.ejpsy.2025.100331
Jozef Dragasek, Matus Hrebenar, Martina Ruzickova
Background and Objectives
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).
Methods
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.
Results
Clinician-rated negative symptoms (m-SAND-N) showed significant correlations with patient-reported negative symptoms (SNS; r = 0.38, p < 0.001) and with poorer psychosocial functioning (PSP; r = 0.68, p < 0.001). In hierarchical regression, objective negative symptoms were the principal factor associated with higher subjective ratings (β = 0.332, p < 0.001). Conversely, higher SNS scores (β = 0.179, p < 0.001), greater overall illness severity (CGI-S; β = 0.156, p < 0.05) and poorer psychosocial functioning (PSP; β = 0.583, p < 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.
Conclusions
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.
背景与目的:阴性症状显著影响精神分裂症患者的心理社会功能和预后。虽然临床评定量表是标准做法,但患者报告的主观评估的临床价值仍未得到充分探讨。本研究调查了主观(消极症状自我评价,SNS)和客观临床评定(修正的消极领域-消极亚量表短评估,m-SAND-N)评估之间的关联,它们的预测关系,以及与社会心理功能(个人和社会表现,PSP)的联系。方法对斯洛伐克20家精神科诊所的188例精神分裂症门诊患者进行横断面分析。参与者完成了SNS,随后进行了结构化的临床访谈,评估阴性症状(m-SAND)、临床严重程度(CGI-S)、PSP、洞察力和依从性。相关分析和分层多元回归检验了人口统计学、临床、主观/客观阴性症状以及社会心理功能之间的关系。结果临床评定的阴性症状(m-SAND-N)与患者报告的阴性症状(SNS; r = 0.38, p < 0.001)和较差的社会心理功能(PSP; r = 0.68, p < 0.001)呈显著相关。在层次回归中,客观阴性症状是与较高主观评分相关的主要因素(β = 0.332, p < 0.001)。相反,较高的社交网络评分(β = 0.179, p < 0.001)、较高的总体疾病严重程度(cpi - s; β = 0.156, p < 0.05)和较差的社会心理功能(PSP; β = 0.583, p < 0.001)与更严重的临床医生评定的阴性症状相关,共占其方差的50.7%。情感钝化的主观评分与临床医生的评估没有显著的相关性,突出了患者和临床医生报告的测量之间的差异。结论将患者的主观评价与客观的临床医生评分相结合,可以全面了解精神分裂症的阴性症状,促进改善治疗方法和心理社会结局。临床医生在解释差异时应考虑患者的见解,特别是在情感钝化方面。
{"title":"Subjective and objective assessment of negative symptoms in patients with schizophrenia and their clinical and functional associations","authors":"Jozef Dragasek, Matus Hrebenar, 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> < 0.001) and with poorer psychosocial functioning (PSP; <em>r</em> = 0.68, <em>p</em> < 0.001). In hierarchical regression, objective negative symptoms were the principal factor associated with higher subjective ratings (β = 0.332, <em>p</em> < 0.001). Conversely, higher SNS scores (β = 0.179, <em>p</em> < 0.001), greater overall illness severity (CGI-S; β = 0.156, <em>p</em> < 0.05) and poorer psychosocial functioning (PSP; β = 0.583, <em>p</em> < 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}
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.
Methods
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.
Results
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.
Conclusion
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.
Future work should test calibrated subscale thresholds and local norms to boost discrimination and clarify context effects on SDQ ratings.
{"title":"Discriminative utility and limitations of the strengths and difficulties questionnaire for ADHD in a referred clinical pediatric sample","authors":"Erica Fongaro , Arnaud Carlier , Alexandra Vauclare , Judith Brisot-Dubois , Damien Huzard , Hervé Caci , Hala Kerbage , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-09DOI: 10.1016/j.ejpsy.2025.100337
Sophie Bayard , Clarisse Madiouni , François Radiguer , Maëva Roulin , Sébastien Henrard
Background and objectives
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.
Methods
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.
Results
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.
Conclusion
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.
{"title":"Late-Onset ADHD symptoms in the general population: A scoping review of longitudinal trajectories in population-based cohorts","authors":"Sophie Bayard , Clarisse Madiouni , François Radiguer , Maëva Roulin , 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}
Pub Date : 2026-01-01Epub Date: 2026-01-20DOI: 10.1016/j.ejpsy.2026.100341
Maria Antonieta Also Fontanet , Sandra Murgui , Elisenda Sant , Mireia Sans-Corrales , Antoni Sisó-Almirall , Ariadna Mas , Clàudia Valenzuela-Pascual , Gerard Anmella , Jordi Blanch , Myriam Cavero , Eduard Vieta , Diego Hidalgo-Mazzei
Background and objectives
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.
Methods
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 >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.
Results
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%).
Conclusions
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.
{"title":"Use of benzodiazepines in primary care: prescriptions from 2010 to 2019 in Catalonia","authors":"Maria Antonieta Also Fontanet , Sandra Murgui , Elisenda Sant , Mireia Sans-Corrales , Antoni Sisó-Almirall , Ariadna Mas , Clàudia Valenzuela-Pascual , Gerard Anmella , Jordi Blanch , Myriam Cavero , Eduard Vieta , 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 >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}
Pub Date : 2025-10-01Epub Date: 2025-10-08DOI: 10.1016/j.ejpsy.2025.100327
Ask Elklit , Signe Fauerholdt Sørensen
Background & objectives
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.
Method
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.
Results
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.
Conclusion
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.
{"title":"Trauma and personality disorders in Danish treatment-seeking veterans","authors":"Ask Elklit , Signe Fauerholdt Sørensen","doi":"10.1016/j.ejpsy.2025.100327","DOIUrl":"10.1016/j.ejpsy.2025.100327","url":null,"abstract":"<div><h3>Background & 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}
Pub Date : 2025-10-01Epub Date: 2025-07-23DOI: 10.1016/j.ejpsy.2025.100317
Guocan Ma , Fengyi Hao , Soon-Kiat Chiang , Dewen Zhou , Roger C. Ho , Roger S. McIntyre
Background and objectives
Bipolar disorder (BD) is a severe mental disorder whose diagnosis heavily relies on subjective symptomatic assessments, thus a need for an objective tool to assist in the timely identification and treatment of BD.
Methods
We systematically reviewed the performance of objective diagnostic biomarkers for classification of BD that presented sensitivity and specificity values. A search on Ovid MEDLINE® ALL, PubMed, as well as manual searching were performed for literature dating from December 2013 to February 2025.
Results
Sixty-one studies were included in the review. Twenty-four of them reported mainly molecular, fluid-based biomarkers, twenty-five reported neurophysiological examinations as biomarkers, and six reported other forms of biomarkers. The most accurate biomarkers included voice features, apoptosis-related long non-coding RNAs, PIK3R1 (Phosphoinositide-3-kinase regulatory subunit 1) and FYN mRNAs, electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), multimodal magnetic resonance imaging (MRI), and serum VGF protein, with area under the receiver operating characteristic curve (AUC) or accuracy values of greater than 0.93. The majority (thirty-six) of the studies utilized machine learning-based classification algorithms.
Conclusions
The results have been promising and replicated for some biomarkers, but these results still need to be validated in larger samples. Future studies should focus on constructing larger cohorts of specific clinical subtypes of BD, predictive utility studies for BD patients initially diagnosed as major depressive disorder (MDD), and utilization of multimodal assessment and machine learning techniques.
{"title":"Current state and future directions of biomarkers for bipolar disorder: A systematic review of studies from 2013 to 2025","authors":"Guocan Ma , Fengyi Hao , Soon-Kiat Chiang , Dewen Zhou , Roger C. Ho , Roger S. McIntyre","doi":"10.1016/j.ejpsy.2025.100317","DOIUrl":"10.1016/j.ejpsy.2025.100317","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Bipolar disorder (BD) is a severe mental disorder whose diagnosis heavily relies on subjective symptomatic assessments, thus a need for an objective tool to assist in the timely identification and treatment of BD.</div></div><div><h3>Methods</h3><div>We systematically reviewed the performance of objective diagnostic biomarkers for classification of BD that presented sensitivity and specificity values. A search on Ovid MEDLINE® ALL, PubMed, as well as manual searching were performed for literature dating from December 2013 to February 2025.</div></div><div><h3>Results</h3><div>Sixty-one studies were included in the review. Twenty-four of them reported mainly molecular, fluid-based biomarkers, twenty-five reported neurophysiological examinations as biomarkers, and six reported other forms of biomarkers. The most accurate biomarkers included voice features, apoptosis-related long non-coding RNAs, PIK3R1 (Phosphoinositide-3-kinase regulatory subunit 1) and FYN mRNAs, electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS)<strong>,</strong> multimodal magnetic resonance imaging (MRI), and serum VGF protein, with area under the receiver operating characteristic curve (AUC) or accuracy values of greater than 0.93. The majority (thirty-six) of the studies utilized machine learning-based classification algorithms.</div></div><div><h3>Conclusions</h3><div>The results have been promising and replicated for some biomarkers, but these results still need to be validated in larger samples. Future studies should focus on constructing larger cohorts of specific clinical subtypes of BD, predictive utility studies for BD patients initially diagnosed as major depressive disorder (MDD), and utilization of multimodal assessment and machine learning techniques.</div></div>","PeriodicalId":12045,"journal":{"name":"European Journal of Psychiatry","volume":"39 4","pages":"Article 100317"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686224","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}