Diagnostic overshadowing (DO)—the misattribution of new physical symptoms to a pre-existing psychiatric diagnosis—can delay recognition of medical illness and worsen outcomes in emergency care. This study examined clinicians’ awareness of DO, the provider- and system-level factors perceived as driving it, and whether distinct awareness/attribution profiles can be identified among emergency physicians and psychiatrists in Türkiye.
Methods
We conducted a nationwide cross-sectional online survey of emergency department–facing emergency physicians and psychiatrists between 15 March and 1 May 2025. A 51-item questionnaire on DO-related determinants was developed and psychometrically refined, yielding a concise nine-item indicator set. Latent class analysis of responses to these indicators was used to identify subgroups of clinicians with similar patterns of DO-related awareness and attribution.
Results
Of 215 invitees, 120 completed the survey (56 % response; median age 33 years; 46.7 % female). Participants: 65% emergency medicine, 35% psychiatry. A three-class solution best fit the data (AIC=2620.17; BIC=2926.80; SS-BIC=2579.03; entropy=0.949; LMR-LRT/BLRT p < 0.001), with the smallest class ≥25%. LCA defined: Low Recognition; System-Tilted Awareness; Multidimensional High Awareness. Age and years in practice differed modestly across classes (p < 0.05), whereas gender, institution, academic title, and DO familiarity did not (p > 0.05).
Conclusions
These findings show that DO awareness is heterogeneous and not confined to a single specialty. A brief indicator set and profile-based framework may support tailored education and service redesign to reduce diagnostic overshadowing and improve safety and equity in emergency care.
{"title":"Clinician awareness and systemic barriers of diagnostic overshadowing in emergency psychiatry: A latent class analysis","authors":"Omer Faruk Karakoyun , Yalcin Golcuk , Fulden Cantas Turkis , Meltem Derya Sahın , Halil Emre Koyuncuoglu , Omer Harun Sagnic","doi":"10.1016/j.psychres.2026.116958","DOIUrl":"10.1016/j.psychres.2026.116958","url":null,"abstract":"<div><h3>Objective</h3><div>Diagnostic overshadowing (DO)—the misattribution of new physical symptoms to a pre-existing psychiatric diagnosis—can delay recognition of medical illness and worsen outcomes in emergency care. This study examined clinicians’ awareness of DO, the provider- and system-level factors perceived as driving it, and whether distinct awareness/attribution profiles can be identified among emergency physicians and psychiatrists in Türkiye.</div></div><div><h3>Methods</h3><div>We conducted a nationwide cross-sectional online survey of emergency department–facing emergency physicians and psychiatrists between 15 March and 1 May 2025. A 51-item questionnaire on DO-related determinants was developed and psychometrically refined, yielding a concise nine-item indicator set. Latent class analysis of responses to these indicators was used to identify subgroups of clinicians with similar patterns of DO-related awareness and attribution.</div></div><div><h3>Results</h3><div>Of 215 invitees, 120 completed the survey (56 % response; median age 33 years; 46.7 % female). Participants: 65% emergency medicine, 35% psychiatry. A three-class solution best fit the data (AIC=2620.17; BIC=2926.80; SS-BIC=2579.03; entropy=0.949; LMR-LRT/BLRT <em>p</em> < 0.001), with the smallest class ≥25%. LCA defined: Low Recognition; System-Tilted Awareness; Multidimensional High Awareness. Age and years in practice differed modestly across classes (<em>p</em> < 0.05), whereas gender, institution, academic title, and DO familiarity did not (<em>p</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>These findings show that DO awareness is heterogeneous and not confined to a single specialty. A brief indicator set and profile-based framework may support tailored education and service redesign to reduce diagnostic overshadowing and improve safety and equity in emergency care.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116958"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-22DOI: 10.1016/j.psychres.2026.116966
Antti Mustonen , Solja Niemelä , Alexander Denissoff , Marta Di Forti , Antti Tanskanen , Ellenor Mittendorfer-Rutz , Jari Tiihonen , Heidi Taipale
Background
Cannabis-induced psychosis (CIP) carries a high risk of relapse. Research has shown that antipsychotic medications are effective in relapse prevention after first diagnosed CIP. Given that antipsychotics carry the potential for dose-related adverse effects, understanding the optimal dose is critical. Therefore, we conducted a dose–response analysis to evaluate the real-world effectiveness of oral antipsychotics in preventing relapse after CIP.
Methods
We used data from linkage of administrative and health care registers from Sweden to identify all individuals with first diagnosis of CIP (ICD-10 F12.5). We modelled oral antipsychotic exposure (aripiprazole, clozapine, risperidone, olanzapine, quetiapine, antipsychotic polytherapy, other oral antipsychotics) as time-dependent using validated PRE2DUP-method. Dose–response association of antipsychotic exposure and outcome were examined across three predefined daily dose (DDD) categories (<0.6, 0.6–<1.4, ≥1.4) using within-individual models in a stratified Cox-regression analysis. The primary outcome was hospitalization for any psychotic episode, defined as schizophrenia-spectrum disorder (F20–F29) or substance-induced psychosis (F1x.5) as the main diagnosis.
Results
We identified 1,772 individuals aged 16-64 years with first-time CIP between 2006 and 2021. Antipsychotic polytherapy was associated with reduced risk of psychosis hospitalization across all dose ranges (HRs=0.54–0.65). Clozapine (0.6–<1.4 DDDs/day), olanzapine (≥0.6 DDDs/day), aripiprazole (0.6–<1.4 DDDs/day), risperidone (<0.6 DDDs/day), and other oral antipsychotics (0.6–<1.4 DDDs/day) were effective, while quetiapine showed no significant benefit.
Conclusions
Findings indicate dose-dependent real-world effectiveness of antipsychotics in CIP, with most agents performing best at 0.6–<1.4 DDDs/day. These results support optimizing dosing of oral antipsychotic medications for relapse prevention after CIP to balance efficacy and adverse effects.
{"title":"Optimizing antipsychotic dosing for relapse prevention in cannabis-induced psychosis: A nationwide cohort study","authors":"Antti Mustonen , Solja Niemelä , Alexander Denissoff , Marta Di Forti , Antti Tanskanen , Ellenor Mittendorfer-Rutz , Jari Tiihonen , Heidi Taipale","doi":"10.1016/j.psychres.2026.116966","DOIUrl":"10.1016/j.psychres.2026.116966","url":null,"abstract":"<div><h3>Background</h3><div>Cannabis-induced psychosis (CIP) carries a high risk of relapse. Research has shown that antipsychotic medications are effective in relapse prevention after first diagnosed CIP. Given that antipsychotics carry the potential for dose-related adverse effects, understanding the optimal dose is critical. Therefore, we conducted a dose–response analysis to evaluate the real-world effectiveness of oral antipsychotics in preventing relapse after CIP.</div></div><div><h3>Methods</h3><div>We used data from linkage of administrative and health care registers from Sweden to identify all individuals with first diagnosis of CIP (ICD-10 F12.5). We modelled oral antipsychotic exposure (aripiprazole, clozapine, risperidone, olanzapine, quetiapine, antipsychotic polytherapy, other oral antipsychotics) as time-dependent using validated PRE2DUP-method. Dose–response association of antipsychotic exposure and outcome were examined across three predefined daily dose (DDD) categories (<0.6, 0.6–<1.4, ≥1.4) using within-individual models in a stratified Cox-regression analysis. The primary outcome was hospitalization for any psychotic episode, defined as schizophrenia-spectrum disorder (F20–F29) or substance-induced psychosis (F1x.5) as the main diagnosis.</div></div><div><h3>Results</h3><div>We identified 1,772 individuals aged 16-64 years with first-time CIP between 2006 and 2021. Antipsychotic polytherapy was associated with reduced risk of psychosis hospitalization across all dose ranges (HRs=0.54–0.65). Clozapine (0.6–<1.4 DDDs/day), olanzapine (≥0.6 DDDs/day), aripiprazole (0.6–<1.4 DDDs/day), risperidone (<0.6 DDDs/day), and other oral antipsychotics (0.6–<1.4 DDDs/day) were effective, while quetiapine showed no significant benefit.</div></div><div><h3>Conclusions</h3><div>Findings indicate dose-dependent real-world effectiveness of antipsychotics in CIP, with most agents performing best at 0.6–<1.4 DDDs/day. These results support optimizing dosing of oral antipsychotic medications for relapse prevention after CIP to balance efficacy and adverse effects.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116966"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-27DOI: 10.1016/j.psychres.2026.116980
Alexey M. Afonin , Aino-Kaisa Piironen , Jordi Julvez , Irene van Kamp , Katja M. Kanninen
Adolescence is a critical developmental period marked by significant physiological, psychological, and behavioural changes, many of which differ between the sexes. We aimed to investigate sex-specific associations between the plasma proteome and questionnaire-based mental health measures in adolescents. Liquid chromatography – tandem mass spectrometry proteomic analysis was used to measure the plasma proteome abundances in 197 adolescents (11-16 years old) from the WALNUTs cohort. Baseline analysis of sexual dimorphism revealed 76 proteins significantly differentially abundant between sexes, which were enriched in cell adhesion, collagen fibril organisation, and ossification pathways. Bioinformatic analysis revealed 37 proteins significantly associated with the total score of the Strengths and Difficulties Questionnaire (SDQ). Modelling the sex-specificity via interaction terms revealed 40 proteins with significant associations with SDQ in females and 1 protein in males. Plasma protein abundancies in males exhibited stronger correlations with SDQ externalizing subscale scores, while in females the associations with the internalizing score were more prominent, consistent with known behavioural sex differences. Female-associated proteins were enriched for haemostasis and complement pathways, while male-associated signals suggested distinct immune and cytoskeletal processes. These findings indicate that both shared and sex-specific plasma proteomic signatures are associated with SDQ scores in adolescents and that models adjusting only for sex may obscure sex-divergent biology. These exploratory results are hypothesis-generating and support the use of sex-aware proteomic analyses to refine biomarker discovery for adolescent mental health.
{"title":"Plasma proteome demonstrates sex-specific associations with mental health risks in adolescents","authors":"Alexey M. Afonin , Aino-Kaisa Piironen , Jordi Julvez , Irene van Kamp , Katja M. Kanninen","doi":"10.1016/j.psychres.2026.116980","DOIUrl":"10.1016/j.psychres.2026.116980","url":null,"abstract":"<div><div>Adolescence is a critical developmental period marked by significant physiological, psychological, and behavioural changes, many of which differ between the sexes. We aimed to investigate sex-specific associations between the plasma proteome and questionnaire-based mental health measures in adolescents. Liquid chromatography – tandem mass spectrometry proteomic analysis was used to measure the plasma proteome abundances in 197 adolescents (11-16 years old) from the WALNUTs cohort. Baseline analysis of sexual dimorphism revealed 76 proteins significantly differentially abundant between sexes, which were enriched in cell adhesion, collagen fibril organisation, and ossification pathways. Bioinformatic analysis revealed 37 proteins significantly associated with the total score of the Strengths and Difficulties Questionnaire (SDQ). Modelling the sex-specificity via interaction terms revealed 40 proteins with significant associations with SDQ in females and 1 protein in males. Plasma protein abundancies in males exhibited stronger correlations with SDQ externalizing subscale scores, while in females the associations with the internalizing score were more prominent, consistent with known behavioural sex differences. Female-associated proteins were enriched for haemostasis and complement pathways, while male-associated signals suggested distinct immune and cytoskeletal processes. These findings indicate that both shared and sex-specific plasma proteomic signatures are associated with SDQ scores in adolescents and that models adjusting only for sex may obscure sex-divergent biology. These exploratory results are hypothesis-generating and support the use of sex-aware proteomic analyses to refine biomarker discovery for adolescent mental health.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116980"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-02DOI: 10.1016/j.psychres.2026.116992
T. Aboulafia-Brakha , A. Buchard , C. Mabilais , S. Alaux , C. Amberger , L. Furtado , F. Seragnoli , J-F Briefer , G. Thorens , M. Sabé , L. Szczesniak , R. Iuga , D. Zullino , L. Penzenstadler
Background
Classic serotonergic psychedelics such as LSD and psilocybin show promising antidepressant effects in controlled trials, but real-world data from routine clinical care remain limited.
Methods
This study retrospectively analysed routine data from adults with treatment-resistant depressive and/or anxiety disorders who received a first standardized Psychedelic-assisted Psychotherapy (PAP) cycle with 100 µg LSD or 25 mg psilocybin at a Swiss university hospital (May 2024–October 2025). Self-reported depression (BDI) and trait anxiety (STAI-T) were assessed at screening, one month before treatment, and 1–3 months post-treatment. In a subset of participants, cognitive emotion regulation (CERQ) was assessed pre- and post-treatment. Subjective drug effects and adverse events were recorded on the treatment day.
Results
The sample consisted of 115 patients (56.5 % female; Mean age = 47.5 years). Depressive and anxiety symptoms significantly decreased over time (BDI: F(2178) = 63.50, p < 0.001, partial η² = 0.42; STAI-T: F(1.74,145.9) = 16.97, p < 0.001, partial η² = 0.17), with no main effect of substance. CERQ analyses indicated reduced self-blame, rumination and catastrophizing, and increased positive refocusing and reappraisal. Perceived intensity followed distinct temporal profiles for LSD and psilocybin, but comparable subjective drug effects and clinical outcomes. Adverse events were mostly mild and transient, with no serious complications or treatment discontinuations.
Conclusions
In this compassionate-use real-world cohort, a first fully-active dose PAP session with LSD or psilocybin was well tolerated and associated with significant improvements in depressive and anxiety symptoms. These findings support the feasibility and effectiveness of PAP in specialised routine care.
背景：经典的5 -羟色胺类致幻剂，如LSD和裸盖菇素，在对照试验中显示出有希望的抗抑郁效果，但来自常规临床护理的实际数据仍然有限。方法：本研究回顾性分析了在瑞士大学医院（2024年5月- 2025年10月）接受第一个标准化迷幻辅助心理治疗（PAP）周期（100 μ g LSD或25 mg裸盖菇素）的难治性抑郁症和/或焦虑症成人的常规数据。在筛查时、治疗前1个月和治疗后1-3个月评估自我报告的抑郁（BDI）和特质焦虑（STAI-T）。在一部分参与者中，认知情绪调节（CERQ）在治疗前后被评估。在治疗当天记录主观药物效应和不良事件。结果：115例患者（56.5%为女性，平均年龄47.5岁）。抑郁和焦虑症状随时间显著减少(BDI: F(2178) = 63.50, p < 0.001，偏η²= 0.42；stei - t: F(1.74,145.9) = 16.97, p < 0.001，偏η²= 0.17)，物质无主效应。CERQ分析表明，自责、反思和灾难化减少，积极的重新聚焦和重新评估增加。LSD和裸盖菇素的感知强度具有不同的时间特征，但主观药物效应和临床结果具有可比性。不良事件大多是轻微和短暂的，没有严重的并发症或治疗中断。结论：在这个同情使用的现实世界队列中，首次使用LSD或裸盖菇素的全活性剂量PAP治疗耐受性良好，并与抑郁和焦虑症状的显着改善相关。这些发现支持PAP在专业常规护理中的可行性和有效性。
{"title":"Real-world effectiveness and safety of psychedelic-assisted psychotherapy: Outcomes from a large-scale compassionate use cohort in Switzerland","authors":"T. Aboulafia-Brakha , A. Buchard , C. Mabilais , S. Alaux , C. Amberger , L. Furtado , F. Seragnoli , J-F Briefer , G. Thorens , M. Sabé , L. Szczesniak , R. Iuga , D. Zullino , L. Penzenstadler","doi":"10.1016/j.psychres.2026.116992","DOIUrl":"10.1016/j.psychres.2026.116992","url":null,"abstract":"<div><h3>Background</h3><div>Classic serotonergic psychedelics such as LSD and psilocybin show promising antidepressant effects in controlled trials, but real-world data from routine clinical care remain limited.</div></div><div><h3>Methods</h3><div>This study retrospectively analysed routine data from adults with treatment-resistant depressive and/or anxiety disorders who received a first standardized Psychedelic-assisted Psychotherapy (PAP) cycle with 100 µg LSD or 25 mg psilocybin at a Swiss university hospital (May 2024–October 2025). Self-reported depression (BDI) and trait anxiety (STAI-T) were assessed at screening, one month before treatment, and 1–3 months post-treatment. In a subset of participants, cognitive emotion regulation (CERQ) was assessed pre- and post-treatment. Subjective drug effects and adverse events were recorded on the treatment day.</div></div><div><h3>Results</h3><div>The sample consisted of 115 patients (56.5 % female; Mean age = 47.5 years). Depressive and anxiety symptoms significantly decreased over time (BDI: F(2178) = 63.50, <em>p</em> < 0.001, partial η² = 0.42; STAI-T: F(1.74,145.9) = 16.97, <em>p</em> < 0.001, partial η² = 0.17), with no main effect of substance. CERQ analyses indicated reduced self-blame, rumination and catastrophizing, and increased positive refocusing and reappraisal. Perceived intensity followed distinct temporal profiles for LSD and psilocybin, but comparable subjective drug effects and clinical outcomes. Adverse events were mostly mild and transient, with no serious complications or treatment discontinuations.</div></div><div><h3>Conclusions</h3><div>In this compassionate-use real-world cohort, a first fully-active dose PAP session with LSD or psilocybin was well tolerated and associated with significant improvements in depressive and anxiety symptoms. These findings support the feasibility and effectiveness of PAP in specialised routine care.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116992"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-30DOI: 10.1016/j.psychres.2026.116987
Manman Zhu , Hao Yang , Bo Feng , Yi Jiang , Yaoyao Zhang
Introduction
The global prevalence of autism spectrum disorder (ASD) is increasing, yet effective strategies for early prediction and prevention are still limited. This umbrella review aims to synthesize available evidence on the association between maternal pregnancy complications and offspring ASD.
Methods
Following PRISMA guidelines, we systematically searched all published literature from PubMed, Embase, Web of Science, and Cochrane Library up to July 16, 2025, for systematic reviews on pregnancy complications and ASD. Only systematic reviews published in English were considered. Observational studies were included, while those on other neurodevelopmental disorders or teratogens were excluded. Study selection, data extraction, and quality assessment (using AMSTAR 2 and ROBIS) were conducted independently by two reviewers. Statistical analyses included random-effects meta-analysis, excess significance bias, Egger’s test for publication bias, and sensitivity analysis.
Results
Among 596 identified records, 43 systematic reviews were assessed, with 2 (4.65%) moderate quality, 7 (16.28%) low quality, and 34 (79.07%) critically low quality. Fourteen meta-analyses (10 complication types, 30 studies) were included. Significant associations with increased ASD risk were found for gestational diabetes (OR = 1.29, 95% CI:1.14-1.45), preconception obesity (OR = 1.42, 95%CI:1.22-1.65), excessive gestational weight gain (OR = 1.18, 95%CI:1.08-1.29), polycystic ovary syndrome (OR = 1.64, 95%CI:1.50-1.82), gestational hypertension (OR = 1.37, 95%CI:1.22-1.55), pre-eclampsia (OR = 1.50, 95%CI:1.26-1.78), unclassified pregnancy infections (OR = 1.13, 95%CI:1.03-1.23), maternal autoimmune diseases (OR = 1.30, 95%CI:1.20-1.42), and asthma (OR = 1.36, 95%CI:1.28-1.44). All analyses had a high risk of bias; no convincing evidence was identified.
Conclusions
In conclusion, this umbrella review provides a stratified assessment of evidence linking pregnancy complications to offspring ASD. No associations were supported by convincing evidence; most were based on suggestive or weak evidence, with only a limited number reaching highly suggestive levels. These findings underscore the need for more robust primary studies to clarify these associations and their effect sizes.
{"title":"Maternal pregnancy complications and offspring autism spectrum disorder risk: an umbrella review","authors":"Manman Zhu , Hao Yang , Bo Feng , Yi Jiang , Yaoyao Zhang","doi":"10.1016/j.psychres.2026.116987","DOIUrl":"10.1016/j.psychres.2026.116987","url":null,"abstract":"<div><h3>Introduction</h3><div>The global prevalence of autism spectrum disorder (ASD) is increasing, yet effective strategies for early prediction and prevention are still limited. This umbrella review aims to synthesize available evidence on the association between maternal pregnancy complications and offspring ASD.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we systematically searched all published literature from PubMed, Embase, Web of Science, and Cochrane Library up to July 16, 2025, for systematic reviews on pregnancy complications and ASD. Only systematic reviews published in English were considered. Observational studies were included, while those on other neurodevelopmental disorders or teratogens were excluded. Study selection, data extraction, and quality assessment (using AMSTAR 2 and ROBIS) were conducted independently by two reviewers. Statistical analyses included random-effects meta-analysis, excess significance bias, Egger’s test for publication bias, and sensitivity analysis.</div></div><div><h3>Results</h3><div>Among 596 identified records, 43 systematic reviews were assessed, with 2 (4.65%) moderate quality, 7 (16.28%) low quality, and 34 (79.07%) critically low quality. Fourteen meta-analyses (10 complication types, 30 studies) were included. Significant associations with increased ASD risk were found for gestational diabetes (OR = 1.29, 95% CI:1.14-1.45), preconception obesity (OR = 1.42, 95%CI:1.22-1.65), excessive gestational weight gain (OR = 1.18, 95%CI:1.08-1.29), polycystic ovary syndrome (OR = 1.64, 95%CI:1.50-1.82), gestational hypertension (OR = 1.37, 95%CI:1.22-1.55), pre-eclampsia (OR = 1.50, 95%CI:1.26-1.78), unclassified pregnancy infections (OR = 1.13, 95%CI:1.03-1.23), maternal autoimmune diseases (OR = 1.30, 95%CI:1.20-1.42), and asthma (OR = 1.36, 95%CI:1.28-1.44). All analyses had a high risk of bias; no convincing evidence was identified.</div></div><div><h3>Conclusions</h3><div>In conclusion, this umbrella review provides a stratified assessment of evidence linking pregnancy complications to offspring ASD. No associations were supported by convincing evidence; most were based on suggestive or weak evidence, with only a limited number reaching highly suggestive levels. These findings underscore the need for more robust primary studies to clarify these associations and their effect sizes.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116987"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-03DOI: 10.1016/j.psychres.2026.116994
Jose A. Piqueras , Raul Castaño , Laura Ballester , Gemma Vilagut , Jordi Alonso , Alexandra Morales , Jose P. Espada , Mireia Orgiles
Objective
To evaluate the diagnostic accuracy of the System for the Assessment of Children and Adolescents (SENA) in identifying emotional disorders and suicidal thoughts and behaviors. SENA is a widely used Spanish screening tool for assessing emotional and behavioral symptoms in youth.
Method
526 primary and secondary pupils aged 8-16 in several Spanish regions (a subset of the EmoChild Project, n=5,652 completed SENA), completed the SENA and underwent with clinical interviews using KSADS-COMP within 3 months. We screened potential participants by identifying possible positive and negative cases based on a T-score equivalent to the 75th percentile and served as a cut-off point for accessing a diagnostic interview.
Results
SENA’s Emotional subscale showed a sensitivity (SN) of 78.5% in children and 80.4% in adolescents for detecting any emotional disorder, with specificities (SP) of 65.9% and 66.1%, and Area Under the ROC curve (AUC) of .74 in children and .73 in adolescents. AUCs were adequate for all subscales (0.72-0.93) other than obsessive compulsive disorder (AUC=.67). Specific subscales performed best: Generalized Anxiety Disorder (SN=100%, SP=88.4%) and Social Anxiety Disorder-SAD (SN = 91.4%, SP = 80.3%) in children, and SAD (SN=88.1%, SP=72.5%), Post-Traumatic Stress Disorder (SN=81.2%, SP=68.2%) and suicidal thoughts in adolescents (SN=84.5%, SP=73.8%).
Conclusions
SENA is a valuable screening tool for educational and clinical settings, facilitating early intervention through a standardized and user-friendly assessment. Nevertheless, there is need for refined thresholds to enhance specificity and clinical alignment.
{"title":"Diagnostic Accuracy of “System for the Assessment of Children and Adolescents” (SENA) for Emotional Disorders in Youth: Insights from the EmoChild Study in Spain","authors":"Jose A. Piqueras , Raul Castaño , Laura Ballester , Gemma Vilagut , Jordi Alonso , Alexandra Morales , Jose P. Espada , Mireia Orgiles","doi":"10.1016/j.psychres.2026.116994","DOIUrl":"10.1016/j.psychres.2026.116994","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the diagnostic accuracy of the System for the Assessment of Children and Adolescents (SENA) in identifying emotional disorders and suicidal thoughts and behaviors. SENA is a widely used Spanish screening tool for assessing emotional and behavioral symptoms in youth.</div></div><div><h3>Method</h3><div>526 primary and secondary pupils aged 8-16 in several Spanish regions (a subset of the EmoChild Project, n=5,652 completed SENA), completed the SENA and underwent with clinical interviews using KSADS-COMP within 3 months. We screened potential participants by identifying possible positive and negative cases based on a T-score equivalent to the 75th percentile and served as a cut-off point for accessing a diagnostic interview.</div></div><div><h3>Results</h3><div>SENA’s Emotional subscale showed a sensitivity (SN) of 78.5% in children and 80.4% in adolescents for detecting any emotional disorder, with specificities (SP) of 65.9% and 66.1%, and Area Under the ROC curve (AUC) of .74 in children and .73 in adolescents. AUCs were adequate for all subscales (0.72-0.93) other than obsessive compulsive disorder (AUC=.67). Specific subscales performed best: Generalized Anxiety Disorder (SN=100%, SP=88.4%) and Social Anxiety Disorder-SAD (SN = 91.4%, SP = 80.3%) in children, and SAD (SN=88.1%, SP=72.5%), Post-Traumatic Stress Disorder (SN=81.2%, SP=68.2%) and suicidal thoughts in adolescents (SN=84.5%, SP=73.8%).</div></div><div><h3>Conclusions</h3><div>SENA is a valuable screening tool for educational and clinical settings, facilitating early intervention through a standardized and user-friendly assessment. Nevertheless, there is need for refined thresholds to enhance specificity and clinical alignment.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116994"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is a lack of data on medication adherence among patients receiving clozapine from Asian countries. Few studies across the globe have longitudinally assessed medication adherence among clozapine patients.
Aim
This study aimed to longitudinally evaluate medication adherence and its correlates in schizophrenia patients receiving clozapine and compare the same with patients receiving other oral second-generation antipsychotics (SGAs).
Methods
100 patients receiving clozapine and 100 patients with another SGA were evaluated at two-time points six months apart for medication adherence using the Medication Adherence Questionnaire (MAQ) and Compliance Rating Scale (CRS).
Results
At the baseline assessment a higher percentage of patients in the clozapine group were fully adherent to their medication as per the MAQ. On CRS, a significantly higher proportion of patients on clozapine reported passive acceptance of medication and resultantly had better medication adherence. At the follow-up assessment, compared to patients on clozapine, a higher proportion of patients on other SGAs reported forgetting to take medication, being careless of taking medication, and stopping medication when they felt better. Overall, the medication adherence of patients on clozapine was higher than that for patients on other SGAs as assessed on MAQ and CRS.
Conclusion
To conclude, the present study suggests that about one-third of patients using clozapine and other SGAs are poorly adherent to their medications, and medication adherence among patients receiving clozapine is better than those receiving other SGAs.
{"title":"A comparative study of medication adherence in schizophrenia patients receiving clozapine and other antipsychotics","authors":"Shweta Chanalia, Sandeep Grover, Subho Chakrabarti","doi":"10.1016/j.psychres.2025.116879","DOIUrl":"10.1016/j.psychres.2025.116879","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of data on medication adherence among patients receiving clozapine from Asian countries. Few studies across the globe have longitudinally assessed medication adherence among clozapine patients.</div></div><div><h3>Aim</h3><div>This study aimed to longitudinally evaluate medication adherence and its correlates in schizophrenia patients receiving clozapine and compare the same with patients receiving other oral second-generation antipsychotics (SGAs).</div></div><div><h3>Methods</h3><div>100 patients receiving clozapine and 100 patients with another SGA were evaluated at two-time points six months apart for medication adherence using the Medication Adherence Questionnaire (MAQ) and Compliance Rating Scale (CRS).</div></div><div><h3>Results</h3><div>At the baseline assessment a higher percentage of patients in the clozapine group were fully adherent to their medication as per the MAQ. On CRS, a significantly higher proportion of patients on clozapine reported passive acceptance of medication and resultantly had better medication adherence. At the follow-up assessment, compared to patients on clozapine, a higher proportion of patients on other SGAs reported forgetting to take medication, being careless of taking medication, and stopping medication when they felt better. Overall, the medication adherence of patients on clozapine was higher than that for patients on other SGAs as assessed on MAQ and CRS.</div></div><div><h3>Conclusion</h3><div>To conclude, the present study suggests that about one-third of patients using clozapine and other SGAs are poorly adherent to their medications, and medication adherence among patients receiving clozapine is better than those receiving other SGAs.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116879"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-18DOI: 10.1016/j.psychres.2026.116955
Chien-Heng Lin , Chih-Lin Chiang , Dae Young Yu , Hiroshi Horio , Natsuko Tokushige , David Bin-Chia Wu
Objective
The study aimed to evaluate the impact of monthly paliperidone palmitate (PP1M) on competitive employment and clinical/function remission in patients with early-phase schizophrenia during an 18-month observational period of a multicenter, open-label, single-arm clinical trial.
Methods
Patients with schizophrenia diagnosed within 5 years were enrolled across the Asia-Pacific region and received PP1M treatment. Employment status (full-time or part-time), symptom severity, and psychosocial functioning were assessed using standardized instruments. Predictors of employment improvement were identified through logistic regressions.
Results
A total of 474 patients were enrolled, with competitive employment rates rising from 28.1 % at baseline to 45.4 % at month 18. For patients unemployed at baseline, the employment rate improved to 33.8 % at month 18. Significant remission improvements were observed in PANSS (40.0 % to 80.4 %), CGI-SCH (55.6 % to 89.3 %), and PSP (25.2 % to 65.4 %) over the same period. Employment and remissions followed distinct improvement trajectories. Baseline employment status (adjusted OR 5.544, 95 % CI: 2.902-10.592) and male sex (adjusted OR 1.927, 95 % CI 1.066–3.483) were significantly associated with employment improvement in multivariate analyses.
Conclusion
PP1M treatment resulted in significant improvements in clinical symptoms, functional recovery, and competitive employment over 18 months. The findings emphasize the need to address systemic barriers to employment while supporting sustained clinical and functional recovery to facilitate workforce reintegration for schizophrenia patients.
{"title":"Clinical remission, functional recovery, and employment in early-phase schizophrenia treated with paliperidone palmitate: An 18-month longitudinal Asia-Pacific study","authors":"Chien-Heng Lin , Chih-Lin Chiang , Dae Young Yu , Hiroshi Horio , Natsuko Tokushige , David Bin-Chia Wu","doi":"10.1016/j.psychres.2026.116955","DOIUrl":"10.1016/j.psychres.2026.116955","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to evaluate the impact of monthly paliperidone palmitate (PP1M) on competitive employment and clinical/function remission in patients with early-phase schizophrenia during an 18-month observational period of a multicenter, open-label, single-arm clinical trial.</div></div><div><h3>Methods</h3><div>Patients with schizophrenia diagnosed within 5 years were enrolled across the Asia-Pacific region and received PP1M treatment. Employment status (full-time or part-time), symptom severity, and psychosocial functioning were assessed using standardized instruments. Predictors of employment improvement were identified through logistic regressions.</div></div><div><h3>Results</h3><div>A total of 474 patients were enrolled, with competitive employment rates rising from 28.1 % at baseline to 45.4 % at month 18. For patients unemployed at baseline, the employment rate improved to 33.8 % at month 18. Significant remission improvements were observed in PANSS (40.0 % to 80.4 %), CGI-SCH (55.6 % to 89.3 %), and PSP (25.2 % to 65.4 %) over the same period. Employment and remissions followed distinct improvement trajectories. Baseline employment status (adjusted OR 5.544, 95 % CI: 2.902-10.592) and male sex (adjusted OR 1.927, 95 % CI 1.066–3.483) were significantly associated with employment improvement in multivariate analyses.</div></div><div><h3>Conclusion</h3><div>PP1M treatment resulted in significant improvements in clinical symptoms, functional recovery, and competitive employment over 18 months. The findings emphasize the need to address systemic barriers to employment while supporting sustained clinical and functional recovery to facilitate workforce reintegration for schizophrenia patients.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116955"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-31DOI: 10.1016/j.psychres.2026.116982
Fu-Shan Xue , Dan-Feng Wang , Yan-Hua Guo
{"title":"Correspondence regarding “Efficacy of esketamine after cesarean section for women with symptoms of prenatal depression: A randomized controlled trial by Xue-Song et al.","authors":"Fu-Shan Xue , Dan-Feng Wang , Yan-Hua Guo","doi":"10.1016/j.psychres.2026.116982","DOIUrl":"10.1016/j.psychres.2026.116982","url":null,"abstract":"","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116982"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-18DOI: 10.1016/j.psychres.2026.116963
Evie Doherty , Aodán Laighneach , Mia Casburn , Fergus Quilligan , Gary Donohoe , Dara M. Cannon , Derek W. Morris
Psychosis is a clinically heterogenous disorder associated with significant difficulties with social and occupational function (psychosocial disability; PD). While environmental and cognitive factors are identified predictors of PD, the genetic contribution remains unclear. Here, we investigated the hypothesis that objective social participation (SP) and occupational engagement are genetically influenced.
We performed mixed-linear-model genome-wide association studies of these phenotypes in the UK Biobank (N∼404,500) and a series of post-hoc analyses including Mendelian randomization (MR) to interpret findings. SP was defined as the frequency of social visits and leisure activities based on response to questionnaires. Occupational engagement was represented by two variables: occupational function (OF) and the established Not in Education, Employment, and Training (NEET) measure, both derived from employment status responses. We identified 17 independent loci for SP, with a SNP-based heritability of 4.1%. A list of contributory genes included TNRC6B, STAU1, CDH7, GBE1, DDX27, and several known schizophrenia risk genes including CSE1L, ZNF536 and TCF4. The regulation of synaptic signalling was implicated in the biology of SP by gene-set analysis. SNP-based heritabilities for OF and NEET were 1.8% and 1.3% respectively and DRD2 was associated with both phenotypes by gene-based analysis. Reduced SP and occupational engagement demonstrated genetic correlations with an increased risk for neuropsychiatric disorders, socioeconomic deprivation, lower cognitive ability, loneliness, neuroticism and chronic pain. MR indicated that attention-deficit hyperactivity disorder and schizophrenia were likely causal for reduced occupational engagement.
PD has a genetic component with shared genetic links and relationships with neuropsychiatric disorders and related traits.
{"title":"Genetic studies of psychosocial disability establish correlations and causal relationships with neuropsychiatric disorders","authors":"Evie Doherty , Aodán Laighneach , Mia Casburn , Fergus Quilligan , Gary Donohoe , Dara M. Cannon , Derek W. Morris","doi":"10.1016/j.psychres.2026.116963","DOIUrl":"10.1016/j.psychres.2026.116963","url":null,"abstract":"<div><div>Psychosis is a clinically heterogenous disorder associated with significant difficulties with social and occupational function (psychosocial disability; PD). While environmental and cognitive factors are identified predictors of PD, the genetic contribution remains unclear. Here, we investigated the hypothesis that objective social participation (SP) and occupational engagement are genetically influenced.</div><div>We performed mixed-linear-model genome-wide association studies of these phenotypes in the UK Biobank (<em>N</em>∼404,500) and a series of post-hoc analyses including Mendelian randomization (MR) to interpret findings. SP was defined as the frequency of social visits and leisure activities based on response to questionnaires. Occupational engagement was represented by two variables: occupational function (OF) and the established Not in Education, Employment, and Training (NEET) measure, both derived from employment status responses. We identified 17 independent loci for SP, with a SNP-based heritability of 4.1%. A list of contributory genes included <em>TNRC6B, STAU1, CDH7, GBE1, DDX27</em>, and several known schizophrenia risk genes including <em>CSE1L, ZNF536 and TCF4</em>. The regulation of synaptic signalling was implicated in the biology of SP by gene-set analysis. SNP-based heritabilities for OF and NEET were 1.8% and 1.3% respectively and <em>DRD2</em> was associated with both phenotypes by gene-based analysis. Reduced SP and occupational engagement demonstrated genetic correlations with an increased risk for neuropsychiatric disorders, socioeconomic deprivation, lower cognitive ability, loneliness, neuroticism and chronic pain. MR indicated that attention-deficit hyperactivity disorder and schizophrenia were likely causal for reduced occupational engagement.</div><div>PD has a genetic component with shared genetic links and relationships with neuropsychiatric disorders and related traits.</div></div>","PeriodicalId":20819,"journal":{"name":"Psychiatry Research","volume":"358 ","pages":"Article 116963"},"PeriodicalIF":3.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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