Pub Date : 2025-12-30DOI: 10.1016/j.ajp.2025.104809
Guangzhe Frank Yuan , Yi Rong , Wei Shi
Children with psychiatric disorders in China represent a significant and growing public health concern. Parents of these children experience substantial psychological distress, including elevated stress, anxiety, and depression, which impairs their well-being and compromises child treatment outcomes. Despite the bidirectional relationship between parental and child mental health, current services in China remain predominantly child-focused, with limited systematic support for parents. This paper proposes a comprehensive framework for developing parental mental health support services within China's child psychiatric care system. The framework integrates multi-tiered services, cross-sectoral collaboration, workforce development, technology-enabled delivery, and quality assurance mechanisms. Guided by principles of family-centered care and cultural adaptation, this framework addresses existing system-level barriers while leveraging opportunities such as the Healthy China 2030 initiative. Implementation of this framework has the potential to enhance family well-being, improve child mental health outcomes, and advance health equity across China.
{"title":"Parental mental health support for families of children with psychiatric disorders: A framework for service system development in China","authors":"Guangzhe Frank Yuan , Yi Rong , Wei Shi","doi":"10.1016/j.ajp.2025.104809","DOIUrl":"10.1016/j.ajp.2025.104809","url":null,"abstract":"<div><div>Children with psychiatric disorders in China represent a significant and growing public health concern. Parents of these children experience substantial psychological distress, including elevated stress, anxiety, and depression, which impairs their well-being and compromises child treatment outcomes. Despite the bidirectional relationship between parental and child mental health, current services in China remain predominantly child-focused, with limited systematic support for parents. This paper proposes a comprehensive framework for developing parental mental health support services within China's child psychiatric care system. The framework integrates multi-tiered services, cross-sectoral collaboration, workforce development, technology-enabled delivery, and quality assurance mechanisms. Guided by principles of family-centered care and cultural adaptation, this framework addresses existing system-level barriers while leveraging opportunities such as the Healthy China 2030 initiative. Implementation of this framework has the potential to enhance family well-being, improve child mental health outcomes, and advance health equity across China.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104809"},"PeriodicalIF":4.5,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881734","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104822
Omar Kassar , Abdullah Selim , Shrabon Insan , Osama Hassan , Alexander Sartorius
Background
Auditory hallucinations (AHs) represent a clinical burden and are refractory to antipsychotics in approximately 25 % of cases. Continuous theta burst stimulation (cTBS) has been explored as a neuromodulation option in treating AHs. However, the current evidence regarding its efficacy is inconclusive. This is the first meta-analysis to synthesize evidence exclusively from sham-controlled trials.
Methods
We conducted comprehensive search until September 2025 to include randomized controlled trials (RCTs) that compared cTBS versus sham stimulation in patients experiencing AHs. The primary outcome was the change in AHs measured by validated scales, pooled using standardized mean difference (SMD).
Results
Five RCTs, including 326 patients with schizophrenia spectrum disorders, were included. cTBS demonstrated a statistically significant superiority over sham stimulation in reducing AHs (SMD = −0.34, 95 % CI [-0.57, −0.12], P = 0.002), with no heterogeneity (P = 0.92, I2 = 0 %), and moderate certainty of the current evidence. Sensitivity analysis and the Galbraith plot confirmed results robustness. No publication bias was observed. Subgroup analyses showed greater efficacy in patients with bilateral temporoparietal junctions stimulation, refractory AHs, and delivering 18,000 total pulses. cTBS and sham stimulation did not differ in discontinuation rates, serious adverse events, headache, dizziness, or gastrointestinal symptoms.
Conclusion
The findings of our study suggest that cTBS can be safely applied and may be effective in reducing auditory hallucinations in patients with schizophrenia spectrum disorders, particularly in patients with limited response to antipsychotic medication. Further RCTs are needed to confirm our results and identify the optimal treatment parameters.
背景：幻听（AHs）是一种临床负担，在大约25% %的病例中抗精神病药物难以治愈。连续θ波爆发刺激（cTBS）已被探索作为治疗AHs的神经调节选择。然而，目前关于其功效的证据尚无定论。这是首个综合假对照试验证据的荟萃分析。方法：我们进行了全面的检索，直到2025年9月，纳入随机对照试验（rct），比较cTBS与假刺激对AHs患者的影响。主要结局是通过有效量表测量AHs的变化，使用标准化平均差（SMD）汇总。结果共纳入5项随机对照试验，共纳入326例精神分裂症谱系障碍患者。cTBS在减少AHs方面比假刺激具有统计学上的显著优势（SMD = - 0.34, 95 % CI [-0.57, - 0.12], P = 0.002），无异质性（P = 0.92,I2 = 0 %），现有证据具有中等确定性。敏感性分析和Galbraith图证实了结果的稳健性。未观察到发表偏倚。亚组分析显示，双侧颞顶连接刺激、难治性AHs和总脉冲递送18000次的患者更有效。cTBS和假刺激在停药率、严重不良事件、头痛、头晕或胃肠道症状方面没有差异。结论cTBS对精神分裂症谱系障碍患者，特别是对抗精神病药物反应有限的患者，可安全有效地减少幻听。需要进一步的随机对照试验来证实我们的结果并确定最佳治疗参数。
{"title":"Efficacy and safety of continuous theta burst stimulation for auditory hallucinations: A GRADE-assessed meta-analysis of randomized sham-controlled trials","authors":"Omar Kassar , Abdullah Selim , Shrabon Insan , Osama Hassan , Alexander Sartorius","doi":"10.1016/j.ajp.2025.104822","DOIUrl":"10.1016/j.ajp.2025.104822","url":null,"abstract":"<div><h3>Background</h3><div>Auditory hallucinations (AHs) represent a clinical burden and are refractory to antipsychotics in approximately 25 % of cases. Continuous theta burst stimulation (cTBS) has been explored as a neuromodulation option in treating AHs. However, the current evidence regarding its efficacy is inconclusive. This is the first meta-analysis to synthesize evidence exclusively from sham-controlled trials.</div></div><div><h3>Methods</h3><div>We conducted comprehensive search until September 2025 to include randomized controlled trials (RCTs) that compared cTBS versus sham stimulation in patients experiencing AHs. The primary outcome was the change in AHs measured by validated scales, pooled using standardized mean difference (SMD).</div></div><div><h3>Results</h3><div>Five RCTs, including 326 patients with schizophrenia spectrum disorders, were included. cTBS demonstrated a statistically significant superiority over sham stimulation in reducing AHs (SMD = −0.34, 95 % CI [-0.57, −0.12], P = 0.002), with no heterogeneity (P = 0.92, I<sup>2</sup> = 0 %), and moderate certainty of the current evidence. Sensitivity analysis and the Galbraith plot confirmed results robustness. No publication bias was observed. Subgroup analyses showed greater efficacy in patients with bilateral temporoparietal junctions stimulation, refractory AHs, and delivering 18,000 total pulses. cTBS and sham stimulation did not differ in discontinuation rates, serious adverse events, headache, dizziness, or gastrointestinal symptoms.</div></div><div><h3>Conclusion</h3><div>The findings of our study suggest that cTBS can be safely applied and may be effective in reducing auditory hallucinations in patients with schizophrenia spectrum disorders, particularly in patients with limited response to antipsychotic medication. Further RCTs are needed to confirm our results and identify the optimal treatment parameters.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104822"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881735","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104810
Raja Babu Ramawat , Omar Afroz , Rajesh Sagar
{"title":"From exclusion to inclusion: Why premenstrual dysphoric disorder (PMDD) research must include transgender and gender-diverse (TGD) menstruators","authors":"Raja Babu Ramawat , Omar Afroz , Rajesh Sagar","doi":"10.1016/j.ajp.2025.104810","DOIUrl":"10.1016/j.ajp.2025.104810","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104810"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882293","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104823
Arsalan Haider , Farhan Haider, Ana Estéveze, Dong-Mei Wang , Xiang-Yang Zhang
{"title":"Identification of risk features for methamphetamine dependence using a machine learning model and comprehensive multimodal measures","authors":"Arsalan Haider , Farhan Haider, Ana Estéveze, Dong-Mei Wang , Xiang-Yang Zhang","doi":"10.1016/j.ajp.2025.104823","DOIUrl":"10.1016/j.ajp.2025.104823","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104823"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910302","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104824
Lalasa Mukku, Vikas Burri
{"title":"Unsupervised digital counselling: Addressing the safety gap of large language models as mental health tools","authors":"Lalasa Mukku, Vikas Burri","doi":"10.1016/j.ajp.2025.104824","DOIUrl":"10.1016/j.ajp.2025.104824","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104824"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881738","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104816
George V. JOY , Febu Elizabeth JOY, Abdulqadir J. NASHWAN
The rapid integration of artificial intelligence (AI) into mental health practice presents both unprecedented opportunities and substantial challenges for contemporary care systems. This discursive review critically examines how AI-enabled tools intersect with the interpersonal foundations of psychotherapy, with particular attention to empathy, therapeutic alliance, and relational dynamics. Drawing on socio-technical theory, psychotherapeutic research, and emerging literature in affective computing and neurotechnology, the review develops a conceptual framework positioning AI as an augmentative, not substitutive partner in mental health care. While AI demonstrates clear strengths in enhancing accessibility, reducing administrative burden, supporting structured interventions, and improving monitoring through data-driven insights, these advantages are counterbalanced by significant concerns. Limitations in genuine empathic capacity, risks to transference and therapeutic authenticity, potential erosion of clinician skills, and ethical tensions related to privacy, accountability, algorithmic bias, and emotional deception underscore the complexity of integrating AI into relationally grounded practices. Differential impacts across therapeutic modalities and clinical conditions reveal that structured, skills-based treatments such as cognitive-behavioral approaches benefit most from AI augmentation, whereas humanistic and psychodynamic therapies rooted in emotional presence and intersubjective meaning-making remain less amenable to technological simulation. The review further highlights the importance of hybrid care models in which human clinicians guide relational processes while AI supports precision, continuity, and scalability. Ethical implementation requires robust frameworks emphasizing transparency, informed consent, equitable access, data protection, and sustained human oversight. Emerging neurotechnologies introduce additional considerations regarding autonomy, identity, and the need for evolving “neurorights.” Overall, this review argues that the future of mental health care depends on harmonizing technological innovation with human compassion. Effective, ethical, and relationally sensitive integration of AI must preserve the therapeutic alliance at its core, ensuring that technology enhances rather than replaces the deep human processes essential to psychological healing.
{"title":"Between empathy and algorithms: Navigating interpersonal dynamics in AI-augmented mental health care- Discursive review","authors":"George V. JOY , Febu Elizabeth JOY, Abdulqadir J. NASHWAN","doi":"10.1016/j.ajp.2025.104816","DOIUrl":"10.1016/j.ajp.2025.104816","url":null,"abstract":"<div><div>The rapid integration of artificial intelligence (AI) into mental health practice presents both unprecedented opportunities and substantial challenges for contemporary care systems. This discursive review critically examines how AI-enabled tools intersect with the interpersonal foundations of psychotherapy, with particular attention to empathy, therapeutic alliance, and relational dynamics. Drawing on socio-technical theory, psychotherapeutic research, and emerging literature in affective computing and neurotechnology, the review develops a conceptual framework positioning AI as an augmentative, not substitutive partner in mental health care. While AI demonstrates clear strengths in enhancing accessibility, reducing administrative burden, supporting structured interventions, and improving monitoring through data-driven insights, these advantages are counterbalanced by significant concerns. Limitations in genuine empathic capacity, risks to transference and therapeutic authenticity, potential erosion of clinician skills, and ethical tensions related to privacy, accountability, algorithmic bias, and emotional deception underscore the complexity of integrating AI into relationally grounded practices. Differential impacts across therapeutic modalities and clinical conditions reveal that structured, skills-based treatments such as cognitive-behavioral approaches benefit most from AI augmentation, whereas humanistic and psychodynamic therapies rooted in emotional presence and intersubjective meaning-making remain less amenable to technological simulation. The review further highlights the importance of hybrid care models in which human clinicians guide relational processes while AI supports precision, continuity, and scalability. Ethical implementation requires robust frameworks emphasizing transparency, informed consent, equitable access, data protection, and sustained human oversight. Emerging neurotechnologies introduce additional considerations regarding autonomy, identity, and the need for evolving “neurorights.” Overall, this review argues that the future of mental health care depends on harmonizing technological innovation with human compassion. Effective, ethical, and relationally sensitive integration of AI must preserve the therapeutic alliance at its core, ensuring that technology enhances rather than replaces the deep human processes essential to psychological healing.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104816"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910299","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104821
Mohamad Saripudin, Aip Badrujaman
The consensus article by Quah et al. (2025) offers an important framework for strengthening perinatal mental health across the Asia–Pacific region but does not sufficiently address the role of cultural wisdom and ritualized social support in maternal wellbeing. Evidence from Indonesia suggests that cultural pregnancy rituals and strong family or community support can protect against antenatal anxiety and depression, even though direct empirical studies on ritual-specific outcomes remain limited. In Indonesia, longstanding practices such as mitoni, ba bu, and topung tawar function as informal, community-driven psychosocial interventions that reinforce maternal identity, collective empathy, and emotional safety. Integrating these culturally embedded supports into regional perinatal mental health frameworks could enhance cultural relevance, strengthen community participation, and bridge gaps between formal healthcare and indigenous caregiving systems. A culturally grounded approach, guided by voluntariness and safety considerations, may contribute to more holistic and equitable maternal mental health strategies in the region.
{"title":"Integrating cultural rituals and social support into perinatal mental health frameworks: Lessons from indonesian pregnancy traditions","authors":"Mohamad Saripudin, Aip Badrujaman","doi":"10.1016/j.ajp.2025.104821","DOIUrl":"10.1016/j.ajp.2025.104821","url":null,"abstract":"<div><div>The consensus article by Quah et al. (2025) offers an important framework for strengthening perinatal mental health across the Asia–Pacific region but does not sufficiently address the role of cultural wisdom and ritualized social support in maternal wellbeing. Evidence from Indonesia suggests that cultural pregnancy rituals and strong family or community support can protect against antenatal anxiety and depression, even though direct empirical studies on ritual-specific outcomes remain limited. In Indonesia, longstanding practices such as <em>mitoni, ba bu, and topung tawar</em> function as informal, community-driven psychosocial interventions that reinforce maternal identity, collective empathy, and emotional safety. Integrating these culturally embedded supports into regional perinatal mental health frameworks could enhance cultural relevance, strengthen community participation, and bridge gaps between formal healthcare and indigenous caregiving systems. A culturally grounded approach, guided by voluntariness and safety considerations, may contribute to more holistic and equitable maternal mental health strategies in the region.</div></div>","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104821"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881741","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104819
Mohsen Khosravi
{"title":"Addressing the paradox of help-seeking reluctance among mental health professionals","authors":"Mohsen Khosravi","doi":"10.1016/j.ajp.2025.104819","DOIUrl":"10.1016/j.ajp.2025.104819","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104819"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881739","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 : 2025-12-29DOI: 10.1016/j.ajp.2025.104813
Yun-An Liu, Yi-Chyan Chen
{"title":"Hemodialysis dramatically alleviates treatment-refractory psychosis in a subject with schizoaffective disorder","authors":"Yun-An Liu, Yi-Chyan Chen","doi":"10.1016/j.ajp.2025.104813","DOIUrl":"10.1016/j.ajp.2025.104813","url":null,"abstract":"","PeriodicalId":8543,"journal":{"name":"Asian journal of psychiatry","volume":"116 ","pages":"Article 104813"},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881740","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}
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