Psychological Medicine最新文献

{"title":"Cognitive effects of intravenous Ketamine in treatment-resistant depression: A systematic review.","authors":"Lou-Anne Chavigny, Véronique Desbeaumes Jodoin, Nicolas Garel, Manola Sob Ndongo, Laura Osborne, Gustavo Turecki, Stéphane Richard Devantoy","doi":"10.1017/S0033291726103961","DOIUrl":"https://doi.org/10.1017/S0033291726103961","url":null,"abstract":"<p><p>Intravenous (IV) low-dose ketamine has emerged as a promising treatment for patients with treatment-resistant depression (TRD). However, its impact on cognitive functioning remains unclear. This systematic review examines the cognitive and executive effects of IV ketamine in TRD, focusing on their relationship to depressive and suicidal outcomes. A systematic search of Cochrane, MEDLINE, Embase, and PsycINFO databases was conducted up to May 15, 2025, using the terms depression, cognition, and ketamine. This review was conducted in accordance with the PRISMA guidelines, and the protocol was registered in PROSPERO (ID: 1160487). Risk of bias was evaluated using the Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. Twenty-one studies, comprising approximately 900-1,180 participants with TRD, assessed cognitive domains of processing speed, working memory, attention, verbal and visual memory, cognitive flexibility, and executive control. Procognitive effects were frequently observed in processing speed and working memory, while attention results were preserved or modestly improved, and verbal and visual memory results were heterogeneous. Executive control, particularly inhibitory performance on Stroop paradigms, improved in several trials. Two studies directly examined cognition as it relates to suicidal behaviors. No cognitive deterioration was reported. Subanesthetic IV ketamine appears to preserve and enhance specific cognitive functions in TRD, notably across processing speed, working memory, and executive control. These procognitive effects, particularly in executive control, may mediate ketamine's antisuicidal action. Standardized longitudinal studies are warranted to clarify their durability and clinical significance.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e133"},"PeriodicalIF":5.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842097","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}

{"title":"Childhood environment clusters reveal heterogeneous associations between large-scale brain networks and youth mental health symptoms.","authors":"Felicia A Hardi, Taylor J Keding, Bailey Holt-Gosselin, Elizabeth V Goldfarb, Dylan G Gee","doi":"10.1017/S0033291726104115","DOIUrl":"https://doi.org/10.1017/S0033291726104115","url":null,"abstract":"<p><strong>Background: </strong>Youth mental health and brain development are profoundly shaped by highly heterogeneous childhood environments. However, research often operates under the assumption that neural networks linked to psychopathology function in the same way across different individuals, with limited consideration of how brain-behavior associations themselves may vary across environmental contexts. This poses challenges for identifying the precise neural correlates of risk or resilience to psychopathology.</p><p><strong>Methods: </strong>In a large, longitudinal sample (<i>N</i> = 8,078), we examined differences in psychological symptoms and their associations with brain network functional connectivity across three clusters of youth identified by their home, school, and community environments.</p><p><strong>Results: </strong>Child environment groups differed in mental health symptoms, as well as the links between large-scale functional network connectivity and symptoms. Youth exposed to high trauma and familial risk showed the highest symptom levels over time compared to those youth in low-risk or economically disadvantaged environments. Moreover, youth in the high trauma and familial risk group showed stronger functional connectivity between the salience and frontoparietal networks with increased symptoms, whereas youth in the high disadvantage group showed the opposite pattern. Notably, these brain and mental health associations were not observed when examined across the entire sample, and group differences were more pronounced in female and older youth.</p><p><strong>Conclusions: </strong>The same neural patterns of functional network connectivity can have different implications for mental health depending on the environment. These findings highlight the importance of context-sensitive approaches for developing personalized interventions in supporting youth mental health.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e134"},"PeriodicalIF":5.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842055","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}

{"title":"Inflammatory markers in the emergency department and PTSD symptoms in the AURORA Study: A longitudinal cohort study.","authors":"Kristen Nishimi, Sarah D Linnstaedt, Thomas C Neylan, Lauren A McKibben, Liz Marie Albertorio-Sáez, Ying Zhao, Stacey L House, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Gari D Clifford, Tanja Jovanovic, Laura T Germine, Scott L Rauch, John P Haran, Alan B Storrow, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Brittany E Punches, Robert A Swor, Jose L Pascual, Mark J Seamon, Elizabeth M Datner, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Paulina Sergot, Leon D Sanchez, Steven E Bruce, Steven E Harte, Ronald C Kessler, Karestan C Koenen, Kerry J Ressler, Samuel A McLean, Aoife O'Donovan","doi":"10.1017/S0033291726103833","DOIUrl":"https://doi.org/10.1017/S0033291726103833","url":null,"abstract":"<p><strong>Background: </strong>Systemic inflammation is hypothesized to contribute to post-traumatic stress disorder (PTSD) vulnerability. Few studies have examined inflammation shortly after trauma as a predictor of later PTSD symptoms. We examined whether inflammation from the emergency department (ED) post-trauma is associated with PTSD symptom severity over the following 6 months.</p><p><strong>Methods: </strong>Our sample included 742 AURORA participants, a longitudinal cohort of patients in 29 EDs across the United States after a traumatic stressor, followed up to 6 months. Plasma cytokines were assessed from a study blood draw in the ED: an inflammatory index (standardized sum of generally pro-inflammatory markers interleukin [IL]-6, IL-8, tumor necrosis factor alpha [TNF-α], interferon gamma [IFN-γ]), and generally anti-inflammatory IL-10. PTSD symptoms were self-reported at 2 weeks, 8 weeks, 3 months, and 6 months post-ED. Covariate-adjusted repeated-measures regressions estimated associations between inflammation and PTSD symptoms, overall and sex-stratified.</p><p><strong>Results: </strong>Among 742 participants (age <i>m</i> = 40.0 [13.7]; 479 [64.6%] female), PTSD symptoms were elevated then modestly decreased over follow-up. Higher ED inflammation was associated with higher PTSD symptoms across follow-up (standardized symptoms <i>β</i> = 0.05, 95% CI: 0.01-0.09), adjusted for potential confounders. Higher pro-inflammatory index levels and IL-6, IL-8, and TNF-α were associated with higher PTSD symptoms in males only, while higher IL-10 was associated with higher PTSD symptoms in females only.</p><p><strong>Conclusions: </strong>Pro-inflammatory levels shortly after traumatic stress are associated with heightened PTSD symptoms, particularly among males. Inflammatory markers may prove useful additions to prediction models for PTSD following trauma, with attention to sex differences.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e123"},"PeriodicalIF":5.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842112","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}

{"title":"Do antidepressants change our interpretations of facial emotions?","authors":"Nigel McKenzie, Jessica Bone, Larisa Duffy, Marcus Mufano, Glyn Lewis","doi":"10.1017/S0033291726104000","DOIUrl":"https://doi.org/10.1017/S0033291726104000","url":null,"abstract":"<p><strong>Background: </strong>Cognitive neuropsychological models propose that antidepressants exert their therapeutic effects by modifying negative emotional processing biases early in treatment. However, evidence from large, long-term clinical samples is limited.</p><p><strong>Methods: </strong>We conducted a mechanistic analysis within the Antidepressants to Prevent Relapse in Depression randomized controlled trial, which compared maintenance antidepressant treatment with placebo substitution in adults with recurrent depression who were currently well (N = 478). Participants completed a computerized facial emotion recognition task at baseline, 12 weeks, and 52 weeks, in which faces morphed from happy to sad. The primary outcome was the number of faces classified as happy (0-45). Linear and longitudinal mixed-effects models were used to compare treatment groups and examine associations with depressive (PHQ-9) and anxiety (GAD-7) symptoms.</p><p><strong>Results: </strong>Of the 462 participants completing at least one task, there was no evidence that discontinuing antidepressants altered performance compared with maintenance at 12 weeks (adjusted mean difference = 0.23, 95% CI -0.5 to 1.0, p = 0.5) or 52 weeks (0.29, -0.5 to 1.2, p = 0.5). Depressive symptoms were negatively associated with happy face classifications both cross sectionally (β = -0.20 per PHQ-9 point, p = 0.02) and longitudinally (β = -0.09, p = 0.05). Anxiety symptoms were positively associated with happy classifications (β = 0.11, p = 0.047).</p><p><strong>Conclusions: </strong>Maintenance antidepressant treatment did not sustain positive emotional processing biases as indexed by facial emotion recognition, despite robust associations between such biases and depressive symptoms. These findings challenge the generalizability of laboratory evidence on emotional bias modification to long-term clinical treatment and highlight the need for further mechanistic research on antidepressant action.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e132"},"PeriodicalIF":5.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842069","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}

{"title":"Slower motor speed as a predictor of suicide attempts in high-risk youth.","authors":"Meilin Jia-Richards, Sriram Ksheeraja, Sarah Riston, Elijah Goodfriend, Adam Z Melhem, Katherine Recker-Mohn, Veda Murthy, Andrew Luskin, Nermin Toukhy, Kehui Chen, Antoine Douaihy, David A Brent, Nadine M Melhem","doi":"10.1017/S0033291726103675","DOIUrl":"https://doi.org/10.1017/S0033291726103675","url":null,"abstract":"<p><strong>Background: </strong>Predicting suicide risk remains a challenge. We examined whether neurocognitive performance on implicit associations toward suicide, motor speed, response inhibition, and executive functioning predicts suicide attempt and behavior in high-risk psychiatric patients.</p><p><strong>Method: </strong>Our sample (<i>N</i> = 298) consisted of inpatients (<i>n</i> = 161) and outpatients (<i>n</i> = 83) admitted for a suicide attempt (SA; <i>n</i> = 78), for suicidal ideation (SI; <i>n</i> = 76), or were non-suicidal psychiatric controls (PC; <i>n</i> = 90), and healthy controls (HC; <i>n</i> = 54). Participants were followed for 12 months, with follow-up assessments at 3-, 6-, and 12-months. Neurocognitive tasks were administered at baseline. Clinical symptom measures, suicidality, and electronic health record data were collected at each timepoint. ANCOVA was used to compare groups on neurocognitive performance, and logistic and Cox regressions examined whether neurocognitive performance predicted future actual suicide attempt and suicidal behaviors.</p><p><strong>Results: </strong>Participants had a mean age of 24.34 years (<i>SD</i> = 3.71). A total of 19 participants made an actual suicide attempt during the study. On neurocognitive tasks at baseline, the SA group had stronger implicit associations with death- and suicide-related words compared to the HC (<i>d</i> = 0.88, <i>p</i> < 0.001) and SI (<i>d</i> = 0.63, <i>p</i> = 0.005) groups and poorer executive functioning than the SI (<i>d</i> = 0.44, <i>p</i> = 0.043) group in multivariate models. Stronger implicit associations with death/suicide predicted higher risk of suicide attempts at the univariate (<i>HR =</i> 1.68 <i>p</i> = 000), but not multivariate level (<i>HR =</i> 1.17 <i>p</i> = 000), while slower motor speed predicted actual suicide attempts (<i>HR =</i> 1.81 <i>p</i> = 000) at the multivariate level.</p><p><strong>Conclusions: </strong>Slower motor speed predicts actual suicide attempt and may help identify psychiatric patients who are at high risk for suicidal behavior.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e125"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841886","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}

{"title":"Clusters of social and substance use-related risks are associated with the duration of untreated psychosis.","authors":"Hannah Edelhoff, Jim van Os, Therese van Amelsvoort, Claudia J P Simons, Lieuwe de Haan, Marieke van der Pluijm, Lucia Sideli, Ilaria Tarricone, Laura Ferraro, Sarah Tosato, Domenico Berardi, Celso Arango, Miguel Bernardo, Paulo Rossi Menezes, Cristina Marta Del-Ben, Franck Schürhoff, Jean-Paul Selten, Bart P F Rutten, Robin M Murray, Craig Morgan, Frederike Schirmbeck, Ulrich Reininghaus","doi":"10.1017/S0033291726103791","DOIUrl":"https://doi.org/10.1017/S0033291726103791","url":null,"abstract":"<p><strong>Background: </strong>The duration of untreated psychosis (DUP) is still considerably long in patients with psychotic disorders worldwide. Social determinants, such as the socioeconomic status, can influence DUP, exacerbating health inequalities in access to timely care. We investigated whether subpopulations with shared characteristics are associated with longer DUP.</p><p><strong>Methods: </strong>We performed latent class analyses to investigate whether classes with shared configurations of social and substance use-related risks can be identified in two large cohorts with psychotic disorders: <i>N</i> = 780 patients from the GROUP project and <i>N</i> = 847 patients from the EU-GEI project. Subsequently, we conducted survival analyses to analyze whether identified classes are associated with DUP.</p><p><strong>Results: </strong>We identified three classes in both samples. Membership of the class with predominantly younger men, higher proportion of cannabis use, and supported living was associated with longer DUP compared with a class with predominantly White ethnicity, higher education, and current employment in GROUP (HR = 1.28, 95% CI: 1.06-1.56, <i>p</i> = .011) and in EU-GEI (HR = 1.27, 95% CI: 1.07-1.51, <i>p</i> = .007). In GROUP, membership of a third class with predominantly White women, without cannabis use, was associated with the shortest DUP (HR = 0.78, 95% CI: 0.63-0.95, <i>p</i> = .016).</p><p><strong>Conclusions: </strong>Results suggest that specific populations differ in their risk distributions for prolonged DUP and highlight the importance of considering configurations of social determinants in context. Public mental health programs need to establish their differential impact for diverse populations and facilitate more targeted pathways to care.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e126"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842077","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}

{"title":"Brain network representations of placebo analgesia.","authors":"Xiaohan Zhang, Xuetian Sun, Weisheng Huang, Kaijie An, Xufeng Zhao, Dan Zhang, Wenwei Zhang, Yongqiang Yu, Yinfeng Qian, Jiajia Zhu","doi":"10.1017/S0033291726103924","DOIUrl":"https://doi.org/10.1017/S0033291726103924","url":null,"abstract":"<p><strong>Background: </strong>Prior neuroimaging studies and meta-analyses investigating brain correlates of placebo analgesia (PA) have yielded neuroanatomically heterogeneous findings, which may be reconciled from a connectomics perspective. The objective of this study was to examine network localization of brain functional alterations related to PA.</p><p><strong>Methods: </strong>We initially identified PA-induced brain activation alterations (hyper-activation and hypo-activation separately) during experimental pain from 29 published studies with 674 individuals. By combining these implicated dysfunctional brain regions with large-scale discovery (N = 1113) and validation (N = 1093) resting-state functional magnetic resonance imaging datasets, we then employed a novel functional connectivity network mapping approach to construct PA hyper-activation and hypo-activation networks, respectively.</p><p><strong>Results: </strong>The PA hyper-activation network manifested as a pattern of circumscribed brain regions mainly involving the limbic, default, and frontoparietal networks. By contrast, the PA hypo-activation network comprised a broadly distributed set of brain regions primarily implicating the ventral attention, somatomotor, and subcortical networks.</p><p><strong>Conclusions: </strong>Our findings regarding the brain network representations of PA may contribute to a deeper understanding of its action mechanisms and provide a neural framework that may inform future clinical translation.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e131"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842081","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}

{"title":"Psychiatric safety of methylphenidate in adults with major depressive disorder: a 1-year retrospective cohort study of 6,422 patients.","authors":"Ting-Hui Liu, Ya-Lin Huang, Jheng-Yan Wu, Chien-Ho Lin, Fong-Lin Jang, Chih-Cheng Lai","doi":"10.1017/S0033291726103845","DOIUrl":"https://doi.org/10.1017/S0033291726103845","url":null,"abstract":"<p><strong>Background: </strong>Methylphenidate is sometimes used to address residual symptoms of major depressive disorder (MDD), but concerns about psychiatric destabilization and limited long-term evidence have constrained its use. We examined the psychiatric safety of methylphenidate in adults with MDD in a large, real-world cohort.</p><p><strong>Methods: </strong>Using the TriNetX Global Collaborative Network, we identified adults with MDD who initiated methylphenidate and matched them 1:1 with controls who did not receive methylphenidate. Patients with attention-deficit/hyperactivity disorder, bipolar disorder, mania, or recent psychiatric destabilization were excluded. The primary outcome was a composite of all-cause hospitalization or emergency room visits; secondary outcomes included hospitalization, emergency visits, suicidal behavior, manic episodes, and recurrence of MDD. Hazard ratios (HRs) were estimated with Cox proportional hazards models after propensity score matching.</p><p><strong>Results: </strong>Of 425,190 eligible patients, 3,211 matched pairs were included (mean age, 55.8 years; 58% female). Over 1 year, the composite outcome occurred less frequently in the methylphenidate group than in controls (574 vs. 694; HR, 0.85; 95% CI, 0.76-0.95). No significant differences were observed for hospitalization, emergency visits, suicidal behavior, manic episodes, or MDD recurrence. Results were consistent across subgroups defined by sex, age, and antidepressant class.</p><p><strong>Conclusions: </strong>In adults with MDD, methylphenidate use was associated with a lower risk of hospitalization or emergency visits and was not linked to increased risk of suicidality, mania, or recurrence. These findings support the psychiatric safety of methylphenidate as an adjunctive treatment for selected patients, though longer follow-up is needed.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e130"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841877","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}

{"title":"A review and integration of models on delusion maintenance.","authors":"Tania M Lincoln, Henning Romberg, David Torrents-Rodas, Antonia Bott","doi":"10.1017/S0033291726103705","DOIUrl":"https://doi.org/10.1017/S0033291726103705","url":null,"abstract":"<p><p>Contemporary definitions of delusions highlight their resistance to conflicting evidence as the core feature. However, most etiological models of delusions have focused on delusion formation rather than maintenance and we lack a coherent understanding of why delusions persist. We conducted a systematic literature search of models on delusion maintenance, extracted their core postulates, point to explanatory gaps, and derive an integrated framework. We identified 74 published accounts that include postulated mechanisms of delusion maintenance. We classified the models into six core perspectives that informed them: Bayesian inference (17 models), associative learning theory (6 models), neurobiological (11 models), cognitive-behavioral (23 models), motivational (7 models), and social (6 models). Most models highlight a mechanistic role of avoidance and operant learning, converging on the idea that a delusional explanation is reinforced. Another repeatedly suggested mechanism is that the delusional belief, once formed, influences the way further information is processed. In addition, most models propose a key role of individual deficits and biases. The proposed factors can be combined in temporal progression, including early risk factors and resulting vulnerability, the common proposed mechanism of formation (i.e. search for explanation of ambiguous experiences), and the short- and long-term consequences of the delusional explanation along with feedback loops. By considering numerous factors and their interactions, the integrative model provides a considerably more compelling account of why delusions persist than any single perspective alone. It can help to identify novel directions for research and intervention, such as addressing short-term benefits of delusion maintenance.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e127"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842093","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}

{"title":"Objective sleep efficiency links to cortisol stress recovery via dorsolateral prefrontal-hippocampal regulation.","authors":"Xiao Luo, Xiaolin Zhao, Yadong Liu, Yina Ma, Yipeng Ren, Zhenni Wei, Zihan Tang, Kaige Guo, Jiahao Luo, Juan Yang","doi":"10.1017/S0033291726104206","DOIUrl":"https://doi.org/10.1017/S0033291726104206","url":null,"abstract":"<p><strong>Background: </strong>Existing evidence highlights sleep's critical role in regulating cortisol stress recovery; the underlying neural pathways remain unclear. To address this gap, the current study aims to elucidate the neurobiological pathway linking objective sleep efficiency to cortisol stress recovery using functional magnetic resonance imaging (fMRI), with a focus on the functional connectivity (FC) between prefrontal cortex (PFC) and hippocampus.</p><p><strong>Methods: </strong>Seventy-seven participants completed an acute stress task during a task-dependent and resting-state fMRI scanning. Salivary samples were collected and analyzed as an indicator of cortisol stress recovery. Objective sleep efficiency was measured the night before the fMRI scanning. Using Seed-based gPPI and resting-state FC analysis, we examined the mediating role of PFC-hippocampus FC in the association between objective sleep efficiency and cortisol stress recovery, both during the stress task and in the post-stress resting-state.</p><p><strong>Results: </strong>Objective sleep efficiency was significantly related to cortisol stress recovery but not with cortisol reactivity. Neurologically, higher sleep efficiency was linked to enhanced prefrontal activity and increased the left dlPFC-hippocampus FC during the acute stress task. Importantly, objective sleep efficiency promoted cortisol stress recovery by the weakened resting-state left dlPFC-hippocampus FC.</p><p><strong>Conclusions: </strong>This study highlights the pivotal role of left dlPFC-hippocampus regulation underlying sleep's effect on HPA axis recovery to acute stress. These results suggest a model whereby high objective sleep efficiency promotes adaptive stress recovery through dynamic reallocation of neural resources across acute stress process, characterized by task-dependent coupling and post-stress decoupling of frontal-hippocampal circuitry.</p>","PeriodicalId":20891,"journal":{"name":"Psychological Medicine","volume":"56 ","pages":"e129"},"PeriodicalIF":5.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841615","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}