Alpha psychiatry最新文献

{"title":"Targeting Network Imbalance in Schizophrenia: The Application of Temporal Interference Stimulation.","authors":"Li Wan, Yiwen Chen, Nuo Chen, Qiong Ye, Shengchun Jin","doi":"10.31083/AP50695","DOIUrl":"10.31083/AP50695","url":null,"abstract":"<p><p>Schizophrenia is a highly heterogeneous psychiatric disorder. Antipsychotics have limited efficacy on negative and cognitive symptoms, and are associated with side effects and high relapse rates. The core pathophysiology remains unclear, with most existing studies providing correlational neuroimaging descriptions lacking causal validation and precise intervention methods. The triple network model proposes that dynamic imbalance among the default mode network (DMN), salience network (SN), and central executive network (CEN) is a key feature of the disorder, underpinned by thalamocortical circuit disruption. Specifically, DMN hyperactivation, reduced SN connectivity, weakened CEN activation, and failure of SN-mediated network switching are observed. In schizophrenia, DMN hyperactivation initially serves as a compensatory response but eventually progresses to pathological decompensation. Conventional noninvasive stimulation techniques cannot effectively target deep brain nodes, limiting causal validation and precise intervention. As a novel noninvasive technique, temporal interference (TI) stimulation uses high-frequency alternating current interference to target deep brain regions, enabling both causal testing of network interactions and personalized modeling-based precise intervention. In summary, dynamic imbalance of the DMN-SN-CEN network is central to schizophrenia pathophysiology, with SN dysfunction as a potential causal factor. Targeting SN function using TI stimulation could directly test its causal role in network dynamics and symptoms, offering a route toward precision network intervention in this disorder.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"50695"},"PeriodicalIF":2.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress, Advances and Challenges in Bipolar Disorder.","authors":"Gin S Malhi, Kinga Szymaniak, Gurubhaskar Shivakumar, Erica Bell","doi":"10.31083/AP49937","DOIUrl":"10.31083/AP49937","url":null,"abstract":"","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"49937"},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Depression in Women With Metabolic Dysfunction-Associated Fatty Liver Disease Using Routine Blood Tests: A Five-Year Longitudinal Analysis From the UK Biobank.","authors":"Junrong Li, Taolong Zhou, Zhongwen Feng, Xiaobing Zhai, Xiaoliang Li, Tao Luo, Henry Hoi Yee Tong, Kefeng Li, Mingxing Huang","doi":"10.31083/AP46337","DOIUrl":"10.31083/AP46337","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Metabolic dysfunction-associated fatty liver disease (MAFLD) affects 38.9% of the global adult population and is associated with increased mortality when it co-occurs with depression. Women exhibit a 1.5- to 3-fold higher prevalence of depression, with postmenopausal hormonal imbalances amplifying susceptibility. This underscores the urgent need for sex-specific predictive models. The aim of this study was to develop a lightweight, high-accuracy model to identify key predictors of depression risk in female MAFLD patients using a five-year longitudinal UK Biobank cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed routine blood biomarkers (hematology and metabolites), lifestyle factors, and reproductive history from female participants with MAFLD identified within the UK Biobank cohort. Logistic regression was adjusted for socioeconomic, lifestyle, multimorbidity, and medication use, and was employed to evaluate sex-specific factors. Feature selection employed a two-stage approach to ensure balanced covariate distributions between cases and controls: Random Forest-based stratified bootstrap resampling (1000 iterations) instead of traditional random sampling, followed by recursive feature elimination. Five models-Light Gradient Boosting Machine (LightGBM), Extreme Gradient Boosting (XGBoost), Random Forest, Feature Tokenizer Transformer (FT-Transformer), and Gated Adaptive Network for Deep Automated Learning of Features (GANDALF)-were assessed via 10-fold cross-validation. SHapley Additive exPlanations (SHAP) and restricted cubic splines (RCS) elucidated feature importance and nonlinear effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 39,430 female MAFLD patients were included in the final analysis, among whom 611 (1.55%) developed incident depression over the five-year follow-up. Adjusted logistic regression identified younger age at first live birth (&lt;20 years) and early menopause (&lt;35 years) as significant risk factors for depression. Among the evaluated models, GANDALF demonstrated superior performance (area under the receiver operating characteristic curve [ROC-AUC] = 0.96 ± 0.03, Matthews' correlation coefficient [MCC] = 0.830 ± 0.068), significantly outperforming conventional machine learning approaches (MCC range: 0.720 to 0.760) and exhibiting better calibration (Brier score: 0.066 vs. 0.093-0.115). SHAP analysis identified red blood cell count, Townsend deprivation index, and neutrophil count as the most influential predictors among the 17-feature panel. RCS analyses revealed nonlinear protective effects of moderate physical activity and higher red blood cell counts, contrasted by adverse effects from elevated white blood cell counts, overweight (body mass index [BMI] &gt;25 kg/m&lt;sup&gt;2&lt;/sup&gt;) and obesity (body mass index [BMI] &gt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;), and early reproductive milestones. Additionally, our feature set showed enhanced predictive validity compared to established biomarker panels from prior studies","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"46337"},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing Trauma-related Dissociation Behind Psychotic Phenomena.","authors":"Hong Wang Fung, Wai Tong Chien","doi":"10.31083/AP46069","DOIUrl":"10.31083/AP46069","url":null,"abstract":"","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"46069"},"PeriodicalIF":2.9,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Expressed Emotion and Relapse of Bipolar Disorder: A Systematic Review.","authors":"Sum Yu Tong, Moses Chung Hei Dye, Anthony Ho Tsun Yue, Yan Li, Dennis Chak Fai Ma","doi":"10.31083/AP47961","DOIUrl":"10.31083/AP47961","url":null,"abstract":"<p><strong>Background: </strong>Expressed emotion (EE) is a robust predictor of relapse in individuals with schizophrenia-spectrum disorders. However, the evidence on this relationship has not been fully examined in individuals with bipolar disorder (BD). This systematic review was conducted to provide updated evidence on the association between EE and relapse in BD.</p><p><strong>Methods: </strong>A systematic search was conducted in seven databases and two registries from inception to 29 December 2025. The Joanna Briggs Institute's (JBI) critical appraisal checklists were used to assess the risk of bias in the included studies. The review process was conducted independently by two reviewers, with consensus for each step achieved through consultation with a third reviewer. A narrative synthesis was performed to categorise the findings, with particular focus on the impact of global EE and its subdomains on relapse in BD.</p><p><strong>Results: </strong>Of the 2963 records identified, seven studies were included in this review. The majority of studies were rated as having a low risk of bias. The narrative synthesis indicates that high EE is significantly associated with an increased risk of relapse in BD, particularly for depressive episodes, and is linked to critical comments and emotional over-involvement, two key subdomains of EE.</p><p><strong>Conclusions: </strong>This review provides evidence of a potential association between high EE, its subdomains, and relapse in BD. These preliminary findings contribute to the development of family-based interventions for BD and highlight the need for larger-scale, longitudinal prospective cohort studies to further clarify this relationship.</p><p><strong>Registration: </strong>The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42025632303; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025632303).</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"47961"},"PeriodicalIF":2.9,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>GRIA</i> Gene Expression in Schizophrenia: A Participant-Level Meta-Analysis.","authors":"Adan Baumel, Assif Yitzhaky, Libi Hertzberg","doi":"10.31083/AP46200","DOIUrl":"10.31083/AP46200","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is a complex mental disorder with an estimated heritability of 80%, yet its underlying pathophysiology remains poorly understood. Emerging evidence implicates the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) glutamate receptor-a key player in fast excitatory synaptic transmission, encoded by Glutamate Ionotropic Receptor AMPA Type Subunits 1-4 (<i>GRIA1-4</i>)-in the disorder's pathophysiology. However, findings from postmortem brain samples regarding <i>GRIA1-4</i> expression have been inconsistent. This study aimed to systematically evaluate the differential expression of <i>GRIA1-4</i> genes in schizophrenia by integrating transcriptomic data from postmortem brain tissue and patient-derived cerebral organoids.</p><p><strong>Methods: </strong>We conducted a participant-level meta-analysis of seven postmortem brain sample datasets (n = 295; 151 schizophrenia, 144 controls) and analyzed an independent organoid dataset (n = 16). Expression differences between schizophrenia and control samples were quantified using Hedges' g under a random-effects model, with heterogeneity assessed using the I² statistic.</p><p><strong>Results: </strong>Our analysis revealed significant downregulation of all four <i>GRIA</i> genes (<i>GRIA1-4</i>) in postmortem brain tissue from individuals with schizophrenia, with the effect concentrated in a subgroup of patients. No substantial heterogeneity was attributable to differences in brain regions or measurement platforms. Consistent downregulation of <i>GRIA1-3</i> was observed in patient-derived cerebral organoids, which model early neurodevelopmental stages.</p><p><strong>Conclusions: </strong>Our findings highlight AMPA receptor dysfunction as a potential contributor to schizophrenia pathophysiology in a subgroup of patients, consistent with the broader role of glutamatergic signaling disruption in this disorder. The convergent evidence from postmortem brain tissue and developmental models underscores the need for further investigation of <i>GRIA</i> genes as potential biomarkers for patient stratification and as therapeutic targets. While further study is needed to understand the functional consequences of our findings, such insights may inform the development of personalized treatment strategies targeting glutamatergic dysfunction in schizophrenia.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"46200"},"PeriodicalIF":2.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histone Modifications in Psychiatry: From Canonical Marks to Neurotransmitter-Mediated Epigenetic Signatures.","authors":"Weidi Wang, Wei Wang, Xuechen Wang, Zhe Liu, Yu Fang, Peijun Ju, Lei Ding, Daihui Peng","doi":"10.31083/AP45381","DOIUrl":"10.31083/AP45381","url":null,"abstract":"<p><p>Histone modifications have emerged as critical epigenetic regulators in the development and progression of mental disorders. This review synthesizes recent advances in the field, highlighting both canonical modifications, such as methylation, acetylation, and phosphorylation, as well as novel discoveries that link neurotransmitter signaling to chromatin regulation. In particular, neurotransmitter-mediated histone modifications, including serotonylation, dopaminylation, and histaminylation, represent a compelling new paradigm by which neuronal activity and environmental stimuli can induce lasting changes in gene expression. Aberrant histone modifications have been implicated in the risk, symptomatology, and treatment response of psychiatric conditions such as depression, bipolar disorder, and schizophrenia. Furthermore, therapeutic strategies that target histone-modifying enzymes, most notably histone deacetylase inhibitors, are being actively explored for their potential to restore epigenetic balance and improve clinical outcomes. A deeper understanding of the mechanistic diversity and disease specificity of histone modifications will be crucial for the development of precision epigenetic therapies in psychiatry.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 3","pages":"45381"},"PeriodicalIF":2.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Children With Autism Spectrum Disorder Based on Multidimensional EEG Feature Fusion Across Temporal-Spectral-Spatial Domains.","authors":"Jiannan Kang, Liang Zhang, Xiaoke Yang, Xiaoli Li, Xiwang Fan, Shukai Zheng","doi":"10.31083/AP45250","DOIUrl":"10.31083/AP45250","url":null,"abstract":"<p><strong>Background: </strong>To better characterize the complex neural features of autism spectrum disorder (ASD) and overcome the limitations of traditional electroencephalography (EEG) analysis methods, we developed a multi-metric EEG framework integrating temporal, spectral, and spatial dimensions, systematically characterized the dynamics, individualization, and nonlinear network features of neural oscillations in ASD, and evaluated their classification performance.</p><p><strong>Methods: </strong>Children with ASD (<i>n</i> = 44) and typically developing (TD) children (<i>n</i> = 44) were recruited and resting-state EEG data were collected. The analysis was conducted from three perspectives: (1) temporal domain - Lempel-Ziv complexity (LZC) was used to quantify the dynamic complexity of signals; (2) frequency domain - the gedBounds method based on generalized eigen decomposition (GED) was applied to identify individualized frequency bands; (3) spatial domain - Generalized Symbolic Nonlinear Granger Causality (GSNGC) was used to construct brain functional networks and compute graph-theoretic metrics. Finally, a support vector machine (SVM) integrated multidimensional features for ASD classification.</p><p><strong>Results: </strong>In the temporal domain, the ASD group showed significantly lower whole-brain LZC compared with the TD group, with the most pronounced reduction observed in the alpha band, suggesting reduced neural dynamic information processing capacity. In the frequency domain, the ASD group showed an expanded theta bandwidth, reduced low-frequency power in central-occipital regions, and increased beta power in frontal regions. In the spatial domain, children with ASD exhibited an atypical connectivity pattern characterized by increased low-frequency connectivity, reduced alpha-band connectivity, and increased beta-band connectivity, along with significantly higher global efficiency in theta and beta networks. The SVM model integrating temporal, frequency, and spatial features achieved an accuracy of 89.2%, significantly outperforming single-domain feature models, confirming that multidimensional feature integration improves classification performance.</p><p><strong>Conclusions: </strong>This study introduces a novel analytical approach combining individualized frequency band identification, nonlinear connectivity modeling, and dynamic complexity analysis. The findings comprehensively reveal multi-scale abnormalities of neural oscillations in children with ASD and demonstrate the discriminative power of multi-dimensional EEG feature integration for ASD classification and auxiliary diagnosis, thereby providing a scientific basis for clinical diagnosis and intervention.</p><p><strong>Clinical trial registration: </strong>No: ChiCTR2400092790. 24 November, 2024, https://www.chictr.org.cn/showproj.html?proj=249950.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 2","pages":"45250"},"PeriodicalIF":2.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Blood-Count-Derived Inflammatory Markers Across Acute Mood Episodes.","authors":"Pelin Göksel, Selçuk Özdin","doi":"10.31083/AP45450","DOIUrl":"10.31083/AP45450","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence has suggested that low-grade systemic inflammation may contribute to the clinical expression of mood disorders, yet findings have differed considerably across studies. The present study compared several complete blood-count (CBC)-derived inflammatory indices among inpatients with bipolar disorder (BD), manic and depressive episodes, and major depressive disorder (MDD), and examined whether psychotropic medications influenced these inflammatory markers.</p><p><strong>Methods: </strong>This retrospective chart-review study included only inpatients hospitalized with a diagnosis of BD or MDD between January 1, 2019, and January 1, 2023. A healthy control (HC) group, matched by age and sex, was included for comparison. For data independence, only the first CBC obtained within 24 hours of admission was analyzed. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated from standardized fasting blood samples. Statistical analyses were performed using the Kruskal-Wallis test for group comparisons, followed by Bonferroni-corrected Mann-Whitney U tests. Additionally, analysis of covariance (ANCOVA) and regression models were employed to control for potential confounders such as age, sex, length of stay, and various psychotropic medications (lithium, antidepressants, and antipsychotics).</p><p><strong>Results: </strong>NLR and MLR ratios were consistently higher in all mood-disorder groups than in healthy individuals. PLR elevation appeared specific to the MDD group, and the SII was increased in depressive episodes but not in mania. These patterns remained statistically significant after adjustment for demographic covariates; male sex was negatively associated with PLR. Regression analyses adjusted for age and sex demonstrated a negative association between antidepressant use and PLR and MLR values.</p><p><strong>Conclusions: </strong>These results suggested that acute mood episodes are accompanied by measurable increases in certain inflammation-related hematologic markers. The inverse relationship between antidepressant use and PLR and MLR was consistent with an association between medication use and nonspecific systemic inflammatory markers observed in acutely hospitalized patients.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 2","pages":"45450"},"PeriodicalIF":2.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Expert Priorities for Promoting Recovery and Coercion-Free Practices in Psychosocial Disability: A Delphi Study.","authors":"Michela Atzeni, Giulia Cossu, Massimo Tusconi, Peter Konstantin Kurotschka, Thurayya Zreik, Antonio Egidio Nardi, Marietta Khurshudyan, Goce Kalcev, Silvia Ciccu, Oye Gureje, Rym Ghachem, Cesar Ivan Aviles Gonzalez, Mauro Giovanni Carta","doi":"10.31083/AP46500","DOIUrl":"10.31083/AP46500","url":null,"abstract":"<p><p>The global crisis of recent years, including pandemics, armed conflicts, climate emergencies, and economic instability, has disproportionately jeopardized the health and rights of persons with psychosocial disabilities, who remain among the most marginalized groups. In this context, promoting a rights-based approach to mental health care is both urgent and ethically imperative. Building on the United Nations (UN) Convention on the Rights of Persons with Disabilities and the World Health Organization (WHO) QualityRights initiative, this study aimed to identify expert-informed priorities for implementing recovery-oriented, coercion-free practices in consultation-liaison psychiatry within a general hospital in Italy, while also incorporating perspectives from international stakeholders. A two-round Policy Delphi study was conducted between December 2024 and May 2025 with 17 invited experts from diverse professional and cultural backgrounds. Nine completed both rounds. The Delphi approach was used to identify areas of convergence while also capturing the diversity of expert perspectives. No fixed consensus threshold was set, reflecting the view that in ethically and contextually complex domains such as human rights in mental health, divergent opinions can yield valuable insights. In Round 1, participants provided qualitative responses to four open-ended questions, which were analyzed thematically to generate items for Round 2. In Round 2, participants prioritized structured response options (n = 8 items) derived from the thematic analysis. Descriptive statistics summarized the response distributions. Round 1 revealed strong convergence on the importance of community inclusion, user participation, and professional training. Round 2 confirmed these priorities: 78% identified 'mutual exchange and learning' as the main benefit of international collaboration, while 44% and 33% prioritized social inclusion and staff training, respectively, as essential for rights-based recovery. Reported barriers included control-oriented care cultures (33%) and insufficient training or tools (22% each). Experts envisioned future mental health care as fully integrated into community life (56%), with reduced reliance on institutional structures or technocratic solutions. This Delphi study underscores that rights-based, recovery-oriented mental health services must prioritize community inclusion, shared governance, and contextual adaptability. Experts cautioned against top-down or standardized reforms, favoring relational and participatory models. These findings provide actionable insights for developing coercion-free consultation-liaison psychiatry within general hospitals and can inform broader international efforts toward sustainable, rights-based mental health reform.</p>","PeriodicalId":72151,"journal":{"name":"Alpha psychiatry","volume":"27 2","pages":"46500"},"PeriodicalIF":2.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}