BMJ mental health最新文献

{"title":"Differentiating indicators of vulnerability to deliberate self-harm in forensic and non-forensic patients with schizophrenia spectrum disorders: a multinational LASSO-based analysis.","authors":"Laura Iozzino, Donato Martella, Elena Toffol, Gabriele Torino, Elisa Caselani, Silvia Leone, Janusz Heitzman, Johannes Wancata, Marco Michael Picchioni, Giovanni de Girolamo","doi":"10.1136/bmjment-2025-302372","DOIUrl":"10.1136/bmjment-2025-302372","url":null,"abstract":"<p><strong>Background: </strong>Deliberate self-harm (DSH) is a major public health concern among patients with schizophrenia spectrum disorders (SSDs). Although forensic patients with SSD show high rates of DSH, they remain under-represented in suicidology research, and differences in risk profiles compared with non-forensic patients are poorly understood.</p><p><strong>Objective: </strong>To compare sociodemographic, clinical, neuropsychological and criminological correlates of lifetime DSH between forensic and non-forensic patients with SSD and identify subgroup-specific vulnerability markers.</p><p><strong>Methods: </strong>Data were drawn from the multinational EU-VIORMED study across five European countries. Participants (N=392) aged 18-65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of SSDs completed standardised assessments. Lifetime DSH was measured dichotomously. Separate LASSO logistic regression models identified the strongest correlates of DSH in forensic and non-forensic subsamples.</p><p><strong>Findings: </strong>Lifetime DSH prevalence was high in both groups (45.9% forensic; 39.5% non-forensic). In forensic patients, the strongest correlate was comorbid personality disorder (β=0.78), followed by functional impairment (β=0.02-0.26). In non-forensic patients, interpersonal victimisation (β=0.85) was the strongest correlate, followed by personality disorder (β=0.71), male gender (β=0.69), lifetime substance use (β=0.37) and psychopathological indicators (PANSS (Positive and Negative Syndrome Scale) items; β=-0.10-0.32). Overall, DSH in forensic patients was more strongly associated with personality pathology and functioning, whereas in non-forensic patients it was linked to trauma, clinical severity and sociodemographic factors.</p><p><strong>Conclusions: </strong>Despite similar DSH prevalence, forensic and non-forensic SSD patients showed distinct patterns of associated factors, suggesting different mechanisms of risk.</p><p><strong>Clinical implications: </strong>Suicide prevention in SSD should adopt tailored risk formulations, emphasising personality pathology and functioning in forensic settings and trauma-informed, integrated care in non-forensic services.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914234","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":"Mental health disorders and risk of solitary confinement among incarcerated individuals: a nationwide longitudinal cohort study from Norway.","authors":"Nicoline Toresen Lokdam, Marianne Riksheim Stavseth, Louis Favril, Morgan Scarth, Torill Tverborgvik, Lars Højsgaard Andersen, Anne Bukten","doi":"10.1136/bmjment-2026-302849","DOIUrl":"10.1136/bmjment-2026-302849","url":null,"abstract":"<p><strong>Background: </strong>Solitary confinement is extensively used in prisons, constituting a risk of deteriorating health. However, its associations with mental health disorders remain unclear.</p><p><strong>Objective: </strong>To investigate the association between history of diagnosed mental health disorders and solitary confinement among incarcerated individuals.</p><p><strong>Methods: </strong>We included 35 210 individuals with 51 502 incarcerations in Norway from 2015 to 2022 in the Norwegian Prison Release study (nPRIS), linking national prison, health, mortality and demographic registries. Mental health disorders diagnosed within 5 years before incarceration were identified. The primary outcome was solitary confinement and four subtypes: court decided, disciplinary, self-requested and security cell. By analysing all incarcerations, we estimated adjusted ORs (aORs) and rate ratios (RRs) with logistic and negative binomial regression, using robust SEs to account for individual-level clustering across multiple incarcerations.</p><p><strong>Findings: </strong>Among all individuals with a 5-year history of diagnosed mental health disorders (n=18 315), 30.8% experienced solitary confinement, compared with 21.3% among those without a diagnosis (n=16 895). Mental health disorders were associated with higher odds of any solitary confinement (aOR 1.77, 95% CI 1.68 to 1.85) and security cell placement (aOR 4.28, 95% CI 3.57 to 5.13). People with mental health disorders also had a higher rate of disciplinary (adjusted rate ratio (aRR) 3.84, 95% CI 3.41 to 4.33) and self-requested (aRR 2.46, 95% CI 1.91 to 3.18) solitary confinement days. Substance use disorders, severe mental illness and multimorbidity were associated with a higher rate of solitary confinement days, while mental health disorders were inversely associated with court decided solitary confinement (aOR 0.52, 95% CI 0.47 to 0.57; aRR 0.48, 95% CI 0.41 to 0.57).</p><p><strong>Conclusion: </strong>People with a history of diagnosed mental health disorders disproportionately experience solitary confinement in prison, risking further deterioration of health.</p><p><strong>Clinical implications: </strong>Health authorities and correctional services should reduce solitary confinement and develop alternative, health-protective segregation strategies for people with mental health disorders.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907669","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":"Well-being differences and changes in people with somatic and psychiatric disorders or multimorbidities: modelling COVID-19 as a global natural experiment of stress vulnerability.","authors":"Till J Adam, Trevor Thompson, Fabiola H Peroz, Jan P Heisig, Paul Gellert, Enrique Alonso-Perez, Lara Bister, Lau Caspar Thygesen, Philippe Conus, Roland von Känel, Soraya Seedat, Denisa Manková, Daniel Guinart, Eduard Vieta, Mark J Millan, Diego De Leo, Michael Berk, Jess Fiedorowicz, Lin Yang, Jari Tiihonen, Harald Aschauer, Monika Schlögelhofer, Jane E Hamilton, Marco Solmi, Christoph U Correll","doi":"10.1136/bmjment-2026-302777","DOIUrl":"10.1136/bmjment-2026-302777","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Somatic and psychiatric illnesses and multimorbidities increase stress-vulnerability and decrease well-being.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to identify high-risk disorder profiles for lower well-being and well-being decline under stress, modelling COVID-19 as a natural experiment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The global Collaborative Outcomes Study on Health and Functioning during Infection Times survey assessed the World Health Organization-Five Well-being Index (WHO-5) (0-100) retrospectively pre-pandemic and intra-pandemically. Mixed-effects models, controlling for demographic/pandemic-related covariates, examined coprimary outcomes: total pre-pandemic WHO-5 and pre-to-intra-pandemic change (estimating β); pre-pandemic WHO-5 &lt;50, new pre-to-intra-pandemic WHO-5 &lt;50 and WHO-5 decrease ≥10 (estimating ORs±95% CIs). Fixed effects were self-reported somatic and psychiatric diagnoses and within-and-across multimorbidities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Altogether, 121 066 adults (female=64.0%, white=69.0%, age=42.0±15.9 years, countries=155) with illnesses (any=49.8%/somatic=44.8%/psychiatric=16.3%) and multimorbidities (any=32.8%/somatic=27.3%/psychiatric=7.4%/somatic-psychiatric=10.8%) were analysed. Well-being was 2-3-fold worse with psychiatric disorders (&lt;i&gt;pre-pandemic:&lt;/i&gt; autism-spectrum disorder (β=-7.00±2.93/OR=1.27-2.65), schizophrenia/schizoaffective disorder (β=-5.39±3.42/OR=1.09-2.64); &lt;i&gt;pre-to-intra-pandemic:&lt;/i&gt; major depressive disorder (β=-2.45±0.89/OR=1.25-1.55), post-traumatic stress disorder (β=-1.98±1.42/OR=1.19-1.67)) versus somatic disorders (&lt;i&gt;pre-pandemic:&lt;/i&gt; diarrhoea (β=-3.29±2.49/OR=1.11-2.15), chronic skin disease (CSD) (β=-2.53±1.44/OR=1.11-1.65); &lt;i&gt;pre-to-intra-pandemic:&lt;/i&gt; CSD (β=-2.31±1.47/OR=1.23-1.75), injury (β=-2.22±0.99/OR=1.11-1.40)). Multimorbidities were associated with non-linear/supra-additive adverse outcomes beyond single disorders (&lt;i&gt;pre-pandemic:&lt;/i&gt; anorexia nervosa+schizophrenia/schizoaffective disorder (β=-27.58±12.71/OR=1.41-19.94), inflammatory bowel disease+psychosis (β=-24.89±10.59/OR=2.68-24.25), stroke+osteoarthritis (β=-13.68±7.33/OR=1.23-6.48); &lt;i&gt;pre-to-intra-pandemic:&lt;/i&gt; haemorrhoids+obsessive-compulsive disorder (β=-8.86±6.54/OR=1.22-5.21), binge-eating disorder/bulimia nervosa+social anxiety disorder (β=-6.87±5.49/OR=0.78-2.85), back pain+retinopathy (β=-6.55±6.54/OR=1.04-4.69)). Dose-response relationships were observed between the number of disorders and poorer well-being (&lt;i&gt;pre-pandemic&lt;/i&gt; per diagnosis: psychiatric (β=-1.22±0.23/OR=1.11-1.17), somatic (β=-0.21±0.13/OR=1.02-1.05); &lt;i&gt;pre-to-intra-pandemic&lt;/i&gt; per diagnosis: psychiatric (β=-0.37±0.24/OR=1.04-1.10)).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Poor well-being and further decline under stress were observed particularly with psychiatric illnesses and complex psychiatric and mixed psychiatric-somatic multimorbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;The findi","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882097","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":"Cognitive signs and symptoms in people with a psychiatric diagnosis on semaglutide: a retrospective cohort study of 13 007 patients in the USA.","authors":"Riccardo De Giorgi, Nadia Lipunova, Elgan Mathias, Fei Shang, Maxime Taquet","doi":"10.1136/bmjment-2026-302828","DOIUrl":"10.1136/bmjment-2026-302828","url":null,"abstract":"<p><strong>Background: </strong>Cognitive deficits across psychiatric disorders are common and difficult to treat. Semaglutide, a GLP-1 receptor agonist, shows potential cognitive benefits in diabetes and obesity, but effects in psychiatric populations remain unclear.</p><p><strong>Objective: </strong>To determine whether initiation of semaglutide is associated with fewer cognitive signs/symptoms over 12 months among adults with psychiatric disorders.</p><p><strong>Methods: </strong>Retrospective cohort study using de-identified multicentre US electronic health records (EHRs) in NeuroBlu Data spanning 1999-2024. We included adults with any International Classification of Diseases (ICD)-9/-10 psychiatric diagnosis with at least one semistructured, clinician-rated routine cognitive assessment in the 12 months before and at least one in the 12 months after initiating an antidiabetic drug. Semaglutide initiation was compared against four comparator strategies including sitagliptin, empagliflozin, glipizide or no antidiabetic treatment. Primary outcome was a 0-100 composite cognitive score (0, no signs/symptoms recorded; 100, signs/symptoms present across all domains) derived from semistructured, clinician-rated routine cognitive assessments across memory, attention, orientation and other cognitive functions, with a 12-month follow-up after antidiabetic drug initiation. We estimated mean ratios (MR) and 95% CIs between comparisons with the parametric g-formula, adjusting for baseline cognitive score and prespecified covariates. Additional analyses were conducted for individual cognitive domains and also grouped by major depression, psychosis and bipolar disorder.</p><p><strong>Findings: </strong>Among 13 007 individuals (mean (SD) age, 62.0 (13.4) years; 6300 (48.4%) female), 1261 initiated semaglutide. Across psychiatric disorders, mean cognitive signs/symptoms scores over 12 months were lower with semaglutide (11.14) than with no treatment (14.91; MR, 0.75 (0.65-0.85); Bonferroni-corrected p=0.00002), glipizide (13.46; MR 0.83 (0.70-0.93); p=0.041) or empagliflozin (13.69; MR, 0.81 (0.69-0.94); p=0.016) and lower but not significantly different from sitagliptin (12.52; MR, 0.89 (0.77-1.02); p=0.50). Associations were stronger for memory and broader cognitive functions. Similar effect sizes were seen across disorders but were only consistently significant in major depression.</p><p><strong>Conclusions: </strong>In this EHR-based cohort of adults with psychiatric disorders, semaglutide initiation was associated with lower clinician-recorded cognitive signs/symptoms than several comparators over 12 months.</p><p><strong>Clinical implications: </strong>Randomised clinical trials are needed to confirm causality and clinical utility of semaglutide to reduce cognitive signs/symptoms in psychiatric disorders.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802324","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":"Therapist-guided and self-guided internet-based behavioural activation versus treatment as usual for adolescents with depression: randomised controlled trial with economic evaluation.","authors":"Rebecca Andersson, Johan Ahlen, Fabian Lenhard, Anna Ohlis, Vera Wachtmeister, Moa Karemyr, Jens Högstrom, Matteo Bottai, David Mataix-Cols, Sarah Vigerland, Eva Serlachius","doi":"10.1136/bmjment-2026-302619","DOIUrl":"10.1136/bmjment-2026-302619","url":null,"abstract":"<p><strong>Background: </strong>Adolescent depression is a major public health concern with limited access to effective treatments. Behavioural activation (BA) is a suitable intervention for digital delivery, but definitive adolescent trials are scarce.</p><p><strong>Objective: </strong>To evaluate whether therapist-guided and self-guided internet-based BA (I-BA) are more efficacious and cost-effective than treatment as usual (TAU) for adolescents with mild to moderate major depressive disorder (MDD).</p><p><strong>Methods: </strong>Single-blinded, parallel-group randomised controlled trial with economic evaluation. A total of 219 adolescents (13-17 years) with mild-moderate MDD were randomised (1:1:1) to 10 weeks of therapist-guided I-BA, self-guided I-BA or TAU. Both I-BA interventions included adolescent and parent modules.</p><p><strong>Primary outcome: </strong>change in depression severity (Children's Depression Rating Scale-Revised, CDRS-R, range 17-113) from baseline to 3-month follow-up (primary endpoint), assessed by blinded evaluators. Analyses included all randomised participants, with statisticians blinded to allocation. A health economic evaluation was performed at the primary endpoint.</p><p><strong>Findings: </strong>Baseline CDRS-R indicated clinically significant depression (mean 57.1, threshold ≥40). Retention at the primary endpoint was 82.6%. Mean reductions were 17.0 (therapist-guided I-BA), 16.0 (self-guided I-BA) and 11.6 (TAU), bringing both I-BA groups below the clinical cut-off. Therapist-guided I-BA showed greater reductions than TAU (estimated mean difference -4.68; 95% CI -0.05 to -9.30; p=0.048, <i>d</i>=-0.47; 95% CI 0.00 to -0.93), while self-guided I-BA was not statistically superior (estimated mean difference -3.44; 95% CI -8.05 to 1.17, p=0.14, <i>d</i>=-0.37; 95% CI -0.86 to 0.12). The predefined six-point clinical important difference was not met. Results were sensitive to modelling: significance disappeared with random slopes but effect estimates were similar; baseline-adjusted analyses favoured both I-BA arms. Both I-BA options had lower costs than TAU (p=0.03, p<0.001), with self-guided I-BA being the most economical.</p><p><strong>Conclusions: </strong>Therapist-guided I-BA reduced depressive symptoms at lower cost than TAU, but clinical importance and robustness are uncertain. Self-guided I-BA showed no clear superiority but was cost-efficient.</p><p><strong>Clinical implications: </strong>Therapist-guided I-BA may increase access to evidence-based care for adolescents with MDD, though findings require cautious interpretation. Self-guided I-BA may be useful where therapist access is limited, but more research is needed.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802249","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":"Clinician perspectives on the utility and acceptability of OxSATS: a qualitative study of a novel structured suicide risk assessment tool.","authors":"Omar Ouaret Sorr, Howard Ryland","doi":"10.1136/bmjment-2026-302650","DOIUrl":"10.1136/bmjment-2026-302650","url":null,"abstract":"<p><strong>Background: </strong>Suicide remains a leading preventable cause of death, and patients presenting with self-harm constitute a high-risk group. The Oxford Suicide Assessment Tool for Self-Harm (OxSATS) is a validated model estimating suicide risk. While its statistical performance is established, its clinical utility remains unexplored.</p><p><strong>Objective: </strong>To understand clinicians' views on the feasibility, acceptability and potential workflow integration of OxSATS.</p><p><strong>Methods: </strong>Semistructured interviews with 15 multidisciplinary National Health Service clinicians explored current suicide risk assessment practice, experience with structured tools and views on OxSATS. Participants applied OxSATS to standardised vignettes to simulate real-world decision-making. Interviews were analysed using reflexive thematic analysis.</p><p><strong>Findings: </strong>Clinicians valued OxSATS for its simplicity, objectivity and percentage-based outputs. OxSATS was viewed as promoting a shared language around suicide risk and supporting assessment consistency. Alignment between OxSATS estimates and clinical judgement was good. However, some clinicians perceived the tool as underestimating risk associated with violent methods. Key implementation barriers included limited scope for wider psychosocial context and potential over-reliance on the tool by inexperienced clinicians. Participants emphasised that OxSATS should complement, not replace, clinical formulation and highlighted the need for clear guidance to support adoption.</p><p><strong>Conclusion: </strong>OxSATS was viewed as a promising adjunct to suicide risk assessment following self-harm. Addressing concerns around scope, interpretation of percentage risk and integration into wider suicide risk training will be key to successful implementation.</p><p><strong>Clinical implications: </strong>This study highlights clinicians' interest in evidence-based adjuncts to suicide risk formulation and supports the use of probability-based models to enhance decision-making.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802246","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":"Research agenda to advance anhedonia assessment, understanding and treatment: an ECNP-GALENOS expert meeting report.","authors":"B W J H Penninx, Martien J H Kas, Gerard R Dawson, Christoph U Correll, Catherine J Harmer, Derek L Buhl, Michele De Prisco, James Downs, Dennis Hernaus, Seth C Hopkins, Masud Husain, Shaun Johnson, Ruth Mckernan, Edoardo G Ostinelli, Diego A Pizzagalli, Christopher R Pryce, Andreas Reif, Rudy Schreiber, Alessandro Serretti, Spyridon Siafis, Elizabeth Tunbridge, Daniel Umbricht, Christiaan H Vinkers, Andrea Cipriani","doi":"10.1136/bmjment-2026-302843","DOIUrl":"10.1136/bmjment-2026-302843","url":null,"abstract":"<p><p>Anhedonia, broadly defined as a reduced ability to experience interest or pleasure, represents an important transdiagnostic neuropsychiatric symptom dimension which may benefit from targeted diagnostics and treatments. Different lines of research have proposed that it comprises multiple facets, including deficits in anticipatory ('wanting') and consummatory ('liking') reward processing as well as reward learning and affects different aspects of life (eg, social, physical, cognitive). Certain facets-more specifically anticipation, motivation and reward learning-likely involve blunted phasic dopaminergic signalling. However, recent meta-analytical evidence of human depression studies indicates that prodopaminergic antidepressants produce relatively small improvements in anhedonia symptoms and suggest that mechanisms beyond dopamine likely contribute to anhedonia. This stimulated an expert meeting to review the literature and define priorities for future research in anhedonia. A central key priority is developing a translational biologically-informed nomenclature and consensus that solves the current mismatch between constructs, paradigms and measures, and mechanisms, which separates discrete reward-related processes such as effort allocation, reward learning and anticipatory interest versus consummatory pleasure. <i>Clinical research</i> priorities are improved multimodal measurement tools, integrating neurobiological frameworks (eg, neuroimaging, electrophysiology and liquid biomarkers capturing dopaminergic, glutamatergic, opioid and immunometabolic pathways) and transdiagnostic studies across neuropsychiatric disorders and developmental stages. Innovative trial designs that explicitly target anhedonic phenotypes as a primary outcome and test mechanism-based interventions are also needed. <i>Translational research</i> recommendations include back-translation strategies that begin with patient-relevant phenotypes followed by the development of comparable human and animal tasks that target reward-related processes, such as effort allocation, reward learning and anticipatory interest versus consummatory pleasure, improve cross-species behavioural paradigms and enhance methodological rigour and reproducibility. Collectively, these recommendations will help refine the conceptualisation of anhedonia and advance its role within precision psychiatry as a mechanistically grounded target across multiple disorders.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764209","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":"Real-world ADHD pharmacological treatment patterns and their association with negative clinical outcomes in youth with comorbid autism: a Swedish population-based study.","authors":"Miguel Garcia-Argibay, Ralf Kuja-Halkola, Brian M D'Onofrio, Paul Lichtenstein, Zheng Chang, Henrik Larsson, Samuele Cortese","doi":"10.1136/bmjment-2026-302902","DOIUrl":"10.1136/bmjment-2026-302902","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit/hyperactivity disorder (ADHD) medications can reduce ADHD symptom severity in individuals with comorbid autism spectrum disorder (ASD). However, clinical guidance on pharmacological treatment of ADHD in this clinical population remains limited and inconsistent. Characterising real-world treatment patterns (ie, initiation timing, medication choices, switching, discontinuation) and the impact of alternative medication choices on clinical outcomes is critical for informing evidence-based management strategies.</p><p><strong>Objective: </strong>To (1) characterise ADHD pharmacological treatment patterns in youth with ADHD+ASD versus ADHD alone and (2) assess whether using alternative ADHD medications versus methylphenidate is associated with differential changes in negative clinical outcomes among youth with ADHD+ASD.</p><p><strong>Methods: </strong>This is a population-based cohort study using Swedish national registers. The study included children (<13 years) and adolescents (13-17 years) with an incident ADHD diagnosis between 2007 and 2018 and followed-up until 2021, comparing youth with co-occurring ASD (n=24 117) and ADHD alone (n=79 830). Descriptive outcomes included time to pharmacological treatment initiation, medication type, number of medication switches and discontinuations. The primary outcome was changes in rates of inpatient psychiatric hospitalisations, accidental injuries and specialist care visits for substance use, depressive or anxiety disorders in the 1 year after versus the 1 year before medication initiation.</p><p><strong>Findings: </strong>Individuals with ADHD+ASD experienced longer delays to treatment initiation (12-14% initiated >12 months after diagnosis vs 7-8% in ADHD alone). Children with ADHD+ASD were slightly more likely to discontinue treatment within 3 months (16% vs 12%) and had the highest average number of medication switches within 3 years (2.6; IQR 0.0-2.0). In within-individual analyses, comparisons of alternative ADHD medications versus methylphenidate did not yield statistically significant differences after correcting for multiple comparisons.</p><p><strong>Conclusions: </strong>Children with ADHD+ASD experienced longer delays to treatment initiation and more frequent medication switching compared with those with ADHD only. The effects of alternative ADHD medication options on key negative clinical outcomes appeared similar to those of methylphenidate.</p><p><strong>Clinical implications: </strong>These findings suggest that, rather than recommending fixed first-line and second-line treatments for individuals with ADHD-ASD, clinical guidelines should emphasise appropriate training as well as prompt and individualised treatment based on a shared decision-making process.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714797","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":"Understanding inequities in accessing neurodevelopmental pathways: a multiple methods study investigating healthcare professionals' views on access for minoritised ethnic families.","authors":"Sarah Elaine Cooper, Shireen Patel, Camilla Babbage, Kapil Sayal, Madeleine Jane Groom, Jennifer Logan, Vibhore Prasad, Charlotte L Hall","doi":"10.1136/bmjment-2026-302716","DOIUrl":"10.1136/bmjment-2026-302716","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Minoritised ethnic families in England experience disproportionate barriers to accessing neurodevelopmental disorder (NDD) assessment and support despite universal healthcare provision. Existing evidence has focused on caregivers' perspectives or non-UK settings but little is known about how healthcare professionals (HCPs) perceive and interpret these inequities. Addressing this gap is essential for improving access, service design and workforce development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore HCPs' perceptions of the barriers and facilitators influencing minoritised ethnic families' access to NDD services in England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multiple methods design was used, comprising an online national survey (n=264) and two online focus groups with primary, secondary and allied health professionals (n=9). Survey data were summarised descriptively and free text responses analysed using summative content analysis. Focus group transcripts underwent reflexive thematic analysis. Findings were summarised following parallel analysis of each data set. Patient and public involvement and engagement members from minoritised ethnic backgrounds contributed throughout.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;HCPs identified four interconnected barriers they perceived to influence access for minoritised ethnic families: (1) language, communication and meaning-making challenges, including differences in how concepts and expressions are understood, inconsistent interpretation and limited mental health literacy; (2) difficulties navigating complex, fragmented NDD pathways, exacerbated by digital literacy demands and unclear referral routes; (3) limited caregiver knowledge and understanding of NDDs, affecting symptom recognition and the ability to advocate effectively and (4) cultural norms, beliefs and stigma, including preferences for non-Western models of care, fear of diagnostic labels and the influence of extended family. Professionals also highlighted the impact of unconscious bias and limited cultural representation within services on referral decision-making and caregiver engagement. HCPs described several effective strategies for mitigating these barriers, such as culturally attuned communication, community-based engagement and flexible assessment approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Inequitable access to NDD services arises from the interaction of cultural, relational and structural factors across the healthcare pathway. HCPs' insights reveal multiple entry points for improving equity, particularly through communication support, culturally responsive practice and simplified referral processes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical implications: &lt;/strong&gt;Embedding culturally informed communication, improving caregiver education, strengthening workforce diversity and coproducing service changes with communities may reduce avoidable delays and promote equitable access to neurodevelopmental assessment and support.&lt;/p","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714776","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":"Building consensus on the core clinical competencies and outcomes related to effective child and adolescent mental health services (CAMHS) crisis team provision: findings from a Delphi study.","authors":"Clau Nader, Lucy Tindall, Kapil Sayal, Josephine Holland, Catherine Elizabeth Hewitt, Paul A Tiffin","doi":"10.1136/bmjment-2026-302719","DOIUrl":"10.1136/bmjment-2026-302719","url":null,"abstract":"<p><strong>Background: </strong>Young peoples' mental health is worsening, increasing demands on Child and Adolescent Mental Health Services (CAMHS) crisis teams. However, evidence is lacking regarding the effectiveness of such services. To pave the way for service developments and robust evaluation, it is crucial to establish a consensus on the core competencies for CAMHS crisis clinicians and the most desirable outcomes from their input.</p><p><strong>Objective: </strong>To elicit and establish consensus among experts, including those with relevant lived experience, regarding the most important staff competencies and outcomes in this service context.</p><p><strong>Methods: </strong>A three-round Delphi study was conducted with young people (aged 18-25 years with relevant lived experience of CAMHS crisis team input), parents/carers and mental health clinicians/academics. The study aimed to establish consensus (≥70% agreement) on which core staff competencies and outcomes were perceived as 'essential'/'very important' in relation to CAMHS crisis services.</p><p><strong>Findings: </strong>Of 69 initial participants, 43 (62%, mainly young people) completed all three rounds. A broad consensus was reached, with over 90% of proposed items meeting the consensus threshold. The strongest agreement was found for competencies in the <i>therapeutic alliance</i> domain, particularly <i>cultural competency</i> (93%) and <i>validation</i> (91%). For the <i>case formulation</i> domain, a <i>holistic mental state examination</i> (91%) was highly prioritised. Key outcomes with high consensus included <i>improved communication with support networks</i> (91%), <i>better understanding of the young person</i> (88%), <i>feeling validated</i> (88%) and <i>reduced involuntary inpatient admissions</i> (88%). The findings were integrated into a Theory of Change-based logic model illustrating how these skills and knowledge could lead to the desired outcomes.</p><p><strong>Conclusions: </strong>Our results demonstrate a clear stakeholder consensus prioritising relational, validating and personalised approaches to assessment and intervention over an emphasis on administrative or diagnostic processes in CAMHS crisis care. The findings also highlight a desire to move from a perception of a paternalistic risk management style to collaborative, community-based support.</p><p><strong>Clinical implications: </strong>These findings underscore the need for crisis team clinicians to be trained and supported to deliver care that is relationship-based, trauma-informed and culturally responsive. These should potentially translate into better outcomes for young people, their families and the crisis team workforce itself.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"29 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714783","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}