BackgroundSocial anxiety disorder starts in adolescence or young adulthood and may have damaging effects on psychosocial development of the individual. Any intervention starts from assessment and the Liebowitz social anxiety scale with later developed self-report version is a valuable tool for practitioners for almost four decades. Even though the original version and adaptations have consistently demonstrated good reliability, there remains considerable debate regarding the factor structure. The aim is to test the factor structure and internal consistency of Lithuanian translation of the self-report version of the Liebowitz social anxiety scale (LSAS-SR) in a non-clinical young adult sample.MethodData of 452 young adults (mean age 21.3, 69.7% female) who volunteered participate in the study was used. Two factor solutions were tested: a single-factor model, with anxiety/fear and avoidance ratings loading on one factor, and a higher-order factor model, including two second-order scales (anxiety/fear scale and avoidance scale) and four first-order subscales (social interaction anxiety, performance anxiety, social interaction avoidance, performance avoidance). Internal consistency assessed using Cronbach’s alpha.ResultsLithuanian version has excellent internal consistency for the total score, scales and subscales, with Cronbach’s alfas ranging.85-.96. Confirmatory factor analysis shows that both tested models have acceptable data fit (RMSEA = .062-.067; CFI = .93-.94), however strong associations between (sub)scales, i.e. correlations exceeding.80, suggests that the use of scale and subscale scores may be less informative, especially in cross-sectional research, but could provide nuanced information in individual assessment.ConclusionFurther research on psychometric properties of Lithuanian versions of LSAS-SR should focus on verifying these results in a representative sample and in a clinical sample as well as testing the convergent and discriminant validity.
Expanding the phenotypic spectrum of Xq28 duplication involving MECP2: a familial case report
X-linked intellectual disability (XLID) is a well-recognized group of neurodevelopmental disorders, with pathogenic variants in X-chromosomal genes accounting for approximately 16% of intellectual disability cases in males. Clinical expression in females is variable and depends on patterns of X-chromosome inactivation. We describe three affected individuals from a single family with XLID caused by a confirmed duplication of the Xq28 region, including the genes SLC6A8, L1CAM, MECP2, TKTL1, FLNA, and GDI1. Two male siblings presented with severe phenotypes, including profound intellectual disability, severe speech impairment, behavioral issues, facial dysmorphism, spastic cerebral palsy, epilepsy, and cutaneous abnormalities. Their mother showed mild intellectual disability and skin manifestations. Family history suggested additional affected male relatives with a similar or even more severe clinical presentation. The duplication of multiple dosage-sensitive genes within the Xq28 region likely explains the multisystem involvement and the marked phenotypic variability observed between male and female family members. This report highlights the importance of considering Xq28 duplication, the most common X-linked copy number variation associated with intellectual disability, in the differential diagnosis of families with X-linked intellectual disability, especially if it is accompanied by additional neurological impairment.
Effectiveness and mechanisms of Intensive Short-Term Dynamic Psychotherapy for treatment-resistant depression: a reanalysis of a randomized controlled trial
IntroductionIntensive Short-Term Dynamic Psychotherapy has shown promising effects for treatment-resistant depression, but it remains unclear whether its hypothesized mechanisms — reducing emotional repression, negative affect, and psychological distress — actually mediate treatment outcomes.MethodsWe reanalyzed publicly available data from a randomized controlled trial (N = 86) comparing 20 sessions of Intensive Short-Term Dynamic Psychotherapy to waitlist control for treatment-resistant depression. Depression and process measures were assessed at baseline, post-treatment, and 3-month follow-up. Linear mixed-effects models analyzed trajectories; bootstrap mediation and cross-lagged panel analyses provided an exploratory examination of proposed process variables.ResultsTreatment produced large effects on depression at post-treatment (Cohen’s d = 1.68) that continued to increase through 3-month follow-up (d = 2.50, 95% CI [1.88, 3.11]). All proposed process measures also showed very large effects (d = 1.96–2.95). However, neither emotional repression nor negative affect significantly mediated depression improvement. Distress showed apparent mediation, but a sensitivity analysis removing the overlapping depression subscale eliminated this effect entirely, confirming it reflected construct overlap rather than a genuine indirect effect. Cross-lagged analyses revealed no temporal precedence for any process measure, indicating concurrent rather than sequential change.DiscussionThese findings confirm that this psychotherapy produces large, durable effects on treatment-resistant depression. However, the theorized sequential process — whereby reducing defensive functioning leads to improved affect regulation, which in turn alleviates depression — was not supported in the present data. Instead, the treatment appears to produce broad, simultaneous therapeutic change across multiple psychological domains. These exploratory findings suggest that understanding how psychotherapy works may require finer temporal measurement and observational methods that capture in-session processes.
Group CBT targeting hostile attribution bias in adolescents and young adults with ASD traits
BackgroundAdolescence is characterized by heightened self-consciousness and sensitivity to social evaluations. During this period, hostile attribution bias—interpreting ambiguous social cues as hostile—can lower quality of life (QOL) and contribute to future mental health problems. Adolescents with autism spectrum disorder (ASD) show similar difficulties, often more pronounced due to their cognitive style and interpersonal vulnerabilities. Group cognitive behavioral therapy (CBT) aims to correct such biases through structured cognitive and social experiences. This study evaluated the psychological effects of group CBT on hostile attribution bias, social functioning, and QOL in adolescents and young adults with ASD traits.MethodsWe conducted an 8-session group CBT program focusing on hostile attribution bias and suspiciousness in 21 adolescents and young adults with ASD traits attending a hospital psychiatric outpatient department. The 15 participants who completed the program were included in analyzes. Psychological indices included hostile attribution bias (Ambiguous Intentions Hostility Questionnaire), social functioning (Social Responsiveness Scale, Second Edition [SRS-2]), and subjective QOL. Pre–post changes were quantified as change rates ((post − pre)/pre × 100). Group-level changes were tested with paired analyzes; exploratory associations among change rates were examined using Spearman correlations.ResultsGroup CBT significantly improved hostile attribution bias (effect size [ES] = 0.698, p = 0.017), social communication and interaction (SRS-2; ES = 0.780, p = 0.012), and subjective QOL (ES = 0.752, p = 0.011). Exploratory individual-level analyzes showed a discordant pattern: smaller reductions in hostile attribution bias (less negative change rates) were associated with greater increases in subjective QOL (ρ = 0.597, p = 0.019).ConclusionsThis pilot study suggests that group CBT may reduce hostile attribution bias and improve QOL and social functioning in adolescents and young adults with ASD traits. Notably, the positive correlation between hostile attribution bias change rates and QOL change rates suggests that greater QOL gains were not necessarily accompanied by larger reductions in hostile attribution bias, indicating that improvements in cognitive bias and perceived well-being may arise through partly distinct or non-linear pathways rather than a simple one-to-one relationship.Clinical trial registryUniversity Hospital Medical Information Network (UMIN000030140).
Deeper is not always better in plasma proteomics
Nature Biotechnology, Published online: 22 April 2026; doi:10.1038/s41587-026-03106-3
This Comment discusses depth, robustness and bias in plasma proteomics, concluding that increasing the depth of coverage does not necessarily translate to quantitative robustness.
Synthetic biology’s uncertain regulatory future in the wake of Loper Bright Enterprises v. Raimondo
Nature Biotechnology, Published online: 22 April 2026; doi:10.1038/s41587-026-03114-3
The US Supreme Court’s decision in Loper Bright Enterprises v. Raimondo, along with federal spending cuts, may limit the potential of synthetic biology to provide innovative solutions for environmental challenges, medicine and biomanufacturing.
Reference-free discovery with barcoded single-cell sequencing
Nature Biotechnology, Published online: 22 April 2026; doi:10.1038/s41587-026-03084-6
sc-SPLASH extends reference-free analysis to barcoded single-cell and spatial transcriptomics data.
The ghost of tuberculosis past
Nature Medicine, Published online: 22 April 2026; doi:10.1038/s41591-026-04356-z
The analysis of the 100 Million Brazilian database reveals that a past tuberculosis diagnosis increases the risk of death up to 14 years later regardless of treatment outcome, which should prompt urgent prioritization of global prevention efforts.
The future of diagnostics in Africa
Nature Medicine, Published online: 22 April 2026; doi:10.1038/s41591-026-04308-7
The authors propose five high-priority areas to close the current gaps in diagnostic testing, providing a path to self-reliance in health security and universal healthcare in Africa.
What 35 years as an NHS CIO taught me about digital leadership
Digital leadership is not about technology, but about improving care, writes Ian McKenzie, CIO at Surrey and Borders Partnership NHS FT