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Purrble Use Among LGBTQ+ Young People With Self-Harm Experiences: Findings From a Qualitative Process Evaluation of a Randomized Controlled Trial

Background: Difficulties with emotion regulation (ER) have widely been associated with the development and persistence of poor mental health, such as depression, anxiety, self-harmful thoughts, behaviors, and suicide attempts. Despite the importance of ER as a transdiagnostic risk factor, few interventions directly target ER. The impact of one such intervention, Purrble (a socially assistive robot; developed by Sproutel and Committee for Children), was recently evaluated when compared to treatment-as-usual (TAU) within a randomized controlled trial (RCT) with sexual orientation and gender identity minorities, that is, lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) youth, who had self-harm experiences. However, while RCTs are well suited to evaluating effectiveness, they offer limited insight into how participants engage with, integrate, and perceive the value of interventions, like Purrble, in their everyday lives. Consequently, complementary qualitative process evaluation is needed to fully understand participants’ experiences and contextualize trial outcomes. Objective: This study aimed to explore and understand the engagement with and integration of the Purrble intervention using process evaluation interviews, considering its perceived influence on ER, mental health, and self-harm experiences. Methods: Following their participation in the Purrble RCT, 40 LGBTQ+ young people (16‐25 years) with current self-harm ideation took part in this qualitative process evaluation using semistructured online interviews. Interviews explored participant expectations of the RCT and Purrble; engagement and appropriation of Purrble; and perceived impact on mental health and self-harm. Thematic analysis was used to develop a thematic framework. Results: Four overarching themes were developed from the data. The first theme describes how participants used Purrble to ground themselves and manage distress, with participants suggesting de-escalation of their self-harm thoughts or behaviors. The second theme captures how Purrble was perceived as a companion or source of comfort, supporting self-soothing and self-care. The third theme highlights the role of accessibility and proximity, how the availability and location of Purrble during moments of distress influenced its perceived usefulness. The final theme examines circumstances in which participants chose not to engage with Purrble, offering insights into barriers to use and individual differences in engagement. Conclusions: This process evaluation helps to contextualize how Purrble could be a helpful intervention for those LGBTQ+ young people with experience of self-harm thoughts and behaviors. This evaluation also clarifies when Purrble may not be helpful. These qualitative findings offer important contextual insights alongside the quantitative results of the related RCT.
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Early Research Shows How Postnatal Depression May Affect Offspring

Research from Nanjing University in China shows that breast milk from mothers with postnatal depression contains three specific micro (mi)RNAs that investigators believe could be linked to changes in brain development in their offspring.

As reported in Cell Metabolism, the researchers also found the same miRNAs, which function to regulate genes, in the breastmilk of female mice showing depressive symptoms and investigated their impact on exposed offspring.

In the mouse model, the three miRNAs reduced production of mGluR8, a protein on nerve cells that acts like a brake on the signals they send by reducing the release of glutamate. Glutamate is a chemical messenger that activates other nerve cells and helps prevent excessive stimulation. With this brake weakened, developing neurons in the hippocampus part of the brain of the young mice received more frequent stimulating signals, matured abnormally and integrated less successfully into brain circuits.

“Postnatal depression, or postpartum depression, affects approximately 10%–20% of women worldwide and poses significant health risks to both mothers and offspring,” write the authors.

“Affected mothers may exhibit depressed mood, apathy, disrupted appetite and sleep, cognitive impairments, and suicidal ideation, while their children face increased risks of delayed cognitive and language development, behavioral challenges, poorer academic achievement, and depression extending into adolescence.”

Although research on postnatal depression has revealed more information about the condition, the way that maternal postnatal symptoms impact their offspring is not well understood. “Postnatal depression and breastfeeding exhibit a bidirectional relationship: postnatal depression reduces exclusive breastfeeding and promotes early cessation, whereas breastfeeding lowers postnatal depression incidence,” explain the team.

Although breastfeeding can be beneficial to the mental health of the mother, it is not clear what the impact of postnatal depression is on breast milk composition. “Postnatal depression can dysregulate physiological and metabolic pathways, potentially altering breastmilk composition. Such modifications may adversely affect infant cognitive, behavioral, and psychological development, potentially offsetting the established benefits of breastfeeding.”

In this study, the authors compared breastmilk microRNAs, from 40 mothers with postnatal depression and 51 without. They found three, miR-15a-5p, miR-15b-5p and miR-205-5p, were elevated in women with postnatal depression and also in model mice with the condition.

The team swapped newborn pups between stressed and unstressed mothers to distinguish effects after birth from those during pregnancy. To isolate milk’s contribution from maternal care, they also gave pups raised by healthy mothers purified human-milk extracellular vesicles, tiny membrane-wrapped particles carrying microRNAs.

The researchers looked at the impact of exposure to the specific miRNAs on pup neuronal development. They found the three milk-borne microRNAs reached the brain and suppressed mGluR8. This disrupted the maturation and integration of newly formed hippocampal neurons. Exposed mice developed learning and memory problems that persisted into adulthood and offspring raised by stressed mothers also showed greater depression-like responses after stress.

Notably, reducing milk-vesicle release, neutralizing the three microRNAs linked to postnatal depression, or restoring mGluR8 prevented or substantially reduced several neuronal abnormalities.

The study results do not show that breastfeeding by mothers with depression harms infants or justifies stopping breastfeeding. However, the study suggests that breast milk’s molecular signals could contribute to developmental effects associated with maternal depression and should be investigated further.

“Our findings define a mechanism underlying postnatal depression-related offspring neurodevelopmental impairments and suggest a therapeutic target for interrupting the intergenerational transmission of maternal mental disorders,” conclude the authors.

The post Early Research Shows How Postnatal Depression May Affect Offspring appeared first on Inside Precision Medicine.

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Characteristic Facial Expressions During Visual Fixation in Japanese Older Adults With Lower Cognitive Screening Performance: Exploratory Cross-Sectional Study

Background: Early identification of older adults with lower cognitive screening performance may facilitate appropriate clinical evaluation and intervention to delay the progress of cognitive decline and onset of dementia. Because facial information can be acquired noninvasively and unobtrusively during everyday life, it has attracted increasing attention as a potential digital biomarker. However, it remains unclear which facial regions are associated with cognitive decline under a neutral facial condition. Furthermore, it is unknown whether these facial characteristics primarily reflect static facial appearance or facial movements. Objective: This study aimed to identify facial action unit (AU) patterns associated with lower cognitive screening performance during a fixation-cross viewing condition that is less susceptible to the influence of language and emotional elicitation. Methods: Older adults were classified into either a lower cognitive screening performance group (Montreal Cognitive Assessment Japanese version [MoCA-J] score ≤25; n=31) or a healthy control group (MoCA-J score ≥26; n=14). Facial videos were recorded while participants viewed a fixation cross for 1 minute. OpenFace 2.0 was used to extract the intensities of 17 AUs and the presence of 18 AUs. Video analyses were first performed to identify AU characteristics associated with cognitive screening performance. For AU intensity, frame-level mixed-effects models with participant-specific random intercepts and a first-order autoregressive (AR(1)) correlation structure were used, adjusting for age, Geriatric Depression Scale score, and sex, and participant-level sensitivity analyses were conducted to assess the consistency of the frame-level findings. For AU presence, participant-level analyses were performed because the frame-level models did not yield reliable parameter estimates. Subsequently, single-frame analyses were performed to examine whether the AU characteristics identified in the video analyses could be explained solely by static facial appearance. As this study was exploratory and hypothesis-generating, values were not adjusted for multiple comparisons. Results: For AU intensity, frame-level video analyses showed that the lower cognitive screening performance group had a higher probability of zero intensity for AU10 (upper lip raiser), with participant-level analysis based on the proportion of zero-intensity frames yielding consistent results. In contrast, single-frame analyses of AU intensity showed no significant group difference for AU10, suggesting that the observed difference may reflect facial movements rather than static facial appearance. For AU presence, video analyses showed no significant group differences. Conclusions: Older adults with lower cognitive screening performance exhibited distinct AU patterns related to AU10 (upper lip raiser) during fixation-cross viewing, which may reflect subtle differences in facial movements around the mouth. These exploratory findings identify candidate facial biomarkers associated with lower cognitive screening performance and warrant validation in larger, balanced, independent samples.
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Effects of Telerehabilitation on Quality of Life, Physical Capacity, and Symptom Burden Within the Post–COVID-19 Condition: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Post–COVID-19 condition (PCC) is characterized by persistent symptoms and functional limitations that impair quality of life, and rehabilitation is an important component of its management. Because access to conventional face-to-face rehabilitation may be limited, telerehabilitation has emerged as an accessible alternative. However, the effectiveness of telerehabilitation across clinical outcomes remains uncertain, and the influence of different delivery modes is not well understood. Objective: This study aimed to evaluate the effects of telerehabilitation on health-related quality of life (HRQoL), physical capacity, and symptom burden in adults with PCC, and to determine whether delivery mode (synchronous, asynchronous, or hybrid) modified these effects. Methods: Seven databases (PubMed, Cochrane Library, Web of Science, Scopus, Embase, EBSCO, and PEDro) were searched for randomized controlled trials published from January 2020 through December 2025. Eligible trials enrolled adults with PCC and compared telerehabilitation with usual care or another control condition. The primary outcome was HRQoL; secondary outcomes included functional capacity assessed by the 6-minute walk test and sit-to-stand test, dyspnea, fatigue, and symptoms of anxiety and depression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Mean differences or standardized mean differences (SMDs) with 95% CIs were pooled using random-effects models with the Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity was quantified using I² and τ², with 95% prediction intervals reported where estimable. Certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: A total of 22 randomized controlled trials involving 2294 participants were included. Telerehabilitation was associated with significant improvements in HRQoL (SMD 1.26, 95% CI 0.07-2.45; <i>P</i>=.04), dyspnea (SMD 1.95, 95% CI 0.60-3.31; <i>P</i>=.005), and functional aerobic capacity (6-minute walk test : mean difference 77.79 meters, 95% CI 30.44-125.14; <i>P</i>=.001). Fatigue was also significantly reduced (SMD 0.89, 95% CI 0.16-1.62; <i>P</i>=.02), but no significant effects were observed for lower-limb strength (sit-to-stand test: SMD 0.55, 95% CI –0.15 to 1.25; <i>P</i>=.12) or symptoms of anxiety and depression (SMD 0.12, 95% CI –0.13 to 0.38; <i>P</i>=.36). No significant differences between delivery modes were observed for HRQoL (<i>P</i>=.93), functional aerobic capacity (<i>P</i>=.29), or dyspnea (<i>P</i>=.16). A significant subgroup difference was observed for lower-limb strength (<i>P</i>=.02). Conclusions: Telerehabilitation may improve quality of life, aerobic capacity, and symptom burden in PCC and offer an accessible option for post-COVID rehabilitation, although the certainty of evidence was generally limited. Asynchronous delivery appears feasible for general reconditioning, whereas its benefit for lower-limb strength and the value of synchronous supervision remain uncertain. Clinical Trial: PROSPERO CRD42023490863; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023490863
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Stress-induced dorsal striatal dopamine release is associated with changes in functional connectivity to the prefrontal cortex in nicotine-dependent individuals—a preliminary report

IntroductionThe neural mechanism linking stress to addiction pathophysiology remains unclear. A proposed pathway involves stress-induced dopamine (DA) transmission impairing inhibitory control, leading to relapse. Lipopolysaccharide (LPS), a biological stressor inducing systemic inflammation, amplifies DA release. Our prior study demonstrated this effect in smokers. Using the same cohort, we investigated whether DA transmission mediates acute stress effects and impacts striatal-prefrontal functional connectivity (FC) in brain regions governing reward, inhibition, and decision-making.MethodsUsing a within-subject, multimodal design, we collected PET and resting-state functional MRI (rs-fMRI) scans in 8 smokers (6 females; mean age: 32 ± 3.6 years). Stress was induced using LPS; plasma cortisol indexed level of stress. DA release was measured in striatal subregions using [11C]raclopride PET before and after methylphenidate administration, while striatal–prefrontal functional connectivity was assessed using seed-based rs-fMRI. Each participant completed three PET scans (one baseline and two post-methylphenidate scans following LPS or placebo [PCBO] pretreatment) and two rs-fMRI scans (LPS and PCBO), resulting in a total of 24 PET scans and 16 rs-fMRI scans.ResultsLPS elevated cortisol and DA release in striatum compared to Placebo (p < 0.05). Cortisol increases correlated with dorsal striatal DA release (r = 0.708, p = 0.04). FC analyses revealed enhanced FC between dorsal striatum and ventral medial prefrontal cortex (vmPFC) (p < 0.001, FDR-corrected), and between whole striatum and dorsal lateral PFC (dlPFC) (p < 0.001, FDR-corrected). Nonlinear associations showed FC initially increased with stress but plateaued at higher stress levels.ConclusionStress-induced changes in DA release within dorsal striatum influence stress-related alterations in frontal-striatal FC. Our present findings in a limited cohort lead us to hypothesize more broadly that stress alterations in frontal-striatal FC reflect adaptation, whereas excessive stress may disrupt circuits, potentially contributing to addictive behaviors such as smoking. While the present pilot study demonstrates the potential value of PET and rs-fMRI to connect neurotransmitter action to downstream cortical activity future work will be essential to confirm the reproducibility and relevance of the observed associations.
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Case Report: Severe depression and suicidality in a young patient with RYR1-related congenital myopathy

BackgroundRYR1-related congenital myopathies (RYR1-CMYO) are rare inherited neuromuscular disorders characterized by considerable clinical and histopathological heterogeneity. Although chronic physical disability may be associated with substantial psychological burden, psychiatric manifestations in patients diagnosed with RYR1-related disorders remain insufficiently characterized.Case presentationWe report the case of an 18-year-old man with a longstanding RYR1-related congenital myopathy with an autosomal dominant family pattern, who was admitted for a severe depressive episode with active suicidal ideation and a suicide plan. The patient also met diagnostic criteria for obsessive-compulsive disorder and retrospectively reported psychotic symptoms of uncertain timing, duration, and diagnostic significance. No active psychotic symptoms were identified at the documented examination. The familial RYR1 p.Leu4579Arg missense variant had previously been identified in both the patient and his clinically affected mother, supporting segregation with the neuromuscular phenotype. However, patient-specific muscle histopathology was unavailable. A particularly salient psychosocial feature was marked resentment toward his mother, whom he perceived as responsible for transmitting the disorder, in the context of longstanding physical disability, reduced autonomy, and intrafamilial conflict. An individualized multimodal treatment approach combining pharmacotherapy, described family-oriented work, suicide-risk management, and multidisciplinary follow-up was associated with partial improvement in depressive symptoms and reduction of active suicidal ideation during follow-up. The contributions of individual interventions could not be separated.ConclusionThis case illustrates the psychiatric and psychosocial burden of living with an inherited disabling neuromuscular disease in a young adult. Although a direct pathophysiological relationship between RYR1 dysfunction and major depressive disorder or an RYR1-specific psychiatric phenotype cannot be inferred, chronic disability, impaired autonomy, awareness of genetic transmission, and associated family dynamics may contribute to psychological distress. The case highlights the importance of systematic assessment of depression and suicide risk in patients with rare disabling neuromuscular disorders and supports the integration of psychiatric care, psychological support, genetic counseling, and family-oriented interventions within multidisciplinary management.
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Family cohesion and adolescent self-esteem: mediating effects of interpersonal self-support and moderating role of school attachment

IntroductionAdolescent mental health is a pressing global concern, and in collectivist societies such as China, family and school contexts are particularly influential. This study examined whether interpersonal self-support mediates the association between family cohesion and self-esteem among Chinese adolescents and whether school attachment moderates the first stage of that mediation pathway.MethodsA cross-sectional survey was conducted with 728 adolescents (mean age = 13.81 years, SD = 0.91, range 12–16; 44.0% male) from five public junior high schools in Hunan Province, China. Confirmatory factor analyses were conducted in Mplus 8.3, and the moderated mediation model was tested with Hayes’ PROCESS macro (Model 7) in SPSS 27 using observed variables and 5,000 bootstrap samples.ResultsFamily cohesion was positively associated with self-esteem and with interpersonal self-support, and interpersonal self-support partially mediated the family cohesion–self-esteem association. School attachment moderated the first stage of the mediation pathway, b = 0.076, 95% CI [0.024, 0.128], ΔR2 = .008: the positive association between family cohesion and interpersonal self-support was significant at all levels of school attachment and was stronger among adolescents reporting higher school attachment, and the conditional indirect effect increased from 0.107 at low to 0.153 at high school attachment.DiscussionThe indirect pathway was secondary to the direct association between family cohesion and self-esteem, and the moderation effect was modest. Because the design was cross-sectional and self-reported, these associations should not be interpreted causally. The findings suggest that schools may support the benefits of family cohesion for adolescent self-esteem by strengthening teacher-student relationships and cultivating a sense of belonging.
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When severe violence becomes a script: a vulnerability-script integration model of media exposure and the form of psychosis-associated maternal filicide

When a publicized act of severe violence is followed by one that resembles it, the resemblance is often read as contagion. This paper argues that resemblance is weak evidence of influence and asks a narrower question: under what conditions can exposure to a publicized crime narrative shape the form of subsequent violence in a person whose antecedent state has already made such violence conceivable? The Vulnerability-Script Integration Model (VSIM) is developed for psychosis-associated maternal filicide. It is an organizing framework with an attached evidentiary protocol and three new propositions: antecedent vulnerability selects exposure as well as moderating its effect; exposure primarily shapes the form rather than the origin of violence; and media influence is inferred only from a dated post-exposure change in narrative-specific behavioral information (acquired or activated) that the documented antecedent state does not parsimoniously explain. The model specifies five functional stages, two moderators, a clinically defined and non-circular vulnerability construct, discriminant coding rules, a causal diagram with explicit estimands, and six predictions with stated classification, test, disconfirming, and inconclusive evidence. A closed, adjudicated case in which a court-tested claim of media scripting proved false illustrates the evidentiary rules. Clinical and reporting implications are framed as research questions.