BackgroundAcademic burnout is a mental-health-relevant outcome of higher-education stress, but its relationship with spontaneous brain dynamics remains unclear. EEG microstates are quasi-stable scalp-potential configurations indexing millisecond-level transitions between large-scale resting brain states. This study tested whether resting-state EEG microstate dynamics are associated with academic burnout beyond trait anxiety, depressive symptoms, and general self-efficacy as perceived coping capacity.MethodsParticipants were 330 Chinese undergraduates (94 men, 236 women; mean age = 18.31 years, SD = 0.84). They completed self-report measures and an eyes-closed resting-state EEG recording. Academic burnout total score was the primary outcome. Covariate-adjusted partial correlations examined burnout–microstate associations. Hierarchical regression tested the incremental value of selected microstate markers.ResultsHigher academic burnout was associated with higher trait anxiety (r = 0.539, p < 0.001), higher depressive symptoms (r = 0.526, p < 0.001), and lower general self-efficacy (r = -0.474, p < 0.001). After adjustment for age, sex, trait anxiety, depressive symptoms, and general self-efficacy, greater burnout was associated with shorter microstate D duration (partial r = -0.196, q = 0.0049), higher microstate C occurrence (partial r = 0.172, q = 0.0081), shorter mean microstate duration, and higher mean occurrence. The psychological block explained substantial variance in burnout (R² = 0.417); adding microstate D duration and microstate C occurrence produced a small but significant improvement in model fit (ΔR² = 0.025, p = 0.001). In a scale-midpoint sensitivity analysis, the higher-burnout group showed shorter class D duration after covariate adjustment (adjusted B = -3.38 ms, 95% CI [-6.12, -0.64], p = 0.016). Dimension-specific analyses indicated that microstate associations were mainly evident for dejection and low sense of accomplishment, not the behavioral (improper-behavior) component.ConclusionAcademic burnout in undergraduates was primarily linked to internalizing distress and lower perceived coping capacity. Resting-state EEG microstate dynamics, especially shorter class D duration, provided modest incremental information, suggesting reduced temporal persistence of a canonical resting-state configuration among students with higher burnout. These findings do not establish a diagnostic EEG marker or a burnout-specific neural mechanism, but support multimodal, context-sensitive research on academic stress and mental health in higher education.
Social talk in virtual spaces: an observational study of pragmatic communication in children with autism spectrum disorder during avatar-mediated interaction
IntroductionImmersive virtual environments offer organized social contexts for the observation of communication behaviors under standardized and interactive conditions. This study adopts a VR-based observational approach to examine pragmatic social communication behaviors exhibited during structured social scenarios in autistic children, with a specific focus on social reciprocity and context-appropriate verbal communication. MethodsThe study included twenty-five children between the ages of 5 and 12 who were diagnosed with Autism Spectrum Disorder (ASD). A structured social scenario was presented by the Virtual Reality (VR) system to elicit social communication behaviors, including greeting initiation and response, attention to speakers, turn-taking, and context-appropriate verbal responses. Social communication outcomes were assessed using selected domains of the Indian Scale for Assessment of autism (ISAA). In addition, the Social Communication Questionnaire (SCQ) and a VR-based Pragmatic Social Communication Observation Checklist (VR-PSCOC) were used to assess in-scenario behaviors. ResultsThe post-VR analysis revealed measurable changes across the assessed pragmatic social communication domains during repeated exposure to the VR scenarios. Variations were observed in the ISAA social-communication related domains, including speech-language, communication, and social relationship and reciprocity scores (p<0.001). Repeated VR exposure was associated with higher observational scores, indicating observable changes in social communication behaviors within the structured virtual environment. DiscussionThe findings indicate that the structured VR-based social scenarios provide a feasible environment for observing and characterizing social communication behaviors in children with ASD within controlled interaction settings.
Strategic Planning for a Digital Health Innovation Hub at a Saudi Academic Medical Center: Qualitative Case Study
Background: Rapid digital transformation is reshaping health care, but many digital initiatives struggle to deliver sustained organizational value when they are introduced as stand-alone technologies rather than as part of an institutional strategy. In Saudi Arabia, Vision 2030 has intensified pressure on academic medical centers to strengthen digital capability, localize innovation, and reduce dependence on externally driven solutions. Objective: This study aimed to examine organizational factors shaping digital health innovation at King Saud University Medical City (KSUMC) and to develop a preliminary strategic planning framework for a digital health innovation hub tailored to that setting. Methods: We conducted a qualitative exploratory case study at KSUMC between April and June 2025. Fourteen stakeholders from clinical, administrative, research, governance, educational, and innovation-related roles were recruited using maximum variation purposive sampling. Semistructured interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Reporting was guided by the COREQ (Consolidated Criteria for Reporting Qualitative Research). Diffusion of innovation theory and systems thinking informed interpretation, while a context-actor-mechanism-outcome lens was used to examine how institutional conditions shaped innovation processes. No patient data were collected. Results: Five interrelated themes were identified. First, leadership support existed at a symbolic level, but middle-management translation and risk tolerance were inconsistent. Second, innovation was constrained by workload, fragmented systems, and weak operational support, which meant that project work was often treated as discretionary rather than embedded. Third, knowledge transfer and commercialization pathways were fragmented; participants repeatedly described unclear routes from idea generation to prototyping, regulatory review, and market engagement. Fourth, incentives and innovation capability were misaligned with institutional expectations, particularly for clinicians and trainees. Fifth, Vision 2030 created strategic legitimacy and momentum, but participants also cautioned that an overreliance on consultant-led or vendor-led approaches could weaken internal capability building. These findings informed a preliminary framework centered on governance, knowledge transfer, partnership structures, workforce development, and phased implementation rather than a validated institutional model. Conclusions: At KSUMC, digital health innovation is shaped not only by technology availability but also by organizational culture, intermediary structures, governance design, and the extent to which innovation work is made operationally feasible. The framework proposed here should therefore be understood as a preliminary planning model derived from one qualitative case study. Its main contribution is to specify how knowledge transfer, commercialization, and institutional capability building can be integrated into a digital health strategy within a Saudi academic medical center.
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A Self-Guided Mobile Mindfulness Intervention Embedded in Daily Routines for Adults With Mild to Moderate Psychological Distress: Randomized Controlled Trial
Background: Mobile mindfulness interventions have shown promise for reducing anxiety and depressive symptoms, but sustaining engagement remains a persistent challenge. Many digital programs still rely on formal practice that requires dedicated time, which may be difficult to integrate into daily life. Objective: This randomized controlled trial evaluated Habitual Mindfulness Practice (HMP), a self-guided mobile mindfulness intervention that embeds brief practices into recurring daily routines, among adults with mild to moderate psychological distress. Outcomes were compared with those of Traditional Mindfulness (TM), Mindfulness-Based Psychoeducation (MBP), and a waitlist control (WL). Methods: Adults aged 18 to 65 years with mild to moderate symptoms of anxiety or depression were randomly assigned in a 1:1:1:1 ratio to HMP, TM, MBP, or WL (N=686). All procedures were conducted online, and the intervention was fully self-guided, with outcomes assessed using self-report measures. The intervention lasted 21 days, with assessments conducted at baseline, postintervention, and 3-month follow-up. Primary outcomes were depressive and anxiety symptoms. Secondary outcomes included mindfulness, cognitive emotion regulation, affective balance, and interpersonal difficulties. Postintervention group differences were examined, controlling for baseline scores, and longitudinal trajectories were evaluated across the active intervention conditions. Results: At postintervention, significant group effects were observed for depressive symptoms (=28.67, <.001, ηp²=0.11) and anxiety symptoms (=30.11, <.001, ηp²=0.12). Both HMP and TM showed lower depressive and anxiety symptom scores than MBP and WL. TM showed lower postintervention anxiety than HMP (=.04), whereas depressive symptoms did not differ significantly between HMP and TM (=.63). The mindfulness practice conditions also showed more favorable postintervention outcomes for mindfulness, affective balance, interpersonal difficulties, and emotion regulation. Improvements in depressive and anxiety symptoms were generally maintained at follow-up among the active intervention conditions, although maintenance of secondary outcomes varied across measures. Postintervention outcome data were available for 55.2% (379/686) of randomized participants, and follow-up outcome data were available for 24.1% (124/515) of participants in the active intervention conditions. HMP and TM did not differ significantly in practice duration, engagement, or satisfaction. Conclusions: A routine-embedded, self-guided mobile mindfulness intervention may be a feasible approach for reducing mild to moderate psychological distress. HMP produced benefits broadly comparable to those of traditional app-delivered mindfulness, but it did not confer advantages in engagement or short-term efficacy. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400093771; https://tinyurl.com/3d6tky8v
enDigital Postpartum Support for Early Risk Identification Among Postpartum Women: Formative Randomized Evaluation and Exploratory Predictive Modeling Study
Background: The postpartum period represents a critical window for maternal health, yet many individuals lack sustained support and timely identification of physical and mental health risks. Digital health interventions offer a scalable approach to extend care beyond clinical settings. Yet, key elements, including real-world challenges, usability, and effectiveness of such platforms, are insufficiently characterized in this literature. Objective: This study aimed to conduct a formative randomized evaluation to assess the feasibility, engagement, and preliminary signals of impact of the Joyuus platform and to examine the potential for early identification of postpartum health risks. Methods: We conducted a 12-week randomized evaluation with postpartum participants recruited through community-based organizations. Participants were randomized to either the Joyuus intervention or standard postpartum care. Primary and secondary outcomes included the Barkin Index of Maternal Functioning, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory, and the Connor-Davidson Resilience Scale. Analyses were conducted using an intention-to-treat approach with linear regression models adjusting for baseline values. Engagement metrics (ie, sessions, time on site, and feature use) were captured through in-app analytics. An exploratory predictive model was developed using baseline clinical, behavioral, and demographic variables to identify individuals at risk for postpartum depression. Results: Baseline characteristics were generally balanced across arms, and no statistically significant differences were observed in education, income, or marital status. No statistically significant differences were found between treatment and control groups in the 12-week changes for the primary or secondary outcomes. Mean EPDS scores were 9.7 in the intervention group and 9.3 in the control group. In the sample, 60 (45.5%) of the 132 participants met the criteria for elevated depression (EPDS score ≥11 or a positive response to question 10 on self-harm), indicating a high burden of symptoms within the study population. Engagement with the platform was highest during the first 4 weeks. Among intervention participants, 80% created an account. Participants reported high levels of perceived usefulness, ease of use, and relevance of content. Qualitative analysis of open-ended survey responses highlighted limited awareness of postpartum-specific resources and a preference for simple, accessible information. An exploratory predictive model demonstrated a recall of 0.89 and a precision of 0.73 in identifying individuals at risk for postpartum depression, suggesting the feasibility of early risk identification using integrated data inputs. Conclusions: Joyuus demonstrated feasibility and acceptability but did not produce statistically significant improvements in maternal functioning or maternal health outcomes over 12 weeks. Joyuus identified high rates of depressive symptoms and early engagement patterns, which suggest an opportunity for earlier identification of risk and intervention during the postpartum period. Exploratory modeling results indicate the potential for data-driven approaches to support earlier detection. Future work includes optimizing engagement strategies and expanding validation of predictive detection to improve postpartum surveillance and outcomes. Trial Registration: ClinicalTrials.gov NCT05876559; https://clinicaltrials.gov/study/NCT05876559?cond=postpartum%20joyuus&viewType=Card&rank=1
Blood Test Foresees Decline into Alzheimer’s Disease
A blood-based biomarker could predict a person’s risk of developing Alzheimer’s disease years before any symptoms arise, research suggests.
Plasma levels of phosphorylated tau 217 (p‑tau217) may one day help identify at-risk individuals before overt signs of dementia, enabling the pre-emptive use of disease-modifying therapies.
Higher plasma p‑tau217 levels were associated with a greater risk of progressing to cognitive impairment in previously unaffected older adults, and they also predicted faster levels of decline.
The research findings appear in JAMA and were simultaneously presented this week at the annual Alzheimer’s Association International Conference in London.
“In this longitudinal study of several selected cohorts, plasma p-tau217 provided long-term prognostic information for individuals who were cognitively unimpaired at baseline, laying the groundwork for possible future development of individualized risk prediction scores,” proposed Rachel Buckley, PhD, from Mass General Brigham, and co-workers in their published work.
“By providing absolute risk estimates of progression to cognitive impairment, this article moves the field closer to presymptomatic risk stratification with p-tau217, supporting trial design.”
The large, pooled multicohort study included 2684 cognitively unimpaired older adults from six longitudinal studies, who were followed for a median of 5.4 years. Their median age was just short of 70 years, and 63% were women.
Results showed that higher baseline p-tau217 was significantly associated with an increased risk of progression to cognitive impairment during up to 13.5 years of follow up, with a hazard ratio of 1.38 per standard deviation (SD) increase.
This remained significant after accounting for age, sex, education, apolipoprotein E ε4 status, cohort, as well as amyloid positron emission tomography—known to accurately detect Alzheimer’s disease brain pathology.
The researchers report that the absolute risk of cognitive decline at five years was “meaningfully elevated” in the group with very high p-tau217 levels (≥2.5 SD) at 38%, versus just 12% in group with low levels.
Estimated 10-years risks were substantially higher at between 40% and 78% for the low and high p-tau217 groups, respectively. However, just 139 participants—or one in every 20—were followed up for at least a decade and the researchers say these risk estimates should be treated with caution.
Elevated p-tau217 was also associated with faster decline on the harmonized latent Preclinical Alzheimer Cognitive Composite assessment tool.
In an editorial accompanying the published study, Suzanne Schindler, PhD, from Washington University in St Louis school of medicine, and David Wolk, MD, from the University of Pennsylvania, note that cognitive impairment likely reflected multiple etiologies, not just Alzheimer’s disease.
“Indeed, even the low p-tau217 group, in which Alzheimer disease pathology was minimal or absent, still had a 12% risk of progression to cognitive impairment at five years, suggesting the importance of other drivers of cognitive decline in this population and the likelihood that in the higher p-tau217 groups, some proportion of individuals who declined may have primarily been driven by other processes,” they pointed out.
“Notably, discordance between plasma p-tau217 and amyloid PET (especially at intermediate or low amyloid levels) highlights that biomarkers beyond p-tau217 could further improve risk prediction.”
Nonetheless, overall they summarized: “The study by Buckley et al. represents a significant advance. It demonstrates that plasma p-tau217 can provide a time-specific absolute risk estimate for development of cognitive impairment.”
The post Blood Test Foresees Decline into Alzheimer’s Disease appeared first on Inside Precision Medicine.
BFRBs vs. OCD: Similarities and Differences
This blog was originally posted by the TLC Foundation for BFRBs
Body-focused repetitive behaviors (BFRBs) and obsessive-compulsive disorder (OCD) are two distinct mental health conditions that share some similarities but also have significant differences. BFRBs involve repetitive, self-grooming behaviors that can cause physical damage, such as hair pulling or skin picking. On the other hand, OCD is a condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) performed to alleviate anxiety.
While both conditions involve repetitive behaviors and can impact daily life, their underlying mechanisms, triggers, and treatment approaches differ. This article explores the key similarities and differences between BFRBs and OCD to better understand these complex conditions.
Similarities Between BFRBs and OCD
Most professionals view BFRBs and OCD as similar conditions due to the similarity in symptoms, such as compulsivity and repetitive behaviors. These two conditions share several similar systems and are usually a reaction to triggering factors such as stress and anxiety. Below are some of their similarities.
Repetitive Behaviors
Individuals dealing with BFRBs often engage in various repetitive behaviors such as hair pulling, lip biting, or skin picking. These actions are usually challenging to control and are frequently triggered by stress or anxiety. One may indulge in the habit subconsciously to find instant relief from the trigger.
Individuals with OCD often experience intrusive thoughts that result in repetitive behaviors known as compulsions. Some common compulsions include washing hands and repetitively checking or counting to alleviate the stress caused by obsessive thoughts. In both conditions, the repetitive behaviors are often exacerbated by stress and anxiety, and individuals may adapt these behaviors as a coping mechanism.
Impulse Control
Closely related to repetitive behaviors is the concept of impulse control. Both BFRBs and OCD involve challenges in this area, albeit in different ways. Individuals with BFRBs and OCD may find it hard to control the urge to perform repetitive behaviors. This is because these repetitive behaviors often relieve tension. Despite knowing the consequences of these behaviors, the desire to indulge in them is usually irresistible.
For example, individuals with BFRBs understand that hair pulling may affect their appearance, but they cannot refrain from doing it. OCD occurs as a result of intrusive thoughts whereby one believes that if they do not perform a specific action, the stressor won’t go away. These intrusive thoughts often cause anxiety, which can be eased by engaging in the said repetitive behavior.
Onset and Course
Having examined the behavioral aspects, let’s now consider how these conditions develop over time. The onset of these two conditions shares several similarities regarding age, triggers, and psychological mechanisms.
The onset of both conditions is usually during childhood or adolescence and often coincides with various developmental changes and stressors. For individuals with BFRBs, the repetitive behaviors alleviate stress and anxiety instantly. At the same time, for those with OCD, performing the compulsions temporarily relieves them from the stress caused by their intrusive thoughts. The cognitive patterns involve repetitive actions, intrusive thoughts, and a lack of impulse control. In BFRBs, the urge to engage in these repetitive behaviors can be intrusive and persistent, while in OCD, one’s obsessions create a sense of urgency, which leads to the adoption of compulsive actions.
Neurobiological Factors
To fully understand the similarities between BFRBs and OCD, we must delve deeper into their biological underpinnings. Both conditions have a genetic origin and are associated with neurobiological factors. Neurobiological studies indicate that the impulse control and emotional regulation difficulties for people with BFRBs and OCD are often caused by abnormalities in brain regions that are responsible for impulse control and habit formation. Therefore, the underlying brain mechanism may result in the onset and development of both conditions. It is not uncommon for individuals to have both BFRBs and OCD or for both conditions to coincide with other mental health conditions, usually depression and anxiety. The overlap is generally because they typically share common underlying factors that play a part in their severity and development.
Differences Between OCD and BFRBs
While BFRBs and OCD share several commonalities, it’s equally important to understand their distinct characteristics, from the symptoms to the underlying mechanisms. Let’s explore the key differences that distinguish these two conditions.
Nature of the Behavior
First and foremost, let’s examine how the behaviors associated with each condition differ in their fundamental nature. Individuals dealing with these two conditions adopt diverse behaviors as coping mechanisms for their triggers. In BFRBs, the behaviors adopted, such as trichotillomania (hair-pulling) or cheek-biting, usually result in physical harm. However, regardless of the consequences, one always feels relieved when picking their skin or pulling their hair.
OCD, on the other hand, involves a wide range of compulsions, from washing to organizing, checking, and counting. Compulsive behaviors are performed due to intrusive thoughts that make one think that if they fail to indulge in a specific behavior, they might get hurt, or there might be other negative consequences.
Presence of Obsessions
Another crucial distinction lies in the cognitive processes behind these behaviors. Generally, BFRBs do not involve obsessive thoughts. The primary focus on BFRBs is usually more on the physical behavior and not the fear of specific consequences.
However, the major characteristic of OCD is intrusive thoughts, which increase the urge to indulge in particular behaviors for relief. The thoughts are usually persistent with unwanted images that result in distress.
People with BFRBs DO NOT report that if they do not pick on their skin, something terrible will happen. Instead, they report that picking or pulling their hair helps relieve them from intense and negative emotions. These behaviors, therefore, serve a self-regulatory function, unlike in OCD, where the repetitive behavior calms them from their intrusive thoughts.
Triggers
The nature of triggers for each condition is closely related to the presence or absence of obsessions. The primary trigger in BFRBs is stress and anxiety, but for OCD, the main trigger is intrusive thoughts, which then result in anxiety. OCD and BFRBs triggers differ in several ways, often resulting in different outcomes. OCD triggers often result in one taking measures to prevent harm, while for BFRBs, one uses the adopted behaviors to regulate and manage intense emotions. The nature of thoughts is an essential distinguishing factor, seeing as OCD involves intrusive and obsessive thoughts that trigger specific behaviors adopted to prevent harm. The purpose of compulsions in OCD is to reduce the anxiety caused by the obsessive thoughts, while in BFRBs, the behaviors are for emotional relief.
Awareness
Beyond triggers, the level of conscious awareness also differentiates these two conditions. Those dealing with BFRBs usually find themselves biting their nails or even pulling their hair subconsciously. Individuals with OCD are generally aware of their intrusive thoughts and are compelled to adopt specific behaviors as a response to these thoughts. Individuals with OCD are often aware of their compulsions and understand when they are being irrational, but they are unable to control themselves. Compared to people with OCD, those with BFRBs often find their behaviors more rewarding than distressing.
Treatment
Finally, while both conditions may benefit from cognitive behavioral therapy, the specific approach to treatment varies significantly. For individuals with BFRBs, the focus is on behavior modification and awareness, achieved through habit reversal training. For OCD, the emphasis is often placed on exposure to anxiety-provoking thoughts to help an individual tolerate anxiety, which prevents compulsive behavior.
Bottom Line
While BFRBs and OCD can coexist, they are distinct disorders with unique manifestations despite sharing some similarities. The key distinctions between these conditions are evident in their underlying mechanisms and treatment approaches.
Both involve compulsive behaviors, but their purposes differ. BFRBs primarily serve as subconscious tools for emotional regulation. OCD compulsions are conscious attempts to alleviate anxiety and prevent perceived harmful consequences. BFRB behaviors often occur with limited conscious awareness, while OCD sufferers are typically more aware of their compulsive actions.
Both conditions can significantly affect daily functioning and social interactions.BFRBs may lead to physical injuries and lowered self-esteem due to visible effects. OCD can cause severe anxiety and time-consuming rituals that interfere with daily activities.BFRB treatment emphasizes behavior modification and awareness techniques, while OCD treatment often involves exposure therapy to reduce anxiety responses.
Understanding these distinctions is crucial for accurate diagnosis and effective treatment. While both conditions present challenges, with proper support and intervention, individuals with BFRBs or OCD can learn to manage their symptoms and improve their overall quality of life.
The post BFRBs vs. OCD: Similarities and Differences appeared first on International OCD Foundation.
Verbal fluency after cochlear implantation: a longitudinal comparison with untreated hearing loss in the ELSA cohort
IntroductionHearing loss is associated with accelerated cognitive decline, and auditory rehabilitation via cochlear implantation (CI) may mitigate this trajectory. In the past, the impact of cochlear implantation on different cognitive subdomains has been described. However, verbal fluency (VF), which requires fast semantic retrieval, executive control, and processing speed, and is predictive of dementia risk and overall survival, has been rarely studied and control groups are mostly missing due to ethical reasons. The present study compares long-term VF trajectories in CI recipients and untreated hearing-impaired controls from a large population-based aging study.Materials and methodsVF was assessed in 74 CI recipients (M = 65.6 years, SD = 9.1) at pre-operative baseline and 1, 2, 4.5, and up to 9 years post-implantation, and in 383 untreated hearing-impaired participants (M = 72.6 years, SD = 10.0) from the English Longitudinal Study of Ageing (ELSA) across a comparable time frame. Scores were z-standardized within each study to enable cross-cohort comparison. Linear mixed-effects models were used to compare VF trajectories, with age, sex, and education as covariates.ResultsVF trajectories differed significantly between groups (Time × Study interaction: b = 0.562, p < 0.001). The ELSA cohort showed a steady linear decline over time (b = −0.261, p = 0.001), whereas the CI cohort exhibited an inverted-U trajectory with initial improvement followed by a plateau. After propensity score matching, results remained robust.ConclusionCochlear implantation is associated with more favorable long-term verbal fluency trajectories compared to untreated hearing loss. These findings add to the growing evidence that auditory rehabilitation may help preserve cognitive function in older adults.
High perceived energy: exploring distinct patterns of energetic and cognitive functioning in older adults
BackgroundA hyperthymic temperament and high perceived energy are often framed as positive dispositional traits, particularly in later life. Indeed, these characteristics are generally associated with a greater tendency to preserve autonomy and with more favorable outcomes in terms of health, engagement, and participation in community life-key dimensions of successful aging. However, the relationship between elevated perceived energy and cognitive performance in older adults remains insufficiently explored. Therefore, this exploratory study aimed to compare cognitive performance and well-being in older adults with different self-reported levels of subjective energy, and to explore potential phenotypic heterogeneity within this population.MethodsWe conducted a cross-sectional study on older adults from the general population. Participants were classified as having higher versus lower levels of perceived energy based on item 10 of the Short Form Health Survey (SF-12) questionnaire. Cognitive performance was assessed using the Addenbrooke’s Cognitive Examination-Revised (ACE-R). Depressive symptoms were evaluated with the Patient Health Questionnaire-9 (PHQ-9), biological and behavioral rhythm regulation with the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), and quality of life with the SF-12 were also evaluated to characterize overall well-being.ResultsStatistically significant difference emerged in global cognitive performance between individuals with higher versus lower perceived energy (ES ACE-R p=0.012). Although subscale scores were within the normative range in both groups, individuals with higher perceived energy consistently showed significantly lower scores in language (p = 0.011) and attention/orientation (p = 0.049) compared to the lower perceived energy group. Interestingly, the higher perceived energy group also reported fewer depressive symptoms (p = 0.013), better social and behavioral rhythm regulation (p = 0.005), and higher quality of life (p < 0.001).Discussion/ConclusionsHyperenergy in older adults with preserved well-being is not associated with global cognitive impairment, but rather with subtle domain-specific performance variations, suggesting a heterogeneous underlying profile. These findings support a high-energy profile that does not appear to be associated with functional impairment, but is instead characterized by preserved or enhanced functioning and overall well-being, despite selective areas of lower performance. Longitudinal studies are needed to clarify its clinical and cognitive implications.
From promise to practice: artificial intelligence in mental health care in the MENA region
Mental health disorders represent a growing burden across the Middle East and North Africa (MENA) region, where depression and anxiety are highly prevalent amid conflict, displacement, and socioeconomic strain, affecting up to 40 percent of adults, yet treatment gaps remain at 80-95% due to provider shortages, financial strain, and cultural barriers. In this context, artificial intelligence (AI), in the form of large language models (LLMs) and specialized psychotherapy chatbots, may offer a scalable adjunct to help address these gaps through anonymous screening, predictive risk modeling, psychoeducation, and brief interventions. This narrative review examines current evidence of AI-driven conversational tools in mental health with a specific focus on their application, acceptance, and limitations within the MENA region. To do so, A structured search of MEDLINE and Embase (2000–2026) identified studies on conversational AI in mental health, prioritizing evidence from the MENA region and supplemented by relevant global literature. Overall, findings suggest that while these tools offer high accessibility and user engagement, particularly for low-intensity support, their effectiveness is limited by linguistic and cultural mismatches, including Arabic diglossia and poor alignment with locally grounded expressions of distress. At the same time, user acceptance reflects a paradox in which stigma and privacy concerns drive reliance on anonymous AI tools while simultaneously limiting trust in their clinical reliability, reinforcing a preference for hybrid models with human oversight. Taken together, these findings indicate that current systems remain insufficiently adapted to the MENA context, underscoring the need for culturally grounded, dialect-sensitive, and clinically supervised approaches to ensure safe and effective integration.