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Exploring the interplay of discrimination perception, alexithymia, and shyness among hearing-impaired college students: a network approach

BackgroundHearing-impaired college students face limitations in auditory and verbal communication, placing them at higher risk for mental health problems. While previous studies have mostly used traditional structural equation models to examine the relationship between discrimination perception and psychological adaptation issues, these approaches have difficulty capturing complex nonlinear associations and dynamic interactions between variables. This study adopted a network analysis perspective to explore the association patterns between discrimination perception, shyness, and alexithymia among hearing-impaired college students, and to identify influential intervention targets.MethodsThis study was conducted in March 2026 on college students with hearing -impairments mainly from Fujian and Sichuan provinces using the Hearing-impaired Children perceived discrimination Questionnaire, the Social Withdrawal Subtypes and Peer Isolation Questionnaire, the Perth Alexithymia Questionnaire, and SPSS software for descriptive statistical analysis, and R software for network analysis.ResultsThe discrimination perception–shyness network had 12 cross-community edges (range: −0.044 to 0.057). Most were small (below 0.06), suggesting weak conditional associations. The strongest edge was Pd3–S5 (0.057). Pd3 showed the highest BEI (0.057). The discrimination perception–alexithymia network had 5 cross-community edges (range: 0.012 to 0.050). All were small (below 0.06). The strongest edge was Pd5–A2 (0.050). Pd6 showed the highest BEI (0.071).ConclusionThis study explored the relationships between discrimination perception, shyness, and alexithymia in hearing-impaired college students using network analysis methods. The Pd3 (Excluded from games) in the shyness network and Pd6 (Dishonesty) in the alexithymia network were identified as the highest bridge centrality nodes, suggesting that these are core symptoms connecting external stress to internal psychological adaptation difficulties and key triggers for social avoidance and emotional recognition difficulties in hearing-impaired college students. Thus, they represent the optimal targets for psychological intervention.
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Case Report: Rapid resolution of psychogenic cough in an adolescent following bromazepam treatment

BackgroundSomatic cough syndrome, formerly termed psychogenic cough or habit cough, is an under-recognized cause of chronic cough in pediatric populations, characterized by repetitive, dry, and honking cough that is absent during sleep. Behavioral interventions are first-line treatment with high success rates of 80%–90%. However, when access to behavioral therapy is unavailable, alternative pharmacological interventions, particularly benzodiazepines, have received minimal investigation in this population.Case presentationI report a 13-year-old previously healthy male patient with abrupt-onset, near-continuous dry cough occurring every 2 seconds during waking hours. The cough had a distinctive honking quality and disappeared completely during sleep. The patient presented with severe impairment in function, including inability to eat for 3 days, multiple emergency presentations requiring intravenous hydration, and complete school absence. Medical evaluation, including physical examination, laboratory investigations, spirometry, and chest X-ray, was unremarkable. Empirical trials of inhaled bronchodilators and nasal corticosteroids yielded no improvement. Psychiatric assessment excluded psychotic features, depression, obsessive-compulsive disorder, and tic disorder but noted family stressors, including high expressed emotion and overprotective parenting behavior. Based on the sign of sleep-related cough cessation and exclusion of organic pathology, somatic cough syndrome was diagnosed. Given the severity of impairment and family circumstances precluding immediate behavioral therapy, bromazepam 3 mg orally was initiated. Within 24–36 hours, the cough resolved completely. At 3-month follow-up, the patient remained symptom-free without medication. He had returned to school and demonstrated normal eating patterns.ConclusionThis case demonstrates rapid and sustained resolution at 3-month follow-up of severe psychogenic cough following short-term bromazepam treatment in an adolescent. While behavioral therapy is still an evidence-based first-line treatment, this report suggests using benzodiazepines as a pharmacological intervention alternative when behavioral therapy is unavailable. The rapid response and sustained remission at 3-month follow-up are consistent with the hypothesis that benzodiazepines may interrupt the self-perpetuating cycle of anxiety and cough in somatic cough syndrome. Further research is needed for this case in pediatric populations to establish efficacy, safety, and optimal treatment duration.
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Implementing BEAM: A Scalable Digital Mental Health Program, for Families of Children Referred to Neurodevelopmental Services

Conditions: Depression and Anxiety Symptom; Anger; Parenting; Stress (Psychology); Parent Child Relationship; Child Development; Neurodevelopmental Conditions

Interventions: Behavioral: The Building Emotional Awareness and Mental Health (BEAM) Program

Sponsors: University of Manitoba; Children’s Hospital Research Institute of Manitoba; Kids Brain Health Network

Not yet recruiting
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Creative Art Teletherapy for Veterans With PTSD

Conditions: Post-Traumatic Stress Disorder F03.950.750.500 D013313

Interventions: Behavioral: Art-therapy Remote Treatment for Veterans Experiencing Trauma

Sponsors: VA Office of Research and Development; Henry M. Jackson Foundation for the Advancement of Military Medicine; Drexel University

Not yet recruiting
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Standardized Manual-Based Smoking Cessation Treatment in Patients With Comorbid Mental Disorders: Qualitative Interview Study

Background: Smoking prevalence is disproportionately high among individuals with mental disorders, who also show reduced cessation success, suggesting that current cessation interventions may not fully address their specific needs. A barrier to smoking cessation is the fear that quitting may worsen mental health, yet little is known about how individuals with mental disorders experience guideline-conform cessation treatments, which may address such concerns. Objective: This qualitative study explored the perspectives of smoking individuals with comorbid mental disorders who participated in a standardized, manual-based, cognitive behavioral smoking cessation program to identify targets for optimizing guideline-conform interventions for this population, spanning treatment engagement, perceived challenges, and facilitators within this context. Methods: Semistructured interviews were conducted with 11 participants representing diverse cessation trajectories (sustained abstinence, relapse, and no quit attempt) 6 months after treatment completion. Data were analyzed using reflexive thematic analysis. Results: Three overarching themes were identified. First, participants described smoking cessation as a multidimensional, processual experience extending beyond behavioral change to encompass psychological and social dimensions, characterized by nonlinearity, adaptive meaning-making, and improvements in self-efficacy despite transient strain during early abstinence. Second, smoking was experienced as a functionally embedded practice serving affective, habitual, and social functions, with motivation emerging as dynamic and relationally sustained rather than stable. Third, treatment engagement was shaped by motivational states and contextual circumstances, with participants offering favorable evaluations of the structured intervention alongside recommendations for greater individualization and flexibility. Notably, mental health–related concerns about cessation largely persisted despite predominantly positive or neutral mental health outcomes, a pattern consistent with cognitive immunization processes. Conclusions: Guideline-conform smoking cessation treatment appears feasible and largely well-received by individuals with comorbid mental disorders. The findings highlight the need for targeted psychoeducation to address persistent misconceptions about the mental health risks of cessation, as well as individualized, context-sensitive treatment adaptations, including greater flexibility in session structure, motivational support beyond the active treatment phase, and explicit attention to the social and functional embeddedness of smoking, to improve cessation outcomes in this high-risk population. Trial Registration: ISCRTN ISRCTN12859609; https://www.isrctn.com/ISRCTN12859609
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Trajectories of Persistent Exposure to Self-Harm–Encouraging Websites and Subsequent Mental Health Outcomes in US Youth: Longitudinal Cohort Study

Background: Self-harm, including suicidal thoughts, self-injurious behavior, and disordered eating, is a major public health concern among adolescents and young adults. Youth increasingly encounter self-harm–related content online, including websites that explicitly encourage harmful behaviors. Although exposure to such content has been linked to poorer mental health, most research is cross-sectional and has not examined longitudinal exposure trajectories. Whether persistent exposure represents a distinct digital risk pattern remains unclear. Objective: This study examined longitudinal trajectories and correlates of exposure to self-harm–encouraging websites over 1 year and tested whether persistent exposure was associated with subsequent suicidal ideation, self-injury, and disordered eating. Methods: We analyzed data from 2197 US youth aged 13 to 22 years who completed waves 2 and 4 of Project Lift Up, a national longitudinal cohort study. Website exposure was categorized into 4 trajectories: none, desist (wave 2 only), new (wave 4 only), and persistent (both waves). Categories reflected reported exposure at the 2 assessment waves rather than the frequency or continuity of website use between assessments. Logistic regression models estimated associations between exposure trajectory and wave 4 suicidal ideation, self-injury, and disordered eating, restricting analyses to participants without the respective outcome at wave 2. Models were adjusted for demographics and wave 2 depression or anxiety symptoms and other mental health indicators. Results: Overall, 26.5% (583/2197) reported exposure to self-harm–encouraging websites at wave 2, and 18.5% (407/2197) reported persistent exposure. Privacy concerns, embarrassment, curiosity, and lack of offline support were associated with greater odds of persistence (adjusted odds ratios [aORs] 1.84‐3.23), whereas accidental exposure was associated with lower odds of persistence (aOR 0.28, 95% CI 0.19‐0.41). Compared with no exposure, persistent exposure was associated with higher odds of suicidal ideation (aOR 1.88, 95% CI 1.24‐2.86; =.003), self-injury (aOR 3.14, 95% CI 2.05‐4.80; <.001), and disordered eating (aOR 2.46, 95% CI 1.54‐3.93; <.001). Adjusted predicted probabilities showed a graded pattern, with persistent exposure associated with the highest predicted probabilities (suicidal ideation: 33.4% vs 21.3%; self-injury: 25.7% vs 10.2%; disordered eating: 11.7% vs 5.3%). New exposure was associated with increased odds of self-injury (aOR 2.32, 95% CI 1.30‐4.15; =.004) but was not significantly associated with suicidal ideation or disordered eating. The desist trajectory was not significantly associated with outcomes. Conclusions: Persistent exposure to self-harm–encouraging websites may represent a distinct digital risk pattern associated with higher subsequent odds of suicidal ideation, self-injury, and disordered eating. Assessing patterns of repeated website exposure and youths’ motivations for seeking this content—not merely whether exposure occurred—may improve the identification of youth at heightened risk and inform digital prevention and clinical intervention strategies.
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Relationship between loneliness and self-efficacy: the mediating role of internet addiction and the moderating role of sleep quality

IntroductionThis study aimed to examine the association between loneliness and self-efficacy among adolescents and to investigate whether internet addiction mediated this association and whether sleep quality moderated the direct and indirect pathways. Although previous research has demonstrated significant associations between loneliness and both general and social self-efficacy, the behavioral mechanisms underlying these associations and the conditions under which their strength may vary remain insufficiently understood.MethodsA cross-sectional survey was conducted among 1,323 students in Grades 7–9 from two schools in Baotou, Inner Mongolia, China. Participants completed the UCLA Loneliness Scale, the General Self-Efficacy Scale, the Internet Addiction Diagnostic Questionnaire, and the Athens Insomnia Scale. A moderated mediation model was used to examine the mediating role of internet addiction and the moderating role of sleep quality in the association between loneliness and self-efficacy.ResultsLoneliness was negatively associated with self-efficacy. Internet addiction partially mediated the association between loneliness and self-efficacy. In addition, sleep quality moderated the direct association between loneliness and self-efficacy and the first stage of the indirect pathway from loneliness to internet addiction. Specifically, the associations of loneliness with self-efficacy and internet addiction varied across different levels of sleep quality.DiscussionThese findings provide a more comprehensive understanding of the mechanisms linking loneliness to adolescent self-efficacy by identifying internet addiction as an important behavioral mediator and sleep quality as a moderating factor. The findings highlight the importance of considering problematic Internet use and sleep quality when developing interventions aimed at promoting adolescents’ psychological adjustment, self-efficacy, and well-being.
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Beyond dopamine: KarXT and emerging mechanism-based therapies in schizophrenia

KarXT (marketed as Cobenfy™), a fixed-dose combination of xanomeline and trospium chloride, represents the first new mechanism of action of an antipsychotic used for adult schizophrenia approved by the US Food and Drug Administration (FDA) in over 30 years. While mainstream drugs (e.g. haloperidol, chlorpromazine, risperidone, olanzapine, quetiapine, aripiprazole) mainly antagonize dopamine D2 or serotonin 5-HT2A receptors, KarXT acts through transient activation of muscarinic M1 and M4 receptors. M4 stimulation influences the functioning of mesolimbic dopaminergic pathways, providing an indirect means of regulating dopamine release that bypasses D2 blockade. Trospium, a peripherally acting muscarinic receptor antagonist, was used to reduce anticholinergic adverse effects (AEs). It does not cross the blood–brain barrier and therefore minimizes central adverse events. In a series of randomized placebo-controlled phase 2 and 3 studies, the KarXT significantly and clinically meaningfully reduced Positive and Negative Syndrome Scale (PANSS) total scores. The effect sizes were moderate to large with few extrapyramidal symptoms (EPS), minimal metabolic disturbances and no significant prolactin level increases. In this narrative review, we discuss in detail the pharmacological mechanism, basis of preclinical development, and clinical outcomes of KarXT. We also contextualize this drug within the development of a new wave of non-D2 antipsychotics, highlighting cholinergic dysfunction as one important mechanistic pathway within the broader multidimensional neurobiology of schizophrenia.