PurposeThe COVID-19 pandemic disrupted essential services, posing unique challenges for individuals with Autism Spectrum Disorder (ASD) who depend on consistent, specialized support. Service providers faced unique challenges in adapting to remote delivery methods, highlighting the fragility of existing systems during crises. This study explored the experiences of ASD service providers in Qatar during the COVID-19 pandemic.MethodsAn online survey of 66 ASD service providers in Qatar was conducted. Data were analyzed using descriptive statistics, chi-square, and likelihood ratio tests, with qualitative responses assessed through thematic analysis.ResultsMost service providers (90.9%) worked remotely during the pandemic, with 81.8% engaging in online services. Providers reported significant skill regression in individuals with ASD. Stress levels were notably high (42.4%) and significantly associated with emotional tolls [p = 0.017, LR = 4.887], financial strains [p = 0.008, LR = 4.337], and personal challenges [p = 0.008, LR = 3.203]. Thematic analysis revealed decreased therapy effectiveness and difficulties in balancing work with family responsibilities.ConclusionThese findings suggest the importance of adaptive service delivery systems that maintain continuity of care during crises. Strengthening autism service infrastructure and developing resilient models are essential to safeguard autism support for future emergencies.
Real-world use of brexpiprazole during inpatient treatment for schizophrenia: continuation, discontinuation, and concomitant psychotropics
IntroductionIn the treatment of schizophrenia, antipsychotics used during acute inpatient care must control acute symptoms while remaining sufficiently tolerable to support treatment beyond the acute phase. Brexpiprazole, a serotonin-dopamine activity modulator may be one such option; however, its real-world use and short-term continuation in acute inpatient settings remain insufficiently characterized.MethodsWe conducted a retrospective observational study of inpatients with DSM-5 schizophrenia treated with brexpiprazole at a university hospital in Japan between June 2018 and July 2024. The index date (week 0) was defined as the date of brexpiprazole initiation during the index hospitalization. The primary outcome was brexpiprazole continuation at week 8. We compared baseline demographic and treatment-related variables between the continuation and discontinuation groups and summarized reasons for discontinuation from electronic medical records. As a secondary exploratory analysis, we examined longitudinal changes in Clinical Global Impressions–Severity scale (CGI-S) and Brief Psychiatric Rating Scale (BPRS) total scores (weeks 0/4/8) in the continuation group using a linear mixed-effects model including time, concomitant psychotropic medication status, and their interaction.ResultsSixty-seven patients were included. Baseline illness severity was substantial (median CGI-S 5.0 [IQR 5.0–6.0]; mean BPRS total 58.5 ± 9.6). Concomitant psychotropic medications were common. Thirty-six patients continued brexpiprazole to week 8 (53.7%). In unadjusted exploratory comparisons, continuation was associated with the female sex (p = 0.036), lower prior chlorpromazine-equivalent dose (p = 0.015), and shorter duration of untreated psychosis (p = 0.003), with a trend toward shorter duration since onset (p = 0.073). The most frequent reason for discontinuation was adverse events (n = 10, 32.3%), most commonly akathisia (n = 6), followed by insufficient efficacy (n = 9, 29.0%) and patient preference/refusal (n = 7, 22.6%). In exploratory mixed-effects analyses within the continuation group, CGI-S and BPRS total scores decreased over time, with significant group-by-time interactions by concomitant medication status. However, between-group differences should be interpreted cautiously.DiscussionThis study describes 8-week continuation and reasons for discontinuation of brexpiprazole in acute inpatient schizophrenia care. Given the retrospective single-center design and potential selection/information bias and unmeasured confounding, further studies are warranted to clarify its clinical positioning in real-world practice.
The Role of a Brief Educational Video Series for Parent of Adolescents With Anorexia Nervosa
Conditions: Atypical Anorexia Nervosa; Anorexia Nervosa
Interventions: Behavioral: Parent Educational Videos; Behavioral: Treatment as usual for adolescents with Anorexia Nervosa
Sponsors: Baylor College of Medicine
Enrolling by invitation
Interventions: Behavioral: Parent Educational Videos; Behavioral: Treatment as usual for adolescents with Anorexia Nervosa
Sponsors: Baylor College of Medicine
Enrolling by invitation
TUBSIS 2.0 – Tobacco Use Behavioral Support and Intervention System
Conditions: Tobacco Use Disorder; Nicotine Dependence; Vaping; Smoking Tobacco
Interventions: Behavioral: TUBSIS 2.0
Sponsors: University of Zurich; State Secretariat for Education Research and Innovation, Switzerland
Recruiting
Interventions: Behavioral: TUBSIS 2.0
Sponsors: University of Zurich; State Secretariat for Education Research and Innovation, Switzerland
Recruiting
Structural Brain Network Alterations in Relation to Treatment and Illness Severity in Bipolar Disorder
Large-scale T1-weighted MRI studies have established grey-matter abnormalities in bipolar disorder (BD), with our group contributing to consensus findings. However, structural connectivity, particularly within emotion- and reward-related circuits, remains poorly understood. Diffusion-weighted MRI (dMRI) enables investigation of white-matter pathways, yet prior work is constrained by small samples, methodological heterogeneity, and unclear medication effects. We conducted the largest dMRI network analysis in BD, relating symptom burden and polypharmacy to tractography-derived connectivity and graph-theoretic metrics.
Addressing the Psychological Needs of Adolescents During the Wait Time for Mental Health Treatment: Service Design Study
<strong>Background:</strong> Adolescents waiting for mental health treatment often experience significant unmet psychological needs, including severe psychological distress, increased use of maladaptive coping strategies, and feelings of abandonment. However, current wait time support offerings across the mental health sector are sparse and lack clear evidence of effectiveness. <strong>Objective:</strong> Using design thinking, this early report describes the development of a service blueprint for a new model of care (<i>While We Wait</i>) designed to address the psychological needs of adolescents during the wait time for mental health treatment in Australia through targeted support from general practitioners (GPs) and brief, self-directed digital interventions. <strong>Methods:</strong> In partnership with health service designers from Deloitte Digital Australia, we conducted a rapid 6-week health service design sprint. This industry-led methodology involved iterative weekly activities, including the development of service user personas and service experience principles, consultation sessions with 12 youth with lived experience experts (aged 18 to 20 years) and 15 GPs, insight synthesis, and service blueprint development. <strong>Results:</strong> The design sprint produced a service blueprint anchored in 5 service experience principles: “I’m never alone,” “It’s for me,” “I’m in control,” “It’s easy to use,” and “It lifts me up.” The proposed service model incorporated a five-stage service journey: (1) recognition (the adolescent acknowledges the need for support), (2) initial consultation and onboarding with the GP, (3) support and monitoring, (4) preparation for treatment, and (5) transition to specialist care and follow-up. Key adolescent service outcomes included uptake, acceptability, self-advocacy, mental health and well-being, perceived quality of care, and help seeking intentions and behaviors. For GPs, outcomes included uptake, feasibility, acceptability, and confidence in supporting adolescents during the wait time. <strong>Conclusions:</strong> This work demonstrates that a rapid, industry-led design thinking approach may help identify priorities for developing services that address adolescents’ needs during the wait time for mental health treatment. The project also highlights the value of co-designing mental health services with lived experience experts and service providers. Together, these findings suggest that the wait time may represent an important opportunity for early therapeutic engagement rather than a passive delay before treatment.
Older Adults’ Experiences Navigating Setup of Digital Health Technology: Implementation Report
<strong>Background:</strong> Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. <strong>Objective:</strong> The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup “pain points” that may influence initial impressions and intention to use the technology over time. <strong>Methods:</strong> A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. <strong>Results:</strong> Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app’s customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. <strong>Conclusions:</strong> First impressions of digital health apps play a critical role in influencing older adults’ emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.
Curiosity in a Novel Virtual Reality Scenario and Its Association With Symptoms of Depression: Observational Pilot Investigation
Background: Curiosity plays a fundamental role in human learning, development, and motivation, and emerging evidence suggests that reduced curiosity is linked to poorer mental health outcomes, including depressive symptoms (DS). However, to date, the majority of curiosity research relies on self-report assessments and thus risks biased reporting. Virtual reality (VR), a novel tool increasingly used within mental health research and treatment, might represent a potent tool for offering ecologically valid insights into curiosity-driven behaviors while circumventing issues related to self-report assessments, including demand characteristics and recall bias. Objective: The study aimed to enhance the assessment of curiosity by using a novel VR environment and to examine its relevance to DS. Specifically, we tested 2 hypotheses using a novel VR environment: first, that curiosity, as assessed through spontaneous exploratory interactions and behaviors in VR, positively correlates with self-reported curiosity, and second, that VR-based curiosity is inversely associated with DS. Methods: This exploratory study used an observational design that included 100 volunteers. All participants completed self-reported assessments of DS and curiosity before engaging in a novel VR scenario. Although progression in the virtual environment required solving cognitive tasks, these were embedded as structural elements rather than framed as the primary objective. Instead, participants’ free explorations and interactions with objects formed the basis for the 4 curiosity metrics used in this study. After VR exposure, participants completed a questionnaire assessing cybersickness symptoms. Results: Hypothesis 1 was not supported, as only one curiosity metric, namely object interactions, was positively associated with one aspect of curiosity relating to motivation to seek new knowledge and experiences. Further, diminishing significance after correction for multiple testing warranted caution. Results relating to hypothesis 2 indicated partial support, in that object interaction was significantly associated with DS while controlling for age, sex, and cybersickness levels. Sensitivity analyses showed no associations between object interactions and self-reported anxiety and stress symptoms. Conclusions: VR may be a potent tool for assessing exploratory behaviors in a controlled, yet ecologically valid, environment that avoids issues related to self-report. However, whether such motivations translate to established curiosity constructs warrants further research. This study also provided preliminary insights into how assessing exploratory interactions in VR may be a promising avenue that could enhance the understanding of the etiology and assessment of DS—particularly its early stages.
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Biomarker of Epigenetic Aging Could Signal Depression
Research led by New York University suggests a marker of epigenetic aging could be linked to depression.
The team found that accelerated aging of a type of white blood cell called a monocyte was significantly associated with the psychological and cognitive expressions of depression in a group of women with and without HIV.
“Depression is not a one-size-fits-all disorder—it can look really different from person to person, which is why it’s so important to consider varied presentations and not just a clinical label,” said lead researcher Nicole Beaulieu Perez, PhD, assistant professor at NYU Rory Meyers College of Nursing, in a press statement.
“Our study reveals unique biological underpinnings of mental health that are often obscured by broad diagnostic categories.”
As reported in The Journals of Gerontology Series A, the researchers analyzed blood samples and depression scores from 440 women, 261 living with HIV and 179 without, from the Women’s Interagency HIV Study. They tested women with HIV as people with this disease and others affecting the immune system are at greater risk of depression than the general public.
The team looked at biological aging using two epigenetic clocks: a broad multi-tissue clock and a monocyte-specific clock that measures chemical modifications to DNA in these cells.
Depression was measured using the CES-D questionnaire, which separates physical, bodily expressions of depression such as fatigue, appetite loss, and agitation from psychological and cognitive expressions of the disorder such as hopelessness, anhedonia, and feelings of failure.
Accelerated monocyte aging was significantly associated with the psychological and cognitive expressions of depression and with anhedonia specifically, even after adjusting for HIV status, race, and ethnicity. The broader multi-tissue Horvath clock showed no association with any depression domain, suggesting it is the monocyte-specific aging signal, not generalized biological aging, that tracks with mood and cognitive symptoms.
Diagnosis of depression relies largely on self-reported symptoms and not a specific physiological test. The finding that monocyte aging maps onto cognitive and mood symptoms rather than physical ones is counterintuitive, since monocytes are inflammatory cells that one might expect to track physical, inflammation-driven complaints like fatigue.
The study is small and cross-sectional, so causality cannot yet be established, but if the claims of the study were validated it could help to personalize treatment for depression in the future.
“The dynamics of monocyte aging and depression warrant further study to clarify mechanistic links,” conclude the authors.
“Our findings bring us a step closer to this goal of precision mental health care, especially for high-risk populations, by providing a biological framework that could guide future diagnosis and treatment,” adds Beaulieu Perez.
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The Child Mind Institute Names Dr. Vera Feuer as Chief Clinical Officer
Feuer brings more than two decades of clinical leadership to inaugural role
New York, NY – The Child Mind Institute, an independent nonprofit dedicated to transforming the lives of children affected by mental health disorders, today announced Vera Feuer, MD, as the organization’s first-ever Chief Clinical Officer. A seasoned specialist in pediatric and adolescent mental health, Dr. Feuer will oversee clinical strategy, including patient care in the New York City and San Francisco Bay Area offices, and help drive innovation across treatment and research.
Dr. Feuer most recently served as Vice President of Child and Adolescent Psychiatry at Northwell Health and is a professor of psychiatry, pediatrics, and emergency medicine at the Zucker School of Medicine at Hofstra/Northwell Health. A board-certified psychiatrist, she brings more than 20 years of clinical expertise and leadership in pediatric and adolescent mental health and crisis care to the Child Mind Institute. She has helped pioneer innovative standards of care in pediatric crisis behavioral health care and suicide prevention, and she has led the development of programs for the pediatric medical community and school district partnerships to expand mental health care access for students.
“I am thrilled to join the Child Mind Institute and beyond excited to bring my extensive experience of working with youth and families, creating access to care and innovative program development, and to work with this remarkable team,” Dr. Feuer says. “Together we will deepen access to high-quality, evidence-based care and develop programs that meet the needs of kids where they are.”
Dr. Feuer will provide strategic oversight to a multidisciplinary team of more than 70 clinicians who deliver over 70,000 patient appointments annually, ensuring continued excellence in delivering care, developing school-based programs, and establishing community partnerships while expanding access to high-quality mental health services. As a member of the Child Mind Institute’s executive leadership, Dr. Feuer will be instrumental in shaping the organization’s clinical vision, providing medical expertise to improve outcomes for children and families and guiding the integration of research through data-driven approaches that advance care and innovation.
“At a time when youth mental health needs are more urgent than ever, Dr. Feuer’s exceptional leadership brings crucial guidance to meet this moment,” says Harold S. Koplewicz, MD, founding president and medical director of the Child Mind Institute. “Our mission has always been to transform how families access and experience mental health care. With Dr. Feuer at the helm as our Chief Clinical Officer, we remain steadfast in our commitment to strengthening our clinical foundation, shaping the future of mental health and helping families nationwide.”
To learn more, visit childmind.org, and read Dr. Feuer’s full biography.
About the Child Mind Institute
The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need. We’ve become the leading independent nonprofit in children’s mental health by providing gold-standard, evidence-based care, delivering educational resources to millions of families each year, training educators in underserved communities, and developing tomorrow’s breakthrough treatments.
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