BackgroundNon-suicidal self-injury (NSSI) is highly prevalent in adolescence, yet the fast dynamics of large-scale brain networks remain poorly understood. We aimed to characterize resting-state EEG microstate dynamics in a clinically recruited adolescent NSSI sample and to examine state-dependent changes following acute social exclusion.MethodsResting-state EEG was recorded in hospitalized, medicated adolescents with NSSI and in healthy controls (HCs). An NSSI subgroup then completed EEG assessments before and after either Cyberball-induced social exclusion or a non-stress control condition. Microstate parameters and transition probabilities were analyzed.ResultsAfter multiple-comparison correction, the core baseline finding was robustly reduced microstate A duration in the NSSI group relative to HCs. In uncorrected exploratory analyses, additional differences included shorter durations of microstates B and F, higher occurrence of microstate D, and increased F→D transition probability. A multivariate pattern analysis suggested group-related information but must be interpreted cautiously given the modest sample size. Within the NSSI group, the exclusion group showed reduced microstate A expression and increased microstate D expression relative to the non-stress subgroup, with a broader transition shift toward microstate D. Several interaction effects survived correction.ConclusionsIn this medicated inpatient sample, resting-state microstate dynamics differed from HCs, most robustly in reduced microstate A duration, and reorganized after social exclusion. Specificity to NSSI remains uncertain given the absence of an MDD-only clinical-control group and healthy Cyberball comparison. These preliminary findings require replication in larger studies including medication-naive MDD-only, MDD+NSSI, and HC groups.
Fragile self, mechanical world: mechanistic delusions and ego fragility in schizotypal–affective spectrum disorder—a CARE case report
Categorical nosological systems frequently fall short when confronted with patients whose presentations cross established diagnostic boundaries. We report M.S., a 44-year-old Brazilian man involuntarily admitted to a psychiatric inpatient unit who presented with systematized persecutory ideation of mechanistic–technological content (chip implantation, satellite-based surveillance), structural ego fragility, absent insight, and progressive social and occupational deterioration. While prior diagnoses of bipolar disorder and provisional schizophrenia had been considered, neither fully captured the clinical complexity. Psychopathological-dimensional analysis, grounded in phenomenological observation and contemporary psychopathological theory, suggests three potentially interacting axes: (1) structural ego fragility (Ich-Schwäche), potentially arising from impaired early attachment and deficient relational learning; (2) a relational causality deficit replaced by concrete–mechanistic reasoning; and (3) limbic hyperactivation that appears to sustain an anxiety–perplexity–paranoia feedback loop. These converge on a schizotypal–affective spectrum formulation. Laboratory investigations identified severe dyslipidemia and marked hyperandrogenism (total testosterone 1,367 ng/dL), the latter potentially associated with limbic hyperactivation, though causality cannot be established from a single cross-sectional measurement. Psychometric assessment (BPRS-18) at admission yielded a total score of 43, with suspiciousness (5) and unusual thought content (5) as dominant items. During a seven-day inpatient course, a multimodal thymic strategy—risperidone, lithium carbonate, and structured psychotherapy—produced attenuation of paranoid reactivity, improved family engagement, and the spontaneous resumption of guitar playing from day 3, as a functional correlate of behavioral stabilization. The patient was discharged with a referral for a three-monthly paliperidone palmitate long-acting injectable. The pharmacological response retrospectively supports the dimensional formulation and illustrates the heuristic value of psychopathological analysis grounded in ego structure, causal reasoning, and affective dysregulation as a complementary approach to categorical nosology in complex psychotic–affective presentations.
Parent-Mediated Social Cognition Intervention for Young Children With Autism Spectrum Disorder
Conditions: Autism; Intervention (Training) Condition; Social Cognition; Cognition Improvement
Interventions: Behavioral: Companion Mind-Drawing Cooperative Game Program
Sponsors: Children’s Hospital of Fudan University
Recruiting
Interventions: Behavioral: Companion Mind-Drawing Cooperative Game Program
Sponsors: Children’s Hospital of Fudan University
Recruiting
MyFILM: A Pilot Study for Social-Emotional Learning in Clinical Youth
Conditions: Mood Disorders; Anxiety Disorders
Interventions: Behavioral: MyFILM
Sponsors: Mark Sinyor
Not yet recruiting
Interventions: Behavioral: MyFILM
Sponsors: Mark Sinyor
Not yet recruiting
Academic burnout in higher education: a multimodal study of resting-state EEG microstate correlates beyond trait anxiety, depressive symptoms, and self-efficacy in Chinese undergraduates
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.”
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