Background: Very low uptake in workplace semen analysis research is difficult to interpret, particularly in employer-adjacent settings, where nonparticipation may reflect limited recruitment reach, limited understanding of the occupational rationale, low perceived relevance, or procedure-related concerns. Objective: This post hoc formative study described self-reported awareness of a parent workplace semen analysis study as an indicator of effective recruitment reach, reported reasons for nonparticipation under the implemented survey condition, and design issues for exposure-defined workplace reproductive health research. Methods: In April-May 2025, we conducted an anonymous web-based cross-sectional follow-up survey among male employees in Japan who had been eligible for, but had not completed, a parent workplace semen analysis study. The parent study invited approximately 2000 male employees from 3 companies between November 2024 and January 2025; 6 completed the protocol. The follow-up survey invited approximately 900 male employees from 1 company. Part 1 assessed awareness, reasons for nonparticipation, interest in male reproductive health information, and general openness to future related research. Optional Part 2 assessed age, knowledge, concerns, expected reactions, and willingness under simplified conditions. Responses were summarized descriptively using Wilson 95% CIs; no hypothesis testing was performed. Results: We analyzed 108 submitted questionnaires; 83 respondents completed Part 2. Overall, 74/108 (68.5%; 95% CI 59.3‐76.5) respondents reported no awareness of the parent study. Among unaware respondents, 68/74 (91.9%; 95% CI 83.4‐96.2) selected “did not know the study existed.” Among aware nonparticipants, the most frequent reasons were perceived irrelevance and resistance to collecting semen (each 9/34, 26.5%; 95% CI 14.6‐43.1), embarrassment or reluctance (8/34, 23.5%; 95% CI 12.4‐40), and hassle (7/34, 20.6%; 95% CI 10.3‐36.8). In Part 2, anxiety about unfavorable results was reported by 52/83 (62.7%; 95% CI 51.9‐72.3) respondents, concerns about collection location or privacy protection by 48/83 (57.8%; 95% CI 47.1‐67.9), and self-reported resistance by 42/83 (50.6%; 95% CI 40.1‐61.1). Under simplified conditions, 36/83 (43.4%; 95% CI 33.2‐54.1) respondents indicated willingness to undergo semen analysis. Conclusions: Very low uptake in this employer-adjacent semen analysis study was not interpretable as a single phenomenon. This post hoc formative process evaluation identified limited awareness, suggesting limited effective recruitment reach under the implemented procedures, and characterized the reason profile among aware nonparticipants, including low perceived relevance and semen collection–related concerns. Rather than identifying primary causal determinants of nonparticipation, the findings support a bounded recruitment-methodological interpretation and highlight recruitment-cascade components for prospective measurement: objective exposure to recruitment materials, information access, understanding of the occupational rationale, voluntary postinformation declination, privacy concerns, logistical burden, and specimen-return completion. Informed acceptability after occupational reproductive-hazard education should be evaluated in future designs that include such education and comprehension assessment.
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Autism-Related Information on Websites and General-Purpose Artificial Intelligence Chatbots: Comparative, Bilingual Study
Background: Parents increasingly consult the internet, both websites and, more recently, artificial intelligence chatbots, for information on autism spectrum disorder (ASD). However, the comparative quality of these two source types, especially across languages, remains underexplored. Objective: This study aimed to assess the completeness and accuracy of ASD information delivered by websites and 5 popular artificial intelligence chatbots and determine whether performance differs between English and Romanian content. Methods: In a cross-sectional design, 25 English-language and 25 Romanian-language websites and the responses of ChatGPT, Gemini, Claude, Copilot, and DeepSeek were evaluated. Content was benchmarked against a 24-item checklist, yielding completeness and accuracy scores. Chatbots were tested in 2 scenarios: a single broad query (A) and 24 item-specific queries (B). Results: Websites achieved higher completeness in English than in Romanian (6.9 vs 5.1; =.007) and marginally higher accuracy (6.9 vs 6.1; =.045). In scenario A, chatbot completeness (English: 5.3 vs Romanian: 6.2; =.15) and accuracy (English: 6.0 vs Romanian: 5.6; =.32) did not show significant differences by language. In the single-query scenario, websites showed higher accuracy than chatbots in both English (6.9 vs 6.0; =.19) and Romanian (6.1 vs 5.6; =.53), with neither difference reaching statistical significance. Conversely, item-specific questioning favored chatbots, which yielded higher accuracy scores than websites in English (8.3 vs 6.9; =.053) and Romanian (8.0 vs 6.1; =.007). Accuracy scores improved significantly from the single-query to the item-specific scenario (English: 6.0 vs 8.3; =.002; Romanian: 5.6 vs 8.0; =.001). While an initial analysis suggested variation in performance between chatbots (repeated measures ANOVA; =.005), pairwise differences between individual models did not remain significant after adjustment for multiple testing. Conclusions: This exploratory study indicates that the quality of online ASD information varies by language and source context. English-language websites are more complete than Romanian-language websites. Among chatbots, targeted questioning yields more accurate answers than single broad queries in both languages. The findings should be interpreted cautiously due to the temporal gap between website and chatbot data collection.
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AI Agents Are Coming: 5-Stage Taxonomy of Language-Based AI Systems for Psychiatry, Psychotherapy, and Counseling
The rapid evolution of large language models has accelerated the development of agentic artificial intelligence (AI) systems capable of pursuing autonomous goals, creating an urgent need for structural frameworks in psychiatry and psychotherapy. While existing classifications often draw parallels to autonomous driving, this paper argues that the mental health domain requires a distinct, domain-specific theoretical foundation, as the 2 domains differ fundamentally in their semantic, ideographic, and epistemological demands. Furthermore, they differ in their end goals, for which we introduce terms such as agentic guidance capability. To guide clinicians and researchers through these developments, we propose a 5-stage taxonomy for language-based AI systems that differentiates technical functionality from clinical effectiveness. The taxonomy progresses from level 1 (knowledge level), in which systems perform static benchmark tasks, to level 2 (elementary level), characterized by dynamic engagement in specific therapeutic microskills. At level 3 (integration level), systems achieve consistency across and within modules, as well as basic case-level conceptualization suitable for blended therapy under human oversight. Level 4 (saturation level) describes therapist-in-the-loop systems capable of autonomous functioning with minimal supervision, whereas level 5 (mastery level) represents AI systems that are technically capable of performing autonomous therapy. By distinguishing technical functionality from clinical effectiveness, we conclude that level 4 or level 5 performance does not automatically translate into full treatment effectiveness, even if high treatment fidelity can be achieved. We conclude by emphasizing the need to shift benchmarking from static knowledge tests to dynamic evaluations of therapeutic capabilities in order to safely navigate the transition toward autonomous care.
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Attention-deficit/hyperactivity disorder and chronic pain: a scoping review of epidemiology, clinical phenotypes, mechanisms, and treatment
IntroductionEmerging evidence suggests a potential association between attention-deficit/hyperactivity disorder (ADHD) and chronic pain; however, extant findings are dispersed across disciplines and have not yet been comprehensively synthesized. This scoping review aimed to systematically map the epidemiological evidence, clinical phenotypes, proposed neurobiological mechanisms, and reported therapeutic interventions related to comorbid ADHD and chronic pain.MethodsA comprehensive literature search was conducted in PubMed, PsycINFO, and the Cochrane Library from database inception to December 28, 2025. Human studies examining the association between ADHD (diagnosed or symptom-defined) and chronic or recurrent pain were also included. Fifty studies met the eligibility criteria, including observational studies (cross-sectional and longitudinal), case reports and series, and one interventional study.ResultsEpidemiological studies have consistently reported significant associations between ADHD symptoms or diagnoses and chronic pain in both the general population and clinical samples. Higher ADHD symptom burden was associated with greater pain severity and pain-related functional impairment. Comorbidity was observed not only in widespread pain syndromes, such as fibromyalgia, but also in site-specific conditions, including chronic low back pain, orofacial pain, and migraine. Proposed mechanisms involve dopaminergic and noradrenergic dysfunction affecting motor regulation, sensory processing, and descending pain modulation systems. Several case-based reports have described improvements in pain outcomes after ADHD-targeted pharmacotherapy. However, controlled trials remain scarce.DiscussionCurrent evidence suggests that ADHD traits may be relevant in a subset of individuals with chronic pain, particularly those with treatment-resistant presentations. Although causality and treatment efficacy remain unconfirmed, consideration of neurodevelopmental characteristics may enhance clinical assessments and inform future research on individualized mechanism-based treatment strategies.
Family caregivers’ involvement in home-based recovery for patients with schizophrenia: a qualitative study in Beijing, China
BackgroundFamily caregivers play critical roles in supporting the home-based recovery of patients with schizophrenia, but they often encounter substantial challenges and receive insufficient systemic support. Understanding caregivers’ involvement in home-based recovery is essential for aligning community mental health services with families’ capacities and needs. This study aimed to explore family caregivers’ involvement and adaptive processes in supporting home-based recovery of patients with schizophrenia in China.MethodsA qualitative study using interpretative phenomenological analysis was conducted through semi-structured interviews. Family caregivers were purposively recruited from four community health service centers (CHSCs) across urban and rural areas of Beijing. All interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed iteratively to identify themes and subthemes.ResultsA total of 20 family caregivers were recruited, including 11 from two urban districts and 9 from a rural district in Beijing. Five themes were identified: Caregivers’ redefinition of recovery as stability rather than cure; Routine recovery involvement in medication management and symptom monitoring; Experienced tensions between the patient’s independence and relapse prevention; Bearing family obligation and personal strain in sustained caregiving involvement; and Uncertainty in sustaining caregiving and the patients’ future stability. Caregivers reported persistent challenges in supporting patients’ independent living, participation in family activities, communication, and social interaction.ConclusionFamily caregivers gradually develop their capacity to support home-based recovery, but continue to encounter complex challenges while receiving limited support from CHSCs. Strengthening recovery-oriented family support within community mental health services, particularly through accessible psychoeducation and rehabilitation guidance, may enhance caregivers’ capacity to support patients’ independence and social participation, thereby promoting sustainable home-based care and long-term functional recovery.
Case Report: A novel de novo heterozygous truncating mutation in MED12L identified in a Chinese autistic boy
BackgroundAutism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder. A previous study by Nizon et al. indicated that some children with intellectual disability (ID) carrying de novo MED12L mutations exhibited mild to moderate autistic features. However, the relationship between MED12L and ASD remains unclear.Case presentationHere we reported a male child with severe autistic features carrying a novel de novo heterozygous truncating mutation of MED12L (NM_053002.5:c.586C>T, p.(Arg196Ter)). He was diagnosed with ASD according to ICD-11 and DSM-5 criteria. Clinical examination indicated that this child exhibited severe autistic features and several dysmorphic features, including a flat nasal bridge, bulbous nasal tip, thin upper lip, and triangular face. Magnetic resonance imaging (MRI) of the brain revealed an enlarged perivascular space in the right temporal lobe.ConclusionThis case demonstrates that this de novo heterozygous truncating mutation in MED12L may be involved in the development of ASD, and haploinsufficiency of MED12L may be associated with severe autistic features. Obvious clinical manifestations and dysmorphic features in this child with a truncating mutation in MED12L expand the phenotypic spectrum of MED12L-related cases and warrant further functional studies to elucidate the relationship between MED12L and ASD.
STAT+: HHS presses ahead with effort to curb antidepressant use
WASHINGTON — Health secretary Robert F. Kennedy Jr. is pressing forward with his effort to help Americans stop taking psychiatric drugs, a medical practice known as deprescribing.
Earlier this month, dozens of mental health professionals met with federal health officials to map out forthcoming clinical guidance they hope will help providers instruct patients on how to come off of antidepressant medications. While the Department of Health and Human Services has discussed plans to hold such a meeting, the outlines of the discussion haven’t been reported.
During those talks, they reviewed guidance from European nations and worked on recommendations for nonmedication-based options for patients to address their mental health, such as therapy. A senior HHS official said they discussed gaps in the research around deprescribing SSRIs, including the side effects a person may experience, which vary depending on the drug and how long the person was on it, and how to recognize the difference between those side effects and a return of a patient’s depressive symptoms.
A Sensory-Profile Framework for Differentiated Swim Instruction in Autistic Children
Conditions: ASD
Interventions: Behavioral: sensory-based instruction; Behavioral: standard instruction
Sponsors: Genesis Indep Research
Completed
Interventions: Behavioral: sensory-based instruction; Behavioral: standard instruction
Sponsors: Genesis Indep Research
Completed
HALO-TRIAL: High, Medium And LOw Intensity Psychotherapy for Binge Eating Disorder
Conditions: Binge Eating Disorder; Binge Eating Episodes; Binge Eating/Loss of Control Eating; Binge Eating Disorders; Binge Eating; Binge Eating Behaviour; Binge Eating Disorder Associated With Obesity; Eating Disorder Binge; Eating Disorders
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting
Efficacy of a Gamified Blended Mindfulness Program to Reduce Burnout, Stress, and Anxiety in Nursing Students: A Randomized Controlled Trial
Conditions: Burnout Syndrome; Psychological Stress, Anxiety, and Depression Associated With Academic Pressure; Anxiety
Interventions: Behavioral: Psychoeducation and Free App Recommendation; Behavioral: Standard Blended Mindfulness Program; Behavioral: Gamified Blended Mindfulness Program
Sponsors: Universidad de Granada
Completed
Interventions: Behavioral: Psychoeducation and Free App Recommendation; Behavioral: Standard Blended Mindfulness Program; Behavioral: Gamified Blended Mindfulness Program
Sponsors: Universidad de Granada
Completed