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A prospective cohort study on the incidence and influencing factors of subsyndromal delirium in ICU patients

BackgroundThis study aims to develop and validate a machine learning-based risk prediction model for subsyndromal delirium (SSD) in ICU patients, while identifying key risk factors.MethodThis study was a prospective study, selecting patients who were hospitalized in the ICU from October 2024 to May 2025. We compared seven machine learning algorithms: Random Forest (RF), Decision Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Elastic Network (EN), Extreme Gradient Enhancement (XGB), and Support Vector Machine (SVM).ResultIn our study, the prevalence rate of SSD was 37.158%. The comparative analysis shows that XGB is the best predictive model (AUC = 0.84). Feature importance analysis identified four significant predictive factors: Use of vasoactive drugs (0.412), Monthly household income (0.306), Undergone surgery (0.191) and Number of Medications (0.036).ConclusionThe prediction model based on XGB has a good effect in identifying the risk of SSD in ICU patients. These findings enable clinicians to stratify high-risk groups and implement timely and targeted intervention measures, effectively reducing the risk of adverse consequences. Future multicenter studies should validate these results in larger cohorts.
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Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi–health care organization analysis

BackgroundHarm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.MethodsA retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18–45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.ResultsBuprenorphine (aHR = 2.33; 95% CI: 1.85–2.94), methadone (aHR = 2.50; 95% CI: 2.05–3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68–10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.ConclusionsIn this first national-scale, multi–health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.
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Scoping review of therapeutic approaches among individuals with secondary exercise addiction

Secondary exercise addiction shows high comorbidity with eating and body image disorders. Despite its substantial impact on physical and mental health and daily functioning, evidence on effective therapeutic interventions remains limited. The aim of this scoping review was to identify and describe therapeutic interventions applied to adult individuals with secondary exercise addiction. This review followed the PRISMA Sc-R guidelines and covered the years 2002–2024. Ultimately, five studies were included (four randomized controlled trials and one quasi-experimental study). Three studies applied psychotherapeutic interventions based on cognitive-behavioral models (Cognitive Behavioral Therapy, Lifestyle, Exercise, Attitudes, and Relationships Program, Physical Exercise and Dietary Therapy), while two integrated physical or nutritional components. A secondary analysis published in 2024 based on the LEAP trial dataset was identified but not treated as an independent study to avoid duplication. EBSCOhost, Web of Science, PubMed, and Google Scholar were searched from January to May 2025 using terms related to exercise addiction, exercise abuse, psychotherapy, intervention, and treatment. English-language studies were eligible if they described an intervention with at least one treated group with pre- and post-test measures; the participants of the study were adult patients suffering from eating disorders and exercise addiction (the therapy programs involved one inpatient and four outpatient treatments) and therapeutic intervention was carried out with outcomes based on exercise addiction level data. Four out of five included studies reported improvements in variables related to compulsivity, although these did not always imply a reduction in the amount of exercise, indicating that qualitative changes may be more relevant. Longer interventions showed more consistent effects, but even brief treatments generated positive changes in non-clinical populations. The examination of the research revealed a gap in studies addressing interventions for those with secondary exercise addiction, especially highlighting the need for randomized controlled trials (RCTs) with proper randomization methods.
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Human Ventral Tegmental Local Field Potentials in Treatment-Resistant Depression and Obsessive-Compulsive Disorder

The ventral tegmental area (VTA) is a key node within the limbic circuitry. Through dense dopaminergic, glutamatergic, and GABAergic projections, the VTA forms reciprocal loops with prefrontal and limbic cortices that are consistently implicated in major depressive disorder (MDD) and obsessive–compulsive disorder (OCD) (1,2). Decades of animal research have established the VTA as a central hub for motivational drive and reward prediction error signaling (3,4). Despite its presumed critical role in mental disorders, direct electrophysiological recordings from the human VTA have so far remained absent.