Redox compromise as an early, modifiable entry point in schizophrenia: a staging framework for early intervention

Schizophrenia is understood as a disorder of dopamine signaling and is treated with dopamine receptor antagonists. These drugs reduce hallucinations and delusions but leave cognitive impairment, negative symptoms and functional decline largely untouched. This article advances a complementary view, as a hypothesis rather than an established account. It treats redox compromise, meaning chronic oxidative stress, glutathione depletion, mitochondrial inefficiency and the inflammatory state that accompanies them, as an early and modifiable point of entry into a self-reinforcing loop. The loop also involves NMDA receptor hypofunction, impairment of parvalbumin interneurons, disturbed circuit connectivity and, last, the dopaminergic phenotype that current drugs address. It runs in both directions: blocking NMDA receptors itself generates oxidative stress in animal models, so the claim is not that redox compromise comes first, but that it can be measured and modified early, before the changes that current treatment cannot reverse. The clinical staging framework of McGorry and the neuroprogression framework of Berk provide the architecture for translating this into intervention windows, with the first two levels treated as risk strata rather than disease stages. Impaired glucose tolerance in first-episode patients who have never taken antipsychotics, which neither medication nor chronicity can explain, is presented as evidence that metabolic disturbance is a parallel expression of the same systemic process. The progressive framing is contested. The principal counterevidence, including the contribution of antipsychotic exposure to brain volume loss and the largely stable course of cognitive impairment after onset, is set out together with the results that would require abandoning it. We organize the biomarker literature by stage and propose three predictions that a trial could refute: that biomarker-stratified prevention will outperform unselected prevention at the clinical high-risk stage; that medial prefrontal glutathione and mismatch negativity deficit will add predictive value beyond clinical assessment; and that removing the redox measures from a multimodal panel will worsen its prediction of transition. A biomarker-stratified phase 2b trial with a formal power calculation is proposed. The human evidence supports association and biological plausibility rather than proven causal direction.

Toward a population-level public health approach to support families living under continuous traumatic stress

Since October 2023, families across Israel have been living under conditions of continuous traumatic stress (CTS): ongoing, unresolved threat due to repeated rounds of regional conflict. Demand for mental health support has far outstripped the capacity of clinician-delivered services, leaving many families without evidence-based help. This community case study describes the development and early implementation of ADAPT-Israel. To our knowledge, this is likely to be the first population-level, parenting-centered public health approach designed for families living under CTS. The initiative uses a tiered model to provide parenting support across layers of care: (i) a universal layer of brief, trauma-informed public health messages and a self-directed, interactive online parenting program (with an optional AI avatar guide); (ii) a selective layer of facilitator-delivered ADAPT groups for live higher-risk families, beginning with families of long-serving military reservists; and (iii) an indicated layer of individual telehealth support for families experiencing clinical levels of difficulty. The approach adapts Adaptive Parenting Tools/ADAPT, an evidence-based program grounded in Social Interaction Learning theory and validated in a different context – for military families in the United States across three randomized controlled trials with nearly 1,000 military families. We describe the rationale, the methodology used to develop each tier, and early implementation experience. Feasibility and acceptability indicators from initial pilot groups are promising, including high group completion and positive participant reports of improved parenting and family relationships, though these are small-sample, self-report, early-stage findings rather than effectiveness evidence. We discuss practical implications, lessons learned, and the model’s potential utility in settings of protracted conflict and chronic threat.

Regional Conference: Investing in Mental Health for Resilient Societies

Mental health is increasingly recognised as a societal priority across Europe, but that recognition has not yet turned into the sustained, cross-sector investment people and communities need. Investing in mental health means investing in education, employment, housing, social protection and community support, not only in health services.

The post Regional Conference: Investing in Mental Health for Resilient Societies appeared first on Mental Health Europe.

[Comment] Action needed to address HbA1C and weight increases in people initiating antipsychotic medicines

Juan Bazo-Alvarez and colleagues1 present a compelling study investigating trajectories of HbA1C concentration and bodyweight before and after the initiation of second-generation antipsychotic medicines in adults living with severe mental illness (SMI). The findings provide valuable real-world data from electronic health records in England on the metabolic alterations that emerge early after antipsychotic initiation. Several important findings stand out from the study. First, increases in HbA1C concentration were not proportional to weight gain.

Key Decision Points for Personalization and Customization in Self-Guided Digital Suicide Prevention: Qualitative Interview Study

Background: Young adults in the United States experience high rates of suicidal thoughts and behaviors (STB) but low engagement with traditional care, highlighting the need for accessible and scalable digital interventions. Self-guided digital safety planning interventions (SPIs) can expand access to support but introduce important decisions about what content to deliver, when systems should intervene, and how users retain control over system actions. Personalization, defined as system-initiated adaptation, and customization, defined as user-initiated control, may offer complementary approaches to these decisions. However, how they should be coordinated to preserve autonomy and reduce burden during periods of distress remains unclear. Objective: This study aims to identify key decision points in self-guided digital SPIs and characterize what, when, how, and by whom (system or user) safety planning functions should be controlled. We further examined how personalization and customization can jointly support autonomy, reduce burden, and promote safety. Methods: Nine young adults (ages 18‐24) with lived experience of suicidal thoughts and behaviors were recruited from an asynchronous remote community comprising individuals who had engaged with the Mental Health America (MHA) website. Participants completed semistructured individual interviews via Zoom. Three coders analyzed interview transcripts using codebook thematic analysis. One coder open-coded all transcripts to develop a preliminary codebook. Two additional coders then applied the codebook to overlapping transcripts, after which all coders revised the codebook and resolved discrepancies by consensus before coding the remaining transcripts. Themes were interpreted using the 5W1H (Who, What, Where, When, Why, and How) framework as an organizing lens for identifying and structuring decision points. Results: Participants identified 3 classes of decision points for self-guided digital SPIs: (1) system-level decisions about what content and actions are automatically provided; (2) user-level decisions about when and at what pace safety planning unfolds; and (3) shared decisions requiring coordination between users and the system. Participants favored system personalization of decision aids, coping suggestions, brainstorming prompts, example messages for contacting trusted others, affirmations, and relevant resources. In contrast, participants wanted control over the timing and pacing of safety planning and the representation and organization of their safety plans. Participants also emphasized that systems should obtain explicit permission before taking safety-relevant actions, such as contacting trusted others or connecting users with crisis counselors in response to increases in detected risk. Conclusions: Personalization and customization can function as complementary mechanisms for allocating decision authority within self-guided digital SPIs. The findings support a model of permissioned automation in which systems reduce cognitive and emotional burden through adaptive support while users retain control over safety-relevant actions. This decision-point framework provides a foundation for designing and evaluating self-guided suicide prevention technologies that balance adaptation, autonomy, and safety.
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Translation, contextual adaptation, and preliminary evaluation of INCRESE-Norwegian Young

BackgroundThe mental health of young people is a global concern. Norway has seen a rise in mental health challenges among young individuals in recent decades, including both Sámi and non-Sámi youth. Culturally responsive and accessible mental health interventions are needed. The NEON Young Norway Study investigates the use of mental health recovery narratives as a low threshold intervention. To engage in recovery narratives mostly have beneficial impact, however, there is also a risk of triggering harmful behavior, which is why safe use of narratives requires careful analysis. For this reason, the Inventory of the Characteristics of REcovery StoriEs (INCRESE) has been developed in English. Our aim was to translate, contextually adapt, and to preliminary evaluate INCRESE for use among young people in Norway.MethodsINCRESE was translated into Norwegian using the UPSIDES proportionate translation methodology. Contextual adaptation was carried out in collaboration with cultural experts and young individuals with lived experience. For reliability assessment, five coders independently coded 32 narratives (whereof 6 Sámi) twice, with a two-week interval between assessments. Test-retest reliability was assessed with Cohen’s kappa and interrater reliability with Gwet’s AC1, with scores above 0.40 considered acceptable. Feasibility and acceptability were assessed qualitatively.ResultsMultiple adaptations were required to ensure contextual fit for both general Norwegian and Sámi youth. Test–retest reliability (Cohen’s K) was moderate, with a mean κ = 0.59 (SD = 0.27; range –0.02 to 1.00). Mean percentage agreement between the two rating rounds was 90.7% (SD = 10.03). Interrater reliability (Gwet’s AC1) ranged from 0.36 (fair) to 1.00 (perfect) per item, mean AC1 0.86 (SD = 0.14), and with a mean percentual agreement of 72.8% (SD = 26.64). Reliability varied considerably between items. Coders generally found INCRESE-NY feasible and acceptable and provided suggestions for further refinement.ConclusionsINCRESE-NY showed overall acceptable reliability for characterizing recovery narratives produced by young Norwegians, including Sámi youth. The adapted inventory appears promising as a tool that can support the safe and systematic use of recovery narratives in youth mental health contexts. However, further refinement is needed to examine its conceptual, cultural and practical applicability.

Feasibility of Online and On-Site Physical Activity Delivery Among Older Adults: Mixed Methods Pilot Randomized Controlled Trial

<strong>Background:</strong> Physical activity (PA) is central to healthy aging, yet interventions targeting older adults often report substantial attrition and variable adherence. Although digital and internet-based exercise programs broaden accessibility and flexibility, their ability to sustain engagement compared with traditional on-site formats remains unclear. Understanding how delivery mode influences attrition and adherence—and why participants persist or withdraw—is essential for designing inclusive and sustainable PA interventions. <strong>Objective:</strong> This pilot study evaluates the feasibility of delivering a 26-week PA intervention to older adults through 2 modes: online or on-site. Feasibility was assessed primarily by attrition, adherence, and participants’ experiences of factors influencing continued participation or withdrawal. Additionally, the study explores preliminary patterns in PA levels and physical and mental health outcomes to inform the design of a future definitive trial. <strong>Methods:</strong> This 26-week pragmatic pilot trial used an embedded convergent mixed methods design. Community-dwelling adults aged 60 years or older (N=35) from 3 residential areas in Sweden were cluster-randomized, without blinding, by site to an online (prerecorded video-based Otago exercises; n=12) or on-site (group-based, in-person Otago exercises; n=23) delivery mode. Feasibility outcomes included attrition and adherence. Exploratory outcomes included PA level (Godin-Shephard Leisure-Time Exercise Questionnaire), lower-body strength (Chair Stand Test), depressive symptoms (Geriatric Depression Scale), and health-related quality of life (EQ-5D-3L), assessed at baseline, midintervention (14 weeks), and postintervention (26 weeks). Exploratory quantitative analyses included t tests, chi-square tests, analysis of covariance, and mixed-design ANOVAs. We analyzed semistructured interviews with completers (n=17) and dropouts (n=7) using qualitative content analysis. Findings were integrated using the COM-B (Capability, Opportunity, Motivation-Behavior) framework. <strong>Results:</strong> The overall attrition rate was 37% (13/35), with no significant difference between delivery modes (<i>P</i>=.29). Most dropouts occurred within the first 2 weeks. Mean adherence appeared higher in the online delivery mode (mean 17.0, SD 6.7) than in the on-site delivery mode (mean 12.1, SD 10.1) but did not differ significantly (<i>P</i>=.15). Qualitative findings indicated that attrition was primarily driven by physical health issues and a perceived lack of fit, whereas adherence was supported by appeal and reward, routine and commitment, flexibility, feedback and PA overview, and (often) social presence. Mixed methods findings suggest that capability, opportunity, and motivation supported participation across both delivery modes. No intervention-related adverse events were reported. <strong>Conclusions:</strong> Both online and on-site delivery modes for PA interventions appeared feasible for many older adults. Although no statistically significant between-group differences were observed, the study was not powered to evaluate effectiveness. Feasibility may depend more on supporting capability, opportunity, and motivation than on delivery mode. Larger, adequately powered trials are needed to test effectiveness, identify optimal formats for different populations, and evaluate strategies to reduce early attrition. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT05885308; https://clinicaltrials.gov/ct2/show/NCT05885308

X-Chromosome Gene Linked to Increased Autism Diagnosis in Males

Researchers at Baylor College of Medicine, the Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, and collaborating institutions have identified new genetic candidates that help explain why autism is diagnosed about four times more often in boys than it is in girls. The study, involving tests in induced pluripotent stem cell (iPSC)-derived neurons (iNeurons), revealed that small changes in the gene MECP2 on the X chromosome might help explain part of this difference.

Huda Zoghbi, MD, Distinguished Service Professor at Baylor, director of Duncan NRI, and a Howard Hughes Medical Institute investigator, is senior and corresponding author of the team’s published paper in The American Journal of Human Genetics, titled “A massively parallel reporter assay of MECP2 cis-regulatory elements reveals genetic candidates for male-biased autism.” In their paper, the team concluded, “These findings suggest noncoding MECP2 variants can cause idiopathic, male-biased autism and provide a framework for uncovering regulatory variants in other X chromosome neurodevelopmental genes that may contribute to autism’s missing heritability.”

“Autism is a common, heritable neurodevelopmental trait that affects how a person communicates, interacts with others, and experiences the world, and is characterized by altered social interactions and restricted, repetitive behaviors or interests,” Zoghbi explained. “It is diagnosed about four times more in male individuals than in female individuals, suggesting sex-specific factors may increase male vulnerability,” the researchers added in their paper.

In the current study, the researchers drew from their long experience with gene MECP2, which is on the X chromosome and has been associated with neurodevelopmental conditions, including autism. “We tested the idea that the predominance of autism in males could be explained in part by mild mutations in an X chromosome gene’s regulatory regions,” commented Rebecca Meyer-Schuman, PhD, a postdoctoral associate in the Zoghbi lab. “Females might be protected from such a mild mutation because of their second X chromosome, but males, who have only one copy, would be more vulnerable. The regulatory regions are like dials that control whether a gene will be expressed and by how much. And what better place to start looking at these regulatory regions than the gene MECP2, where brain health depends on how much of the gene is expressed, and where mutations can cause neurodevelopmental disorders that include autism.”

Previous murine studies by Zoghbi lab and others have taught researchers that MECP2 produces a Goldilocks protein, meaning that it must maintain a “just right” concentration or activity level for a healthy brain. Having too little—about 50% or less of the normal levels—leads to Rett syndrome, and having twice the normal levels causes a different neurodevelopmental condition called MECP2 duplication syndrome. “Both loss-of-function and gain-of-function variants lead to severe neurodevelopmental conditions—Rett syndrome (MIM: 312750) and MECP2 duplication syndrome (MDS; MIM: 300260[intellectual developmental disorder, X-linked, syndromic, Lubs type (MRXSL)]), respectively,” the authors commented. “Because MECP2 is on the X chromosome, hemizygous male individuals have a more severe phenotype than heterozygous female carriers with the same variant.”

Meyer-Schuman also noted, “Previous studies in mice also showed us that milder changes in MECP2 levels, for instance reducing the expression by 30% or increasing it by 50%, do not cause the more severe features of Rett syndrome or MECP2 duplication syndrome like seizures or motor problems, but lead to autism-like behaviors.”

For their current study the team used a massively parallel reporter assay (MPRA) to screen the regulatory regions of the MECP2 gene in induced pluripotent stem-cell (iPC)-derived neurons. “This allowed us to identify and manipulate the regulatory regions and determine what kinds of changes would alter their function,” Meyer-Schuman said. The researchers also screened MECP2 regulatory regions in autistic individuals and tested the genetic variants they identified using the MPRA assays.

“We identified two regulatory regions where male autistic individuals inherited a variant from their unaffected mother that altered regulatory activity,” Meyer-Schuman said. “One of these variants reduced MECP2 expression by approximately 30% in human neurons, a magnitude that produces social deficits, hyperactivity and anxiety-like characteristics in mice. As predicted by the mouse model, this individual was diagnosed with autism and ADHD but had none of the defining characteristics of Rett syndrome.”

In their paper, the authors commented that their work supports a broader hypothesis that altered dosage or expression of sex chromosome genes are a major source of the male bias observed in autism. Zoghbi added, “These findings, a result of integrating human and animal studies, suggest that MECP2 regulatory variants can contribute to male-biased autism and reveal just the tip of the iceberg, providing a framework for uncovering regulatory variants in other X chromosome neurodevelopmental genes that may contribute to autism’s missing heritability.”

The post X-Chromosome Gene Linked to Increased Autism Diagnosis in Males appeared first on GEN – Genetic Engineering and Biotechnology News.

Associations Between Daily EMA of Emotional Exhaustion and Monthly Burnout Symptoms During Work Reintegration: Longitudinal Multilevel Study

Background: Burnout is increasingly conceptualized as comprising both stable, slowly changing features and more dynamic, fluctuating features, with emotional exhaustion widely regarded as one of burnout’s core components. Traditionally, burnout has been assessed using retrospective self-report questionnaires, such as the Burnout Assessment Tool (BAT), administered at sporadic intervals. In contrast, ecological momentary assessment (EMA) enables high-frequency assessment of daily experiences while reducing recall bias. However, it is not well understood how EMA-based measures fluctuate and develop longitudinally within individuals or how they relate to retrospective burnout measures. Objective: This paper examined the relationship between 30-day aggregates of daily EMA-assessed emotional exhaustion, specifically the within-person mean level and variability (SD), and monthly burnout symptoms measured with the BAT. Methods: Eighteen participants undergoing work reintegration after stress- or burnout-related sick leave completed daily EMAs of emotional exhaustion (N=3157) and monthly BAT questionnaires over 6 months (N=94). For each monthly BAT assessment, EMA data from the preceding 30 days were aggregated into within-person mean and SD values. Linear mixed-effects models with random intercepts and time effects were fitted separately for each BAT subscale. Additionally, intraclass correlation coefficients (ICCs) were calculated to quantify the proportion of variance attributable to between-person differences. Results: ICCs indicated that a large proportion of variance in the BAT subscales was attributable to between-person differences, whereas daily EMA emotional exhaustion showed relatively greater within-person variability. Significant time-related changes were observed for the BAT subscales of Cognitive Impairment, Mental Distance, and Emotional Impairment. Within-person increases in the EMA mean of emotional exhaustion were significantly associated with higher scores on BAT Exhaustion (=0.073; =.001) and BAT Cognitive Impairment (=0.041; =.04). EMA-based variability (SD) and between-person mean levels were not significantly associated with any BAT subscale. Conditional values were high (0.667-0.777), whereas marginal values were modest (0.056-0.121). Consistent with the ICC findings, these results suggest that most explained variance in BAT scores reflects between-person differences and time-related changes, with EMA-derived predictors accounting for only a limited additional proportion of explained variance. Conclusions: EMA-based aggregates showed partial correspondence with monthly burnout scores. Within-person increases in mean daily emotional exhaustion were associated with higher subsequent scores on the BAT Exhaustion and Cognitive Impairment subscales, but EMA-based variability was not associated with any BAT subscale. Together with the ICC results, these findings suggest that EMA-based aggregates of emotional exhaustion can reflect short-term fluctuations and longer-term changes in symptom severity of exhaustion and cognitive impairment. Retrospective questionnaires remain useful for global symptom assessment or diagnoses at specific time points but appear less well suited for tracking within-person changes and supporting personalization. These results highlight the importance of aligning the choice of assessment with temporal and clinical goals.
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