Tag: Mental health

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Call for expert – Research & report on deinstitutionalisation and psychosocial disabilities in Europe

Seeking an expert to support the development of a study on deinstitutionalisation (DI) and psychosocial disabilities in Europe, exploring how mental health systems and disability-inclusive policies can be better aligned at the EU level.

The post Call for expert – Research & report on deinstitutionalisation and psychosocial disabilities in Europe appeared first on Mental Health Europe.

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Development of Virtual Mental Health Stepped Care Service for a Heart Failure Remote Management Program: Qualitative Descriptive Study

Background: Depression is highly prevalent yet undertreated among people living with heart failure, indicating barriers to mental health services. Although various digital mental health interventions have been developed to detect, treat, and manage depression in this population, these interventions have seen limited integration into clinical care and a lack of implementation research. Stepped care is a service innovation that may promote the implementation of these technologies into clinical settings, but few studies have examined how these services are designed in clinical settings. Objective: This study aimed to identify strategies to address health system barriers to accessing mental health care from the perspective of people living with heart failure, clinicians, and researchers, and to incorporate these strategies into the design of a virtual mental health stepped care service within a heart failure remote management program. Methods: A qualitative description study was conducted using purposive recruitment of people living with heart failure, clinicians, and researchers from a heart failure remote patient management program. As part of a service design approach, semistructured interviews explored potential strategies to address barriers to accessing mental health services. Two researchers coded the data descriptively and constructed themes to guide the development of a virtual stepped care service. Results: A total of 22 participants were interviewed, comprising 13 people living with heart failure and 9 clinicians and researchers. Six themes were identified, comprising 4 requirements and 2 foundational principles. The requirements were to (1) adopt a collective approach to identify distress across methods, people, and time points; (2) maintain a referral-based approach; (3) rely on existing mental health human resources; and (4) offer patient choice among various mental health care options. These requirements were supported by two principles: (1) building on organizational strengths and (2) reducing treatment burden. Based on these findings, a virtual stepped care service was developed, incorporating a depression screening module, referral-based workflows, and, where clinically appropriate, patient choice in treatment selection. Conclusions: The stakeholder-informed design of this virtual stepped care service contributes to the limited literature on stepped care service design and demonstrates how such models can be tailored to their intended contexts. Although each component was designed to address health system barriers to mental health care for people living with heart failure, resource limitations may constrain the balance between feasibility and quality of care. Future research should evaluate the acceptability of this model among people living with heart failure and clinicians.
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Down Syndrome Chromosomal Therapy Draws Closer

Gene editing has been able to silence the extra chromosome that is mostly responsible for Down syndrome (DS) in a cell-based study that could be the first step towards therapeutic treatment.

The approach uses a modified form of CRISPR-Cas9 to alter precise sections of DNA.

Researchers used this to insert the X-inactivation specific transcript (XIST) gene to deactivate X chromosomes in female cells, thereby correcting chromosomal triplication.

The partial transcriptional correction, reported in PNAS, offers a scalable, targeted platform for chromosomal therapy in Down syndrome and other aneuploidy disorders, which are conditions involving an abnormal number of chromosomes.

“These studies overcome a major hurdle in the treatment of Down syndrome (a genetic disorder cause by three rather than two copies of chromosome 21) by dramatically increasing the efficiency with which to insert XIST onto a single copy of chromosome 21 and thereby silencing this third copy,” senior researcher Volney Sheen, PhD, from Beth Israel Deaconess Medical Center, told Inside Precision Medicine.

“Determination of the best ways and times to deliver these constructs to the brain will become the next focus as we seek a clinical treatment for DS.”

Down syndrome is the most common genetic disorder and occurs in one out of 700 live births. It is linked with cognitive impairment, heart defects, and early-onset Alzheimer’s disease and results from the triplication of approximately 500 genes as well as other genetic changes on chromosome 21.

The XIST gene produces a long, noncoding RNA that inactivates many of the genes on one of the two X chromosomes of female mammals. It has therefore been mooted as a treatment for Down syndrome but technical limitations, including low levels of gene integration, have hindered progress.

In an attempt to address this, Sheen and team created a CRISPR-based method that involved fusing a codon-optimized λ-phage with Cas9, assembling single guide (sg)RNAs specific to single nucleotide polymorphisms (SNPs), and enhancing donor-acceptor DNA pairing.

The modified CRISPR-Cas9 method achieved a high level of genomic integration of large genetic material, improving the efficiency and specificity of XIST integration.

Inserting XIST onto one of the trisomic chromosome 21 alleles using SNP-dependent sgRNAs achieved an integration efficiency of 20% to 40% for the 14kb XIST gene.

XIST integration was revealed through expression of the enhanced green fluorescent protein reporter, clonal sequencing of individual lines, and fluorescent in situ hybridization.

The team further demonstrated that XIST activation led to upregulation of epigenetic markers, broad downregulation of messenger RNA expression on chromosome 21, and downregulation of specific genes on this chromosome.

“Our findings demonstrate atrial transcriptional correction of trisomic gene dosage and offer a scalable targeted platform for chromosomal therapy in DS and other aneuploidies,” the researchers reported.

They added: “The modified CRISPR method with XIST paves a rode for therapeutic treatment for DS.”

The post Down Syndrome Chromosomal Therapy Draws Closer appeared first on Inside Precision Medicine.

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<![CDATA[With Artemis II’s journey in mind, a psychiatrist urges mental health action on climate denial, resilience, and saving Earth before it’s too late.]]>
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Mitochondrial dysfunction, neuroinflammation, and associated mechanisms in sepsis-associated encephalopathy: from pathogenesis to emerging therapeutics

Sepsis-associated encephalopathy (SAE) is a devastating neurological complication of sepsis, leading to diffuse brain dysfunction, long-term cognitive deficits, and increased mortality. Its pathogenesis is complex, with mitochondrial dysfunction and neuroinflammation emerging as central, interconnected drivers. This review systematically elucidates the pathogenic crosstalk between these two processes. We detail how dysregulated mitochondrial dynamics (e.g., Drp1-mediated fission), impaired biogenesis (via the proliferator-activated receptor-gamma coactivator-1α axis), oxidative stress, and the activation of mitochondria-dependent cell death pathways (ferroptosis, pyroptosis) contribute to neuronal injury. Concurrently, microglial activation, particularly through the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome, creates a vicious cycle that exacerbates mitochondrial damage and synaptic loss. Furthermore, we summarize emerging therapeutic strategies that target this mitochondrial-neuroinflammatory axis, including molecular hydrogen, mitochondria-targeted peptides (SS-31), natural compounds, and specific inhibitors (e.g., Mdivi-1, MCC950). The integration of recent insights on the gut-brain axis and cerebral metabolomics further expands the therapeutic landscape. Ultimately, targeting this core axis offers a promising paradigm for developing effective interventions to improve neurological outcomes in septic patients.
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A longitudinal analysis of the prevalence of restrictive interventions involving women with mental health conditions, learning disabilities or autism in mental health services in England

IntroductionRestrictive interventions, including physical restraint, seclusion, chemical restraint, and segregation, continue to be used within mental health services, despite sustained policy efforts to promote least-restrictive and trauma-informed care. However, little is known about national trends affecting women, for whom restrictive interventions often carry heightened risks of re-traumatisation and stigma.MethodsWe conducted a longitudinal secondary analysis of publicly available administrative data from the Mental Health Bulletin covering NHS-funded mental health services in England between 2017 and 2025. Annual counts of restrictive interventions involving women were examined relative to the number of women detained under the Mental Health Act to estimate annual rates per 1,000 detained. Regression modelling was used to assess temporal trends overall, by age group and type of restrictive intervention, and interrupted time-series analyses to examine changes following implementation of the Mental Health Units (Use of Force) Act 2018 (“Seni’s Law”). Trends were also examined alongside available national data on restrictive interventions involving men.ResultsRates of restrictive interventions involving women increased by approximately 12 percent per year over the study period, with no evidence of a reduction following the introduction of Seni’s Law. Increases were most pronounced for chemical restraint, seclusion, and segregation, while physical and mechanical restraint remained stable. Restrictive interventions declined among women under 18 but increased consistently across all adult age groups, indicating a widening age-related divergence. Although overall trends broadly mirrored those observed among men, the types of restrictive interventions used and their potential impact may differ, highlighting gendered dimensions in how restrictive practices are experienced and applied.DiscussionDespite extensive national initiatives, restrictive interventions involving women have continued to rise in England, highlighting a persistent gap between policy intent and practice. The findings suggest that legislative frameworks alone are insufficient to achieve meaningful reductions without operational changes in clinical practice, organisational culture, and monitoring systems. Internationally, the study contributes rare gender-disaggregated longitudinal evidence and highlights the need for comparable monitoring systems and coordinated research to inform rights-based, trauma-informed strategies to reduce restrictive interventions in mental health services.
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Medical evaluation of first presentation of psychotic symptoms in children and adolescents

IntroductionPsychotic symptoms in children and adolescents may represent either normative developmental phenomena or severe psychiatric and medical conditions, requiring careful differential diagnosis.MethodsThis retrospective study aimed to evaluate the medical workup of children and adolescents admitted for a first presentation of psychotic symptoms at a tertiary pediatric center over a 10-year period. The sample included 68 patients (mean age 13.7 ± 3.7 years) who underwent clinician-directed evaluations including physical exams, laboratory tests, toxicology screens, neuroimaging, and lumbar puncture when indicated.ResultsSixteen patients (23.5%) were diagnosed with substance-/medication-induced or medically-associated psychosis. In this cohort, younger age, very early onset psychosis (<13 years), and catatonia at first presentation were more frequently observed among patients with secondary etiologies, whereas documented prior subthreshold symptoms were more frequently documented among those diagnosed with primary psychiatric disorders. Most investigations did not identify a secondary cause, reflecting clinician-directed evaluation in routine practice; however, selected cases (e.g., autoimmune encephalitis, multiple sclerosis) illustrate the clinical importance of careful assessment when specific suspicion is present.ConclusionThese findings suggest that targeted medical evaluation may be useful in pediatric psychosis, particularly when clinical features raise suspicion for secondary etiologies, and may help inform clinical decision-making in tertiary pediatric settings.
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Self images: an empirical enquiry into Rembrandt’s self-portraits

Many have speculated that events of personal and financial loss in the life of Rembrandt van Rijn (Rembrandt) caused depression and that this is revealed by examination of his work particularly self-portraits painted in old age. Some report detecting various physiological diseases associated with aging, including vision impairment, which may have affected his mood and work. Aging and neurodegenerative disease which often accompanies it, are both associated with depression. Depression is characterised by visual deficits including perception of reduced contrast and colour. Age-related neurological disorders are associated in artists with reduced complexity. Recent advances in imaging and computer technology make it possible to empirically examine changes in artistic style which can contribute to understanding artists’ physical and mental health. Previous studies have identified associations between adverse events in artists’ lives and altered contrast and colour in their self-portraits. In the current study changes in contrast, colour and fractal dimension were measured in the entire corpus of Rembrandt’s painted self-portraits and portraits to determine whether changes in style indicate depression, cognitive decline, or neurological disease and whether differences in style can be detected between self-portraits and portraits of related and unrelated others. Productivity was also examined as an indirect indicator. The results suggest that it is unlikely that Rembrandt suffered from unipolar or bipolar depression, age-related cognitive decline, or neurodegenerative disease. The data are consistent with someone experiencing episodes of low mood associated with normal grieving and adversity followed by resilient recovery. There is evidence of a gradient in saliency and complexity between self-portraits and related and unrelated portraits and of a ‘late’ style identified by leading art historians consistent with macular degeneration.