IntroductionSelf-esteem is widely regarded as an important construct in the psychological functioning of individuals with borderline personality disorder (BPD) symptoms. During emerging adulthood, fluctuations in self-esteem are often linked to emotional dysregulation and maladaptive adjustment; however, self-esteem has rarely been examined within a broader system of culturally relevant psychological resources. Drawing on the Theravāda Buddhist framework of the Ten Pāramīs, inner strengths may represent protective resources that can be examined alongside self-esteem to clarify how these strengths co-occur among students experiencing BPD symptoms.MethodsThe present study employed a regularized psychological network approach to investigate partial associations between self-esteem and Ten Pāramī–based inner strengths among Thai university students screening positive for BPD symptoms. Participants were 346 Thai university students (25.4% male, 74.6% female; mean age = 21.60 ± 2.24 years) identified using a standardized BPD screening instrument. Inner strengths included Truthfulness, Perseverance, Wisdom, Generosity, adherence to the Five Precepts, Meditation, Tolerance, Equanimity, Determination, and Loving-kindness.ResultThe estimated network showed a predominantly positive pattern of partial associations among strengths. The strongest edge was observed between Generosity and Loving-kindness, and links between self-esteem and Determination (and Equanimity) were among the most consistently estimated associations (based on bootstrap confidence intervals). Centrality indices were examined descriptively; however, case-dropping bootstrap results indicated very limited stability of centrality estimates (CS(cor = 0.7) = 0.13 for strength and expected influence), and centrality rankings were therefore treated as strictly exploratory. Discussion: Although some negative partial associations were estimated (e.g., involving Truthfulness, Perseverance, and Equanimity), their precision was limited and such patterns should be treated as exploratory. Exploratory gender-stratified analyses suggested that the strongest edges were similar in the female subsample, whereas the male subsample yielded a sparse/near-empty regularized network, limiting inference regarding gender differences. Given the cross-sectional design, all associations are interpreted as conditional co-occurrence rather than directional or causal effects.ConclusionOverall, these findings highlight a small set of robust co-occurring inner strengths linked to self-esteem in Thai university students with BPD symptoms and provide a culturally informed basis for hypothesis generation regarding strengths-based skills cultivation and supportive interventions in university settings.
Research progress on addictive features and reward circuit mechanisms in non-suicidal self-injury and the feasibility of precision neuromodulation
Non-Suicidal Self-Injury (NSSI) presents a significant public health challenge; however, its underlying neurobiological mechanisms remain insufficiently understood, limiting the development of targeted interventions. Emerging evidence suggests that NSSI exhibits core addictive features, such as compulsive urges and tolerance, which may be driven by dysfunctions in the brain’s reward circuitry. This review synthesizes current research on the neural overlaps between NSSI and addiction, specifically focusing on the dysregulation of the ventral striatum and prefrontal cortex. Based on this mechanistic framework, we propose the potential of Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT)—a high-dose, functional connectivity-guided transcranial magnetic stimulation protocol—as a precision treatment for NSSI. By targeting specific reward network deficits, SAINT may offer a novel, rapid-acting therapeutic strategy for patients who do not respond to conventional pharmacological or psychological interventions.
Hair cortisol as psychotherapy process parameter – an inpatient pediatric psychosomatic study
IntroductionPediatric-psychosomatic inpatient therapy is an essential part of the German health care system for the treatment of mental disorders in children and adolescents. However, empirical research in this field remains scarce and limited to psychological parameters. This longitudinal naturalistic study aimed to evaluate the efficacy and sustainability of inpatient psychosomatic therapy in children and adolescents by examining both psychological outcomes and biological markers.MethodsA total of 58 patients were assessed at seven time points before, during, and after treatment. Hair cortisol concentration (HCC) was measured as a neuroendocrine parameter of long-term stress regulation. Psychometric data were collected using five validated questionnaires.ResultsFindings indicated significant improvements in perceived stress, depressive and anxiety symptoms, family functioning and internalizing symptoms in the course of inpatient treatment. Overall, these effects remained stable at three- and six-month follow-ups, with only transient increases in depressive symptoms and family problems. HCC showed a significant decrease from admission to discharge and remained stable across follow-ups.DiscussionThese results support the efficacy of inpatient pediatric psychosomatic interventions on both psychological outcomes and neuroendocrine stress regulation and highlight the value of integrating biological markers into psychotherapy research.
Technology-Enhanced Peer Support for Depression in Older Adults: Single-Arm Mixed Methods Feasibility Study
<strong>Background:</strong> Depression in late life is often compounded by social isolation and barriers to care. There is limited study of technology-enhanced peer support for depression among older adults. <strong>Objective:</strong> This study aimed to assess the feasibility and acceptability of a technology-enhanced peer support intervention to decrease depression among older adults. <strong>Methods:</strong> We used a mixed methods pilot study among adults aged 50 years and older with depression who received a peer support intervention called Peers+. The intervention consisted of 8 weekly video chats and unidirectional texts focused on increasing depression self-care and coping. Data obtained from screening, baseline, postintervention, and 3-month follow-up were used in the analysis to assess preliminary outcomes of the intervention. Mixed effects longitudinal models were used to assess change in depression, and qualitative data were collected and analyzed to identify key themes related to participant experiences. <strong>Results:</strong> A total of 34 older adults with a mean age of 67 (SD 9.57) years participated in the study, and 82.4% (28/34) of participants finished all 8 intervention meetings. Depressive symptoms declined over the course of the study of 35 weeks (<i>F</i><sub>1, 88.8</sub>=26.0; <i>β</i>=–.14, 95% CI –0.20 to 0.09; <i>P</i><.001). Emotional well-being (<i>β</i>=.48, 95% CI 0.26-0.70; <i>P</i><.001), social functioning (<i>β</i>=.71, 95% CI 0.33-1.09; <i>P</i><.001), self-efficacy (<i>β</i>=2.29, 95% CI 0.83-3.75; <i>P</i><.001), and coping (<i>β</i>=2.90, 95% CI 0.24-5.55; <i>P</i><.001) improved throughout the study period. Participants perceived supportive texts as reinforcing trust between peer coaches, using coping strategies, increasing social connection, and providing accountability for improving self-care. Peer coaches and older adults needed technology support for participation in the study. <strong>Conclusions:</strong> This study demonstrated the feasibility and acceptability of a peer support intervention enhanced by video chats and texts, delivered by older adult peer coaches to an ethnically diverse group of older adults with depression. Study findings indicate that ongoing and accessible technology support contributed to older adult participation and engagement.
Fatherhood and addictive disorders: experiences and support needs – results of a qualitative interview study
ObjectivesParental addictive disorders are a major public health problem. Despite already known negative effects, the parental role of men seeking help is rarely acknowledged within addiction support services. This study aims to identify existing relations between fatherhood and addiction, and the resulting support needs of affected fathers.MethodsFor data collection 15 fathers with addictive disorders were interviewed by using qualitative, guided interviews. The data material was analyzed using qualitative content analysis.ResultsThe effects of addictive disorders on fatherhood are predominantly unfavorable. Conversely, fatherhood can have consumption-reducing as well as consumption-increasing effects. In this context, five topics were identified in which fathers expressed specific support needs. Particularly fathers with substance use disorders expressed their need for further support, while fathers with behavioral addictions expressed a lesser need.ConclusionsPaying attention to fatherhood in the context of addiction services provides a starting point for increasing the motivation to change. Individual support needs should be considered when implementing father-specific programs. Not only the fathers themselves, but also their children can benefit from successful treatment and expected changes in fatherhood.
Targeted stool metabolomics suggests exploratory catecholamine- and tryptophan-linked metabolic features in autism spectrum disorder
BackgroundGut-brain axis dysregulation and microbiome-linked metabolic alterations have been implicated in autism spectrum disorder (ASD), but the contribution of gut-derived neuroactive metabolites remains incompletely characterized.MethodsWe conducted a cross-sectional case-control study of 59 participants (32 ASD, 27 controls) and quantified 18 stool metabolites related to catecholamine synthesis, inhibitory neurotransmission, and tryptophan-linked NAD+-precursor metabolism using targeted liquid chromatography-tandem mass spectrometry. Group differences were assessed using fold-change analysis and linear models adjusted for age and sex. Random forest models evaluated classification performance, and within-group Spearman correlations were used to examine metabolic relationships.ResultsNorepinephrine showed the largest increase in ASD, whereas dopamine and tetrahydrobiopterin exhibited nominal group differences that did not remain significant after correction for multiple testing. A three-metabolite panel comprising tetrahydrobiopterin, γ-aminobutyric acid, and kynurenine showed exploratory discrimination between groups (area under the receiver operating characteristic curve = 0.750, 95% confidence interval 0.622–0.878), but this performance requires external validation. Correlation analysis revealed conserved bile acid coupling in both groups. In controls, tryptophan was positively associated with kynurenine, whereas this relationship was not observed in ASD. Instead, ASD samples showed broader associations between tryptophan and metabolites linked to neurotransmission and NAD+-precursor metabolism.ConclusionStool metabolite profiling revealed altered organization of tryptophan- and catecholamine-linked metabolic associations in ASD and identified a small metabolite panel with exploratory discriminative potential. These findings provide a foundation for future studies examining gut-derived neuroactive metabolites in ASD and their relationship to gut-brain axis biology.
Case Report: Delirium and complications resulting from the abuse of compound liquorice tablets
BackgroundCompound liquorice tablets is a cough-suppressing compound formulation containing opium powder and liquorice. With the strict regulation of traditional opioids, this medication has emerged as a novel alternative for substance abuse due to its easy accessibility and low cost; however, its addiction potential and severe adverse complications remain underrecognized and insufficiently addressed in clinical practice.Case summaryThe patient is a 29-year-old male who began self-medicating with compound liquorice tablets for a dry cough after COVID-19 infection. His daily dosage gradually escalated to 200–600 tablets within two years, resulting in established drug dependence. Two days after discontinuing the medication, he developed delirium manifested as confusion, disorientation, visual hallucinations and psychomotor agitation, accompanied by palpitations, hypertension, tremors, rhinorrhea, vomiting, severe hypokalemia, and bilateral lower limb edema. Organic brain diseases were excluded by systematic examinations. According to the ICD-10 diagnostic criteria, he was diagnosed with opioid-induced mental and behavioral disorders, hypokalemia and hypertension. We implemented a benzodiazepine tapering regimen to control delirium and sympathetic excitation associated with withdrawal symptoms, combined with antidepressants and antipsychotics to improve mood, anxiety, and psychotic symptoms, Under the guidance of a cardiologist, we actively managing hypertension and correcting internal environmental disturbances. Following comprehensive management, the patient’s withdrawal symptoms and delirium resolved, with stable emotional state and blood pressure, resulting in successful withdrawal.ConclusionThis is the first reported case of delirium caused by withdrawal from compound liquorice tablets. It provides preliminary insights for clinical identification, diagnosis, and multidisciplinary management of dependence on compound liquorice tablets, as well as related withdrawal symptoms and complications. This case also alerts to the emerging risk of abuse associated with new substances such as compound liquorice tablets and underscores the need for stricter prescription controls and patient education regarding the risks of abuse.
Mental health stigma among nursing students: current status and intervention strategies— an integrative review
ObjectiveAims to synthesize the current evidence on the prevalence of mental health stigma among nursing students and to summarize the interventions that have been developed and evaluated to reduce such stigma.MethodsA comprehensive search was conducted across PubMed, CINAHL, and Web of Science databases for peer-reviewed studies published in English between January 2018 and June 2024.ResultsA total of 25 studies were included. The prevalence of mental health stigma among nursing students was found to be moderate to high. Stigma manifested in various forms, including negative attitudes toward patients, internalized shame, and public stigma directed at nursing students themselves. Interventions such as mental health training, empathy enhancement programs, and clinical internships demonstrated varying degrees of effectiveness in reducing stigma, with multi-component interventions showing the most promise.ConclusionMental health stigma among nursing students is a persistent and multifaceted issue that requires targeted strategies to address. Enhancing mental health education, increasing clinical exposure, and implementing comprehensive intervention programs are essential steps to reduce stigma and support the development of compassionate, skilled nursing professionals.
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Biomarkers Could Help in Antidepressant Choice
Antidepression treatment based on a person’s individual biomarkers could help determine which of the world’s most popular medications to use, a clinical trial suggests.
The SMART Trial to Predict Anhedonia Response to Antidepressant Treatment results suggest that behavioral, brain, and clinical data could together determine the optimal antidepressant to choose before a person starts treatment.
There were no significant primary endpoint differences in depression outcomes between participants who received bupropion or sertraline based on biomarkers identified in the prior Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study.
But people negative for biomarkers with both drugs had significantly worse depression symptom trajectories than those who had at least one positive biomarker, regardless of the drug they received.
Response rates among participants with both biomarkers were almost double that of those without any biomarkers, with those who had at least one biomarker having an intermediate response.
“Our results suggest that we could boost response rate by using two sets of biomarkers previously identified in the EMBARC study, making an important contribution to advancing the goals of precision psychiatry,” reported Peter Zhukovsky, PhD, from Harvard Medical School, and co-workers in Nature Mental Health.
“Ultimately, we strongly hope these advances will enable personalized treatment guidance to accelerate and boost antidepressant benefits.”
Treatment for depression is often still trial and error, with symptoms improving in only half the people taking an antidepressant. This could be due to treatments not being chosen based on people’s individual characteristics.
Finding markers that predict response to different antidepressants could therefore provide patients and clinicians with valuable information to guide treatment choice.
The trial was among the first to investigate how treatment could be guided using clinical information such as responses to questionnaires, behavioral information such as performance in computerized tasks, and brain data such as magnetic resonance imaging (MRI) scans.
It was carried out as part of the Wellcome Leap Multi-Channel Psych Program effort to double the number of people who respond to the first treatment they try for depression via the integration of multimodal biomarkers.
Firstly, the researchers investigated biomarker models that predicted response to the selective serotonin reuptake inhibitor (SSRI) sertraline or the norepinephrine-dopamine reuptake inhibitor bupropion using the EMBARC study.
The treatment-assignment algorithm that was developed generated two marker-based indications for each patient—one for bupropion and sertraline—with the predictive model achieving a cross-validated area under the curve of 0.86 and 0.66, respectively.
The team then examined whether antidepressant response could be boosted using their created biomarker combination of a functional MRI imaging marker, reward learning and sensitivity, cognitive control, the clinical variables of depression severity and neuroticism, and the demographic variable of employment status.
After analyzing these biomarkers among participants, who had major depressive disorder, the group was randomly assigned to receive a full 8-week course of an SSRI or non-SSRI.
The primary outcome was the change in depression severity from pretreatment baseline to eight weeks after the start of treatment, with no significant differences in treatment outcomes for those assigned a drug consistent versus inconsistent with their biomarkers.
This, the researchers say was possibly due to the limited power to detect moderate effects.
However, significant differences emerged in symptom reduction trajectories for those with positive markers for both medications, with a response rate of 71.4% compared with 65.4% for those with a positive biomarker for either drug and 42.9% for those with two negative markers.
The authors concluded: “We found that, relative to patients with two negative markers, those with one or two markers were characterized by significantly larger reduction in depressive symptoms, showing that biomarker-guided treatment selection can boost efficacy for two of the most widely prescribed antidepressants around the world.”
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