ObjectiveTo identify latent profiles of postoperative day-7 cognitive performance among older adults after elective surgery and to explore demographic, behavioral, clinical, and social factors associated with profile membership.MethodsThis prospective observational study included 308 consecutively recruited patients aged ≥65 years who underwent elective surgery under general anesthesia. Cognition was assessed with the Mini-Mental State Examination (MMSE), and latent profile analysis used five study-defined postoperative domain scores. Candidate correlates were organized with the health ecological model and examined using univariate tests and posterior-probability-weighted exploratory multinomial regression.ResultsThree severity-ordered profiles were identified: low (n=83, 26.9%), intermediate (n=72, 23.4%), and high postoperative cognitive performance (n=153, 49.7%). Older age and lower education were associated with both lower-performance profiles. Greater activities-of-daily-living dependence, lower income, and living alone were associated with the low-performance profile, whereas poorer sleep was associated with the intermediate-performance profile.ConclusionsDay-7 MMSE performance formed a severity gradient across three data-driven profiles. These cross-sectional profiles do not demonstrate postoperative decline, a clinical diagnosis, or an effect attributable specifically to general anesthesia. Longitudinal studies with retained baseline scores, appropriate comparison groups, and broader neuropsychological assessment are required before profile-specific interventions can be recommended.
Trajectories of perinatal depression, anxiety, perceived stress, sleep quality, and psychological flexibility from pregnancy to six months postpartum and their relationship with the number of abortions and deliveries
BackgroundPerinatal psychological distress is common and longitudinally heterogeneous, yet little is known about how obstetric history shapes symptom trajectories. We identified trajectories of depressive symptoms, perceived stress, sleep quality, psychological flexibility, and anxiety from early pregnancy to 24 weeks postpartum and examined their associations with the number of previous abortions and deliveries.MethodsIn this prospective longitudinal cohort study, 254 pregnant women were recruited at 13 weeks of gestation from a tertiary hospital in China and assessed eight times through 24 weeks postpartum using the EPDS, CPSS, PSQI, CompACT, and GAD-7. Group-based trajectory modeling identified latent trajectory classes. Logistic regression examined associations with obstetric history, adjusting for sociodemographic covariates.ResultsThree trajectories emerged for depressive symptoms (low-stable, 38.98%; mild-stable, 47.24%; moderate-increasing, 13.78%), perceived stress (low-stable, 31.89%; moderate-increasing, 16.54%; high-stable, 51.57%), and sleep quality (good-stable, 50.00%; mild-worsening, 38.58%; persistent poor, 11.42%); two emerged for psychological flexibility (continuously declining vs high-stable) and anxiety (low-stable, 93.70%; moderate, 6.30%). Compared with women without abortion history, those with two or more abortions had higher odds of mild-stable (OR = 5.14) and moderate-increasing depression (OR = 19.12), mild-worsening (OR = 3.06) and persistent poor sleep (OR = 5.51), and declining psychological flexibility (OR = 2.61); one abortion was associated with increased stress (OR = 2.54 and 2.16) and moderate anxiety (OR = 4.18). Number of deliveries was not associated with any trajectory.ConclusionsPrevious abortions predict adverse perinatal psychological trajectories in a dose-dependent manner. Routine assessment of abortion history at the first prenatal visit could help target early screening and tailored interventions.
Comparison of short-term peripheral nerve stimulation, single-target supraorbital nerve pulsed radiofrequency, and dual-target supraorbital nerve–stellate ganglion pulsed radiofrequency for herpes zoster ophthalmicus–associated pain: a retrospective cohort study
ObjectiveTo compare the clinical outcomes of short-term peripheral nerve stimulation (st-PNS), supraorbital nerve pulsed radiofrequency (SON-PRF), and combined supraorbital nerve and stellate ganglion pulsed radiofrequency (SON + SG-PRF) for herpes zoster ophthalmicus (HZO)-associated pain.MethodsThis retrospective study included patients with HZO-associated pain who underwent st-PNS, SON-PRF, or SON + SG-PRF between January 2023 and January 2026. The primary outcome was the longitudinal change in Numerical Rating Scale (NRS) scores over 24 weeks. Secondary outcomes included the clinical response rate, anxiety (GAD-7), depression (PHQ-9), sleep quality (PSQI), and treatment-related adverse events. The incidence of postherpetic neuralgia (PHN) was assessed as an exploratory outcome only in patients with a disease duration of ≤90 days at treatment. Longitudinal outcomes were analyzed using baseline-adjusted linear mixed-effects models, with propensity score weighting used for sensitivity analyses.ResultsA total of 269 patients were included: 84 in the st-PNS group, 96 in the SON-PRF group, and 89 in the SON + SG-PRF group. NRS scores decreased over follow-up in all three groups. In the primary and both propensity score-weighted analyses, the overall NRS trajectory was lower with st-PNS than with SON-PRF, whereas no significant difference was observed between st-PNS and SON + SG-PRF. The overall GAD-7 trajectory was lower with SON + SG-PRF than with SON-PRF, and the overall PSQI trajectory was lower with SON + SG-PRF than with either st-PNS or SON-PRF; these differences remained statistically significant in both weighted analyses. The overall trajectories of depressive symptoms did not differ significantly among the groups. Exploratory analysis did not establish a difference in PHN risk among the three groups. No serious treatment-related adverse events occurred during follow-up.ConclusionTo our knowledge, this study is the first to compare multidimensional clinical outcomes of st-PNS, SON-PRF, and SON + SG-PRF for HZO-associated pain within the same cohort. st-PNS showed a relatively consistent analgesic benefit over SON-PRF, whereas SON + SG-PRF also provided analgesia and showed potential benefits for anxiety and sleep outcomes. These findings require confirmation in prospective studies.
Assisting Screening of Adolescent Depression With Large Language Models as Symptom Detectors: Algorithm Development and Validation
<strong>Background:</strong> Depression prevalence is rising in adolescents and young adults (ages 10-24 years). Traditional screening methods for depression, such as the Patient Health Questionnaire (PHQ-9), are particularly challenging for adolescents. AI has potential to help with this, but the scarcity of annotated datasets highlights the need for off-the-shelf approaches. In this study, we investigate the feasibility of using state-of-the-art large language models (LLMs) to detect depressive symptoms in adolescent settings (ages 15-17 years). <strong>Objective:</strong> This study aimed to evaluate the feasibility of using in-context learning with LLMs to identify depressive symptoms in free-text clinical notes for adolescent populations, to evaluate the feasibility of off-the-shelf LLM configurations in detecting PHQ-9 symptom-related information under zero- and few-shot settings, and to demonstrate the potential clinical utility of LLM-driven evidence extraction through an interpretable AI-based depression screening tool. <strong>Methods:</strong> We examined free text of the electronic health records (EHRs) of adolescent patients with the diagnosis of depression or related mood disorders (age groups 15-17 years, 924 patients) from the Cincinnati Children’s Hospital Medical Center. We leveraged the combination of the Beck Depression Inventory (BDI) and the PHQ-9 to develop tailored categories suited for adolescent depression symptoms. We applied 3 state-of-the-art LLMs (Llama, smaller FLAN-T5, and Phi) to identify these symptom categories in zero- and few-shot configurations, allowing us to assess their performance without additional task-specific training. A word-search model was used as the baseline comparator. <strong>Results:</strong> We manually annotated clinical notes for 22 patients across 16 depression-related symptom categories. Our analysis shows that all LLMs substantially outperformed the word-matching baseline. Within the evaluated prompting configurations, FLAN-T5 achieved the highest precision (average <i>F</i><sub>1</sub>-score=0.65, precision=0.78) and strong performance in detecting rare symptoms such as sleep problems (<i>F</i><sub>1</sub>-score=0.92) and self-loathing (<i>F</i><sub>1</sub>-score=0.80). Phi offered a balanced performance (precision=0.44, recall=0.60), while Llama 3 achieved the highest recall (0.90) but tended to overgeneralize, making it less suitable for precise screening. Within this pilot study, the best-performing LLM exceeded the baseline <i>F</i><sub>1</sub>-score by 0.43. Finally, we demonstrate the clinical utility of FLAN-T5 annotations as features in a machine learning model, which distinguished depression cases from controls with high precision (0.78). <strong>Conclusions:</strong> We used a range of popular LLMs to identify indicators of adolescent (ages 15-17 years) depression symptoms in mental health notes. Within the evaluated configurations, FLAN-T5 demonstrated the most favorable balance between precision and recall. These results support the feasibility of using off-the-shelf LLMs for symptom detection in adolescent clinical notes, while future work using standardized prompting strategies and task formulations will help establish more definitive comparisons between model architectures. The computational efficiency of FLAN-T5 further supports its potential for deployment in resource-limited clinical settings. Our findings require further validation for broader populations and other mental health conditions.
Increased frequency of rare damaging variants in PLIN4 in patients with anorexia nervosa
BackgroundAnorexia nervosa (AN) is a severe psychiatric disorder characterized by pathological fear of weight gain, persistent restriction of energy intake, and pervasive body image disturbance. Although AN is substantially heritable, the rare coding variants contributing to susceptibility remain incompletely defined. Pedigree-based whole-exome sequencing studies can help to identify rare, high-effect protein-coding variants and thereby elucidate disease mechanisms.MethodsWhole-exome sequencing was performed on AN-dense family pedigrees to identify candidate genes. The frequency of rare (minor allele frequency <1%), putatively damaging [combined annotation-dependent depletion (CADD) >15, including predicted loss-of-function (LOF)] variants in 32 candidate genes was assessed in 154 unrelated probands of European ancestry. Carrier counts were compared against gnomAD v4 non-Finnish European reference using a TRAPD-style coverage-adjusted denominator (maximum allele number/2 across qualifying sites per gene). Significance was assessed by one-sided Fisher exact test, Bonferroni-corrected across 32 candidate genes.ResultsPLIN4 was the only gene enriched in AN cases at Bonferroni-corrected significance: 17 of 154 patients (11.0%) carried a rare damaging variant versus 3.2% in gnomAD non-Finnish Europeans [odds ratio (OR) 3.86, 95% confidence interval (CI) 2.35 to 6.35; one-sided Fisher p = 9.98e−06; Bonferroni-corrected p = 3.19e−04]. The result is preserved with the index proband removed (n = 153; OR 3.64, 95% CI 2.18 to 6.07; corrected p = 1.13e−03). Six of 154 patients carried predicted LOF variants; 4 of 6 had at least one AN-affected first- or second-degree relative carrying the same variant, providing co-segregation evidence. The LOF-only burden did not survive Bonferroni correction in isolation.ConclusionsPatients with AN carry a statistically significant excess of rare, putatively damaging variants in PLIN4, at a threshold surviving Bonferroni correction across 32 candidate genes. These findings implicate lipid-droplet biology as a candidate contributor to AN pathophysiology.
Transdiagnostic Sleep Intervention to Improve Mental Health in Adolescents
Conditions: Sleep Disturbance; Sleep Problems; Substance Use (Drugs, Alcohol); Anxiety; Depression
Interventions: Behavioral: Transdiagnostic Intervention for Sleep and Circadian Dysfunction; Behavioral: Healthy habits psychoeducation
Sponsors: Universidad Pública de Navarra
Not yet recruiting
Interventions: Behavioral: Transdiagnostic Intervention for Sleep and Circadian Dysfunction; Behavioral: Healthy habits psychoeducation
Sponsors: Universidad Pública de Navarra
Not yet recruiting
The dynamic features of long-term habituation of negative emotions: evidence from eye-tracking and hypothalamic-pituitary-adrenal axis research
ObjectivesNegative emotional habituation (NEH) plays a crucial role in individuals’ survival and adaptation. However, systematic research on long-term negative emotional habituation remains limited. This study aimed to explore the dynamics of the habituation process during prolonged repeated exposure to negative stimuli, from the perspectives of eye-tracking and hypothalamic–pituitary–adrenal (HPA) axis responses.MethodsEmploying a 2 × 7 mixed factorial design, we enrolled 50 healthy male undergraduates and randomly assigned them to moderate- or high-intensity negative-image groups. Negative stimulus intensity served as the between-subject factor, and repeated exposure across seven consecutive daily testing sessions served as the within-subject factor. A single-blind procedure was adopted. Baseline trait anxiety and resilience were assessed. On each testing day, we concurrently obtained subjective ratings (valence, arousal), eye-tracking indices [mean fixation duration (MFD), pupil size], and salivary cortisol samples.ResultsOver the seven-day repetition, valence increased over time while arousal decreased. MFD increased significantly while pupil size decreased significantly, with both indices differing by stimulus intensity. Daily changes in salivary cortisol exhibited a significant downward trend, with a steeper decline under high-intensity negative stimulation. Cross-system coupling varied by intensity: under moderate intensity, valence and cortisol habituation were positively correlated, whereas under high intensity, this association was not significant. Additionally, trait anxiety was significantly negatively correlated with pupil habituation, and resilience moderated the relationship between trait anxiety and valence habituation at a marginally significant level.ConclusionThese findings indicate that NEH is not a unitary pathway but a dynamic process jointly realized by multiple systems with distinct sensitivities and convergence rhythms. The results reveal nonlinear cross-level coupling in NEH and may inform methodological bases for timing, dose optimization, and process evaluation in exposure-based therapies.
Sex differences in sleep architecture among patients with severe mental disorders: a polysomnographic study
BackgroundSleep disturbances are common in severe mental illness, including schizophrenia, bipolar disorder, and major depressive disorder. Yet sex-specific sleep patterns across schizophrenia, bipolar disorder, and major depressive disorder remain poorly characterized.MethodsIn this cross-sectional study, we compared overnight polysomnography between 372 first-episode patients (aged 18-45) (93 schizophrenia, 181 major depressive disorder, 98 bipolar disorder). All participants underwent a single-night 10-channel polysomnography.ResultsAfter controlling for age, illness duration, BMI, and medications, women achieved significantly longer total sleep time (median 449.3 vs 420.3 min; p <0.001), time in bed (543.0 vs 525.5 min; p = 0.03), and higher sleep efficiency (83.3% vs 82.3%; p = 0.004) than men. Exploratory post-hoc analyses revealed potential sex-related differences in major depressive disorder and bipolar disorder (all p < 0.05, uncorrected for multiple comparisons). However, these findings did not survive correction for multiple comparisons, indicating that the observed differences should be interpreted with caution as preliminary.ConclusionsThis study found that biological sex modulated sleep macro-architecture in severe mental illness, with women exhibiting longer sleep duration and higher sleep efficiency relative to men. Although the cross-diagnosis comparison revealed only a marginally significant sex-by-diagnosis interaction that did not persist after multiple testing correction, these exploratory subgroup findings suggest potential nuanced variations in sleep architecture. Consequently, future studies with larger cohorts are warranted to evaluate whether sex-stratified approaches could refine clinical sleep interventions across psychiatric conditions.
Sleep and Drug Use: Neuroimaging Evidence for a Multidimensional Brain Framework
Sleep plays a critical role in the initiation and maintenance of drug use, as well as recovery among individuals with substance use disorders. Sleep is a multidimensional construct, and a growing body of research has demonstrated the relative independence of various components. Specific sleep characteristics including insomnia (self-reported sleep disturbances), short sleep duration, late sleep timing and sleep irregularity have each been associated with increased risks of drug use. However, it remains unclear whether these sleep components contribute to substance use through shared neurobiological pathways.
If I Only Knew Then — Living with OCD
By Vinay Krishnan
My OCD has always manifested itself through a debilitating fear of harm coming to loved ones and to myself, a subset of OCD called Harm OCD. This showed up most prominently after the September 11th, 2001 attacks in New York. The violent imagery and loss of life stuck to my brain and sparked all sorts of hypothetical violent intrusive thoughts and threats that I’d spend hours imagining every day, to which I would respond with repeated mental and physical reassurances of safety (calming words and affirmations, locking and re-locking the front door). Over the following years, this cycle of obsessions and compulsions would lead to long bouts of depression, of insomnia, and of self-harm. I was 13 on 9/11/2001, I didn’t start medication for my illness until 2012, I didn’t start Exposure and Response Prevention treatment until 2016, and I didn’t find medication that kept me stable until 2020. That is a long long time to go without feeling secure and fully functional. If I knew to see the signs of my illness and if I knew to seek treatment earlier, I could have saved myself over a decade of painful dysfunction and mental torment, and my symptoms would have been far easier to course-correct at an early age than they were later on.
Now, I’m well versed in a variety of tools that keep me safe and healthy. I know to write exposure scripts when my OCD gets intense, I know that mindfulness meditation practices help me process intrusive thoughts without getting stuck to them, and I use a combination of antidepressants and anxiety medications that keep my symptoms far more manageable than they were for most of my life. I’ve told my story in a variety of contexts and mediums–speaking about OCD for NPR, Good Morning America, and as part of the documentary An Unquiet Mind–and I work as a community organizer trying to dismantle some of the systemic barriers that prevent people from accessing and affording the healthcare they need.
Again and again, I remind people still grappling with their OCD symptoms that learning to sit with uncertainty rather than fighting it off is the key to living the life you want with OCD. If folks can learn to do that, they can engage in whatever is most important to them, they can live joyful lives, they can hold stable jobs and provide for their families and do all the things OCD is perhaps telling them is currently impossible to do. I’m 38 now and living a life far beyond any of my expectations or dreams growing up, one filled with joy and companionship and artistry and adventure. That may all feel far-fetched to people growing up with OCD or to people just learning how their OCD works, but there are plenty of tools available now to help folks sit with doubt and gradually loosen OCD’s grip on us. I’m sending everyone some love and strength and lightness on their journey.
While every experience with OCD is different, far too many kids and families face the same barriers to getting answers and effective treatment. See what new IOCDF findings reveal about pediatric OCD care—and what we can do to change it—in Losing Childhood to America’s OCD Care Crisis.
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