BackgroundSleep disturbances are highly prevalent in first-episode schizophrenia and are associated with poor clinical and functional outcomes. Although repetitive transcranial magnetic stimulation (rTMS) has shown therapeutic potential for insomnia and schizophrenia, its efficacy for sleep disturbances in first-episode schizophrenia remains insufficiently characterized, and the underlying white matter network mechanisms remain unclear. This study aimed to determine whether active rTMS improves sleep quality compared with sham stimulation and whether longitudinal white matter network reorganization is associated with treatment-related sleep improvement.MethodsOne hundred patients with first-episode schizophrenia were included in the final analysis and randomly assigned to receive active rTMS or sham stimulation over an 8-week intervention period. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and objective sleep parameters were measured using wrist actigraphy. Diffusion tensor imaging was acquired at baseline and after treatment to construct individual white matter structural networks. Graph-theoretical metrics, nodal efficiency, and rich-club organization were examined. Linear mixed-effects models were used to evaluate group-by-time interaction effects, and correlation analyses were performed to examine associations between network changes and sleep improvement.ResultsCompared with sham stimulation, active rTMS produced greater improvements in subjective and objective sleep outcomes, including reduced PSQI scores, increased sleep efficiency, and decreased wake after sleep onset and sleep latency. Active rTMS was also associated with greater longitudinal increases in global efficiency, local efficiency, clustering coefficient, and nodal efficiency in prefrontal, default-mode, temporal, and salience-related regions. Rich-club connectivity increased more strongly after active rTMS than after sham stimulation, whereas feeder connectivity, normalized rich-club coefficient, and local connectivity did not show significant group-by-time interaction effects after FDR correction. In the active rTMS group, increases in rich-club connectivity were positively associated with improvements in actigraphy-derived sleep efficiency (r = 0.43, P = 0.002).ConclusionsActive rTMS improved sleep quality more effectively than sham stimulation in patients with first-episode schizophrenia and was accompanied by longitudinal changes in DTI-derived white matter network organization. The association between increased rich-club connectivity and improved sleep efficiency suggests that hub-related network reorganization may represent a network-level correlate of rTMS-related sleep improvement.
Enhancing a Behavioral Intervention Using Rest-Activity Rhythm Monitoring via a Consumer Wearable in Older Dementia Caregivers and People With Dementia: Feasibility and Acceptability Study
Background: Despite being established risk factors for poor mental or brain health outcomes in aging, rest-activity rhythm (RAR) disturbances are not routinely monitored or treated. This is, in part, due to a lack of clinician-friendly RAR monitoring systems. Objective: We tested the feasibility and acceptability of personalizing a 6-week behavioral intervention using RAR monitoring from a consumer wearable device (Apple Watch). We selected a target population study of people with dementia and their family caregivers, given that rest-activity pattern disturbances are common in these groups. Methods: This single-arm trial enhanced a behavioral activation rhythm treatment with the Apple Watch–based app myRhythmWatch, providing users and their therapists with objective RAR monitoring for customizing therapy. Therapists used information from the myRhythmWatch app to visualize the participants’ behavioral patterns, identify treatment targets, and track progress. Participants included 21 older adults (15 dementia caregivers: mean age 61.8, SD 8.4 years; 6 people with dementia: mean age 81.45, SD 8.5 years). Feasibility outcomes were as follows: (1) proportion adherent enough to assess RARs (defined as ≥3 consecutive valid days with ≥20 hours per day) and (2) the total number of valid days. Acceptability was measured via the Likert scale to gauge participants’ satisfaction with the intervention. We secondarily examined preintervention and postintervention changes in depression (9-item Patient Health Questionnaire scores) and insomnia (Insomnia Severity Index) scores among a smaller group of 11 caregivers who completed these measures. Results: All 21 participants obtained the minimum data requirement for characterizing an RAR snapshot. Caregivers averaged 35 valid RAR monitoring days, and all 15 caregivers were still using the app at week 6 of the trial. In contrast, people with dementia averaged 30 valid days, and of the 6 people with dementia, only 6 were active users at the end of the trial. On average, caregivers completed 5.7 (SD 0.46) of the 6 therapy sessions offered, and participant satisfaction with program components was “high.” Depression symptoms improved with medium preintervention and postintervention effect sizes (=2.417; =.02; Hedges =0.67, 95% CI 0.04‐1.28), and there were large effect size improvements in insomnia symptoms (=3.377; =.004; Hedges =0.94, 95% CI 0.25‐1.61). Conclusions: These findings show that older adults without dementia were highly engaged with RAR monitoring. This supports the feasibility of personalizing interventions for older adults with objective RAR monitoring. Randomized controlled trials are warranted to determine whether adding RAR monitoring improves intervention efficiency, efficacy, or durability. While feasible in a subset of people with dementia, we observed lower use rates indicating that there are more barriers to implementing long-term consumer wearable–based RAR monitoring in people with dementia. Trial Registration: Clinicaltrials.gov NCT05309577; https://clinicaltrials.gov/study/NCT05309577
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Smartphone addiction, physical activity engagement, and sleep quality in Chinese adolescents: a parallel and serial mediation model
IntroductionExcessive smartphone use has become a major public health concern among adolescents, particularly in China where smartphone use is widespread. Although smartphone addiction is consistently associated with poor sleep quality, the mechanisms underlying this association remain insufficiently understood. This study examined whether physical activity engagement and depressive symptoms operate as parallel and serial mediators linking smartphone addiction to sleep quality in Chinese adolescents.MethodsA cross-sectional survey was conducted among 612 adolescents (Mage = 14.2 years, SD = 1.6; 51.3% female) from four secondary schools in Hubei Province, China. Participants completed the Smartphone Addiction Scale–Short Version, the Physical Activity Questionnaire for Adolescents, the Pittsburgh Sleep Quality Index, and the Depression subscale of the Depression Anxiety Stress Scales-21. Path analysis of observed composite scores with robust maximum likelihood estimation and bias-corrected bootstrapping (5,000 resamples) was used to test the proposed parallel and serial mediation model.ResultsSmartphone addiction was positively associated with poor sleep quality (β = .38, p <.001). Both physical activity (indirect effect = .04, 95% CI [.01,.07]) and depressive symptoms (indirect effect = .14, 95% CI [.09,.19]) significantly mediated this association in parallel. In addition, the serial pathway from smartphone addiction to low physical activity, elevated depressive symptoms, and poor sleep quality was significant (indirect effect = .02, 95% CI [.01,.04]). The mediators collectively accounted for 52.6% of the total effect.DiscussionThese findings suggest that problematic smartphone use is associated with poorer adolescent sleep through behavioral and psychological pathways involving reduced physical activity and elevated depressive symptoms. School-based interventions that promote physical activity while reducing problematic smartphone use may help protect adolescent sleep and mental health. Longitudinal and experimental designs are needed to establish causal direction and inform intervention development.
Adolescent non-suicidal self-injury scale – short form: revision and evaluation of its reliability and validity
ObjectiveNon-suicidal self-injury (NSSI) is a clinically significant concern among adolescents, and its accurate yet efficient assessment is essential for research, early identification, and intervention. Existing Chinese instruments—most notably the 19-item Adolescent Self-Harm Questionnaire (ASHS)—are relatively lengthy and ill-suited to rapid, large-scale screening. The present study had two aims: (a) to develop a short form of the ASHS, the Adolescent Non-Suicidal Self-Injury Scale–Short Form (ANSSI-SF), by integrating classical test theory (CTT) item analysis with genetic algorithm (GA) cross-validation, and (b) to evaluate its reliability, validity, and screening utility relative to the parent scale.MethodsUsing a convenience sample of 1,090 primary and secondary school students, seven items—one for each of seven behavioral categories derived from a functional–typological framework of self-harm—were selected on the basis of CTT item statistics and GA cross-validation. The scale was evaluated through item analysis, internal-consistency and split-half reliability, exploratory and confirmatory factor analysis (EFA/CFA), correlations with theoretically related constructs, known-groups comparisons (gender; smartphone addiction), and consistency and screening-accuracy analyses against the full 19-item ASHS.ResultsIt indicated that all items demonstrated strong correlations with the total score, and both internal consistency and split-half reliability reached satisfactory levels.A unidimensional factor structure also exhibited good model fit. Additionally, scale scores were significantly positively correlated with related psychological indicators such as depression, anxiety, and sleep problems, and effectively differentiated differences in self-injurious behavior across gender and smartphone addiction groups.GA cross-validation confirmed that the selected items balanced parsimony with full coverage of all seven behavioral categories.DiscussionThese findings indicate that the ANSSI-SF is a brief, reliable, and valid instrument that preserves the content breadth of the parent ASHS while substantially reducing administration burden. It is well suited to rapid, large-scale screening and early identification of at-risk adolescents, facilitating timely referral and prevention. Limitations include convenience sampling from a single region and the absence of test–retest reliability; future research should validate the scale in clinical and diverse cultural samples and examine its predictive validity.
Methodology of Super-Early Training of Developer Engineers and Leading Analysts With a Diagnosis of ADHD/ASD for Ensuring the Engineering Sovereignty of the State: Time Horizon: 2026-2038-2050
Conditions: Attention Deficit Hyperactivity Disorder (ADHD)
Interventions: Device: Voice of Sleep “MamaBee” training modules (Fairy Tales)
Sponsors: Pisareva Citadel Group LLC
Active, not recruiting
Interventions: Device: Voice of Sleep “MamaBee” training modules (Fairy Tales)
Sponsors: Pisareva Citadel Group LLC
Active, not recruiting
Perinatal Mental Health Detection and Prediction Using Mobile Sensing Data: Systematic Review
Background: Perinatal mental health disorders affect approximately 20% of pregnant and postpartum individuals, and are associated with substantial maternal and infant morbidity. Traditional assessment relies on infrequent, subjective self-reports. Mobile devices, including smartphones and wearables, offer opportunities for continuous and objective measurement, but evidence on their assessment utility in perinatal populations remains fragmented. Objective: This review aimed to examine the application of wearable devices and smartphones for detecting and predicting perinatal mental health outcomes, with emphasis on predictive performance, informative features, and methodological rigor. Methods: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO CRD420251249218). Six databases (PubMed, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ACM Digital Library) were searched initially in January 2026 and supplemented by an amended search in June 2026, with no publication date restrictions. Evidence was synthesized narratively, and the risk of bias was assessed using PROBAST+AI (Prediction Model Risk of Bias Assessment Tool With AI extension). Results: The initial and supplementary searches yielded 1952 unique records after deduplication, of which 10 studies met the inclusion criteria. The included studies covered postpartum depression, prenatal stress, discrete emotions during pregnancy (eg, happiness, anxiety, and sadness), and maternal loneliness. High discrimination metrics were reported for postpartum depression in individual studies, including a multiclass area under the curve of 0.85, a binary area under the curve of 0.871, and an -score of 0.9872. Heart rate variability, GPS-derived mobility, physical activity, and sleep features were most frequently reported as useful, and their interpretation requires perinatal-specific contextualization. Methodological quality was limited, with 80% (12/15) of PROBAST+AI assessment units rated as having high overall quality concern or risk of bias, mainly due to small samples, limited validation, inadequate handling of missing data, and potential overfitting in the analysis domain. Conclusions: Mobile sensing shows preliminary potential for perinatal mental health assessment, but current evidence does not yet support clinical screening or decision-making, and independent external validation in perinatal populations is currently lacking. Progress toward clinical utility requires broader mental health outcome coverage, larger longitudinal cohorts, standardized analytical and reporting practices, adoption of modeling approaches better suited to perinatal trajectories, independent external validation, and human-centered monitoring designs.
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Non-motor correlates of anxiety in de novo Parkinson’s disease: a cross-sectional study with exploratory subgroup analyses
ObjectiveAnxiety is a prevalent early non-motor symptom of Parkinson’s disease (PD), but its clinical correlates remain poorly defined in de novo, drug-naïve patients. This retrospective cross-sectional study enrolled 284 medication-naïve de novo PD patients and 147 age- and sex-matched healthy controls to identify non-motor correlates of anxiety after adjustment for demographic and motor covariates, and explore potential subgroup heterogeneity.MethodsAnxiety was assessed with the Hamilton Anxiety Rating Scale; multivariate logistic regression and prespecified stratified analyses by age, sex, disease duration, Hoehn-Yahr stage and motor severity were performed.ResultsClinically significant anxiety was detected in 44.0% of PD patients versus 8.1% of controls (p < 0.001), with psychic anxiety as the dominant subtype. After multivariate adjustment, higher depressive symptom scores were positively associated with anxiety (OR = 1.386), whereas better sleep quality (OR = 0.965) and intact olfactory identification (OR = 0.815) were negatively associated with anxiety; motor severity showed no significant association after multivariable adjustment. Exploratory subgroup analyses revealed heterogeneous patterns of sleep and olfactory correlates across clinical strata. The three-factor predictive model yielded an overall classification accuracy of 84.81%.ConclusionThese findings indicate that non-motor abnormalities, rather than motor impairment, are associated with anxiety in early PD after adjustment for demographic and motor covariates. The distinct correlative patterns across subgroups provide preliminary clinical clues for the heterogeneous neurodegenerative processes underlying PD-related anxiety, and support routine screening of depressive, sleep and olfactory symptoms to facilitate anxiety risk stratification at initial diagnosis.
Case Report: Rapid resolution of psychogenic cough in an adolescent following bromazepam treatment
BackgroundSomatic cough syndrome, formerly termed psychogenic cough or habit cough, is an under-recognized cause of chronic cough in pediatric populations, characterized by repetitive, dry, and honking cough that is absent during sleep. Behavioral interventions are first-line treatment with high success rates of 80%–90%. However, when access to behavioral therapy is unavailable, alternative pharmacological interventions, particularly benzodiazepines, have received minimal investigation in this population.Case presentationI report a 13-year-old previously healthy male patient with abrupt-onset, near-continuous dry cough occurring every 2 seconds during waking hours. The cough had a distinctive honking quality and disappeared completely during sleep. The patient presented with severe impairment in function, including inability to eat for 3 days, multiple emergency presentations requiring intravenous hydration, and complete school absence. Medical evaluation, including physical examination, laboratory investigations, spirometry, and chest X-ray, was unremarkable. Empirical trials of inhaled bronchodilators and nasal corticosteroids yielded no improvement. Psychiatric assessment excluded psychotic features, depression, obsessive-compulsive disorder, and tic disorder but noted family stressors, including high expressed emotion and overprotective parenting behavior. Based on the sign of sleep-related cough cessation and exclusion of organic pathology, somatic cough syndrome was diagnosed. Given the severity of impairment and family circumstances precluding immediate behavioral therapy, bromazepam 3 mg orally was initiated. Within 24–36 hours, the cough resolved completely. At 3-month follow-up, the patient remained symptom-free without medication. He had returned to school and demonstrated normal eating patterns.ConclusionThis case demonstrates rapid and sustained resolution at 3-month follow-up of severe psychogenic cough following short-term bromazepam treatment in an adolescent. While behavioral therapy is still an evidence-based first-line treatment, this report suggests using benzodiazepines as a pharmacological intervention alternative when behavioral therapy is unavailable. The rapid response and sustained remission at 3-month follow-up are consistent with the hypothesis that benzodiazepines may interrupt the self-perpetuating cycle of anxiety and cough in somatic cough syndrome. Further research is needed for this case in pediatric populations to establish efficacy, safety, and optimal treatment duration.
Relationship between loneliness and self-efficacy: the mediating role of internet addiction and the moderating role of sleep quality
IntroductionThis study aimed to examine the association between loneliness and self-efficacy among adolescents and to investigate whether internet addiction mediated this association and whether sleep quality moderated the direct and indirect pathways. Although previous research has demonstrated significant associations between loneliness and both general and social self-efficacy, the behavioral mechanisms underlying these associations and the conditions under which their strength may vary remain insufficiently understood.MethodsA cross-sectional survey was conducted among 1,323 students in Grades 7–9 from two schools in Baotou, Inner Mongolia, China. Participants completed the UCLA Loneliness Scale, the General Self-Efficacy Scale, the Internet Addiction Diagnostic Questionnaire, and the Athens Insomnia Scale. A moderated mediation model was used to examine the mediating role of internet addiction and the moderating role of sleep quality in the association between loneliness and self-efficacy.ResultsLoneliness was negatively associated with self-efficacy. Internet addiction partially mediated the association between loneliness and self-efficacy. In addition, sleep quality moderated the direct association between loneliness and self-efficacy and the first stage of the indirect pathway from loneliness to internet addiction. Specifically, the associations of loneliness with self-efficacy and internet addiction varied across different levels of sleep quality.DiscussionThese findings provide a more comprehensive understanding of the mechanisms linking loneliness to adolescent self-efficacy by identifying internet addiction as an important behavioral mediator and sleep quality as a moderating factor. The findings highlight the importance of considering problematic Internet use and sleep quality when developing interventions aimed at promoting adolescents’ psychological adjustment, self-efficacy, and well-being.
STAT+: Pharmalittle: We’re reading about Novo plans to expand its pipeline, early Alkermes ADHD data, and more
Hello there and welcome to a new week. STAT reporter Andrew Joseph here in London filling in for Mr. Pharmalot for the day. Before we get to the headlines, an extra dose of encouragement to check out all the great pieces that STAT has to offer today, from Reed Jobs opining on the NIH budget to our new trust-in-science reporter Nick Florko outlining his own experience grappling with, as he puts it, “how frustrating it is to realize that modern medicine does not have all the answers.” Now to those headlines. …
Novo Nordisk is seeking to assure investors that it can regain its momentum in the coming years, outlining plans to expand its pipeline and find new products that it could sell more like consumer goods than traditional medicines, building off what’s occurring with its obesity treatments, STAT shares. At the company’s capital markets day in London, CEO Mike Doustdar said Novo would launch at least five multi-blockbusters by 2030 and deliver revenue growth on par with other major pharma firms. He also presented a strategy that involved investing more in disease areas outside diabetes and obesity and said the company “will be more active within business development,” an acknowledgment of investors’ concerns that Novo was too reliant on its landmark GLP-1 drugs and needed to develop other products.
Drugs called orexin agonists have been hailed for their ability to treat rare sleep disorders, but with new data, Alkermes is showing for the first time that the new class of therapies may benefit people with ADHD, STAT writes. In a randomized Phase 1 study, the company’s new drug, called ALKS 7290, was well tolerated and showed a signal of efficacy. Participants in the study started with a median score of 39 on a diagnostic known as the Adult ADHD Investigator Symptom Rating Scale, indicating that they had moderate to severe symptoms. After two weeks, those taking a high dose of 50 milligrams of ALKS 7290 experienced a 19-point reduction on the scale, indicating that their symptoms had become mild.