Ran Li,1 Jiqin Tang,2 Mengmeng Zhou,1 Bijia Yang,1 Xu Zhang,1 Fujie Jing1 1College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of China; 2College of Continuing Education, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of ChinaCorrespondence: Fujie Jing, College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, 250355, People’s Republic of China, Email 60050018@sdutcm.edu.cnAbstract: The gut-brain axis (GBA), particularly communication between the gut microbiota (GM) and the brain, has become a major focus in neuropsychiatric research because of its role in appetite regulation, energy metabolism, immune function, and behavior. Anorexia nervosa (AN) is a severe eating disorder with high morbidity and mortality, but the contribution of GBA dysfunction to its pathogenesis remains incompletely defined. This review synthesizes evidence linking GM dysbiosis with AN and organizes the current literature around neural, endocrine, immune, and metabolic pathways. It also summarizes altered brain regions and circuits implicated in AN and discusses how peripheral microbial changes may interact with central regulatory systems. Current evidence supports a multidirectional model in which GM alterations, intestinal barrier function, vagal signaling, hypothalamic-pituitary-adrenal (HPA) axis activity, immune activation, microbial metabolites, and neurocircuit dysfunction may reinforce disordered appetite and weight regulation. Microbiota-targeted strategies, including probiotics, prebiotics, fermented foods, dietary modulation, and lifestyle interventions, may offer adjunctive therapeutic potential, but clinical evidence remains preliminary. Future studies should use longitudinal multi-omics designs, mechanistic animal models, and rigorously controlled clinical trials to determine whether microbiome changes are drivers, consequences, or modifiers of AN.Plain Language Summary: Anorexia nervosa is a serious eating disorder that affects both mental and physical health. Growing evidence suggests that microorganisms living in the intestine may communicate with the brain through nerves, hormones, immune signals, and microbial metabolites. This two-way communication is known as the microbiota–gut–brain axis. People with AN often show changes in gut microbial composition, but it remains unclear whether these changes contribute to the illness, result from severe dietary restriction and weight loss, or both. This review summarizes current human and animal evidence and explains how gut microorganisms may interact with appetite, stress responses, inflammation, and brain circuits. It also discusses emerging microbiota-targeted approaches, while emphasizing that current clinical evidence remains limited and these strategies should be considered experimental or adjunctive rather than established treatments.Keywords: anorexia nervosa, gut-brain axis, gut microbiota, eating disorders, public health
Christoph U Correll,1– 6 Ravi Patel,7 Tavneet Singh,8 Kaitlyn McBride,8 Sana Mirza,8 Halley Costantino,8 Pin Xiang7 1Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; 2Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; 3Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, NY, USA; 4Department of Child and Adolescent Psychiatry, Charité – Universitätsmedizin Berlin, Berlin, Germany; 5German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany; 6Einstein Center for Population Diversity (ECPD), Berlin, Germany; 7Health Economics and Outcomes Research (HEOR), Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 8Health Economics and Outcomes Research (HEOR), BluePath Solutions, Los Angeles, CA, USACorrespondence: Sana Mirza, Health Economic and Outcomes Research (HEOR), BluePath Solutions, 1640 S Sepulveda Blvd. Ste. 207, Los Angeles, CA, USA, Email smirza@bluepathsolutions.comPurpose: To estimate the prevalence and burden of proxy-defined experiential negative symptoms and characterize their associated burden among adults with schizophrenia in the US.Methods: Retrospective analyses of the Medical Expenditure Panel Survey (2004– 2022) were conducted to identify adults (≥ 18 years) with schizophrenia. Self-reported experiential negative symptom proxies were defined across three domains: avolition, anhedonia, and asociality using available MEPS survey items. Outcomes included demographic, clinical, and socioeconomic characteristics, healthcare resource utilization (HCRU) and expenditures, as well as humanistic and indirect burdens. Descriptive and comparative analyses were stratified by the presence of negative symptom proxies and weighted to generate nationally representative estimates, with expenditure reported in 2024 US dollars. State-level exploratory analyses examined burden among proxy-positive respondents in states with high schizophrenia prevalence.Results: Among 616,530 weighted participants with schizophrenia (mean age=47.5 years; male=53.2%), 71.3% met criteria for ≥ 1 experiential negative symptom proxy. Compared with individuals without negative symptoms, those with negative symptoms had statistically significantly more overall (3.2 vs 2.0; P< 0.001) and psychiatric (2.1 vs 1.2; P< 0.001) comorbidities, higher unemployment (79% vs 61%; P< 0.001), and greater reliance on Medicaid (65% vs 51%; P< 0.01). Proxy-positive participants also experienced statistically significantly higher healthcare resource and economic burden, including increased hospitalizations (25% vs 14% P< 0.05), emergency department visits (36% vs 20%; P< 0.05), and annual expenditures ($20,038 vs $13,502; P< 0.001), as well as poorer humanistic and functional outcomes (all P< 0.001). Exploratory state-level analyses revealed variation in demographics, healthcare use, and expenditures.Conclusion: Adults with schizophrenia who reported negative symptom proxies experienced greater clinical, socioeconomic, functional, and healthcare burden than those without these symptoms. They also had higher healthcare utilization and expenditures and poorer quality-of-life outcomes. These findings highlight the importance of recognizing negative symptom-related experiences and addressing the broader needs of this high-burden population.Keywords: negative symptoms, schizophrenia, medicaid, medical expenditure panel survey
Yue Ma,1,2 Yonghua Cui,3 Nan Song,4 Hairong Liu,2 Jiajia Gao,2 Hongmei Duan1 1School of Nursing, Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China; 2Department of Nursing, Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital, Beijing, 101300, People’s Republic of China; 3Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Healthy, Beijing, 100101, People’s Republic of China; 4Department of Nursing, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Healthy, Beijing, 100101, People’s Republic of ChinaCorrespondence: Hongmei Duan, School of Nursing, Beijing University of Chinese Medicine, No. 11, Beisanhuan East Road Chaoyang District, Beijing, 100029, People’s Republic of China, Tel +86 10 53912281, Email Duanhongmei66@163.comObjective: This study aimed to examine whether emotional symptoms mediate the association between core symptoms of attention-deficit/hyperactivity disorder (ADHD) and social impairment in children.Methods: In this cross-sectional study, 403 children diagnosed with ADHD were recruited through convenience sampling from the psychiatry and psychology outpatient clinics of a tertiary Grade A hospital in Beijing between January and November 2024. Data were collected using a general demographic questionnaire, the Swanson, Nolan and Pelham, Version IV Scale–Parent Form Parent Rating Scale, the Strengths and Difficulties Questionnaire Emotional Symptoms Subscale (Parent Version), and the Weiss Functional Impairment Rating Scale–Parent Report. After adjustment for relevant covariates, structural equation modeling combined with bootstrapping procedures was applied to evaluate the mediating effect of emotional symptoms.Results: Core behavioral symptoms of ADHD, emotional symptoms, and social impairment demonstrated significant positive correlations (all p < 0.01). Emotional symptoms partially mediated the association between core behavioral symptoms and social impairment. The indirect effect was 0.25 (95% CI: 0.19– 0.33), accounting for 22.69% of the total effect.Conclusion: Emotional symptoms represent a significant mediating factor in the social impairment experienced by children with ADHD, suggesting a pathway linking ADHD symptoms, emotional difficulties, and functional outcomes. These findings contribute to a more precise understanding of whether improvements in behavioral symptoms correspond to functional recovery. The results indicate that clinical nursing practice should extend beyond behavior-focused management to incorporate assessment and intervention addressing both behavioral and emotional symptoms. Integrating structured emotional symptom management into comprehensive nursing care may improve social functioning in children with ADHD.Keywords: attention deficit hyperactivity disorder, children, emotional symptoms, mediating effect, nursing management research, social functioning
