INTRODUCTIONS:Lithium remains the first-line maintenance treatment for bipolar disorder (BD), yet its safety in older-age BD (OABD) is uncertain due to limited large-scale data. OABD patients often experience more severe physical comorbidities compared to younger BD patients, but systematic evidence regarding lithium's association with these conditions is lacking. This study examined the association between lithium use and physical comorbidities across age groups using the international Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset. METHODS:A cross-sectional analysis was conducted using combined Wave 1 and 2 data from GAGE-BD project, encompassing 37 studies from 20 sites worldwide. Participants aged ≥ 18 years with BD were classified according to current lithium use. Physical comorbidities were harmonised into eight organ-system domains. Sociodemographic and clinical variables were compared between individuals receiving lithium treatment and those not prescribed lithium. Generalised linear mixed models adjusted for age, site and lithium × age interaction were applied to evaluate associations with physical comorbidities. RESULTS:Of the 2873 total participants included in the study, 1069 were currently receiving lithium treatment and 1804 were not prescribed lithium. Participants treated with lithium showed a lower overall prevalence of physical comorbidities compared with those not receiving lithium. Regression analyses revealed significant age-by-lithium interactions for cardiovascular (χ2 = 9.27, p = 0.002), respiratory (χ2 = 7.56, p = 0.006), genitourinary (χ2 = 8.66, p = 0.003) and endocrine (χ2 = 16.96, p < 0.001) comorbidities. Model-estimated curve crossings occurred at approximately 43 years (cardiovascular), 32 years (respiratory), 51 years (genitourinary) and 59 years (endocrine), above which predicted prevalence was lower among participants treated with lithium, whereas no differences were observed for gastrointestinal, hepatic, renal or musculoskeletal systems. CONCLUSIONS:Lithium use in OABD was associated with a lower burden of specific physical comorbidities, particularly cardiovascular, respiratory and endocrine conditions. Although prescription bias cannot be excluded, the findings challenge the perception that lithium exacerbates physical health risks in older adults. Instead, they support lithium's continued use-with appropriate monitoring-as a safe and effective treatment option for OABD, and highlight the need for prospective studies to further clarify the relationship between lithium exposure and physical health outcomes.
INTRODUCTION:Delayed catatonia diagnosis may cause preventable harm. The 4-item Catatonia Quick Screen (CQS) allows rapid screening, but its specificity requires evaluation. We assessed CQS sensitivity and specificity using the original Bush Francis Catatonia Rating Scale (BFCRS) cohort. METHODS:Retrospective reanalysis of data from 215 consecutive inpatient psychiatric admissions. CQS classifications were compared against BFCRS, DSM-5-TR, and ICD-11 criteria. 95% confidence intervals (CIs) were calculated via Clopper-Pearson exact methods, treating the eight single-sign patients conservatively as false positives. RESULTS:All 15 catatonia cases screened positive (true positives). The CQS demonstrated 100% sensitivity (95% CI: 78.2% to 100%), 96.0% specificity (95% CI: 92.3% to 98.3%), 65.2% positive predictive value (95% CI: 42.7% to 83.6%), and 100% negative predictive value (95% CI: 98.1% to 100%). CONCLUSION:The CQS showed excellent sensitivity and high specificity in this psychiatric cohort. It serves as a rapid, low-burden screening tool to accelerate clinical recognition, though positive results require formal diagnostic confirmation.
BACKGROUND:Dissociation and childhood trauma are strongly associated with borderline personality disorder (BPD), yet it remains unclear whether this reflects disorder-specific mechanisms or differences in symptom severity within a shared transdiagnostic structure. OBJECTIVE:Using network analysis, we examined whether the conditional dependency architecture linking childhood trauma, dissociation, posttraumatic stress symptoms, and general psychological distress differs between individuals diagnosed with BPD and affective disorders (AD). METHOD:Participants were drawn from a large outpatient clinical sample and matched on age, gender, and global symptom severity (BSI-GSI). Networks were estimated using regularized partial correlation models including CTQ subscales, DES subscales, PTSD symptom clusters, and overall distress. Network Comparison Tests assessed structural invariance and global strength differences between diagnostic groups. RESULTS:As expected, individuals with BPD reported significantly higher levels of childhood trauma and dissociation than those with AD. However, despite these marked differences in severity, the overall network structure did not significantly differ between groups, and global connectivity was comparable. Bridge centrality analyses indicated similar patterns of interconnection across trauma, dissociation, and PTSD domains in both diagnoses. CONCLUSIONS:These findings suggest that BPD is characterized by elevated severity within a largely shared trauma-dissociation architecture, rather than by a qualitatively distinct network configuration. The results support a transdiagnostic model in which childhood trauma and dissociative processes are embedded within a common psychopathological structure, with diagnostic distinctions reflecting differences in magnitude rather than rewiring of interrelations. This severity-versus-architecture distinction has implications for understanding mechanisms of vulnerability and for targeting shared pathways across diagnostic categories.
OBJECTIVES:Age-stratified suicide methods in bipolar disorder remain underexplored. This study compared method selection between suicide decedents with bipolar disorder and the general population. METHODS:We identified 47,488 individuals with bipolar disorder between 2003 and 2023 from Taiwan's nationwide health database and linked mortality records to ascertain suicide deaths. Using a decedent-only design, we compared the distribution of suicide methods between suicide decedents with bipolar disorder and those from the general population. Age-stratified (< 30, 30-49, 50-64, and ≥ 65 years) multivariable logistic regression analyses were performed with adjustment for sex, age at death, urbanization level, and employment status. RESULTS:Among 1452 suicide deaths over 478,729 person-years (incidence: 303.3 per 100,000), the most common methods were hanging (28.0%), charcoal burning and other gas poisoning (20.9%), jumping from a high place (18.0%), drug overdose (16.9%), and drowning (11.4%). Suicide decedents in the bipolar cohort had higher odds of drowning (adjusted odds ratio [aOR]: 1.70, 95% confidence interval [CI]: 1.44-2.00) and jumping from a high place (aOR: 1.31, 95% CI: 1.14-1.50) but lower odds of charcoal burning and other gas poisoning (aOR: 0.69, 95% CI: 0.60-0.79) and hanging (aOR: 0.87, 95% CI: 0.77-0.98) than did general-population decedents (n = 81,159). Age-stratified analyses showed charcoal burning concentrated in younger and middle-aged decedents, drowning consistently elevated across age strata, and jumping elevated in middle-aged and older decedents. CONCLUSION:Individuals with bipolar disorder who die by suicide exhibit distinct, age-dependent patterns of suicide methods. Therefore, prevention strategies should be tailored to both age groups and methods.
BACKGROUND:Obsessive-compulsive disorder (OCD) affects 1%-3% of the population, significantly impairing daily functioning and quality of life. Traditional treatments, including cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), often face implementation challenges. AIM:This scoping review explores the efficacy and effectiveness of the Bergen 4-Day OCD Treatment (B4DT) across various populations and clinical settings. METHOD:A systematic search was conducted for studies published between 2005 and 2025, focusing on the B4DT's outcomes, patient satisfaction, and treatment acceptability. The PCC framework guided the development of the inclusion and exclusion criteria. RESULTS:Twelve studies met the inclusion criteria, demonstrating a reduction in OCD symptoms, high response and remission rates, and strong patient satisfaction. Long-term follow-up indicated durable treatment effects, with minimal relapse. CONCLUSION:The Bergen 4-Day Treatment is a viable frontline option for OCD management, warranting further research to optimize its implementation across diverse healthcare systems. Future studies should focus on enhancing patient adherence and expanding the treatment's applicability.
INTRODUCTION:Understanding the differences in treatment response between subtypes of major depressive disorder (MDD) may help to prevent lengthy trial-and-error processes by identifying effective treatment options. The aim of the study was to investigate the impact of atypical features of MDD (MDD-A) on the response to lithium augmentation (LA). METHODS:In a multicenter prospective cohort study, response to LA was compared between patients with atypical symptoms of MDD (MDD-A, n = 24) versus patients without atypical symptoms (MDD-nA; n = 94) using a Cox regression analysis. RESULTS:A total of 62.5% of patients with MDD-A and 36.2% of patients with MDD-nA responded to LA. Analysis adjusted for age, sex, sufficient lithium serum concentration, and symptom severity at baseline showed a significantly higher probability of patients with atypical symptoms to respond to LA (HR 2.20, p = 0.02). CONCLUSION:This is the first study investigating lithium-response in patients with MDD-A. The MDD-A subtype may help to predict response to LA. TRIAL REGISTRATION:EudraCT number: 2008-004182-26; ClinicalTrials.gov identifier: DRKS00026205.
INTRODUCTION:Postictal agitation (PIA) is an impactful confusional state occasionally occurring after electroconvulsive therapy (ECT). PIA creates dangerous situations for caregivers and patients, prolongs lead times, and sometimes leads to the premature discontinuation of ECT. Despite the impact PIA can have on patients and caregivers, little is known about its incidence and the factors associated with its occurrence. This study aims to investigate putative prognostic factors for PIA. METHODS:We utilized data from the "Rivastigmine for ECT-induced Cognitive Adverse effects in Late-Life depression" (RECALL) prospective cohort study; a study on older adults (≥ 55 years) with a major depressive episode receiving ECT. We investigated several putative prognostic factors based on previous research, biological plausibility, and availability. PIA was defined by either a Richmond Agitation-Sedation score ≥ 2 or the administration of emergency medication specifically for PIA. Mixed-effects logistic regression was used to analyze univariate and adjusted odds ratios for the prognostic factors. RESULTS:We included 142 patients who received 1838 ECT sessions. The incidence of PIA was 34.5% at the patient-level and 9.2% at the session-level. A small subset of older adults (19.7%) accounted for 87.5% of all PIA occurrences. We found that male sex, flumazenil use, and a longer seizure duration were associated with higher odds of developing PIA. Multi-seizure sessions and a higher level of education were associated with lower occurrence of PIA. CONCLUSION:This study identified sex, flumazenil use, seizure duration, the amount of seizures during a session, and education level as prognostic factors for PIA. The pronounced clustering of PIA events within a small subset of patients suggests meaningful interindividual vulnerability, but should be replicated in future studies. If confirmed, these findings could provide actionable insights for preventive treatment strategies. In particular, the use of flumazenil should be critically reconsidered in persons experiencing PIA. TRIAL REGISTRATION:EudraCT 2014-003385-24.
BACKGROUND AND HYPOTHESIS:Recent studies demonstrate that individuals who attend psychiatric services in adolescence, especially inpatient care, have an increased risk of psychotic disorders in adulthood. Given the extensive literature demonstrating a relationship between developmental trauma and psychosis, we investigated whether trauma history would help to identify elevated psychosis risk within a clinical cohort. STUDY DESIGN:The sample consisted of patients admitted to a regional adolescent inpatient psychiatric unit (Oulu, Finland) between April 2001 and March 2006. The Kiddie Schedule for Affective Disorders and Schizophrenia was used to assess history of developmental trauma. Primary analyses investigated childhood sexual and/or physical abuse and secondary analyses investigated other types of traumatic events (car accident, other accident, fire, witness of a disaster, witness of a violent crime, victim of a violent crime, confronted with traumatic news, witness to domestic violence, other). Diagnoses from specialist healthcare were followed up in the national healthcare register until June 2023. Logistic regression was used to assess the relationship between childhood trauma and subsequent schizophrenia-spectrum disorders (SSDs). STUDY RESULTS:Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 14% reported a history of childhood sexual abuse and 27% reported a history of childhood physical abuse. Exposure to childhood sexual or physical abuse was not associated with a subsequently increased risk of SSDs (adjusted OR = 1.05, 95% CI = 0.59-1.83). Similarly, none of the other developmental adversities were associated with a subsequently increased risk of SSDs. CONCLUSIONS:In a clinical cohort made up of non-psychotic adolescent psychiatry inpatients, a group known to be at elevated risk of psychosis, none of the assessed developmental adversities were prognostic factors for subsequent psychotic disorders.
INTRODUCTION:People with severe mental illness (SMIs) are at an increased risk of morbidity and reduced life expectancy. Obstructive sleep apnoea (OSA), a prevalent but underdiagnosed condition in SMIs, may precipitate more physical health complications. This meta-analysis aimed to estimate the prevalence of OSA and assess its risk in SMIs populations. METHODS:We conducted a systematic review and meta-analysis on studies reporting either diagnosis or high risk of OSA in bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD). Databases were searched through January 2026. Pooled prevalence of OSA was calculated through a single-group meta-analysis, while odds ratios (ORs) comparing SMIs and control groups were estimated by a two-group meta-analysis. RESULTS:A total of 47 articles were included in the meta-analysis. The pooled prevalence of OSA in SMIs was 41.2%, largely influenced by clinical and sleep-referral settings, with a 38.3% prevalence in SCZ, 38.2% in MDD and 35.6% in BD. Compared to healthy controls (HCs) without psychiatric diagnosis, participants with SMIs had significantly higher odds of being diagnosed with OSA (OR = 6.96; 95% CI = 2.48, 19.51; k = 2; p-value < 0.001). High risk of OSA was present in 46.7% of SMI individuals. BD participants showed significantly higher excessive daytime sleepiness compared to HCs (SMD = 0.63; 95% CI = 0.28, 0.98; k = 2; p-value < 0.001). CONCLUSION:People with SMIs have a high prevalence of OSA and are at an increased risk of OSA compared to the general population. These findings highlight the considerable burden of OSA in SMIs and support the need for systematic assessment within psychiatric care settings.
Introduction Diabetes, obesity and bipolar disorder often co-occur and may have shared pathophysiology. Glucagon-like peptide 1 receptor agonists (GLP-1RA) treat diabetes and obesity but their impact on bipolar disorder is unknown. In this era of stagnated pharmacotherapy, we examined psychiatric hospitalisation and absence from work due to sick leave as potential measures of relapse in people diagnosed with bipolar disorder who were also prescribed antidiabetic medications, including GLP-1RA.Methods The study cohort was derived from the National Swedish Registers and included all people with a diagnosis of bipolar disorder who used any antidiabetic medication, between the years 2009 and 2024. GLP-1RA individually and as a group were compared with non-use of GLP-1RA, and directly with other second-line antidiabetic medications. A within-individual design was utilised for all comparisons to reduce confounding. The main outcome was psychiatric hospitalisation for any reason, with secondary outcomes being psychiatric hospitalisation after a relapse of bipolar disorder, and sick leave due to psychiatric reasons. Within-individual stratified Cox models with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were used.Results 14,694 people were included in the study, of whom 5200 used GLP-1RA. Semaglutide was associated with a 21% (aHR 0.79, 95% CI 0.69-0.91) lower risk of psychiatric hospitalisation compared with non-use of GLP-1RA in that same individual. Liraglutide and dulaglutide were not specifically associated with a lower hospitalisation risk. Semaglutide was also linked to a 17% (aHR 0.83, 95% CI 0.69-0.99) lower risk of relapse of bipolar disorder. Absences from work due to sick leave were not significantly associated with the specific antidiabetic medications studied.Conclusion In people with both bipolar disorder and diabetes and/or obesity, the use of semaglutide was linked to lower rates of psychiatric hospitalisation compared with time periods when GLP-1RA were not used by that individual. Liraglutide and dulaglutide were not associated with reduced psychiatric hospitalisation, implying this is not a class effect. This finding with semaglutide should be further tested in a randomised controlled trial.
INTRODUCTION:We aimed to investigate the risks of all-cause and cause-specific mortality associated with dose-dependent benzodiazepine and Z-drug (BZDR) use in the Finnish population initiating new BZDR use with five-year follow-up. METHODS:Study subjects were included if BZDR use had started in 2006 with no BZDR dispensing during the preceding years 2004-2005. The information drug dispensing was modeled with PRE2DUP method as time-varying measure updated at every dispensing and then divided into three dose categories which were low dose (< 1.0 Defined Daily Doses [DDDs] per day), medium to high dose (1.0-< 3.0 DDDs/day) and very high-dose (≥ 3.0 DDDs/day). Risk of mortality was studied with Cox regression models. RESULTS:The study included 48,124 incident BZDR users aged 18-65 years (44.4% male). During the 5-year follow-up, 2294 (4.9%) individuals died. Compared to non-use periods, BZDRs use was associated with increased mortality risk (adjusted Hazard Ratio HR 1.28, 95% Confidence Interval CI 1.16-1.41). Compared to the time periods when BZDRs were not used, both medium to high-dose use (aHR 1.58, 1.36-1.74) and very-high-dose use (aHR 2.68, 95% CI 2.20-3.26) were associated with an increased risk of all-cause mortality, whereas low dose use was not. The highest risk estimates were observed during very high-dose use and for potentially preventable deaths such as overdoses (aHR 6.18, 95% CI 3.77-10.12), suicides (aHR 4.46, 95% CI 2.79-7.13), and accidents (aHR 3.77, 95% CI 2.66-5.35). CONCLUSIONS:Persons using BZDRs in very high doses are at a six-fold increased risk of overdose deaths compared to non-use, and those using BZDRs in medium to high doses are at a three-fold increased risk. In low doses, however, the risk of all-cause mortality was not elevated. The mortality risk strongly associates with higher doses and is often characterized by concomitant use of more than one BZDRs at the same time.
INTRODUCTION:Suicidal behaviors are complex phenotypes, often studied in the context of psychiatric comorbidities. However, little is known about the specific roles of psychiatric disorders and the etiology of suicidal behaviors that occur outside the context of psychiatric comorbidities. METHODS:We included 926,040 individuals born 1980-1990 from the Swedish national registries. We conducted separate analyses for suicide attempt (SA) and suicide death (SD) and first tested whether family genetic risk scores (FGRS) for SA and SD differed across individuals with versus without a registration for psychiatric disorders. We then performed Cox proportional hazards models to evaluate the main effects of psychiatric disorders (alcohol use disorder, major depression, anxiety disorders, drug use disorders, attention-deficit/hyperactivity disorder) in risk of SA/SD, and their interaction with genetic liability (FGRS). The interaction was introduced to evaluate potential differential effects of genetic risk in those with versus without a prior psychiatric comorbidity. RESULTS:Only ~30% of individuals registered for SA/SD had a prior psychiatric diagnosis. FGRS for SA/SD was higher in those with prior psychiatric disorders. All psychiatric comorbidities were significantly related to SA (HRs 4.61-9.03) and SD (HRs 8.06-15.90). Interaction analyses indicated that, in those with no prior psychiatric disorder, the effect of genetic liability on SA/SD was higher. CONCLUSIONS:Though psychiatric disorders were associated with increased risk of SA/SD, a substantial proportion of suicidal behaviors occurred outside the context of psychiatric disorders, urging the development of screening and prevention in non-psychiatric populations. Despite their low genetic liability for SA/SD, findings suggest that the effect of genetic risk on SA/SD risk is stronger in those with no psychiatric comorbidity.
OBJECTIVE:For decades, a persistent claim has been that autobiographical memory loss after electroconvulsive therapy (ECT) for depression might actually contribute to ECT efficacy by reducing or even eliminating autobiographical memories. To test this claim, the primary aim of this study is to examine the association between autobiographical memory loss and remission of depression. The hypothesis is that remitted patients have more autobiographical memory loss after ECT compared to non-remitted patients. METHODS:In 71 patients with major depressive disorder undergoing ECT, autobiographical memory consistency (Kopelman Autobiographical Memory Interview) and depression severity (Montgomery-Åsberg Depression Rating Scale) were assessed before and within 1 week after treatment. Logistic regression analyses were conducted to examine the association between both autobiographical memory loss (i.e., memory consistency) and remission (MADRS < 10), including age, episode duration, baseline MADRS score, and treatment condition as covariates. RESULTS:All logistic regression models were significant. The overall autobiographical memory consistency-score (OR = 1.072, 95% CI [1.018-1.130], p = 0.009) and the consistency-score for recent memories (OR = 1.043, 95% CI [1.006-1.082], p = 0.021) were significantly associated with the odds of remission but in the opposite direction of the hypothesis. A higher age and shorter episode duration further increased the likelihood of remission. Additionally, post hoc analyses showed that the trajectories of autobiographical memory performance over time differed between remitters and non-remitters, indicating a slight decrease in autobiographical memories for more recent events in non-remitters and no change in remitters. CONCLUSIONS:This study shows that, contrary to the hypothesis, remitted patients have less autobiographical memory loss, particularly for recent memories than non-remitters. This refutes the premise that the loss of autobiographical memories contributes to the therapeutic effectiveness of ECT.
INTRODUCTION:Psychotic depression (PD) is a severe form of depression that can occur in both major depressive disorder (MDD) and bipolar disorder (BD). Although relatively prevalent, the prognostic impact of psychotic symptoms in depression remains controversial. OBJECTIVE:To systematically review the available evidence comparing PD and non-psychotic depression (NPD) in terms of clinical course, functional outcomes, and treatment outcomes. METHODS:A systematic search of electronic databases (PubMed, Cochrane Library and Web of Science) following PRISMA guidelines was conducted from inception to 31st January 2025 to integrate current evidence about the impact of psychotic symptoms in both unipolar and bipolar depressed patients. This study was registered in PROSPERO (CRD42024563172). RESULTS:Fourty-one studies met inclusion criteria. Compared to NPD, PD was associated with greater clinical severity, longer hospitalizations, and higher inpatient treatment rates. Several studies showed lower remission rates and greater chronicity in PD. Relapse, readmission, or shorter time to recurrence were also more common in PD. Evidence indicated a higher risk of suicide and poorer functional outcomes in PD. Treatment patterns showed more frequent use of ECT and pharmacological combinations in PD, although no consistent drug-specific differences emerged. Overall, heterogeneity across designs and outcome measures was substantial. CONCLUSIONS:Despite heterogeneity, evidence across 41 studies indicates that PD is a higher-risk depressive subtype, characterized by greater service use, higher relapse liability, lower sustained remission, increased suicidality, and poorer functioning. These findings support the need for intensified assessment and management and highlight the importance of large, standardized prospective studies, especially in BD.
INTRODUCTION:There is evidence that electroconvulsive therapy (ECT) can augment the effects of antipsychotics in schizophrenia. However, there is limited evidence from Western populations on whether ECT reduces the risk of relapse compared to non-ECT treatment in schizophrenia. This study aimed to compare time to psychiatric readmission or suicide among inpatients with schizophrenia treated with or without ECT, as well as those receiving index series with or without continuation ECT (C-ECT). METHODS:Register-based study utilizing data from Swedish nationwide registers. Patients with schizophrenia who received both inpatient ECT and non-ECT treatment between 2011 and 2020 were included. Each patient served as their own control, contributing one admission with and without ECT. Admissions with or without ECT, as well as index series with or without C-ECT, were compared in univariate Cox regression analyses regarding time to psychiatric readmission or suicide within 30 days, 90 days, 180 days, and 1 year from discharge. RESULTS:A total of 351 patients were included. Of these patients, 64.1% were male and the mean (SD) age was 48.2 (14.4) years. ECT was associated with longer time to readmission or suicide compared to non-ECT treatment within 30 days (HR: 0.66; 95% CI: 0.50-0.87; p = 0.003), 90 days (HR: 0.70; 95% CI: 0.56-0.87; p = 0.001), 180 days (HR: 0.68; 95% CI: 0.56-0.82; p = < 0.001), and 1 year from discharge (HR: 0.77; 95% CI: 0.65-0.91; p = 0.003). Furthermore, 15 patients received C-ECT, which was associated with longer time to readmission or suicide compared to index series without C-ECT within 90 days (HR: 0.13; 95% CI: 0.02-0.91; p = 0.040) and 180 days from discharge (HR: 0.26; 95% CI: 0.08-0.81; p = 0.021). CONCLUSION:This study suggests that ECT can be associated with a longer time to relapse compared to non-ECT treatment in schizophrenia.
INTRODUCTION:Individuals with mental illness have a markedly reduced life expectancy, partly due to a significantly increased risk of developing type 2 diabetes, driven by lifestyle factors and the adverse metabolic effects of psychotropic medications. This study examined whether abnormal laboratory values indicating incident diabetes, when ordered within psychiatric services, were followed by documented interventions. METHODS:We used electronic health record data from the Psychiatric Services of the Central Denmark Region and drew a random sample of patients with incident diabetes detected between 2019 and 2024. Incident diabetes was defined by the first laboratory value ordered by the psychiatric services indicating diabetes: glycated haemoglobin ≥ 48 mmol/mol, fasting plasma glucose ≥ 7.0 mmol/L, plasma glucose ≥ 11.1 mmol/L during a 2-h oral glucose tolerance test or random plasma glucose. Patients with pre-existing diabetes, identified through ICD-10 codes or antidiabetic medication history, were excluded. Manual chart review assessed whether incident diabetes was followed, within 3 months, by documented clinical intervention (such as referral, repeat testing, or medication initiation), or was merely acknowledged without further action. Descriptive statistics and adjusted logistic regression analysis were used to characterise the cohort and examine characteristics associated with lack of intervention. RESULTS:Among 416 patients with incident diabetes (57% male, median age 48 years [IQR: 35-59], 33% with schizophrenia or other psychotic disorders), only 37% received a clinical intervention. The most frequent intervention was referral to a general practitioner (27%), while antidiabetic medication was initiated in only 6% of those who received an intervention. The only characteristic associated with lack of clinical intervention was body mass index < 25 kg/m2 (adjusted odds ratio 3.82, 95% CI: 1.92-8.20). CONCLUSION:This study suggests that appropriate clinical intervention following detection of incident diabetes is lacking. This may inform future strategies to reduce metabolic and cardiovascular risks among individuals with mental illness.
INTRODUCTION:Major depressive disorder (MDD) affects 11%-19% of adolescents globally. Early treatment is vital, but the risk of relapse is high, with 46% relapse within 5 years, which threatens a chronic course. Hence, better solutions are needed. Repetitive transcranial magnetic stimulation (rTMS) is effective in adults, but its use in adolescents is limited. While studies-including trials and meta-analyses-exist, their generalizability is unclear. This review evaluates rTMS's efficacy and safety for adolescent MDD. METHODS:Following PRISMA guidelines, a comprehensive literature review was conducted using English-language databases Embase, PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews. We included studies published up to February 2025. Data were pooled to calculate standardized mean change (SMC), proportions, log odds ratios, and their respective 95% confidence intervals (CI), measuring effectiveness, response rate, and suicidality. We systematically described adverse effects. RESULTS:We identified 687 studies, 42 underwent full-text assessment, and 19 were included. The within-intervention group pooled SMC between pre-post scores of depression severity was -2.15 (95% CI [-2.58, -1.73]), indicating a strong effect but with high heterogeneity (I 2 = 87.13%). For RCT-only studies, the pooled SMC was -0.90 (95% CI [-1.90, 0.11]), showing a smaller effect. The pooled response rate was 54% (95% CI [42%; 66%]) with similarly high heterogeneity (I 2 = 82.25%). A large reduction in suicidal ideation was observed (pooled SMC = -2.78, 95% CI [-5.98, 0.42]), albeit this was based on a limited number of studies (n = 3) and the SMC was not statistically significant. Mild and transient adverse effects were reported. The majority of studies were rated as having a high risk of bias. CONCLUSION:Our findings demonstrated that rTMS is effective, safe, and well-tolerated by adolescents with MDD. However, high heterogeneity of methods, bias, and inclusion of uncontrolled trials demand more rigorous trials, whereby adaptive designs could potentially increase the empirical availability.
