Cognitive impairment is a core feature in schizophrenia spectrum disorders, strongly associated with daily functioning, and remains difficult to treat. This study aimed to investigate changes in cognitive function following an exercise intervention in individuals with schizophrenia spectrum disorders. Data were derived from a single-arm intervention study conducted across 16 outpatient units in Sweden. The intervention consisted of one circuit training session per week, incorporating both aerobic and muscle-strengthening exercises. Cognitive function was assessed before and after the six-month-long intervention using the Cogstate Schizophrenia Battery (n = 90) and the Trail Making Test (n = 125). Analyses included within-person change summaries, t-tests, effect sizes and regression models. In the Cogstate Schizophrenia Battery, the most prominent changes were an improvement in executive function and declines in psychomotor function and the psychomotor/attention composite. Improvements were observed in both Trail Making Test domains: processing speed/attention and executive function. Greater improvement in VO2max was associated with greater improvement in processing speed/attention in the Trail Making Test. These findings suggest that physical exercise may be associated with modest improvements in some aspects of cognitive performance in individuals with SSD, particularly in executive function.
Background Depressive disorder (DD) is associated with attentional dysfunction, but objective measures of altered visual-attention processing remain limited. We characterized eye-tracking patterns during visual search and evaluated their potential adjunctive diagnostic value. Methods 42 patients with DD and 43 healthy controls (HC) performed a visual-search task with eye tracking. Forty-two features derived from six areas of interest (AOIs) and seven eye-tracking metrics were compared using false-discovery-rate (FDR) correction. Associations with scores on the 24-item Hamilton Depression Rating Scale (HAMD-24) were examined within the DD group. Predictive performance was evaluated using repeated stratified nested five-fold cross-validation. Results The final sample included 40 DD and 43 HC participants. The DD group showed longer reaction times than HC(median, 1546.73 vs 1241.52; P=0.004), whereas participant-level accuracy did not differ significantly (median, 1.00 vs 0.99; P=0.775). Twenty-five eye-tracking features showed FDR-corrected between-group differences, but none was significantly associated with HAMD-24 scores after correction. Four features were selected in at least 80% of the 50 outer-training models: fixation count in AOI-C, gaze duration in AOI-E, fixation count in AOI-D, and saccadic amplitude in AOI-D. Across ten repetitions, the mean out-of-fold AUC was 0.990 (SD=0.007; range, 0.971-0.995), with mean accuracy of 95.7%, sensitivity of 94.4%, specificity of 96.9%, and a Brier score of 0.052. The ensemble AUC based on averaged out-of-fold probabilities was 0.996 (95% CI, 0.988-1.000). Conclusions DD was associated with distinct visual-attention and eye-movement patterns. Eye-tracking features may represent candidate markers with potential adjunctive diagnostic value, but external validation in larger independent cohorts is required.
Mental disorders are highly prevalent and impose substantial burdens on individual well-being, daily functioning, and society; yet early diagnosis, risk identification, subtyping, and effective treatment remain major clinical challenges. Precision psychiatry has emerged to mitigate these challenges and aims to deliver “the right treatment to the right patient at the right time”. The translation of precision psychiatry into practice, however, is still limited. Here, we propose that progress towards precision psychiatry depends on addressing four interdependent and interdisciplinary challenges: moving from (i) diagnostic categories to transdiagnostic mechanisms, (ii) homogeneous groups to individual heterogeneity, (iii) only behavioral symptoms to complementary biological markers, and (iv) a cross-sectional to a longitudinal research focus. Importantly, these challenges are not independent, but can rather be organized as a cascading framework of interdependent components that together define the requirements for more personalized mental health care. For each level of this cascade, we review methodological promises and critically evaluate their strengths and limitations in relation to the conceptual framework. In doing so, we delineate why their clinical impact remains limited by identifying key methodological gaps that must be addressed to meet the requirements of the highest level of the cascade and to achieve fully personalized care. Finally, we synthesize all insights into a concrete proposal for moving forward, which calls for a conceptual shift from a diagnosis-centered perspective to a health-centered one, focused on individual mental health trajectories. Ultimately, implementing such individualized, health-centered approaches at the highest level of the cascade might make diagnosis and treatment more globally accessible, thereby improving the well-being of individuals across diverse populations and clinical settings.
Introduction Research suggests that gender and sexual minorities report elevated rates of psychiatric disorders, but the clinical correlates of sexual and gender minority status are often lacking or seem contradictory. Existing literature on sexual minorities indicates no significant difference in hair pulling severity between heterosexual and sexual minority individuals, but it does indicate greater severity of skin picking behaviors on some metrics in sexual minorities. No study, however, has examined hair pulling and skin picking in gender minorities. Methods Participants who self-reported hair pulling and skin picking behaviors completed an online survey. Descriptive statistics were derived to determine prevalence of gender and sexual minorities. For each gender minority participant, two cisgender sexual minority participants and two cisgender heterosexual participants were matched on age, sex assigned at birth, and behavior (hair pulling, skin picking, or both). The final sample (mean age = 26.2, SD = 5.2) consisted of 33 gender minority participants, 66 cisgender sexual minority participants, and 66 cisgender heterosexual participants. All participants were assigned female at birth. All three groups were compared on demographics, pulling and picking characteristics, and comorbidities. Results In the overall survey, 9.0% were gender minorities and 34.8% were cisgender sexual minorities. In the final sample, gender minority participants picked their skin for more days over the past week than cisgender heterosexual participants. Gender minority participants also began picking at a younger age than cisgender heterosexual participants. There were no significant differences in any pulling variables between gender minority and cisgender heterosexual participants. There were no significant differences in pulling or picking variables between cisgender sexual minorities and gender minorities or between cisgender sexual minorities and cisgender heterosexual participants. Conclusions There may be greater representation of gender and sexual minorities in people who engage in excessive hair pulling and skin picking. Moreover, gender and sexual minority status may be associated with more severe picking and an earlier onset of picking behavior.
The duration of untreated eating disorder (DUED), defined as the time between the onset of clinically significant symptoms and the initiation of appropriate treatment, may influence prognosis and treatment outcomes in eating disorders (EDs).To update the evidence on DUED and its association with clinical outcomes in individuals with EDs. A systematic review was conducted according to PRISMA guidelines, with protocol registration in PROSPERO. PubMed/MEDLINE, Embase, and PsycINFO were searched for studies published between January 1, 2020, and July 20, 2025. Eligible studies included original research assessing DUED in individuals diagnosed with EDs. Two independent reviewers performed study selection and data extraction. Findings were synthesized descriptively and compared narratively across studies. Of 753 records identified, 11 studies met inclusion criteria (7 interventional and 4 non-interventional). Combined with 14 studies from the previous review, 25 studies involving 21,270 patients were analyzed. Most participants were female and diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN). Significant heterogeneity was found in the definition and measurement of DUED. Longer DUED was associated with greater illness severity, lower motivation, poorer treatment response, and worse long-term outcomes, particularly in AN. Early intervention models such as First Episode Rapid Early Intervention for Eating Disorders (FREED) were associated with shorter DUED, reduced waiting times, and improved eating disorder psychopathology. Longer DUED is linked to poorer outcomes, especially in AN. Early intervention strategies such as FREED may improve prognosis, although delayed access to treatment remains a major barrier.
Objectives Describe the prevalence of opioid misuse among patients with psychiatric conditions in the All of Us (AOU) Research Program, its association with social determinants of health (SDOH), and psychiatric comorbidities. Methods This observational, retrospective analysis of participants with common psychiatric conditions used survey and medical record data from AOU. Pearson correlation and ordinal logistic regression were used to examine associations between SDOHs and opioid misuse. Results The study included a total of 49,964 participants who were predominantly white (79.6%), female (71.2%), and with an average age of 57.5 years; most had depression (77.8%). Final logistic regression identified significant predictors of opioid misuse: bipolar disorder (OR = 1.71, 95% CI 1.57–1.86), PTSD (OR = 1.47, 95% CI 1.38–1.57), depression (OR = 1.33, 95% CI 1.23–1.44), anxiety (OR = 1.19, 95% CI 1.12–1.27), white (OR = 1.47, 95% CI 1.34–1.61), food insecurity (OR = 1.45, 95% CI 1.35–1.57), perceived neighborhood disorder (PND) (OR = 1.02, 95% CI 1.01–1.02), and male (OR = 1.43, 95% CI 1.34–1.52)(p < 0.001 for all). Higher education (OR = 0.84, 95% CI 0.82–0.87, p < 0.001) and income (OR = 0.97, 95% CI 0.95–0.98, p < 0.001) were associated with lower opioid misuse. Conclusion In addition to common psychiatric conditions, food insecurity and PND were associated with opioid misuse, highlighting the need for integrated prevention strategies, early intervention, and targeted opioid misuse screening.
The COVID-19 pandemic introduced widespread stressors that adversely affected maternal mental health and increased substance use risk. This study compared prenatal substance use risk before and during the COVID-19 pandemic and examined whether COVID-19 moderated the association between maternal internalizing symptoms and prenatal substance use. Data were drawn from two community samples of pregnant women in Eastern Washington and North Idaho, as well as through online recruitment methods, collected before and during the later stages of the pandemic. Participants completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI). After controlling for demographic factors, multivariate analyses of covariance revealed significantly higher overall ASSIST scores and those for risk of tobacco, alcohol, and cannabis use in the COVID-19 exposed compared to the pre-pandemic sample. Hierarchical regression analyses indicated that COVID-19 exposure moderated the association between maternal depressive symptoms and tobacco use risk, insofar as more severe depression was associated with elevated tobacco use risk among women exposed to the pandemic. Findings suggest that the pandemic context amplified substance use vulnerability among pregnant women, particularly those with elevated depressive symptoms. These results underscore the need for enhanced screening and support for maternal mental health and substance use during future public health crises to mitigate risks to both maternal and fetal well-being.
The persistence of physical symptoms, such as pain, fatigue, and dizziness, has been linked to altered interoception, but the mechanisms remain unclear. This study used a novel psychophysical heart rate discrimination task and self-report measures of interoceptive sensibility and awareness to investigate interoceptive deficits in patients with somatic symptom disorder (SSD) and healthy controls from a predictive processing perspective. Both groups underestimated their heart rate, with no differences on sensory precision and discriminability. Patients with SSD reported lower decision confidence and showed higher between-person variation in interoceptive bias, either under- or overestimating their heart rate. Self-report data revealed reductions on regulatory and trusting facets of interoceptive sensibility, related to symptom reporting. Through a predictive processing lens, the pattern found is consistent with heterogeneous priors combined with higher-level cognitive “immunization” that resists disconfirmatory evidence. This study highlights the need for a broader understanding of interoception in persistent physical symptoms, integrating both higher-order and lower-order interoceptive mechanisms.
Introduction While traumatic experiences are an established risk factor for developing distressing voices, relatively little is known about the nature of the relationship between the two. Cognitive mechanisms and dissociation may explain why some traumatised people develop voice hearing, while others do not. This study investigated whether voice hearing patients differ in their experience of childhood maltreatment, transitional states operationalised as schema modes and dissociative experiences. It was hypothesised that voice hearing patients would report the highest levels of childhood maltreatment, maladaptive schema modes, and dissociation, with non-voice hearing patients showing intermediate scores. Methods In this cross-sectional online questionnaire study, three groups were assessed: transdiagnostic voice hearing patients (n=56), transdiagnostic non-voice hearing patients (n=66) and non-help seeking (non-patient, non-voice hearing) controls (n=61). The Childhood Trauma Questionnaire, Dissociative Experiences Scale, and the Schema Mode Inventory were administered. Results Total childhood maltreatment scores were significantly higher in voice hearing patients compared to non-voice hearing patients and non-help seeking controls; non-voice hearing patients scored higher than controls. A similar pattern was observed for dissociation and dysfunctional schema modes. Conclusions The findings confirm the role of childhood maltreatment in developing voice hearing. In addition, the study emphasizes the relevance of dissociation and schema modes for voice hearing, and marks these as potential mechanisms in the maltreatment-voice hearing relationship. These results contribute to a better understanding of voice hearing and suggest that screening for trauma, dissociation, and schema modes may be important targets for treatment and early intervention efforts.
Background Adequate financial performance is essential. Problems in this area can contribute to serious financial problems. People with psychosis show difficulties with financial performance, which can be affected by contextual factors such as financial scarcity and substance use. Prior research mainly relied on standardized tests, which capture performance under structured, optimal conditions, not necessarily in everyday life. Additionally, evidence for people in the recent-onset phase of psychosis (ROP) is lacking. This study aims to provide a detailed exploration of self-reported everyday financial performance in people with ROP, to exploratively re-evaluate this performance one-year later, and to examine associations with financial scarcity and substance use. Method Thirty-five people with ROP and 39 matched controls completed questionnaires on financial performance, financial scarcity, and substance use. Financial performance was reassessed after one year in the ROP group (n = 23). Results People with ROP reported poorer financial performance than controls (p < .001; d = 1.32); a self-evaluation that appeared similar one year later (p = .65; d = .18). They also reported greater financial scarcity (p < .001; d = −1.61) and more substance use-related problems (p < .001; d = .44). Financial scarcity was significantly associated with financial performance in controls, not in people with ROP. No significant associations were found with substance use. Conclusions Self-reported difficulties in financial performance and financial scarcity can already emerge in the early stages of psychosis. Addressing daily-life financial functioning in mental healthcare is essential to support timely recognition of potential financial problems and referral to targeted interventions.
Background Students with disabilities represent an underserved population in public-health and higher education, yet little is known about their risk for substance use. Objective To examine the relationship between disability status and substance use severity among a national sample of U.S. college students. Methods Data were drawn from the American College Health Association's National College Health Assessment (ACHA-NCHA) III surveys administered between Fall 2019 and Spring 2025 (n = 640,806). The primary exposure was self-reported disability type. The primary outcome was high-risk substance-specific involvement score (SSIS), calculated using the ASSIST tool. Multivariable logistic regression models were used to estimate adjusted odds of high SSIS by disability type, number of disabilities, and multiple disability categories. Models adjusted for demographic and health-related covariates including psychological distress. Results Most disabilities were associated with significantly increased odds of high SSIS. ADHD (aOR = 1.85), speech/language disorders (aOR = 1.56), learning disabilities (aOR = 1.32), and sensory disabilities (aOR = 1.31) were among the strongest predictors. Autism showed a protective association overall (aOR = 0.85), with lower odds of high-risk tobacco use, and no significant differences for alcohol or cannabis. Odds increased with the number of disabilities reported. Several disability combinations, such as sensory disabilities combined with speech/language disorders, were associated with especially high SSIS (aOR = 2.59). Conclusions Disability status, particularly ADHD, speech/language disorders, sensory impairments, and multiple disability categories, is associated with elevated high-risk substance use among students. This highlights the need for inclusive, disability-informed prevention and intervention strategies in campus health programs.
Background: Pregnancy and the postpartum period involve substantial neurobiological and psychological changes. Although subjective complaints such as forgetfulness and mental fatigue are common, empirical evidence regarding objective cognitive changes remains inconsistent. This study aimed to longitudinally characterize cognitive trajectories from early pregnancy through the postpartum period in healthy women. Methods: We conducted a prospective, longitudinal cohort study (2018-2024). Fifty healthy women underwent four consecutive neuropsychological assessments: once during each trimester of pregnancy and one month after partum. The neuropsychological assessment evaluated memory, attention, processing speed, and executive functions. Participants also completed self-reported measures of fatigue, emotional status, and quality of life. Repeated-measures analyses were employed to account for intra-individual variability. Results: Working memory improved significantly during the second trimester (p = .013) and postpartum (p = .006) compared to the first trimester. Processing speed showed a transient decline during pregnancy but improved significantly postpartum (p = .020). Executive functions, specifically cognitive flexibility (p = .032) and verbal fluency (p = .032), showed a statistically significant improvement after delivery. Learning capability, long-term memory, and attention span remained stable throughout the study. Interestingly, despite increased self-reported postpartum fatigue (p = .031), no negative effect on cognitive performance was observed. Conclusions: Our findings suggest that the transition to motherhood is characterized by selective cognitive enhancement, particularly in executive functioning and working memory, rather than generalized decline. These fluctuations likely reflect adaptive neuroplastic processes. Although subjective fatigue is prevalent postpartum, it does not appear to translate into objective cognitive impairment.
Background: Despite advances in pharmacological and psychological treatments, many individuals with schizo phrenia spectrum disorders (SSD) experience persistent symptoms and functional impairments. Yoga-bared in terventions ghow promise for improving symptoms and quality of life, yet robust evidence from randomized controlled trials (RCTs) is limited. Previous studies often use inactive controls, lack dose definitions, information on concurrent treatments, and blinded ratings. Study design In a single-center, rater-blinded RCT building on a prior feasibility study, inpatients with SSD were randomized to guideline-concordant treatment as usual (TAU) or yoga-based group intervention (YoGl) in addition to TAU. YOGI was delivered over four weeks in a structured group format. Outcomes included blinded rater-based symptom severity, mindfulness, quality of life, and functioning. Medication use and adverse events were monitded. Results: Eighly participants were randomized (YOGI + TAU: 39; TAU: n = 41 ) Dropout was low (59%). Within group analyses in YoGI TAU showed improvements across most domainz (d = 0.31 - 0.66) , including the primary outqome poritive symptoms (d = - 0.5) Between-group comparisons significant difference for positive symptoms 03), but a significant improvement in social functioning (505). Conclusions: This trial extends prior feasibility work, showing YoGI can be implemented safely and acceptably for inpatients with SSD. Significant between-group improvement was observed only in social functioning, possibly reflecting the effects of concurrent multimodal TAU. Consistent within-group improvements suggest clinical benefits of YBGI. Further trials are warranted to optimize dosing, confirm efficacy, and explore sustainability and mechanisms of action.
This cross-sectional study investigated whether metacognitive beliefs and automatic thoughts differ between adolescents with autogenous and reactive subtypes of obsessive-compulsive disorder (OCD) and healthy controls. Between December 2023 and June 2024, 66 adolescents aged 12-18 years with OCD were recruited from the Child and Adolescent Psychiatry Outpatient Clinic of Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital, Turkey, along with 32 matched healthy controls. Participants were classified into autogenous (n = 32) and reactive (n = 34) subtypes using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), which carries methodological constraints in capturing autogenous content. All participants completed the Metacognitions Questionnaire for Children and Adolescents (MCQ-C) and the Children's Automatic Thoughts Scale (CATS). Adolescents with OCD demonstrated significantly higher negative metacognitive beliefs and automatic thoughts than controls, except for positive metacognitive beliefs. No significant differences emerged between subgroups on any metacognitive dimension or automatic thought scores, indicating that the primary hypothesis of subtype differentiation was largely unsupported. The only content-specific finding was that the autogenous group scored significantly higher than controls on the CATS physical threat subscale (epsilon 2 = 0.07). Correlational analyses indicated that in the autogenous group, obsession severity was strongly associated with both negative metacognitive beliefs and automatic thoughts, whereas in the reactive group, compulsion severity showed a modest association with metacognitive beliefs. These findings suggest that adolescent OCD is characterized by shared cognitive and metacognitive mechanisms across subtypes.Instrument limitations, developmental variability within 12-18 age range, and the cross-sectional design should be considered when interpreting these results.
Background Large language models (LLMs) are increasingly used in mental health contexts, yet their ability to respond safely to suicide-related risk in dynamic interactions remains unclear, and clinically grounded evaluation frameworks are limited. Methods We developed a clinically informed framework based on crisis intervention principles, encompassing connection and listening, suicide risk assessment, and coping strategy exploration. Using a simulation-based design, an AI agent enacted a help-seeking individual across four scenarios with explicit and culturally embedded suicide risk indicators. Three widely used LLMs were evaluated in repeated multi-turn interactions. Responses were coded using binary criteria by three trained raters (intraclass correlation coefficient = 0.78). Results All models demonstrated strong relational engagement, including empathy and active listening. However, suicide risk assessment was inconsistent and often inadequate. Earlier models rarely initiated direct inquiry about suicidal ideation, while newer models showed improvement but lacked consistency. Detection of culturally embedded risk cues remained limited across all models. Coping-related responses were common but generally unstructured and lacked key elements of evidence-based safety planning. Performance was stronger for explicit than for indirect or culturally embedded risk signals. Conclusions LLMs can generate empathetic responses but show critical deficiencies in systematic risk assessment and structured intervention. The proposed framework offers a clinically grounded, transferable approach for evaluating AI safety in high-risk mental health contexts and informing responsible development and governance.
Background The Food Cravings Questionnaire (FCQ-S) is a widely used multidimensional instrument for the measurement of an individual’s craving for different types of food. The aim of this study was to examine the psychometric properties of a novel Arabic translation of the state version of the FCQ-S. Methods Data for this cross-sectional study was collected via a Google Form link, between February and March 2023. A sample of 515 Lebanese adults completed the FCQ-S, as well as previously validated measures of psychological distress and well-being. Results The confirmatory factor analysis supported the five-dimensional model of FCQ-S scores, with all 15 items retained. Scores achieved scalar invariance across gender. FCQ-S scores were found to have adequate composite reliability and adequate patterns of convergent and criterion-related validity. Additionally, higher state food cravings were associated with greater psychological distress and lower well-being. Conclusion These results suggest that the Arabic FCQ-S is a psychometrically valid tool for the assessment of state food cravings. The availability of the Arabic FCQ-S should facilitate the understanding of the effectiveness of existing interventions designed to regulate state food cravings among Arabic-speaking communities especially since they play an important role in the emergence as well as persistence of eating- and weight-related disorders.
Background Consultation liaison psychiatry (CLP) remains a minimally researched area in sub-Saharan Africa. This study examined the profiles of patients referred for psychiatric consultation at the University Teaching Hospital Kigali (CHUK), Rwanda. Methods All adult patients who were referred or consulted for psychiatry evaluation between September to December 2024 were included, and descriptive analysis was conducted. Further in-depth individual interview of non-mental health specialists was employed. Result A total of 53 adult patients were received from other non-mental health departments. The median age was 38 years (IQR: 27-49), and the patients were predominantly female (n=36, 68%). Internal Medicine was the most frequent source of consultation, accounting for 32.7% (n=17) of referrals. From the outpatient consultation, the most common psychiatric diagnosis was somatic symptom disorder (n=13, 34.2%), followed by major depressive disorder (n=10, 26.3%). Among inpatients, delirium was the most common psychiatric diagnosis (7/15). Most of the patients were managed by either psychotherapy (n=19, 35.8%), or psychotherapy plus psychotropic medication (n=18, 34%). In-depth individual interviews with seven non-mental health specialists revealed general satisfaction with the CLP service of the hospital, with further room to improve the service by continuity of care and integrated communication. Conclusion The profile of patients referred for CLP service at CHUK closely resembles researches from other Sub-Saharan countries, with predominance of depression and delirium diagnoses. Providing multidisciplinary care for patients with comorbid medical and psychiatric conditions is essential for achieving improved health outcomes.
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a high risk of adverse events (AEs) and unplanned hospital encounters (UHEs) but the impact of pre-existing depression and/or anxiety is unknown. We aimed to examine this association. Methods: We analyzed multi-centre prospective data on adults undergoing ERCP to examine associations between pre-existing anxiety and/or depression and post-ERCP UHEs (any emergency department visit or unplanned admission) within 30 days, separately for reasons related to AEs and for reasons not meeting criteria AEs. We conducted multivariable logistic regressions to examine associations including relevant covariates. Results: The cohort included 6648 patients, with 11.8% having pre-existing depression and/or anxiety. The group with depression and/or anxiety was significantly younger, had higher rates of opioid and cannabis use, and had a greater proportion of females. There were no statistically significant differences in non-AE-related UHEs in patients with and without depression/anxiety (5.0% vs 4.1%, respectively, p = 0.26), or AEs (7.4% vs 7.7%, respectively, p = 0.75). There was no association between depression/anxiety and non-AE UHEs on multivariable modelling (adjusted odds ratio, OR, 1.27, 95% CI 0.86-1.89), including on sub-analysis of UHEs to somatic symptoms only (OR 0.85, 95% CI 0.47-1.53). Similarly, no association was found between depression/anxiety and AEs (OR 0.85, 95% CI 0.61-1.17). Conclusions: We found no statistically significant associations between pre-existing depression and/or anxiety and ERCP outcomes. Further research is needed investigate diagnostic classes and symptom severity along with other factors that could impact outcomes.
Background: Problematic internet use (PIU) has a higher prevalence in people with obsessive-compulsive disorder (OCD) than the general population. However, the nature of the relationship between OCD and PIU and its clinical significance is less well-understood. Methods: 76 adult participants recruited from the community screened positive for OCD in a self-report online survey (mean age = 35.2, SD = 12.3, female = 46.7%). Age matched-controls (n = 76) were pulled from the same survey. All participants reported on demographic variables and lifetime comorbidities. Participants completed the Obsessive Compulsive Inventory-Revised (OCI-R), Internet Severity and Activities Addiction Questionnaire (ISAAQ), and the Barratt Impulsiveness Scale - Short Form (BIS-15). They were also asked a variety of exploratory questions related to internet use. Results: 26.3% (n = 20) of participants with probable OCD met criteria for PIU while 14.5% of participants without OCD (n = 11) met criteria. Participants with probable OCD had significantly higher ISAAQ total scores than those without OCD. The OCI-R Hoarding and Obsessing subscales were positively correlated with the ISAAQ total score. Participants with probable OCD were significantly more likely to endorse lashing out online at others than those without OCD. Among participants with probable OCD, those with comorbid PIU had significantly higher BIS-15 total scores. Discussion: This study corroborates prior research that found a link between OCD, OCD symptom severity, and PIU, particularly in obsessions and hoarding symptoms. It also suggests that perhaps impulsivity is one underlying cognitive commonality in a subset of those with OCD and PIU.
Background Threat/control-override (TCO) delusional experiences have been linked to aggression in schizophrenia and may also shape threat-related social-cognitive processing. We compared facial emotion recognition and stimulus-based emotional attribution in patients with schizophrenia and healthy controls, and tested whether TCO symptoms were associated with task performance, aggression, and insight. Methods Thirty male inpatients meeting DSM-5 criteria for schizophrenia and fifteen healthy controls completed a computerized task assessing recognition of five facial expressions (happiness, anger, disgust, fear, neutral) and attribution of the identified emotion’s likely cause (forced choice between a neutral vs emotion-congruent context picture). TCO symptoms were assessed with the Threat/Control-Override Questionnaire (TCOQ), aggression with the Buss-Perry Aggression Questionnaire (BPAQ), and insight with the Birchwood Insight Scale (BIS). Results Compared with controls, patients showed reduced accuracy in both emotion recognition and causal attribution, with the largest deficits for anger recognition and anger attribution. Within the patient sample, higher TCO symptom levels were associated with higher self-reported aggression, primarily anger and hostility, and with poorer insight driven by reduced perceived need for treatment. In exploratory subgroup analyses (low vs high TCO), both patient subgroups showed impaired anger recognition, while additional differences emerged for fear and neutral attribution in low TCO group. Conclusions TCO symptom severity was associated with heightened aggressive affect and reduced treatment-related insight and may selectively modulate threat-relevant social-cognitive processes. In this sample, higher TCO levels were linked to differences in fear-related processing without further exacerbating anger recognition deficits, suggesting a specific association with threat vigilance rather than generalized social-cognitive impairment.
