Purpose of review Diagnosis of personality disorders (PDs) in children and adolescents remains clinically controversial, despite revisions in DSM-5-TR Alternative Model for Personality Disorders (AMPD) and ICD-11 removing formal age-limits for PD diagnosis. This review synthesizes recent 12–18-month evidence on conceptual debates, diagnostic frameworks, assessment instruments, cross-cultural considerations, diagnostic risks (over-diagnosis versus under-diagnosis), and clinical-ethical implications for personality pathology among young people. Recent findings Dimensional severity-centred systems (AMPD Criterion-A/ICD-11 personality-functioning severity) have gained empirical ground for youth populations, yet categorical and dimensional approaches show partial nonoverlap in clinical adolescent cohorts. Validated brief self-report screening tools (LPFS-BF 2.0, BPFSC-11, LoPF-Q 12–18 screener) cannot replace semi-structured clinical interviews (STiP-5.1, CI-BPD). Youth PD presentations vary substantially across cultural contexts; identity-disturbance may be less prominent in nonwestern samples. Longitudinal data confirm substantial plasticity of personality-functioning in adolescence, while sub-threshold personality pathology predicts later psychosocial impairment. Ethical scholarship favours staged-care over stepped-care models, arguing that appropriate early diagnosis reduces rather than amplifies stigma. Summary Contemporary youth-PD diagnosis requires hybrid categorical-dimensional, multiinformant assessment. Clinicians must differentiate normative adolescent developmental turmoil from enduring personality-related functional impairment. Gaps persist in youth-specific cut-offs for dimensional tools, cross-cultural measurement invariance, and longitudinal real-world clinical outcome research.
Purpose of review Individuals with chronic pain (CP) are at elevated risk of mental health problems, but the awareness of this issue among patients as well as medical personnel is limited. Chronic musculoskeletal pain (CMP) is the most common type of CP. This narrative review summarizes the latest literature on the comorbidity of CMP with depression, anxiety and sleep problems. Recent findings Around 40% of CP patients suffer from depression and/or anxiety of clinical severity. Sleep problems affect up to 75% of patients with CP. CMP. Depression, anxiety and impaired sleep are characterized by common underlying physiopathological mechanisms associated with serotonin and noradrenaline neurotransmission, glutamate/γ-aminobutyric acid signaling balance, low Brain-derived neurotrophic factor (BDNF) and altered immune system response. Comorbidity of depression, anxiety and sleep impairment is associated with decline in mental health, functioning and quality of life of the affected individuals, leading to a cumulative disability burden. Evidence supports cognitive behavioral therapy and acceptance and commitment therapy psychotherapies for CMP. Duloxetine is efficacious for pain relief, improvement of mood, anxiety, sleep and quality of life in CMP. Summary Comorbidity of psychiatric issues among CMP patients is an unmet need which should be addressed to improve patient outcomes. Mental healthcare specialists ought to be integrated into the teams managing CMP patients.
Purpose of review Lithium remains the most effective long-term treatment for bipolar disorder, but concern about chronic kidney disease (CKD) continues to limit its use in older adults, in whom renal reserve is already reduced and competing renal risk factors are common. Whether that concern is proportionate, and whether risk depends on serum concentration or on the comparator chosen, remains unsettled. We synthesized the observational evidence on lithium and CKD in adults aged 50 and over with bipolar disorder. Recent findings Across 6 cohorts, lithium was associated with a higher risk of CKD than nonlithium exposure (pooled hazard ratio 1.62, 95% confidence interval 1.25–2.11), although heterogeneity was substantial and the prediction interval crossed the null. Risk tracked with serum concentration: a higher-versus-lower contrast across 5 cohorts gave a pooled hazard ratio of 2.07 (1.47–2.91), the least heterogeneous analysis and the only one whose prediction interval lay entirely above the null. Against valproate the association attenuated to 1.39 (0.77–2.51). Hard kidney-failure endpoints were too few to estimate reliably. No study reported cognition in relation to renal function. No study was at low risk of bias, and confounding was the dominant concern. Summary In older adults with bipolar disorder, lithium is associated with a modest, concentration-dependent increase in CKD risk that narrows when valproate rather than nonuse is the comparator. The evidence is observational and confounding-prone, and supports minimising serum concentration and monitoring renal function against age-appropriate thresholds rather than avoiding lithium.
Purpose of review Adverse childhood experiences (ACEs) are well established risk factors for anxiety disorders. This review critically examines the evidence linking ACEs and childhood anxiety, the mechanisms underpinning this association, challenges in the conceptualisation and measurement of ACEs, and current public health and clinical approaches, including the potential moderating role of positive childhood experiences (PCEs). Recent findings There is clear evidence linking ACEs to anxiety, but much of this literature relies on adult's retrospective reports of childhood adversity. Research involving children is often limited by reliance on caregiver-reports of their child's adversity. Traditional ACE frameworks may not adequately capture contemporary and culturally relevant adversities, including bullying victimisation. Emerging evidence indicates that PCEs can attenuate associations between ACEs and anxiety. For health services, more research is needed so that the screening for ACEs in children can improve outcomes. For children with anxiety, assessing for ACEs informs the support needed for the individual and their family. Summary Strengthening prevention and early intervention efforts requires improved conceptualisation and measurement of childhood adversity. At a population level, policies that both reduce children's experiences of adversity and promote positive, protective experiences are likely to have the greatest impact on reducing the burden of childhood anxiety.
