The menopausal transition is a period of reproductive changes linked to heightened risk for depressive symptoms, and in some cases, a major depressive episode. Understanding risk is critical to identifying patients experiencing distress from these affective disturbances. Once identified, both subsyndromal and major depressive episodes can be treated with pharmacological as well as non-pharmacological methods.
Anxiety disorders can be challenging to diagnose in patients with cardiovascular disease who often suffer from chest pain or tightness, shortness of breath, fatigue, dizziness, rapid heart rate, and other symptoms that overlap with those of anxiety. Benzodiazepines (BZs) are efficacious for the treatment of anxiety; they reduce catecholamines, lower coronary and vascular pressures, and mitigate muscle spasms that often contribute to cardiac symptoms. BZs are efficacious in those with panic disorder and panic associated with arrythmias, implantable cardioverter defibrillators, dyspnea, or unrelenting anxiety that threatens treatment adherence. The short-term risks of BZs are primarily related to their central nervous system depressant effects, which contribute to falls and confusion, especially in older individuals. At higher doses, BZs can precipitate respiratory depression, hypotension, bradycardia, and atrioventricular block.
Physician assistants (PAs) increasingly expand access to psychiatric care, yet little evidence describes how organizational factors affect their well-being. This study evaluates the relationship between leader burnout, leader span of control (SOC), and PA burnout within a large Midwestern health system. Using data from the 2024 enterprise-wide Culture of Safety survey, burnout scores were analyzed from 778 employees, including 88 PAs and their 38 managers. Direct-report two-question summative scores were significantly higher when managers screened positive for burnout, demonstrating a cascading effect of leader well-being on employees. Total SOC did not show a statistically significant association with manager burnout, but the direction of effect aligned with prior literature and strengthened when analyses focused on emotional exhaustion. These findings underscore the need to support PA leaders and incorporate SOC considerations into work-force planning to improve clinician well-being.
Increased brain microglia activation and density have been documented in different severe mental disorders by both postmortem and neuroimaging studies. These brain changes seem to be linked to suicidal behavior in a transdiagnostic way. The gut microbiome has a central role in modulating the immune system and abnormalities in gut-brain interactions have been associated with chronic systemic inflammation and neuroinflammation. Neuroinflammation is known to impact neurotransmission and neuroplasticity, potentially leading to mood abnormalities, cognitive difficulties and suicidality. The gut microbiome is heavily influenced by lifestyle factors such as diet, physical activity, substance use, stress management, and sleep. Unhealthy lifestyle habits have been associated with increased suicidality and can disrupt the gut microbiome, contributing to neuroinflammation through an imbalance in microbial signaling molecules. Brain-gut-microbiome interactions play an important role in moderating the impact of lifestyle habits on brain and behavior, constituting an important neurobiological factor associated with suicidality.
Self-harm (SH) is a global public health crisis, with individuals who engage in SH facing a significantly increased risk of subsequent suicide, particularly in the immediate post-SH period. Although systematic reviews and meta-analyses have established the efficacy of interventions like Problem-Solving Therapy and Brief Intervention and Contact, many potentially valuable approaches are often excluded from quantitative synthesis due to a limited number of randomized controlled trials (RCTs). This scoping review, an extension of a comprehensive systematic review, aims to qualitative ly map the landscape of under-represented early interventions for SH (defined as occurring within one month prior to enrollment) that were not meta-analyzable. Interventions including psychodynamic therapy, Safety Planning, family interventions, and pharmacological approaches, focusing on their theoretical models, delivery formats, target populations, and methodological limitations, are descriptively mapped. Significant conceptual diversity and persistent evidence gaps are identified. Safety Planning, despite its widespread clinical use, shows mixed results in recent meta-analyses, especially in adolescents. Psychodynamic and pharmacological interventions remain limited and heterogeneous. This review highlights a critical research gap, underscoring the need for larger, well-designed RCTs for these underrepresented interventions, as well as a focus on standardizing outcomes and understanding mechanisms of change to inform clinical practice and improve outcomes for at-risk individuals.
Phenotypic heterogeneity and frequent comorbidity across psychiatric diagnoses complicate efforts to identify causal mechanisms and develop novel treatments for psychopathology, and challenge the diagnostic validity of modern psychiatric nosology. Categorical and dimensional latent variable models, which conceptualize symptoms as passive indicators of underlying disease entities, do not account for phenotypic diversity and dynamic interrelations among psychiatric symptoms. This article reviews the historical and theoretical foundations and current state of the science of network approaches to psychopathology within mood disorders, which reconceptualizes psychiatric disorders as dynamic systems of directly interacting symptoms. The article outlines how symptom network approaches offer alternative explanations for diagnostic heterogeneity, comorbidity, and symptom persistence, drawing on evidence from both nomothetic and idiographic data. Emphasis is placed on potential clinical applications, including case formulation, personalized treatment planning, and outcome monitoring, alongside methodological limitations and translational challenges. Overall, network approaches represent a promising shift toward transdiagnostic, symptom-focused, precision-oriented psychiatric care.
Violence in mental health care, encompassing both self-directed behaviors such as suicidal ideation and attempts and other-directed behaviors including aggression and assault, represents a major clinical and public health challenge. Traditional violence risk assessment tools and structured clinical data offer limited predictive accuracy and often fail to capture the dynamic, contextual, and linguistic signals embedded in clinical narratives. Natural language processing (NLP) has emerged as a promising approach to leverage free-text electronic medical record notes for more precise and timely violence-risk prediction. This systematic review synthesizes evidence on the use and effectiveness of NLP-based models applied to unstructured clinical text to predict self-directed and other-directed violence in health care populations, with the aim of informing both the research evidence base and the clinical readiness of these tools. Following PRISMA guidelines and a registered PROSPERO protocol, comprehensive searches identified 21 eligible studies spanning diverse clinical settings, populations, outcomes, and modeling strategies. Across studies, NLP-enhanced models consistently outperformed structured-data-only approaches, with area under the receiver operating characteristic curve values frequently exceeding 0.80 for self-directed outcomes and demonstrating meaningful gains for aggression-related predictions. Performance improvements were particularly pronounced for short-term and near-event prediction horizons. Methodological approaches varied substantially with respect to preprocessing pipelines, embedding tech niques, algorithms, validation strategies, and outcome definitions, limiting direct comparability and meta-analytic synthesis. Reporting of calibration, interpretability, fairness, and external validation was inconsistent, and many studies exhibited moderate to high risk of bias under PROBAST and PROBAST-AI criteria. Taken together, the findings indicate that free-text clinical notes contain clinically meaningful signals not captured by structured data alone, but also highlight important constraints on immediate clinical deployment. This review aims to support clinicians, health systems, and researchers in interpreting current model performance, understanding residual risks, and identifying the methodological and governance requirements necessary for safe and effective clinical implementation of NLPbased violence-risk prediction tools.
Generative AI chatbots for mental health offer great promise in expanding access to evidence-based psychotherapies. A number of recent reports have described chatbots that draw from behavior change theories central to human-delivered treatments. This review details the diversity in theories selected for chatbots, and how chatbots have been evaluated in respect to delivering upon theoretical models. Overall, there was limited adoption of best practices in measurement of treatment fidelity from human therapist trials. Thus, skepticism is frequently warranted regarding claims of alignment with behavior change approaches, yet there is reason for optimism in the role of chatbots in expanding access to evidence-based interventions along with rigorous testing and validation.
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur in adulthood, creating a clinical profile that differs meaningfully from either condition alone. Evidence indicates that impulsivity and attentional inconsistency characteristic of ADHD interact with the rigidity, sensory sensitivities, and social-cognitive differences associated with ASD, amplifying executive, emotional, and social-communication difficulties. Assessment in adults remains challenging due to reliance on child-normed instruments, symptom masking, and overlapping phenomenology, underscoring the importance of nuanced clinical judgment. Treatment is most effective when integrated, combining cautious stimulant use when indicated, targeted nonstimulants, cognitive-behavioral therapy adapted to autistic cognition, executive-function coaching, and environmental modifications across work and home contexts. Finally, key research gaps are highlighted, including the need for adult-specific diagnostic tools, greater attention to sex and gender differences, and clinical trials designed specifically for comorbid presentations to improve long-term functional outcomes and quality of life.
The neurodiversity paradigm re-frames autism as a neurological difference rather than a deficit, yet its application in adult autism care remains underexplored. A scoping review was conducted using PubMed with MeSH terms "autism and neurodiversity and adults and (approaches or perspectives)." From 104 initial results and four manual additions, 25 articles met inclusion criteria after excluding articles unrelated to autism, focused on children, or lacking neurodiversity perspectives. Eight themes emerged: preference for identity-first language and strengths-based framing; validity of autistic communication; strengths-focused assessment; environmental accommodation over individual remediation; importance of self-acceptance and community for well-being; intersectionality with gender, sexuality, and culture; autism as lifelong variation; necessity of co-production in research; and employment equity through universal design. Neurodiversity-informed approaches prioritize systemic change, participatory design, and intersectional inclusion. Implementation requires shifting from pathologizing to neurodiversityinformed frameworks that center autistic voices and remove barriers.
Women with anorexia nervosa (AN) frequently exhibit autistic traits, and a sizeable subgroup meets diagnostic thresholds for autism spectrum disorder (ASD). Large-scale population and registry studies indicate shared liability, and clinical cohorts report ASD prevalence rates of 20% to 30% in AN. Recognition is complicated by the female autism phenotype, characterized by camouflaging, internally directed interests, sensory sensitivities, and preserved social motivation despite high social-cognitive load. These features contribute to underdiagnosis and diagnostic overshadowing in eating disorder (ED) services. Neurocognitive research highlights overlapping set-shifting difficulties, theory of mind (ToM) challenges, and altered social attention, while neurobiological evidence suggests distinct but partially convergent pathways. Autistic features predict longer illness duration and poorer psychosocial outcomes even when weight restoration is achieved. Female-sensitive screening, autism-informed adaptations such as structured routines and sensory accommodations, and service-level models like the PEACE pathway and Delphi consensus recommendations improve engagement and treatment fit.
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by differences in social communication, sensory processing, and patterns of restricted or repetitive behaviors. While much of our cultural awareness and psychiatric clinical practice has focused on how ASD affects children and their development, significantly lower levels of attention have been directed towards the transition into adulthood, particularly as challenges with social communication and restrictive/repetitive behaviors can persist throughout an individual's life. Adults with ASD experience a multitude of special considerations, including delayed development/maturation, difficulty with academic achievement, obtaining secure employment, as well as navigating interpersonal and romantic relationships. Additionally, families often remain in caregiver roles for adults with ASD, adding significant emotional, financial and physical demands that contribute to burnout, as options for supporting housing are limited for most due to scarcity and high expense level. Increasing clinical awareness of these considerations is critical to begin addressing these challenges.
This review covers the rationale for, and the mechanisms of action of, benzodiazepines (BZs) in the treatment of alcohol withdrawal syndrome (AWS), a potentially life-threatening condition that arises after the abrupt cessation of, or drastic reduction in, chronic heavy drinking. Following a case presentation that illustrates the clinical features of severe AWS, strategies for the assessment of risk, selection of an appropriate BZ regimen, and guidance for further treatment are discussed. In addition, the roles of short-acting versus long-acting BZs are discussed, with an emphasis on fixed-dose versus symptom-triggered approaches. Adverse effects and contraindications of BZs, as well as BZsparing strategies, are also presented to guide safe and efficacious management, particularly in those with co-morbid medical conditions.
Insomnia is a prevalent, chronic, and disabling disorder without ideal first-line pharmacological agents. Nevertheless, benzodiazepines (BZs) are indicated as short-term treatments for insomnia, when cognitive-behavioral therapy is unavailable or ineffective. Although all BZs release sleep-promoting gamma-aminobutyric acid, they have different pharmacokinetic profiles, which influence their onset of action, efficacy, and side-effect profiles. Unfortunately, BZs are associated with a wide range of undesirable effects, including dependence, the propensity for drug withdrawal, cognitive impairment, and disinhibition. This review presents recent evidence on the clinical efficacy of BZs for insomnia, compares their use with other sedative-hypnotics, and provides an overview of their adverse effects, especially in elderly individuals.
To foster sustained improvements in clinician well-being, health care organizations must prioritize systemic changes. Overcoming barriers to transformation within large health systems requires training distributed leaders- both formally designated and informally recognized-in the principles of organizational well-being, process improvement, and change management. Effective training initiatives should extend beyond assessing knowledge to including ongoing evaluations of impact after program completion. This article reviews the current evidence supporting well-being-centered leadership development and presents Scholars of Wellness as a case study. Scholars of Wellness cultivates champions of wellbeing across our organization and has demonstrated sustained improvements through individual projects and by developing well-being-centered leaders to improve our organization's health.
Peer support programs have emerged as essential interventions to address the psychological and occupational impacts clinicians experience after adverse events, including second victim syndrome, burnout, and moral injury. This review examines the evolution, structure, and outcomes of peer support models across major health systems, highlighting their influence on clinician well-being, organizational culture, and safety outcomes. Evidence demonstrates that peer support mitigates burnout, reduces turnover, and enhances psychological recovery, while fostering transparency and interdisciplinary collaboration. Program case studies illustrate scalable strategies and challenges such as measurement limitations inherent in confidential support models. As health care organizations increasingly recognize the financial and cultural value of supporting clinicians after adverse events, peer support programs represent a critical, cost-effective component of a comprehensive well-being and safety strategy.
