Research has established that borderline personality disorder (BPD) can be diagnosed before the age of 18. However, many clinicians are apprehensive about using the diagnosis and treating BPD in adolescence. Specialized treatments have been developed and evaluated for BPD in adolescence. Mentalization-based therapy (MBT) is one of these. However, long-term follow-up studies are lacking, and the potential effects of getting the BPD diagnosis and treatment in adolescence are not yet well understood. We set out to explore the experiences of MBT group treatment for BPD five years later. The aim was to understand how they experienced the treatment and how it may have influenced them since. Twelve women aged 19–23 were included in the study. The women had participated in a randomized controlled trial investigating group MBT five years earlier. Qualitative data was collected through semi-structured interviews. The data were analyzed using a narrative, phenomenological framework by an interdisciplinary research group. The results showed a common narrative consisting of four themes: (1) patients without influence, (2) the process of getting diagnosed in adolescence, (3) group therapy: dynamics alliance, and (4) frustration alternative coping strategies. The four themes were intertwined by two cross-cutting themes: (1) the system, (2) the life outside. The results showed that the BPD diagnosis had impacts on the participants’ identity and self-understanding. Feeling like a patient without influence made the participants unwilling to seek help from mental health services later in life. The MBT group treatment was generally experienced as unhelpful due to a range of treatment specific-, common- and systemic factors. The participants developed maladaptive coping strategies to deal with serious mental health problems to stay out of touch with the mental health services.

Abstract Background Staff education may improve clinicians’ attitudes toward self-harm, but whether this translates into reduced coercion is unclear. We evaluated a regional strategy to improve care for self-harming patients and its impact on staff attitudes and coercive interventions across services. Methods Quasi-experimental dual design: (a) interrupted time-series of registry data on coercive interventions (Jan 2021–Dec 2024) and (b) three-wave pre–post surveys using the revised 17-item Self-Harm Antipathy Scale (SHAS-DR) at baseline, 2 months, and 8 months post-training. Change points: June 2022 (strategy announcement) and June 2023 (training implementation). Results In registry data, coercive interventions declined after the strategy announcement (level IRR 0.39, 95% CI 0.21–0.73) with no subsequent trend change. A temporary increase occurred at the training point (level IRR 2.58, 95% CI 1.57–4.25), consistent with implementation disruption. Reductions were largest for mechanical restraints, particularly among self-harming patients, while rapid tranquillization remained most frequent. Annual coercive episodes fell from 1,280 (2021) to 409 (2024). Staff attitudes improved and were sustained. Mean SHAS-DR decreased from 40.0 (SD 10.8) at baseline to 34.8 (SD 7.4) at 2 months and 35.4 (SD 8.2) at 8 months; baseline-to-follow-up changes were significant ( p ≤ 0.001). Conclusions The strategy coincided with an immediate reduction in coercion and a transient rise during training, while staff attitudes reflected reduced antipathy toward people who self-harm. Sensitivity analyses suggested changes were not driven by high-frequency patients. Sustained reductions likely require continued organizational and relational supports. Trial registration Not applicable.

Non-suicidal self-injury (NSSI) is common in inpatient mental health care and poses challenges for staff, patients, and organizations. While training programs can improve knowledge and attitudes, less is known about how staff collectively experience implementing new strategies for managing self-harm and how such strategies influence ward culture and professional practice. This qualitative study was part of a broader evaluation of implementing a regional self-harm strategy in a Danish inpatient mental health service. The strategy included staff training, clinical tools, and supervision. Four focus group interviews with 25 staff members from five inpatient units were conducted in 2024. Data were analyzed using reflexive thematic analysis. The analysis generated four interrelated themes: (1) Relational work as invisible yet essential: Staff valued listening and dialogue as crucial for preventing escalation but described these practices as undervalued and the first to be dropped under pressure. (2) Diagnostic hierarchies: psychosis as the legitimate inpatient diagnosis, self-harm as responsibility: Psychotic patients were viewed as genuinely ill and beyond control, while patients who self-harm were often framed as responsible, sustaining moralized hierarchies of care. (3) Cultural change – from control to dialogue: The strategy disrupted routines of restraint in relation to self-harm. Initially perceived as “doing nothing,” the new strategy was increasingly legitimized as staff witnessed calmer units, reduced coercion, and clearer professional roles grounded in relational practice. (4) Responsibility, guilt, and emotional distance — Staff struggled with the emotional and moral burden of refraining from coercion, negotiating professional boundaries, and managing feelings of guilt and emotional withdrawal. Implementing a self-harm strategy requires more than new clinical tools. It depends on staff integrating the approach into everyday practice, supported by structural and cultural change. Sustainable implementation relies on legitimizing relational care as skilled clinical work, creating space for reflection, and addressing the emotional demands placed on staff. The findings also show that diagnostic hierarchies continue to shape how legitimacy and responsibility are distributed within psychiatric care.

The new ICD-11 Personality Disorder (PD) classification introduces a global severity classification (i.e., mild, moderate, and severe) of personality dysfunction, which may be further accompanied by up to five trait domain specifiers delineating individual manifestations of personality disturbance (i.e., Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). Although these trait domains are conceptualized as dimensions, the ICD-11 only allows clinicians to code them as being categorically present versus absent. It is therefore appropriate to examine the ability of clinicians' judgements in capturing variance in trait domains using dichotomous trait ratings. A total sample of 238 patients was characterized by their clinicians using both dimensional and dichotomous single-item ratings for each trait domain. Subsequently, clinicians filled out the Informant Personality Inventory for ICD-11 (IPiC) as a standardized criterion-measure for trait domains. The dichotomous ratings were all moderately associated with their corresponding IPiC score, except for Negative Affectivity, which only showed a small but statistically significant association. The dimensional ratings were all moderately to strongly associated with their corresponding IPiC scores. However, only the dimensional single-item ratings of Disinhibition and Dissociality were significantly superior to the dichotomous single-item ratings in capturing the IPiC trait domain scores. Findings overall support the use of categorical assignment of trait domain specifiers in the ICD-11 although dimensional formats improve the accuracy of clinicians' judgements.

BACKGROUND:Serious drug crime involves a high level of risk and is often characterised as requiring a network of suitable and trustworthy collaborators. Although prior studies have focused on the importance of economic, social and work-related factors for involvement in such crime, there has been less research into the mental health of the people involved. AIMS:To assess the prevalence of mental disorders in a full nationwide cohort of individuals convicted of serious drug crimes in Denmark (2001-2020), who were born after 1984 and had a personal national identification number. METHODS:We compared four groups: large-scale serious drug crime offenders sentenced to ≥ 5 years' imprisonment (n = 232); moderate-scale serious drug crime offenders sentenced to under 5 years' imprisonment (n = 2955); offenders convicted only of small-scale drug offences, such as low-level supply, but never of serious drug crime (n = 7630); and sex- and age-matched general population controls who had never been convicted of a serious drug crime (n = 3187). Mental disorders were identified using hospital and pharmacy registers. RESULTS:The adjusted prevalence of any mental disorder was similar across offender groups (large-scale: 32%, 95% CI [27%-38%]; moderate-scale: 36%, 95% CI [34%-38%]; small-scale: 36%, 95% CI [35%-37%]) and, in all three groups, was substantially higher than among controls (23%, 95% CI [22%-25%]). A similar pattern was observed for specific disorders. CONCLUSIONS:Our results challenge the assumption that engagement in serious drug crime requires skills and behaviours that are incompatible with having a mental disorder. We conclude that people with serious drug crime convictions are as likely as minor drug offenders to need mental health services and that people with mental disorders are vulnerable to recruitment into serious drug crime.

BACKGROUND:Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators. METHOD:A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688). RESULTS:Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = -0.21, CI: -0.45 to -0.02, SE = 0.12, p = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = -0.40, 95% CI: -0.73 to -0.08) and a higher number of co-occurring disorders (β = -0.08, 95% CI: -0.15 to -0.01) were associated with larger treatment effects (not significant after alpha correction). CONCLUSION:Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.

Objectives Clozapine is continuously underused. The existing systematic reviews addressing barriers to clozapine prescribing primarily focus on clinical staff’s attitudes and perceived barriers to prescribing. However, a preliminary literature search revealed additional literature on the subject not previously included in systematic reviews, including literature on patient perspectives. A scoping review is warranted to map the scope of primary studies on patients’ and/or clinicians’ perspectives on clozapine treatment and to identify gaps in research.Design A scoping review was designed and reported in accordance with established guidelines for scoping reviews.Data sources The electronic databases Cochrane Library, CINAHL, Web of Science, PsycINFO, MEDLINE, EMBASE, Google Scholar and two grey literature databases were searched. Furthermore, citation tracking of selected studies was undertaken.Eligibility criteria We included primary, empirical studies reporting clinicians’ and/or patients’ perspectives on clozapine treatment. No limitation was set for the year of publication or type of primary study.Data extraction and synthesis Two researchers independently screened for studies, extracted the data and coded the content. Findings were summarised visually and narratively.Results 146 studies were included. Most studies reported on patients’ or clinicians’ perspectives on active clozapine treatment or on clinicians’ perspectives on barriers to clozapine initiation in general. Three gaps in research were identified: (1) clozapine-eligible, yet clozapine-naïve, patients’ attitudes towards clozapine commencement, (2) clinicians’ reasons for clozapine withholding and perceived facilitators of clozapine treatment in specific patient-cases and (3) patient and clinician perspectives on clozapine discontinuation, continuation and rechallenge in specific patient cases.Conclusions Research on clozapine perspectives tends to repeat itself. Future studies addressing the identified gaps in evidence could provide the insights needed to optimise clozapine utilisation.

ADHD and personality disorders, like emotional unstable personality disorder and dissocial personality disorder, overlap to some extent but they also commonly co-occur in clinical populations. Prevalences, key issues in differential diagnosis, and the different aetiological background of the two categories are presented in this review. In depth, clinical diagnostic evaluation of both disorder syndromes, not only based on use of questionnaires, is needed to sufficiently distinct the separate main categories. In case of co-occurrence treatment, recommendations of both disorders and social support should be considered to achieve a patient-centered approach of the specific needs.

Friendships are vital for the well-being of young adults, yet their social network is often reduced during episodes of life-disruptive mental distress, such as psychosis. Despite this, our study shows that young adults do either maintain or build friendships during such periods and that these relationships are crucial for recovery in youth. As research on the role of friendships in the recovery journey of this group is limited, this study explores the significance of friendships for young adults engaged in early psychosis interventions to generate insights that can inform mental health recovery practices. In-depth life-story and intensive interviews were conducted with six young adult users of early psychosis intervention OPUS. Using abductive thematic analysis, two main themes and four subthemes emerged: (1) "Seeking different kinds of recovery support with different types of friends" with subthemes (1.1) "Seeking safety in life-witnessing friendships" and (1.2) "Shaping identity with friends in communities of interest"; and (2) "Belonging and unbelonging with friends and their significance to recovery in youth" with subthemes (2.1) "Struggling with friendship expectations perpetuates social isolation" and (2.2) "Connecting with friends enables belonging to humanity as a whole." The findings highlight that, while social isolation can reinforce feelings of alienation, belonging with friends instills a sense of hope and meaning. The involvement of friends in early psychosis interventions may enhance social skills training, strengthen social bonds, and support the inclusion and well-being of young adults.

Objectives This study aimed to investigate the perspectives of clozapine-naïve outpatients with treatment-resistant schizophrenia on clozapine commencement and the barriers and facilitators of it.Design A mixed-methods convergent design was employed using both qualitative and quantitative data on the same items.Setting In-home visits or meetings at three Mental Health outpatient facilities in Region Zealand East, Denmark.Participants Clozapine-eligible, yet clozapine-naïve, outpatients with schizophrenia. A convenience sample of 206 patients with schizophrenia treated with antipsychotic polypharmacy (APP) was screened for clozapine eligibility. Clozapine eligibility included recurrent/continued prescription of APP throughout the past year, ≥ 3 different antipsychotics (APs) trialled at a therapeutic dose and ≥2 APs trialled adequately before current treatment. All eligible patients able to provide written informed consent were invited to participate.Methods The participants’ perspectives were assessed qualitatively through semistructured interviews and quantitatively with closed-ended questions, numerical scale ratings, and standardised patient-reported outcome measures. Moreover, the participants’ sociodemographic and clinical characteristics were collected through case files, participant questionnaires, and clinical ratings made by the participants’ treating clinicians. Interviews were transcribed verbatim and analysed thematically. Quantitative data were analysed with descriptive statistics. Finally, qualitative and quantitative results were compared and merged to draw meta-inferences.Results Eighteen patients were included, 10 (56%) were men and the median age was 30.0 years (IQR 24.8–37.8). Nine participants (50%) were willing to commence clozapine if offered now, nine were not. No apparent clinical or socioeconomic differences were observed between refusers and acceptors; however, the acceptors rated their subjective recovery on the Brief INSPIRE-O significantly lower than the refusers did, and qualitatively, they all expressed subjective distress due to their current symptoms. Three themes characterised the refusers’ reasons for not accepting clozapine: ‘Reconciliation with the current situation warrants no change in treatment’, ‘Clozapine is a last-resort treatment for last-resort people’ and ‘Permanent or situational reluctance due to practical aspects of treatment’. In the vast majority of cases, blood sampling had little or no impact on the participants’ current willingness to commence clozapine, and quantitatively, blood sampling ranked lowest of the suggested barriers, whereas hospital admission for clozapine commencement ranked highest. The adverse side effects of clozapine, sedation and, weight gain in particular, were considered a major barrier if previously encountered with ineffective AP trials. The introduction of individualised commencement plans mitigating personal barriers was highlighted as the facilitator with the greatest impact on clozapine willingness, able to turn refusals into acceptance.Conclusions Patients tend to prefer the predictability in status quo over switching to clozapine if they previously have trialled multiple APs with inadequate symptom reduction and subsequent deterioration/rehospitalisation or AP-induced weight gain and sedation. Moreover, the impression that clozapine treatment was unmanageable or a last-resort option further accentuated their reluctance to switch. Antipsychotic-trial fatigue and the stigma of clozapine as a last-resort treatment should be avoided by adhering to guidelines, thereby limiting the number of antipsychotics trialled before offering clozapine. Fortunately, it seems as if the patient’s willingness to trial clozapine is positively impressionable to the conversation about customised commencement plans offering commencement on the patient’s terms. For patients with subjective distress due to their symptoms, such plans can even reverse an initial clozapine refusalCite Now

INTRODUCTION:Adolescence is a crucial period for the onset of both borderline personality disorder (BPD) and first-episode psychosis. Although transient stress-related paranoid ideation and dissociative symptoms are one of the diagnostic criteria for BPD, determining when these psychotic features progress to early-stage schizophrenia remains unclear. METHODS:Two case studies aimed to explore the challenges in assessing and following up on psychotic features in BPD over time. Two adolescent girls aged 14 and 15 were initially diagnosed with BPD using semi-structured clinical interviews for DSM-IV personality disorder. Five years later, symptom development was explored using comprehensive diagnostic interviews. RESULTS:Both cases exhibited lapses in reality testing at baseline, interpreted as transient and stress-related symptoms. The first case illustrated the difficulties in distinguishing normative magical and imaginative thinking in youth from odd beliefs or bizarre fantasies and preoccupations, emphasizing the need for age-adapted and elaborate, detailed phenomenological assessment of the content, duration and frequency of these experiences and their impact on functioning. The second case demonstrated the progression of psychotic features from adolescence into early adulthood and the challenge of judging whether these features crossed the threshold to psychosis. CONCLUSION:Both cases underscore the need for clinical training regarding differential diagnostics and management of psychotic features when present in early manifestations of BPD. This gap in care presents a missed opportunity for inclusion of patients in targeted early intervention programs for first-episode psychosis. We propose the implementation of a continuous monitoring strategy in BPD with psychotic features.

INTRODUCTION:Borderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA). METHODS:A literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688). RESULTS:Out of 33,696 records identified, 42 RCTs (3,848 participants) were eligible. IPD was obtained from 19 trials (1,482 participants). All trials had an overall high risk of bias or some concerns regarding risk of bias. There was a high rate of missing data across trials (378/1,482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: -0.25, 95% CI: -0.43 to -0.07, SE: 0.09, p = 0.0065; 19 trials, 1,104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: 0.31, 95% CI: 0.03 to 0.59) and exposure to sexual trauma (β: 0.60, 95% CI: 0.16 to 1.04), while positive moderators were co-occurring anxiety disorder(s) (β: -0.34, 95% CI: -0.64 to -0.03) and alcohol use disorder(s) (AUD) (β: -0.34, 95% CI: -0.67 to -0.01). CONCLUSION:Psychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.

The factor structure of personality disorder (PD) criteria has long been debated, but due to previous heterogeneous findings, a common structure to represent covariation among the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)/DSM-5 Section II PD criteria remains an open question. This study integrated individual participant data from 25 samples (N = 30,545) to conduct factor analyses of PD criteria. Measurement invariance tests across gender, clinical status, and assessment method indicated substantial structural differences between interview-based and self-report measures. In interviews, a confirmatory 10-factor model with factors representing specific DSM-5 PDs showed a major misfit, with results from exploratory factor analyses suggesting that this was due to a relatively small number of substantial secondary loadings. In self-reports, a confirmatory 10-factor model showed greater misfit than in interviews, and exploratory solutions were more complex. When five factors were extracted, the factors showed some similarity to maladaptive trait domains such as Negative Affectivity and Disinhibition, but there were substantial differences in factor content between interviews and self-reports. In bifactor models, a general factor explained more common variance in self-reports, whereas the content of general factors was similar in both assessment methods. Our findings suggest that interview and self-report measures of PD criteria are not structurally equivalent. To advance research on the structure of PD, it may be useful to consequently focus on the shared variance of multiple methods. For this purpose, future multimethod studies should combine interviews and self-reports with other assessment methods such as informant reports. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Sleep disturbances are commonly reported in individuals with borderline personality disorder (BPD) and are often worsened by comorbid mental health disorders such as ADHD, PTSD, and depression. Sleep problems may contribute to the persistence of symptoms, highlighting the importance of early identification and treatment of sleep disturbances as part of early intervention strategies. Despite this, the prevalence and predictors of persistent sleep problems in the early course of BPD remain understudied, particularly in longitudinal designs. In this study, we followed up on 110 female adolescents with BPD pathology 5 years after being included in the study to investigate the prevalence and predictors of sleep problems collected using a semistructured interview as participants transitioned into early adulthood. At baseline, BPD severity, ADHD, and melatonin use were associated with sleep disturbances. However, at 5-year follow-up, baseline ADHD, depression severity, and melatonin use emerged as the strongest predictors of persistent sleep problems, while BPD severity was no longer predictive. These findings underscore the complex interplay between comorbid mental health disorders and the development and maintenance of sleep problems in BPD. Targeting adolescents with BPD and severe sleep disturbances requiring medical intervention, comorbid ADHD, and significant depressive symptoms is crucial for alleviating persistent sleep problems. Integrating specific sleep interventions into early treatment strategies represents sound clinical management in the early stages of BPD, and future research should explore whether targeted interventions for these risk factors can mitigate long-term sleep-related challenges and improve overall outcomes for individuals with BPD.

BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015. OBJECTIVES:To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate. SELECTION CRITERIA:We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ > 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life. DATA COLLECTION AND ANALYSIS:Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach. MAIN RESULTS:We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only 165/212 trials included usable data on one or more outcomes from 14,271 participants. Of the 212 trials, we assessed 191 at high risk of bias and 21 at low risk of bias. If, however, deblinding of methylphenidate due to typical adverse events is considered, then all 212 trials were at high risk of bias. PRIMARY OUTCOMES:methylphenidate versus placebo or no intervention may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -0.88 to -0.61; I² = 38%; 21 trials; 1728 participants; very low-certainty evidence). This corresponds to a mean difference (MD) of -10.58 (95% CI -12.58 to -8.72) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points). The minimal clinically relevant difference is considered to be a change of 6.6 points on the ADHD-RS. Methylphenidate may not affect serious adverse events (risk ratio (RR) 0.80, 95% CI 0.39 to 1.67; I² = 0%; 26 trials, 3673 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 0.91 (CI 0.31 to 2.68). SECONDARY OUTCOMES:methylphenidate may cause more adverse events considered non-serious versus placebo or no intervention (RR 1.23, 95% CI 1.11 to 1.37; I² = 72%; 35 trials 5342 participants; very low-certainty evidence). The TSA-adjusted intervention effect was RR 1.22 (CI 1.08 to 1.43). Methylphenidate may improve teacher-rated general behaviour versus placebo (SMD -0.62, 95% CI -0.91 to -0.33; I² = 68%; 7 trials 792 participants; very low-certainty evidence), but may not affect quality of life (SMD 0.40, 95% CI -0.03 to 0.83; I² = 81%; 4 trials, 608 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS:The majority of our conclusions from the 2015 version of this review still apply. Our updated meta-analyses suggest that methylphenidate versus placebo or no-intervention may improve teacher-rated ADHD symptoms and general behaviour in children and adolescents with ADHD. There may be no effects on serious adverse events and quality of life. Methylphenidate may be associated with an increased risk of adverse events considered non-serious, such as sleep problems and decreased appetite. However, the certainty of the evidence for all outcomes is very low and therefore the true magnitude of effects remain unclear. Due to the frequency of non-serious adverse events associated with methylphenidate, the blinding of participants and outcome assessors is particularly challenging. To accommodate this challenge, an active placebo should be sought and utilised. It may be difficult to find such a drug, but identifying a substance that could mimic the easily recognised adverse effects of methylphenidate would avert the unblinding that detrimentally affects current randomised trials. Future systematic reviews should investigate the subgroups of patients with ADHD that may benefit most and least from methylphenidate. This could be done with individual participant data to investigate predictors and modifiers like age, comorbidity, and ADHD subtypes.

In a 5-year longitudinal follow-up study of adolescents (N = 97) treated for borderline personality disorder (BPD), we examined the characteristics of the persistent BPD group (N = 23), the stability of BPD criteria from baseline to 5 years, and the predictors of remission (N = 74). Significantly more participants in the persistent BPD group, compared to the remitted group, had depression, bipolar disorder, schizophrenia, or another personality disorder, received psychotropic medication, and were less likely to be in a relationship or in education. All nine diagnostic criteria of BPD exhibited extremely low stability over time across groups. Prior sexual abuse, conduct disorder, and high levels of general BPD psychopathology at baseline predicted persistent BPD at the 5-year follow-up. These findings suggest that while the status from late adolescence to young adulthood on each diagnostic criterion for BPD is highly variable over time, clinicians need to be aware that adolescents with high overall levels of BPD symptoms, a record of sexual abuse, and co-occurring externalizing behaviors are at increased risk of a poor prognosis.

PurposeTo describe the prevalence of self-reported depression in a socioeconomically deprived area in Denmark and the association to socioeconomic position (SEP) defined by education, occupation, and being in financial strain.Method13,955 adults completing the Major Depression Inventory (MDI) in the Lolland-Falster Health Study questionnaire were included.Multivariate logistic regression on symptoms of depression based on MDI sum score and ICD-10 scores, associated to education, occupation, and financial strain - unadjusted and adjusted for sex and age group.Method13,955 adults completing the Major Depression Inventory (MDI) in the Lolland-Falster Health Study questionnaire were included.Multivariate logistic regression on symptoms of depression based on MDI sum score and ICD-10 scores, associated to education, occupation, and financial strain - unadjusted and adjusted for sex and age group.ResultsWe found a prevalence of depression at 2.7% using the ICD-10 category, at 7.6% using the MDI sum score, and a very strong association between symptoms of depression and SEP.The adjusted odd ratios (aORs) for depression for each socioeconomic group compared to the opposite showed that having no postsecondary education was associated with an aOR of 2.9; being temporarily out of job with an aOR of 7, and being in financial strain with an aOR of 8. Using more strict criteria for depression (ICD-10), showed an aOR of 4 when having no education, an aOR of 8 when temporarily out of job, and an aOR of 10 for positive depression when in financial strain.ResultsWe found a prevalence of depression at 2.7% using the ICD-10 category, at 7.6% using the MDI sum score, and a very strong association between symptoms of depression and SEP.The adjusted odd ratios (aORs) for depression for each socioeconomic group compared to the opposite showed that having no postsecondary education was associated with an aOR of 2.9; being temporarily out of job with an aOR of 7, and being in financial strain with an aOR of 8. Using more strict criteria for depression (ICD-10), showed an aOR of 4 when having no education, an aOR of 8 when temporarily out of job, and an aOR of 10 for positive depression when in financial strain.ConclusionSymptoms of depression are strongly associated to SEP. Estimations of the prevalence of depressive disorders in population studies should take this into account. We estimate a more accurate prevalence of depressive disorders to be at 7.6% in this socioeconomically deprived area of Denmark.

BACKGROUND:Negative attitudes among mental health professionals toward individuals who self-harm can impact the quality of care and contribute to antipathy and stigma. This study aimed to investigate the psychometric properties of a Danish version of the Self-Harm Antipathy Scale (SHAS-DR), designed to measure mental health professions attitudes toward patients who self-harm. METHODS:The SHAS-D was administered to 261 mental health professionals. Confirmatory factor analysis (CFA) was used to examine dimensionality and structural validity. Internal consistency was evaluated using Cronbach's alpha reliability and McDonald's omega coefficients, and discriminant validity was assessed via factor intercorrelations. RESULTS:Neither a unidimensional global factor nor the originally proposed six-factor model, based on all 30 items, were supported. Consistent with a previous study, a 17-item three-factor solution and a 19-item five-factor solution showed acceptable model fit. Internal consistency was acceptable for most subscale scores. The three-factor model was superior to the five-factor model in terms of internal consistency and discriminant validity. CONCLUSIONS:The 17-item form of the SHAS-DR, capturing three subscales, is a structurally valid and reliable tool for assessing attitudes toward self-harm in Danish mental health care. The three factors of 'Sympathy and Support', 'Judgmental Perception', and 'Acceptance and Understanding' point to central areas of antipathy and may be important targets for future training and stigma-reduction efforts among mental health care staff working with patients who engage in self-harm.