Although sex differences in the epidemiology and clinical expression of schizophrenia (SZ) are well established, sex differences in cognition during the chronic stage of SZ remains controversial and merits further investigation. We aimed to examine sex differences in executive function and working memory within a longitudinal family study of SZ, hypothesizing that sex effects would be negligible. A total of 266 participants, including 113 individuals with SZ, 58 unaffected first-degree relatives (SZR), and 95 healthy controls (HC), were assessed twice over one year using a comprehensive neuropsychological battery. Mixed one-way analyses of covariance were performed to compare these participant groups, accounting for sex. No significant sex differences were found in performance on executive functioning and working memory tasks across SZ and SZR (p > 0.05). This performance pattern was also maintained for HC. However, the SZ group performed significantly worse than other two groups in most tasks (p < 0.0001; η²p = 0.09 to 0.14). The present results support previous evidence reporting the absence of sex differences in higher-order cognition in schizophrenia and provide new evidence that there are no sex effects in these domains in unaffected relatives of individuals with SZ.

BACKGROUND:Individuals with severe mental illness (SMI) have increased risk of physical comorbidities, linked to worse outcomes such as greater psychopathology, frailty, and neurocognitive impairment. Mechanisms underlying this burden remain unclear. This study examined whether frailty and psychopathology predict evening chronotype, especially in SMI with comorbidities. METHODS:A longitudinal study assessed 165 participants at two time points over one year: schizophrenia (n = 30), bipolar disorder (n = 42), major depressive disorder (n = 35), and healthy controls (n = 58). The SMI group (n = 107) was divided into SMI with comorbidities (SMI-C; n = 47) and without (SMI; n = 60). Measures included psychopathology, frailty, chronotype, neurocognitive and functional performance, and hematological biomarkers. RESULTS:Neurocognitive and functional impairments were greater in SMI groups than controls (F = 10.3-31.4; p < 0.0001; η²p = 0.12-0.34). The SMI-C group showed worse frailty than controls at T1 (F = 4.3; p < 0.01; η²p = 0.05) and than SMI at T2 (F = 8.5; p < 0.0001; η²p = 0.12), and elevated MCV/MCH (F = 3.8-9.4; p < 0.05-0.0001; η²p = 0.04-0.11). Chronotype distribution did not differ. Frailty and psychopathology predicted chronotype in SMI (p < 0.05-0.01); in controls, frailty and performance did so (p < 0.05). CONCLUSIONS:Psychopathological and hematological profiles are associated with chronotype and may help identify subgroups for chronobiology-informed interventions. These findings support more personalized treatment approaches.

Direct and inverse comorbidities between neuropsychiatric disorders and cancer are increasingly recognised as important features of the nervous system-cancer relationship, yet the inherited genetic architecture underlying these patterns remains poorly understood. Here, we analysed pairwise genetic correlations across 35 diseases represented by 115 GWAS datasets, including 9 psychiatric disorders, 10 neurological diseases and 16 cancers, using linkage disequilibrium score regression (LDSC) and high-definition likelihood (HDL), complemented by meta-analysis, subtype-resolved analyses, local covariance mapping and multi-omic benchmarking. Genetic correlations were predominantly positive and strongest within disease categories, whereas cancer-neurological pairs showed the weakest overall genetic affinity. Meta-analysis and subtype resolution uncovered associations obscured in aggregate analyses, including opposing correlations between familial and late-onset Alzheimer's disease and lung cancer, revealing subtype-dependent neuro-oncological biology. Local analyses identified recurrent genomic loci where direct comorbidities are consistent with shared inflammatory, interferon, survival and tissue-remodelling programs, whereas inverse comorbidities suggest competing demands on apoptotic regulation, immune tone and stress-response calibration between neuronal and tumour-cell states. Together, these findings provide a genome-scale genetic framework for neuropsychiatric-cancer comorbidity and identify shared inherited biological programs as candidates for mechanistic investigation and therapeutic translation.

In this opinion article, we discuss Pokémon Go as a paradigmatic example of how digital platforms can influence users’ health. In our view, the short-term reductions in sedentary behaviour and the increased walking, but also its social benefits reported in several studies illustrate the potential for digital platforms to promote healthier habits. However, we argue that these benefits coexist with notable risks, some of them being related to an irresponsible use of the platform, but some related to the game’s design and corporate strategies. In our opinion, Pokémon Go reflects the broader dual impact of interactive technologies, which can support communication, physical activity, and community building while also generating health concerns. We contend that educational initiatives, combined with appropriate regulatory measures, are essential to maximize benefits and mitigate potential harms.

Introduction Patient and public involvement (PPI) in research is increasingly recognised for its potential to enhance feasibility, improve relevance and foster collaboration at different stages of a study. Reporting guidelines such as GRIPP2 (Guidance for Reporting Involvement of Patients and the Public) have been developed to help improve completeness and transparency in PPI reporting. This meta-research project aims to assess the impact of the GRIPP2 reporting guidelines through citation and alternative metrics, analysing its uptake or adoption across authors, institutions, journals and countries, as well as its practical application in reporting PPI within diverse research designs.Methods and analysis This protocol for a meta-research project consists of two studies. In Study 1, we will conduct a search across Web of Science, Scopus and Google Scholar to identify all publications citing the GRIPP2 guidelines (planned for July 2026 using forward citation analysis). Retrieved records will undergo standardised processing and structured de-duplication to ensure each citing article is represented once. Following de-duplication, data from unique citations—including title, publication year, journal, subject category, keywords, document type, citations, authors’ names, institutional affiliations, country and funding sources—will be collected. Citation counts, alternative metrics (eg, mentions in policy documents, news media) and knowledge production patterns across authors, institutions, journals and countries will be analysed to assess GRIPP2’s impact and uptake of the guidelines. Descriptive analyses will be conducted (including the number of papers, citations, authors, countries, journals, keywords, funding, field distribution and main collaboration metrics). Network analyses will be carried out to study the structure of collaborations. In Study 2, we will evaluate a random sample of 300 research articles citing GRIPP2, including randomised trials (n=100), systematic reviews with meta-analyses (n=100) and health economic evaluations (n=100). If an insufficient number of citing studies are available within these categories, we will include additional study types identified in Study 1 (eg, study protocols, observational studies, mixed-methods or qualitative research studies and other types of reviews). Reporting and PPI practices in each article will be extracted by at least two researchers using a standardised data extraction form. Information on general, methodological and PPI items will be analysed and reported, stratified by study design (eg, randomised trials vs systematic reviews vs health economic evaluations).Ethics and dissemination Due to the nature of the proposed study, no ethical approval will be required. All data will be deposited in a cross-disciplinary public repository. It is anticipated the study findings could be relevant to a variety of audiences. Study findings will be disseminated at scientific conferences and published in peer-reviewed journals.Trial registration number Open Science Framework: https://osf.io/et85d

Patient and public involvement in research contributes to improving the relevance of studies, although its reporting in the literature is inconsistent and lacks clarity. To enhance the transparency and quality of this involvement, the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public) guidelines were developed, providing specific guidance for systematic and transparent reporting. This methodological note describes the adaptation and translation of these guidelines into Spanish, with the aim of promoting quality, consistency, and transparency in the evidence on patient and public involvement in research. Two versions are presented: GRIPP2 long form, with 34 items aimed at studies where patient and public involvement is the primary focus, and GRIPP2 short form, with 5 items for studies where involvement is a secondary component. The guidelines are primarily intended for researchers and authors wishing to incorporate patient and public involvement in their research, as well as for reviewers and journal editors. Additionally, they may be of interest to research policy makers, funding agencies, health technology assessment bodies, and, of course, patients and the public.

Background Obsessive-compulsive disorder (OCD) is a chronic mental health condition, and standard treatment often results in incomplete symptom relief. Growing evidence suggests that nutritional supplements, including vitamins, minerals, and amino acids, may serve as potential adjunctive treatments for OCD by influencing neurotransmitter regulation and inflammation. Our systematic review aims to assess the comparative efficacy of nutritional supplements on relevant clinical outcomes in individuals with OCD. Methods/design A protocol was developed and registered for this systematic review. Randomized controlled trials (RCTs) assessing the efficacy of nutritional supplementation compared with standard treatments (pharmacological and psychological interventions) will be included. Primary outcomes are changes in cognitive performance, quality of life, and psychiatric symptoms. Secondary outcomes include the presence of comorbidities or multimorbidities (e.g., metabolic syndrome). Systematic searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception onward. Two independent researchers will screen the citations and full-text articles. The risk of bias and study quality will be evaluated using validated tools, and association measures with 95% confidence intervals will be calculated. Potential sources of heterogeneity will also be analyzed. Discussion We aim to address the gaps in the current treatment paradigm for OCD by evaluating the efficacy of nutritional supplementation as an adjunctive therapy. These findings may provide insights into the potential of these supplements to improve cognitive and psychiatric outcomes. This protocol establishes a foundation for the rigorous synthesis of available evidence, which may inform future clinical practices and support the integration of nutritional strategies in OCD management. Systematic review registration Open Science Framework [https://doi.org/10.17605/OSF.IO/NZ5MU] ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Deidentified research data will be made publicly available when the study is completed and published

BackgroundThe relationship between cancer and central nervous system disorders has received increasing attention recently. Consequently, antipsychotics and antidepressants, commonly prescribed for conditions such as depression, bipolar disorder, and schizophrenia, have emerged as potential modulators of subsequent cancer risk. Previous studies have suggested that the use of these medications is associated with a decreased risk of cancer incidence and mortality, making them suitable candidates for drug repurposing. However, the potential therapeutic benefits do not extend to all cancer types, as some data suggest an increased risk for specific tumors. ObjectiveThis study aims to conduct a comprehensive review of systematic reviews and meta-analyses (review of reviews) that assess whether exposure to antidepressants or antipsychotics influences cancer incidence and mortality. MethodsTo provide a clear overview of this review, we have designed and registered the study protocol. Specifically, we will include systematic reviews and meta-analyses that examine the relationship between previous antipsychotic or antidepressant treatments and the subsequent cancer risk. The primary outcome will be the risk of cancer incidence and mortality (all malignant neoplasms) associated with exposure to psychopharmacological medications. Furthermore, secondary outcomes will include site-specific cancer incidence and mortality (eg, lung cancer). Literature searches will be conducted in multiple electronic databases (from their inception onwards), including PubMed/MEDLINE, Embase, and the Cochrane Database of Systematic Reviews. Three researchers will independently screen all citations, abstracts, and full-text articles. We will perform parallel search, selection, and extraction tasks using a large language model (GPT-4o; OpenAI). Data selection and extraction will involve both human reviewers and GPT-4o, whose performance will be validated through human evaluations. Thus, we will verify whether this type of tool can accelerate or even perform the tasks involved in a systematic review. The risk of bias and the quality of individual studies will be evaluated using appropriate tools. Subsequently, we will extract the summary association measures (eg, pooled relative risk, odds ratio, and hazard ratio) as reported in each included systematic review. Where available, we will summarize subgroup and sensitivity analyses as described by the authors. ResultsPlanned searches will be conducted in various electronic databases from their creation until September 2025. No results are available or included in this protocol. The expected results will be published in 2026. ConclusionsThis overview of systematic reviews and meta-analyses will provide an updated synthesis of the cancer risk associated with antipsychotic and antidepressant drugs. Furthermore, this study will examine factors that may explain potential study variations. Ultimately, these findings will be published in a peer-reviewed journal. Trial RegistrationOSF Registries 10.17605/OSF.IO/5ACWH; https://osf.io/5acwh/overview International Registered Report Identifier (IRRID)DERR1-10.2196/78596

Introduction: Psychiatric disorders and type 2 diabetes mellitus (T2DM) are chronic conditions that are often comorbid with each other. Neurocognitive and functional impairments are associated with numerous clinical changes during the course of illness. Immune-inflammatory dysfunction is emerging as a critical factor in the progression of these disorders. This study aimed to identify neurocognitive deficits and immune-inflammatory biomarkers that are suitable for signaling different illness trajectories from transdiagnostic and longitudinal perspectives. Methods: Clinical status, neurocognitive and functional performance, and peripheral blood biomarkers of immune-inflammation were assessed twice a year in 165 individuals, including 30 with schizophrenia (SZ), 42 with bipolar disorder (BD), 35 with major depressive disorder (MDD), 30 with T2DM, and 28 healthy controls (HCs). Participants with chronic illness (n = 137) were stratified into quartiles, taking their years of illness duration at baseline as a reference into categories of short illness duration (SD; n = 37), middle illness duration (MD; n = 36), long illness duration (LD; n = 32), and very long illness duration (VLD; n = 32). The illness duration was used to measure the illness trajectory, and the exposure of interest was clinical progression, calculated as the difference between clinical severity at baseline (T1) and after 1 year (T2). Results: Neurocognitive impairment was more significant in the VLD group than in the other groups, with small-moderate effect sizes (F = 2.9 to 9.3; p < 0.05-0.0001; eta(2)p = 0.06-0.24). Moreover, the HC group showed significantly higher functional outcomes than the other groups (F = 5.8 to 6.0; p < 0.0001; eta(2)p = 0.13-0.16). On the contrary, the HC group showed lower levels of immune-inflammatory markers (white blood cell count, absolute neutrophils, absolute monocytes, absolute basophiles, neutrophils/lymphocyte ratio, and platelets/lymphocyte ratio [PLR]) (F = 2.9 to 6.7; p < 0.05-0.0001; eta(2)p = 0.07-0.18). In all groups, significant prospective associations were observed between cognitive function (short-term memory and processing speed), global functional scores, immune-inflammatory biomarkers (monocyte/lymphocyte ratio [MLR] and PLR), and clinical status (p < 0.05). Furthermore, a similar combination of neurocognitive deficits and immune-inflammatory alterations compounded the transdiagnostic model that best discriminated the different illness trajectories (chi(2) = 67.4 to 78.7; p < 0.05-0.01). Conclusions: Neurocognitive dysfunction and systemic inflammation are associated with prolonged illness trajectories in individuals with psychiatric disorders and T2DM. An immune-inflammatory profile and neurocognitive and functional performance may be valuable to differentiate individuals with different illness trajectories. These findings have potential translational utility for early transdiagnostic interventions targeting these groups.

BackgroundSocial media use among adolescents and young adults has increased exponentially over the last decade, with TikTok being one of the most popular platforms. In Spain, 61% of adolescents use TikTok, spending an average of 1.5 hours daily on the app. This phenomenon coincides with an alarming increase in the prevalence of self-harm and suicidal behavior among adolescents and young adults. Moreover, suicidal behavior is one of the leading causes of morbidity and mortality in this age group. ObjectiveThe primary aim of this study is to evaluate the existing evidence on the association of TikTok use with self-harm and suicidal behavior in the adolescent population. MethodsThis systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure transparency, rigor, and reproducibility. Original studies that evaluate the impact of TikTok use on self-harm and suicidal behavior will be selected. The primary outcome will be the occurrence and prevalence of self-harm and suicidal behavior related to TikTok use among adolescents and young adults. Health science literature databases, including PubMed/MEDLINE, Cochrane, Web of Science, PsycINFO, and Scopus, will be searched. Two researchers will independently select studies that meet the predefined eligibility criteria, and they will extract data from each included study. The risk of bias and methodological quality of the included studies will be assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Joanna Briggs Institute tools, respectively. The methodological characteristics, association measures, and qualitative conclusions of the reviewed studies will be analyzed, and a descriptive synthesis will be presented through tables and graphs. ResultsThis systematic review formally began in July 2025, although it has been planned since September 2024. The final systematic review will be performed and reported according to this protocol and the PRISMA guidelines. Initially, the search returned 6126 records, and 3664 records are currently being screened for eligibility. Data from the final included studies will be extracted, collated, and analyzed. The risk of bias and quality of evidence will be determined. A narrative synthesis will be used to summarize the results of the systematic review. When possible, statistical analyses will be presented using graphs and figures. The final systematic review is expected to be published in December 2025. ConclusionsThis systematic review will help to better understand the relationship between TikTok use and self-harm and suicidal behavior among adolescents and young adults. Our findings may support future research, recommendations, and policies in this field, emphasizing the need to incorporate the digital environment as a key factor in adolescent mental health. Trial RegistrationOpen Science Framework MX5CJ; https://osf.io/MX5CJ International Registered Report Identifier (IRRID)DERR1-10.2196/78600

BackgroundObsessive-compulsive disorder (OCD) is a chronic mental health condition, and standard treatment often results in incomplete symptom relief. Growing evidence suggests that nutritional supplements, including vitamins, minerals, and amino acids, may serve as potential adjunctive treatments for OCD by influencing neurotransmitter regulation and inflammation. ObjectiveOur systematic review aims to assess the comparative efficacy of nutritional supplements on relevant clinical outcomes in individuals with OCD. MethodsA protocol was developed and registered for this systematic review. Randomized controlled trials assessing the efficacy of nutritional supplementation compared with standard treatments (pharmacological and psychological interventions) will be included. Primary outcomes are changes in cognitive performance, quality of life, and psychiatric symptoms. Secondary outcomes include the presence of comorbidities or multimorbidities (eg, metabolic syndrome). Systematic searches will be conducted in MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov from their inception onward. Two independent researchers will screen the citations and full-text studies. The risk of bias and study quality will be evaluated using validated tools, and association measures with 95% CIs will be calculated. Potential sources of heterogeneity will also be analyzed. ResultsThe search commenced in January 2025. Between June and August 2025, studies were identified and the full texts reviewed. Data extraction is anticipated to be completed in September 2025. The final synthesis is scheduled for December 2025. ConclusionsWe aim to address the gaps in the current treatment paradigm for OCD by evaluating the efficacy of nutritional supplementation as an adjunctive therapy. These findings may provide insights into the potential of these supplements to improve cognitive and psychiatric outcomes. This protocol establishes a foundation for the rigorous synthesis of available evidence, which may inform future clinical practices and support the integration of nutritional strategies in OCD management. Trial RegistrationOSF Registries 10.17605/OSF.IO/NZ5MU; https://osf.io/NZ5MU International Registered Report Identifier (IRRID)DERR1-10.2196/80240

BACKGROUND:Biological differences between women and men lead to variations in the prevalence and progression of many diseases, influencing diagnosis, management, and treatment outcomes. However, the biological mechanisms that contribute to sex differences in disease co-occurrence remain largely unexplored. This study aims to uncover the molecular processes underlying sex-specific patterns of comorbidity. METHODS:We analyze gene expression data from over 100 diseases, considering the biological sex of each sample (8906 samples, 43.06% women). For each sex, we construct disease similarity networks based on differential gene expression profiles and identify enriched biological processes. We then compare these networks with epidemiological data from population-level comorbidity studies to assess their concordance. Finally, we investigate drugs associated with sex-specific comorbidities to identify potential differences in therapeutic response. RESULTS:We show that 13-16% of transcriptomically similar disease pairs are sex-specific. These similarities recover 53-60% of known comorbidities that differ between women and men. Diseases can co-occur through the differential alteration of biological processes, with immune and metabolic pathways playing a greater role in women, and extracellular matrix organization and signal transduction pathways in men. We also identify drugs differentially linked to comorbid diseases depending on sex, suggesting possible sex-dependent effects on disease co-occurrence. CONCLUSIONS:Our findings demonstrate that transcriptomic data can reveal sex-specific molecular links between diseases and suggest that biological sex should be considered in the design of therapeutic strategies and drug administration.

Liver cirrhosis can present with complications such as hyperammonemia and inflammation, and the consequent appearance of minimal hepatic encephalopathy (MHE), which has been associated with poorer motor performance. Our aim was to analyze whether motor impairment would predict blood levels of ammonia and inflammatory factors in cirrhotic patients, independently of cognitive impairment. Blood was extracted from 67 cirrhotic patients from two hospitals in Valencia (Spain) (41.79% with MHE, diagnosis by Psychometric Hepatic Encephalopathy Score). Blood ammonia and plasma levels of interleukins (IL-6, IL-13, IL-18, IL-21, IL-22, IL-23, TNF-α, TGF-β) and chemokines (CCL20, CX3CL1, CXCL13, CCL2) were measured by micro-diffusion and ELISA, respectively. Gait, balance, hand strength, and manual motor speed were evaluated with biomechanical tools. All measurements were performed at University of Valencia, Spain. Motor outcomes were used as predictors in multiple linear regression analysis to determine their predictive capacity on blood ammonia and inflammatory factors. We found that levels of blood ammonia and TNF-α were significantly predicted by the set of motor parameters with a coefficient of determination (R2)>0.50, particularly by balance performance through the movement and velocity of Center of Pressure across the balance test. On the other hand, the models for IL-13, IL-21, CX3CL1, IL-6, CCL2, yielded an R2 varying between 0.31-0.39. Lastly, R2 was between 0.29 and 0.16 for the cytokines CXCL13, IL-22, CCL20, IL-18, and TGF-β. Beside balance outcomes, gait speed and swing phase, as well as grip and lateral pinch strength, and hand motor speed, were frequent predictors in the models calculated. In conclusion, motor performance can predict blood levels of ammonia and cytokines in patients with liver cirrhosis, independently of the cognitive impairment present. Motor impairment could serve as an early, non-invasive indicator of disease severity, indicating the utility of conducting these tests in daily clinical practice and in follow-up studies.

Introduction This study aimed to evaluate the predictive validity and discriminatory ability of clinical outcomes, inflammatory activity, oxidative and vascular damage, and metabolic mechanisms for detecting significant improve maximum heart rate after physical activity training in individuals with psychiatric disorders and obesity comorbid using a longitudinal design and transdiagnostic perspective. Methods Patients with major depressive disorder, bipolar disorder and, schizophrenia and with comorbid obesity (n = 29) were assigned to a 12-week structured physical exercise program. Peripheral blood biomarkers of inflammation, oxidative stress, vascular mechanisms, and metabolic activity, as well as neurocognitive and functional performance were assessed twice, before and after intervention. Maximum heart rate was considered a marker of effectiveness of physical activity. Mixed one-way analysis of variance and linear regression analyses were performed. Results Individuals with psychiatric disorders and comorbid obesity exhibited an improvement in cognition, mood symptoms and body mass index, increase anti-inflammatory activity together with enhancement of the oxidative and cardiovascular mechanisms after physical activity training (p<0.05 to 0.0001; d = 0.47 to 1.63). A better clinical outcomes along with regulation of inflammatory, oxidative, and cardiovascular mechanisms were critical for predicting significant maximum heart rate variation over time (χ2 = 32.2 to 39.0, p < 0.0001). Conclusions The regulation of the anti-inflammatory mechanisms may be essential for maintained of healthy physical activity across psychiatric disorders and obesity. Likewise, inflammatory activity, oxidative stress, vascular and cardio-metabolic mechanisms may be a useful to identify individuals at greater risk of multi-comorbidity.

Verbal fluency (VF) has been proposed as a putative neurocognitive endophenotype in schizophrenia (SZ) and bipolar disorder (BD). However, this hypothesis has not been examined using a longitudinal family approach. We conducted a five-group, comparative study. The sample comprised 323 adult participants, including 81 BD patients, 47 unaffected relatives of BD BD-Rel), 76 SZ patients, 40 unaffected relatives of SZ (SZ-Rel), and 79 genetically unrelated healthy controls (HC). All subjects were assessed twice with semantic VF (sem-VF) and phonological VF (ph-VF) tests over a 2-year follow-up period. ANCOVAs controlling for age and years of education were used to compare performance across groups. Patients with SZ and BD and their unaffected relatives showed sem-VF and ph-VF deficits at baseline, which persisted over time (all, p < 0.05). Moreover, BD-Rel showed an intermediate performance between SZ and HC. A repeated-measures ANOVA revealed no significant differences in the between-group trajectories comparison (p > 0.05). Our findings support that VF may represent a neurocognitive endophenotype for SZ and BD. Further longitudinal, family studies are warranted to confirm this preliminary evidence.

Abstract Background The economic crisis that began in 2008 has severely affected Southern (Greece, Italy, Portugal, Spain) Western European (SWE) countries of Western Europe (WE) and may have affected ongoing efforts to eliminate viral hepatitis. This study was conducted to investigate the impact of the economic crisis on the burden of HBV and HCV disease. Methods Global Burden of Diseases 2019 data were used to analyse the rates of epidemiological metrics of HBV and HCV acute and chronic infections in SWE and WE. Time series modelling was performed to quantify the impact of healthcare expenditure on the time trend of HBV and HCV disease burden in 2000–2019. Results Declining trends in incidence and prevalence rates of acute HBV (aHBV) and chronic HBV were observed in SWE and WE, with the pace of decline being slower in the post-austerity period (2010–2019) and mortality due to HBV stabilised in SWE. Acute HCV (aHCV) metrics and chronic HCV incidence and mortality showed a stable trend in SWE and WE, whereas the prevalence of chronic HCV showed an oscillating trend, decreasing in WE in 2010–2019 (p < 0.001). Liver cancer due to both hepatitis infections showed a stagnant burden over time. An inverse association was observed between health expenditure and metrics of both acute and chronic HBV and HCV. Conclusions Epidemiological metrics for HBV and HCV showed a slower pace of decline in the post-austerity period with better improvement for HBV, a stabilisation of mortality and a stagnant burden for liver cancer due to both hepatitis infections. The economic crisis of 2008 had a negative impact on the burden of hepatitis B and C. Elimination of HBV and HCV by 2030 will be a major challenge in the SWE countries.