Social communication deficits are common across mental-health disorders, yet little is known about how individuals perceive their own gesture behaviours. Gaining insight into this, particularly across different disorders, could enhance our understanding of social communicative impairments and disruptions in self-awareness. The current study included 274 participants: N = 113 with schizophrenia, N = 65 with depression and N = 96 healthy controls where we compared self-reported gesture behaviours in social and non-social contexts. These self-reports where further explored in relation to objective-measures of gesture performance and expert-rating scales of symptom severity and social functioning. Both patient groups self-reported impairments compared to controls, but with disorder-specific profiles. Specifically, people with schizophrenia uniquely reported reduced gesture perception and use, while both patient groups reported diminished social gesture production. The schizophrenia group also reported elevated social perception relative to the other groups. The depression group consistently rated themselves higher than the schizophrenia group across domains. Furthermore, only the schizophrenia group showed distinct associations: self-reported social perception was negatively associated with self-reported gesture perception, but positively associated with self-reported social production. Notably, only schizophrenia showed a significant link between self-reported difficulties in social gesture production and objective gesture performance deficits. These findings suggest that disruptions in self-awareness of gesture behaviours manifests differently across disorders and underscore the value of integrating self-report measures together with objective assessments to capture the complexity of social-communicative impairments. This will help in designing tailored interventions aimed at enhancing social communication and awareness in diverse mental-health disorder populations.

Abstract In psychiatry, therapeutic drug monitoring (TDM) is routinely used to improve treatment safety and efficacy, yet its association with hospitalization duration and cost-effectiveness remains unclear. We hypothesized that the frequency of routinely requested TDM is associated with hospitalization duration. In this retrospective study, patients with major depressive disorder receiving TDM of antidepressants between 2015 and 2021 ( N = 383) were analyzed. Inclusion criteria were a hospital stay ≥7 days and a first TDM request at admission. Regression analyses assessed associations between TDM frequency and hospitalization duration. Receiver operating characteristic analysis identified a minimum effective TDM frequency of 0.66/week, which was associated with a mean reduction in hospitalization duration of 21 days ( p < 2.2*10 − ¹⁶). The upper effective threshold was approximated at 1.3/week. Higher TDM frequency was associated with more therapy adjustments within 7 days after TDM, including dose adaptations ( p = 3.07*10 − ¹⁶) and drug initiation/discontinuation ( p = 6.70*10 −6 ). Drug-specific analyses for amitriptyline, venlafaxine, and mirtazapine confirmed these associations. Cost-effectiveness analysis demonstrated a 37% cost reduction for patients with TDM frequencies ≥0.66/week. In conclusion, frequent, clinically integrated TDM of antidepressants and timely treatment adaptations were associated with shorter hospitalization and reduced hospitalization costs. These findings suggest that at least biweekly TDM combined with subsequent treatment adaptations may represent a previously underappreciated strategy to improve clinical and economic outcomes in a tertiary referral center for severe major depression. Whether these findings are transferable to other inpatient and outpatient settings of depression care requires further studies.

Tardive dyskinesia (TD) is a persistent sensorimotor syndrome associated with antipsychotic exposure in schizophrenia spectrum disorders (SSD) and mood disorders (MOD), yet its neurobiological basis remains poorly understood. We investigated whether TD represents a distinct clinical and neurobiological phenotype across SSD and MOD. In this study, we examined a bicentric cohort of 453 individuals with SSD (n = 360) or MOD (n = 93), including early-psychosis (EP) and multiple-episode SSD patients. TD status was defined using Schooler and Kane criteria based on the Abnormal Involuntary Movement Scale (AIMS). Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). Structural MRI data were processed using FreeSurfer (v7.4.1). Propensity score matching was applied to compare TD-positive and TD-negative patients while controlling for age, sex, illness duration, antipsychotic dose, and PANSS scores. TD prevalence was 10.6% in multiple-episode SSD (n = 31) and 7.5% in MOD (n = 7), whereas no EP patients met criteria for TD. Logistic regression identified male sex (p = 0.005) and higher PANSS general psychopathology scores (p = 0.021) as independent predictors of TD. TD-positive patients showed reduced paracentral cortical surface area in both the matched SSD sample (n = 86; p = 0.006, corr.) and the combined transdiagnostic sample (n = 179; p = 0.024, corr.). These alterations were absent in EP patients. In conclusion, our findings suggest that TD is a transdiagnostic phenomenon, occurring in both SSD and MOD. However, TD in SSD appears to be associated with a distinct clinical and neurobiological phenotype, marked by greater illness severity, male predominance, and focal sensorimotor cortical alterations.

Background and Hypothesis Gesture impairments are increasingly recognized as a core feature of schizophrenia, apparent across different domains and gesture categories. However, the potential differential effects of specific symptom domains on distinct types of gestures are unknown. The current study aimed to investigate whether specific domains of negative symptoms (NS) and formal thought disorder (FTD) relate to different aspects of gesture performance in patients with schizophrenia.Study Design Gesture accuracy was assessed using the well-established test of upper limb apraxia, which examines performance across 2 domains and 3 semantic categories in 87 patients with schizophrenia and 57 age- and gender-matched controls. Further, we used standardized clinical rating scales to assess NS and FTD across their different subdomains.Study Results Patients performed worse than controls in both domains and all gesture categories. Further, both NS and FTD were associated with gesture impairments, yet the associations were distinct. Negative symptoms, particularly avolition and affective flattening, as well as Objective Negative FTD, were specifically linked to reduced performance of pantomime meaningless gestures. Conversely, Objective Positive FTD was associated with a broader range of gesture deficits, impacting both imitation and pantomime domains, including intransitive and transitive gestures.Conclusions Our findings reveal that gesture impairments in schizophrenia vary across distinct symptom domains, indicating that NS and FTD contribute differently to motor and cognitive dysfunctions suggesting different underlying neural mechanisms. These insights can guide targeted interventions to address specific gesture deficits based on underlying psychopathology.

Psychomotor agitation (PmA), a common yet understudied symptom in Major Depressive Disorder (MDD), is characterized by heightened motor activity such as restlessness and fidgeting. PmA, like other symptoms of MDD, may persist into remission. This study examined the role of PmA in remitted MDD by using a novel smartphone based physiological measure of tremor. Participants (N = 157) consisted of healthy controls (N = 76) and those with remitted MDD (N = 81, to reduce the impact of current MDD symptoms on PmA), and tremor was assessed under the manipulation of position (palm-up, arm extended) and cognitive load (no cognitive load, cognitive load). Individuals with remitted-MDD exhibited a distinct pattern from HCs: specifically, greater tremor under high cognitive load compared to no cognitive load, while HCs showed lower tremor under cognitive load compared to no cognitive load. These findings suggest that tremor is sensitive to cognitive demands, and that tremor may provide an objective, physiological marker of PmA in remitted MDD. More generally, our results highlight the importance of using instrumental measures to assess PmA.

Background Repetitive transcranial magnetic resonance imaging is an effective treatment for depression. Accelerated TMS-protocols (aTMS) are applied several times per day and hold promise to rapidly decrease depressive symptoms. This study used high-resolution 7-Tesla MRI to anatomically precisely investigate aTMS-induced alterations of resting state functional connectivity (rs-FC) of the subgenual anterior cingulate cortex (sgACC). We hypothesized that aTMS reduces hyperactivation of the sgACC by decreasing rs-FC with key cortical regions. Furthermore, we explore associations between sgACC related rs-FC alterations, depression severity and mindfulness, which is often impaired in depression. Methods Twenty-four patients with current depression underwent 7-Tesla MRI-scans before and after a two-week aTMS treatment series (target: left dorsolateral prefrontal cortex, total number of pulses: 24,000). Fifteen healthy controls were also scanned twice for comparison, without receiving aTMS. Group × time interactions of changes in sgACC seed-based rs-FC were calculated. In addition, we examined baseline group differences of sgACC rs-FC. Correlations between longitudinal changes in sgACC rs-FC, depression severity, and mindfulness, were calculated. Results aTMS reduced rs-FC between the sgACC and the precuneus (core part of the default mode network; DMN), normalizing elevated baseline rs‑FC in depressed patients. No significant association was observed with changes in overall depression severity. However, decreases in sgACC–posterior DMN connectivity were significantly associated with improvements in mindfulness. Conclusions Treatment response in depression is associated with a normalization of rs‑FC alterations between the sgACC and the DMN. Observed changes might reflect processes related to improvements in mindfulness.

Psychomotor dysfunction, which can manifest as slowing (psychomotor retardation; PmR) and jerkiness or restlessness (psychomotor agitation; PmA) often occurs in individuals with major depressive disorder (MDD). As psychomotor dysfunction predicts a worse treatment response, accurately measuring and tracking PmR and PmA may improve outcomes. Traditionally, psychomotor dysfunction has been assessed using self-report or observer-based methods, which are often insensitive to subtle but potentially relevant movement abnormalities. Instrumental probes often require specialized equipment. Speech presents a promising option as it requires a significant motor component and is easy to collect. This study serves as a preliminary test of the association between speech indicators of PmR and PmA and manual motor tasks (handwriting velocity and force variability). Participants with current MDD (n = 36) and remitted MDD (n = 78) completed a diadochokinetic speech task, quickly repeating syllables in a sequence ("pataka" and "katapa"), as well as a test of handwriting velocity while drawing loops (PmR) and a test of variability in force applied to a transducer (PmA). Velocity of speech production and speech rate variability were automatically measured. For current MDD individuals, speech velocity was positively associated with the manual PmR measure (t(29) = 2.59, p < 0.05), and speech rate variability was positively associated with the manual PmA measure (t(33) = 2.952, p < 0.01). Effects were not significant for remitted MDD individuals, suggesting that this method may detect PmR/PmA only in those with acute depressive symptoms. These results suggest that diadochokinetic speech is a promising, objective measure of psychomotor dysfunction.

This study explores transdiagnostic patterns of grip strength in schizophrenia, current depression, and remitted depression.

OBJECTIVE:Suicidal ideation and behaviour (SIB) occur across various psychiatric disorders. Although certain disorders are associated with elevated rates of SIB, diagnostic labels alone provide limited information about suicide-related presentations. Psychological pain has been proposed as an important experiential process operating across diagnostic boundaries, but its relationship with psychiatric comorbidity remains poorly understood. This study examined associations between psychiatric diagnoses, the number of co-occurring diagnoses, and psychological pain across clinical groups differing in suicide-related presentations. METHOD:N = 233 psychiatric inpatients were recruited (recent suicide attempters [SUAT], recent suicide ideators [SUID], clinical controls [CLIN]). Psychiatric diagnoses were assessed using the Mini-International Neuropsychiatric Interview; psychological pain was measured using the Mee-Bunney Psychological Pain Assessment Scale. Analyses evaluated group differences in the number of diagnoses and psychological pain, their association, and diagnostic patterns. RESULTS:SUAT and SUID had higher mean numbers of diagnoses than CLIN; these did not differ between SUAT and SUID. Psychological pain differed across all groups and was positively associated with the number of diagnoses across the sample and within each group. Affective-anxiety and alcohol-dysthymic profiles were associated with suicide-related status. CONCLUSION:The number of diagnoses did not reflect differences between suicide-related groups. Although suicidal groups displayed greater diagnostic complexity than non-suicidal controls, differences between ideation and attempt were not mirrored by the number of diagnoses. Psychological pain differentiated all groups and was associated with the number of diagnoses. These findings suggest that psychological pain captures aspects of suicide-related clinical states not fully represented by diagnostic descriptions alone.

Anxiety disorders are common and impairing mental health conditions. Using data from 26,378 adults in the German National Cohort Study (NAKO), we investigated psychosocial and neuroimaging predictors of generalized anxiety disorder (GAD) symptoms and panic attacks. We conducted machine-learning analyses of 246 regions of interest from whole-brain imaging data in combination with psychosocial variables. Neuroimaging data alone showed suboptimal classification performance, whereas psychosocial variables alone - particularly depressive symptoms, stress, and childhood trauma - achieved the strongest discrimination for GAD symptoms and panic attacks. Adding neuroimaging features to psychosocial models modestly improved unbalanced accuracy and specificity by reducing false-positive classifications, indicating a conditional and complementary contribution of neuroanatomical information. Within the multivariate models, features from anxiety-related circuits, including the amygdala and superior parietal lobule, were consistently selected. Overall, these findings suggest that psychosocial factors dominate classification of anxiety outcomes, while structural MRI measures may provide complementary information within multimodal frameworks aimed at refining classification and supporting the development of individualized risk profiles to guide tailored therapeutic and preventive strategies.

BACKGROUND AND HYPOTHESIS:Catatonia is a transdiagnostic syndrome in schizophrenia spectrum disorders (SSD) and mood disorders (MOD), but both its empirical structure and the frequency of its signs and symptoms remain insufficiently understood. STUDY DESIGN:We examined 465 patients with SSD or MOD from Mannheim (Germany) and Bern (Switzerland) using the 40-item Northoff Catatonia Rating Scale (NCRS); 336 patients were additionally assessed with the Bush-Francis Catatonia Rating Scale (BFCRS). We examined the frequency of catatonia signs and symptoms across subthreshold and syndromal presentations (ICD-11, DSM-5) and analyzed the relationships between signs and symptoms using network analysis. STUDY RESULTS:84.1% of patients exhibited at least 1 catatonia sign or symptom, and 65.8% 3 or more on the NCRS, with 86 patients (18.5%) meeting ICD-11 criteria and 26 (5.6%) fulfilling DSM-5 criteria based on overlapping NCRS items. In the BFCRS subsample, 26.8% of patients showed at least 1 sign or symptom, and 14.6% 3 or more signs and/or symptoms. The most frequent signs/symptoms were flat affect, autism/withdrawal (>40%), staring, and rigidity (>20%), whereas severe motor signs/symptoms such as stupor, mutism, catalepsy, and waxy flexibility were less frequent (5%-10%). The NCRS network revealed weak to moderate associations among affective, behavioral, and motor signs and symptoms. The BFCRS network demonstrated comparable interrelations, supporting the NCRS findings, whereas the network in the ICD-11 subgroup was unstable. CONCLUSIONS:Catatonia emerges as a dimensional syndrome with frequent subthreshold manifestations. While syndromal catatonia aligns with ICD-11 psychomotor domains, subthreshold presentations do not, highlighting the need for systematic screening and refined dimensional models beyond categorical diagnosis.

ObjectivesRescue workers face frequent occupational trauma, increasing their risk for posttraumatic stress symptoms (PTSS), depression, and suicidal ideation. However, pathways linking trauma to suicidality remain poorly understood. This study investigated these mechanisms by testing a serial mediation model.MethodsFrom a larger survey of Swiss rescue workers, participants reporting suicidal ideation (n = 44) were matched by age, sex, and profession with a control group without suicidal ideation (n = 44). Symptomatology was assessed using validated questionnaires such as the Posttraumatic Stress Scale-10 (PTSS-10) for posttraumatic stress and the Brief Symptom Inventory (BSI) for depressive symptoms. Structural Equation Modeling (SEM) was employed to test a serial two-mediator model: Trauma Exposure - PTSS - Depressive Symptoms - Suicidal Ideation.ResultsParticipants with suicidal ideation had significantly higher levels of trauma, PTSS, and depressive symptoms. SEM confirmed an excellent model fit (χ² = 1.925, CFI = 1.000, RMSEA <.001) and a full mediation effect: trauma exposure was associated with PTSS, which in turn related to depressive symptoms, which were subsequently linked to suicidal ideation. The specific serial indirect pathway was significant (B = 0.143, p = .011), while the direct path from trauma to suicidal ideation was non-significant. The model explained 69.4% of the variance in suicidal ideation.ConclusionThe findings suggest a developmental pathway in which trauma exposure is associated with suicidal ideation through the sequential roles of PTSS and depressive symptoms. Consequently, suicide prevention for rescue workers should prioritize the management of post-traumatic and depressive symptoms to potentially disrupt this symptomatic progression.

BACKGROUND:Neurological soft signs (NSS) are frequent in schizophrenia spectrum disorders (SSD) and have been linked to structural alterations in basal ganglia-thalamic (BGT) regions. We hypothesized that SSD patients would show BGT volume differences compared to healthy controls (HC) and that NSS severity would relate to BGT volume and surface morphology in a replicable pattern. METHODS:Structural 3T T1-weighted MRI scans were obtained from 327 SSD patients and 134 matched HC in Mannheim (Germany) and Bern (Switzerland). NSS were assessed using the Heidelberg Scale and the Neurological Evaluation Scale (NES). BGT volumes were segmented using FSL-FIRST and compared across groups using general linear models adjusted for age, sex, intracranial volume, and daily antipsychotic medication. Associations with NSS scores were tested using regression analyses. RESULTS:High-NSS compared to low-NSS SSD patients showed reduced left accumbens volume in both cohorts, with a significant main effect in the Mannheim cohort (β = -43.73, p = .002 uncorrected, p = .019 corrected) and a partial replication in the Bern cohort (β = -53.06, uncorrected p = .03, p > .05, corrected). In contrast, IF-related effects on left accumbens and bilateral thalamic volumes were cohort specific. Daily antipsychotic medication and illness duration did not mediate or moderate these associations. CONCLUSIONS:This bicentric MRI study provides converging evidence that NSS severity in SSD is associated with BGT alterations, particularly reduced left nucleus accumbens volume. However, thalamic and surface-level findings were cohort specific, indicating partial rather than uniform reproducibility. Associations were not explained by daily dosage of antipsychotic medication or illness duration.

Introduction: Psychological pain is a central risk factor for suicidal behaviour. Nonverbal synchrony between patients and therapists has been shown to facilitate the development of therapeutic alliance, which in turn is linked to symptom reduction. Building on these associations, the present study investigated whether movement synchrony in suicide-specific therapy exceeds random synchrony and whether it is associated with patients' psychological pain. Method: A sample of 95 video recordings from therapy sessions of the Attempted Suicide Short Intervention Program (ASSIP) were analysed using Motion Energy Analysis to assess synchrony in head and upper body movements. Psychological pain was assessed using the Suicide Status Form II (SSF-II). Results: Genuine synchrony was significantly greater than pseudosynchrony t(110.16) = 4.314, p < .001, d = 0.49, 95% CI [0.005, 0.014], confirming the validity of the synchrony measurement. Additionally, movement synchrony was negatively correlated with psychological pain (r(84) = -.319, p = .003). This relationship remained significant after controlling for potential mediating factors (r(84) = -.302, p = .008). Conclusion: This study highlights the role of nonverbal synchrony in suicide-specific therapy, demonstrating that it exceeds random synchrony and is associated with lower levels of psychological pain.

Major Depressive Disorder (MDD) is a common and costly mental health condition that is often associated with deficits in executive function. Smartphone applications ("apps") have emerged as promising methods for assessing mental health-related outcomes in individuals' daily lives that can detect changes that unfold over time. Although smartphone apps have been used to evaluate executive functioning in individuals with neurological conditions and in other mental health disorders, few studies have examined this in MDD. The present study tested whether smartphone-assessed executive function is (1) impaired in individuals with current MDD (cMDD; n=30) relative to healthy controls (HC; n=43) and (2) related to resting-state functional connectivity within cognitive control-related neural networks. For two weeks, participants completed a set-shifting (Trail Making Test, TMT-B) task on their smartphone. Participants with cMDD had significantly lower TMT accuracy (β=-.24, p=.044) and greater variability in TMT accuracy (β=.25, p=.049) compared to HC. Resting-state analyses revealed that the association between TMT accuracy and connectivity between nodes of the dorsal attention network (bilateral intraparietal sulcus) was greater in HC than cMDD. The results extend previous laboratory-based findings by demonstrating that individuals with cMDD exhibit poorer mean-level smartphone assessed set-shifting performance and greater variability, along with altered set-shifting-related functional connectivity within the dorsal attention network. Smartphone-based assessments may offer a scalable and accessible approach for identifying executive function deficits in individuals with depression, which could potentially be integrated in monitoring treatment effects over time.

INTRODUCTION:Background: ASSIP flex is a structured, low-threshold brief therapy for individuals with suicidal behavior. As a flexible treatment approach, it can be delivered in inpatient, outpatient, and home settings. This study examines its feasibility, acceptability, and clinical application in routine practice. Method: In an observational pre-post study, 105 patients (53.8 % women; M = 38.8 years, SD = 15.2) were interviewed before (t0) and after (t1) the ASSIP flex brief intervention. Sociodemographic characteristics, feasibility aspects, and clinical variables were assessed. In addition, nine therapists evaluated implementation and acceptability. Results: ASSIP flex was mainly recommended by professionals (57.3 %) and showed high acceptability, with its adaptability across different treatment settings cited as a key advantage. Patients demonstrated a significant reduction in suicidal ideation (t104 = 4.5, p 0.001) and depressive symptoms (t104 = 6.0, p 0.001), as well as an increase in self-efficacy (t104 = -2.3, p 0.05). Higher perceived effectiveness of ASSIP flex correlated with lower suicidal ideation (r = -0.28, p 0.01) and depressive symptoms (r = -0.29, p 0.01), as well as increased self-efficacy (r = 0.22, p 0.05). Conclusion: ASSIP flex is a versatile treatment option for individuals with suicidal behavior. The results confirm its potential as a promising addition to existing care structures and its ability to address a critical gap in post-attempt care.

Anhedonia is a core feature of depression. It contains a consummatory and a motivational aspect. Whilst much neuroimaging research in patients with depression focused on the consummatory aspect of anhedonia, less is known about its motivational aspect. This study aimed to explore the neurobiology of networks related to motivational anhedonia. Thirty-eight patients with major depressive disorder (MDD) and 19 healthy controls underwent diffusion-weighted and resting state functional magnetic resonance imaging (rs-fMRI). For assessment of motivational anhedonia, we summed the values of the CORE non-interactiveness score, and the items 1 (hopelessness) and 7 (work and activities) of the Hamilton Depression Rating Scale. Whole-brain voxel-wise statistical analysis of fractional anisotropy (FA) data was performed using Tract-Based Spatial Statistics (TBSS). Additionally, we performed a whole-brain comparison of integrated local correlation of rs-fMRI signal (LCOR), to investigate regional functional differences between patients and healthy controls. Whole brain correlations between motivational anhedonia and measures of structural and functional connectivity (FA, and LCOR) were calculated. TBSS-analyses revealed reduced FA in the left superior longitudinal fasciculus (SLF) in patients with MDD. LCOR was reduced in patients with depression in an adjacent cluster localized in bilateral precunei. Within patients, there was a positive correlation between motivational anhedonia and LCOR in the precunei and a negative correlation in bilateral sensorimotor areas. FA-values did not show significant correlations. These findings suggest that motivational anhedonia in depression is linked to alterations of functional connectivity within bilateral precunei. Observed white matter microstructural alterations in the SLF do not show such an association.