Insight assessment in psychosis remains challenging in practice-oriented research.

To develop and validate a proxy measure for insight based on information from electronic health records (EHR). For that purpose, we used data on the Scale to Assess Unawareness of Mental Disorder (SUMD) and data from EHR notes of patients in an early psychosis intervention programme (Programa de Atención a Fases Iniciales de Psicosis, Santander, Spain).

Junior and senior clinicians examined 134 clinical notes from 106 patients to explore criterion and content validity between SUMD and a clinician-rated proxy measure, using three SUMD items.

In terms of criterion validity, SUMD scores correlated with the proxy (r = 0.61, P < 0.001), even after adjusting for the following confounders: type of psychotic disorder, clinical remission status and rater experience (r = 0.58, P < 0.001); and the proxy predicted good insight status (odds ratio 20.95, 95% CI 7.32–59.91, P < 0.001). Regarding content validity, the three main SUMD subscores correlated with the proxy (r = 0.55–0.60, P < 0.005). There were no significant differences in age, gender or other clinical variables, i.e. discriminant validity, and the proxy significantly correlated with validated psychometric instruments, i.e. external validity. Intraclass correlation coefficient (i.e. interrater reliability) was 0.88 (95% CI 0.59–1.00, P < 0.05).

This SUMD-based proxy measure was shown to have good to excellent validity and reliability, which may offer a reliable and efficient alternative for assessing insight in real-world clinical practice, EHR-based research and management. Future studies should explore its applicability across different healthcare contexts and its potential for automation, using natural language-processing techniques.

Marked increases in mental health services utilisation across university settings mean that students often spend long periods waiting for evaluation and treatment.

To assess whether digital unguided self-help delivered while waiting for face-to-face therapy could reduce anxiety and depression and improve functioning in university students.

We retrospectively analysed routinely collected data from the student mental health service at the University of Padua, Italy. From June 2022, all students waiting for clinical evaluation and treatment received a self-help stress management booklet (The World Health Organization’s Doing What Matters in Time of Stress (DWM)). The clinical evaluation included depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and functional impairment (Work and Social Adjustment Scale). Single-group interrupted time series (ITS) analyses compared outcomes in users contacting the service between October 2021 and 23 June 2022 (pre-intervention) and, respectively, between 24 June 2022 and 18 November 2023 (post-intervention).

Seven hundred and forty-nine Italian students (77% women, median age 23 years) were included; of these, 411 (55%) received the intervention and 338 (45%) did not. ITS indicated that the intervention introduction coincided with immediate and sharp decreases in depression (level change, β = −2.26, 95% CI −3.89, −0.64), anxiety (β = −1.50, 95% CI −3.89, −0.65) and impaired functioning (β = −2.66, 95% CI −4.64, −0.60), all largely maintained over time.

In the absence of a control group, no causal inferences about intervention effects could be drawn. DWM should be studied as a promising candidate for bridging waiting time for face-to-face treatment.

Gender dysphoria is linked to various psychosocial challenges in adolescence, underscoring the need to identify and support youth experiencing gender-related distress. Although gender identity exists on a spectrum beyond the binary, no validated tool currently exists in Turkey that uses inclusive, gender-neutral language to assess it in adolescents.

This study aimed to evaluate the psychometric properties of the Turkish adaptation of the Utrecht Gender Dysphoria Scale–Gender Spectrum (UGDS-GS) among clinical- and community-based adolescents.

A total of 240 participants aged 12–23 years were included. The validity of UGDS-GS was assessed through content validity and confirmatory factor analysis. Reliability was measured using Cronbachʼs alpha and test–retest intraclass correlation coefficient (ICC). A sociodemographic data form, UGDS, UGDS-GS, Rosenberg Self-Esteem Scale (RSES) and Youth Self-Report (YSR) were utilised.

Findings demonstrated strong content validity, with a content validity Index of 0.69, and robust construct validity, indicated by a comparative fit index of 0.993 and a root-mean-square error of approximation of 0.071 following the exclusion of three items. UGDS-GS effectively differentiated scores across demographic groups, showing significant variances based on assigned gender and age. The scale also exhibited excellent criterion validity, evidenced by an area under the curve of 0.947 in receiver operating characteristic analysis, with high sensitivity (80%) and specificity (95.9%) at an optimal cut-off value of 42.50. With a Cronbachʼs alpha of 0.935, UGDS-GS demonstrated strong internal consistency and substantial test–receiver operating characteristic retest reliability (ICC 0.884), alongside notable but weak correlations with several RSES subscales and low to moderate correlations with YSR scores.

These results affirm that tUGDS-GS is valuable and reliable in assessing gender dysphoria in Turkish adolescents. Further research is warranted to improve applicability in diverse contexts and populations.

Ketamine is a promising treatment for post-traumatic stress disorder (PTSD), but further research is required to extend early findings.

To determine the short-term efficacy and tolerability of intramuscular (i.m.) ketamine compared with i.m. fentanyl for treatment-resistant PTSD symptoms.

We completed a randomised double-blind psychoactive-controlled study with single doses of i.m. racemic ketamine 0.5 mg/kg or 1.0 mg/kg or i.m. fentanyl 50 μg (psychoactive control). Eligible participants were aged between 18 and 50 years old and had treatment-refractory PTSD. The primary efficacy measure was the Impact of Events Scale – Revised (IESR), and tolerability was measured with the Clinician-Administered Dissociative States Scale. Analysis of variance with dose and time as repeated measures was used to assess the effects of drug treatment on total IESR and Clinician-Administered Dissociative States Scale scores.

Thirty-three participants completed the study (26 females, mean age 34.5 years). Ketamine, particularly at 1 mg/kg, was associated with substantially reduced IESR ratings, with some effect remaining after 1 week. Ketamine was also associated with short-term dissociative and cardiovascular effects.

We provide preliminary support for the efficacy and tolerability of i.m. ketamine in a community sample of individuals with PTSD. Further work is required to establish the optimal dosing regimen and longer-term role of ketamine in treatment of PTSD, but our findings are encouraging given the well-known of treatments in this area.

Accommodation of treatment preferences is known to improve treatment outcomes and increase patient satisfaction, and is further advised in several national guidelines.

The aim of this study was to systematically review studies that elicited treatment preferences and related determinants among adults with depressive or anxiety disorder for out-patient mental healthcare.

The systematic review was registered in PROSPERO (CRD42024546311). Studies were retrieved from Web of Science, PubMed, CINAHL and PsycINFO. We included studies of all types that assessed treatment preferences of adults with depressive or anxiety disorder for out-patient care. Extracted data on preferences and determinants were summarised and categorised. Preferences were categorised into treatment approaches, psychotherapy delivery and setting, and psychotherapy parameters. Study quality was assessed with the Mixed-Methods Appraisal Tool.

Nineteen studies were included in the review. Preferences examined related to treatment approaches (n = 13), psychotherapy delivery and setting (n = 10), and psychotherapy parameters (n = 7). High heterogeneity in statistical methods and preference types restricted the derivation of robust conclusions, but tendencies toward a preference for psychotherapy (compared with medication), and particularly individual and face-to-face therapy, were observed. Regarding determinants, results were highly diverse and many findings were derived from single studies.

Our review synthesised evidence on treatment preferences and related determinants in out-patient mental healthcare. Results showed considerable heterogeneity regarding preference types, determinants and statistical methods. We highly recommend to develop and use standardised instruments to assess treatment preferences. Care providers should consider preference variance among patients, and provide individualised care.

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) has been validated across various settings and health conditions. However, few studies have evaluated the 12-item WHODAS 2.0 within low- and middle-income countries (LMICs) among individuals with mental health conditions.

This study aimed to evaluate the psychometric properties of the 12-item WHODAS 2.0 in populations with depression, anxiety and psychosis from seven LMICs.

Secondary analyses were carried out using existing longitudinal data-sets in adult populations with depression, anxiety and psychosis across Brazil, Ethiopia, Ghana, India, Nigeria, Peru and South Africa. Reliability, validity and responsiveness to change of the 12-item WHODAS 2.0 were examined.

The 12-item WHODAS-2.0 was acceptably one-dimensional for all data-sets at baseline, with model-fit indices ranging from moderate to excellent. Internal consistency of the measure was found to be high across settings (Cronbach’s α = 0.83−0.97). Weak to moderate correlations with measures of symptom severity were found across all countries, except India. Moderate to strong correlations were observed with measures of functioning/quality of life across all countries, except Nigeria and Ghana.

Internal responsiveness to change was large in five out of seven studies, except both Ethiopian studies. However, external responsiveness to change exhibited variability, with weak to moderate correlations between change in WHODAS 2.0 and symptom scores across all countries.

The 12-item WHODAS 2.0 generally showed acceptable psychometric properties across different settings and mental health conditions. However, high variability was observed in convergent validity and external responsiveness to change, which warrants further investigation.