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This chapter provides an overview of chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repetitive head trauma. It discusses the historical background of CTE, its neuropathology, clinical features, and epidemiology. The chapter also explores the current understanding of CTE staging and common co-pathologies. It highlights the challenges in diagnosing and monitoring CTE in living patients and the ongoing research efforts to develop biomarkers for early detection. The chapter concludes by discussing the prevention, treatment, and future directions in CTE research. It is important to recognize the risks of head trauma and implement measures to reduce the incidence of CTE and other neurodegenerative diseases associated with head trauma.
Accurate and up-to-date epidemiological data on the prevalence and treatment of common mental disorders are essential for evidence-based healthcare policy and resource allocation. However, large-scale, representative epidemiological surveys on common mental disorders in China—particularly those incorporating insomnia disorder and applying the latest diagnostic criteria alongside validated assessment tools—remain notably lacking.
Methods
We conducted a population-based, cross-sectional epidemiological survey to assess the prevalence and treatment of common mental disorders among adults in Beijing, China, using a multistage clustered probability sampling design (n = 10,778). Licensed psychiatrists administered standardized diagnostic interviews based on DSM-5 criteria to assess both lifetime and current mental disorders through a single-stage assessment protocol.
Results
Among all lifetime mental disorders assessed, depressive disorders constituted the most prevalent diagnostic category (7.7%), with major depressive disorder representing the most common specific diagnosis (5.4%). Individuals aged 65 years and older exhibited significantly higher 1-month prevalence of both depressive disorders and insomnia disorder compared with younger age groups. Alcohol-related disorder was more prevalent in men than in women, and in urban residents than in rural residents. Help-seeking patterns revealed a predominant reliance on informal support over professional services among individuals with lifetime mental disorders. Only 13.4% sought help from mental health professionals, and 12.7% received mental health professional treatment.
Conclusions
The improved access to treatment did not translate into a reduction in population-level mental disorder prevalence, which may be attributable to the low rate of professional mental health treatment. Governments must optimize mental healthcare access.
A phenomenon distinctive to attention-deficit hyperactivity disorder (ADHD) is that the effects of stimulants are evident in domains of attention, mood, energy and focus, independent of the presence of an ADHD diagnosis. This reflects recreational use of stimulants for these and other effects. Perceived treatment response probably reinforces diagnosis, and hence diagnostic and prescribing habits.
Cognitive impairment is a significant, yet often overlooked, non-motor symptom of Parkinson’s disease, and a strong predictor of quality of life for those affected. Despite the availability of both pharmacological and non-pharmacological treatment options for Parkinson’s disease, their efficacy for the cognitive symptoms of the disease specifically is unclear, as no ‘gold standard’ treatment strategy for cognitive impairment in the disease has yet emerged. Further, a comparative understanding of the efficacy of each of these treatment options is severely lacking.
Aims
This systematic review aims to critically evaluate the efficacy of non-pharmacological interventions for the treatment of cognitive impairment in Parkinson’s disease.
Method
A comprehensive systematic search will be conducted to identify studies involving participants clinically diagnosed with Parkinson’s disease that assess non-pharmacological interventions targeting cognitive impairment. If feasible, results will be synthesised using meta-analysis; otherwise, narrative synthesis will be used.
Results
This is a protocol for a systematic review that is yet to be conducted.
Conclusions
The findings from this review will provide critical insight into the efficacy of non-pharmacological treatment options for cognitive impairment in Parkinson’s disease, which may help to influence clinical recommendations for the treatment of cognitive impairment in Parkinson’s disease and highlight existing gaps in the literature.
Test whether a dissonance-based transdiagnostic eating disorder treatment, body project treatment (BPT), produces greater reduction in brain reward region response to the thin ideal and behaviors used to pursue this ideal and eating disorder symptoms, and higher abstinence from eating disorder behaviors and remittance from eating disorder diagnoses than a matched transdiagnostic interpersonal psychotherapy (IPT).
Methods
Women with various eating disorders (N = 83) were randomized to 8-week group-implemented BPT or IPT and completed functional magnetic resonance imaging (fMRI) at pretest and posttest, and surveys and masked diagnostic interviews at pretest, posttest, and 6-month follow-up.
Results
BPT versus IPT participants showed significantly greater reductions in mid cingulate cortex response to thin models, anterior cingulate cortex response to eating disorder behavior words, eating disorder symptoms (d = 0.54), and body dissatisfaction (d = 0.57), and marginally greater reductions in psychosocial impairment (d = 0.39) at posttest, as well as significantly greater reductions in body dissatisfaction (d = 0.68) and psychosocial impairment (d = 0.63), and marginally greater reductions in eating disorder symptoms (d = 0.53) at 6-month follow-up. At posttest, BPT versus IPT participants showed significantly greater abstinence from binge eating and purging (48% versus 23%, respectively) but did not differ on remittance from eating disorder diagnoses (52% versus 44%, respectively).
Conclusions
Results provide further evidence of target engagement for BPT and suggest that it is more effective than IPT in treating a range of eating disorders.
This chapter provides an overview of neurodevelopmental disorders (NDDs) in children and young people. The definition and classification of NDDs is discussed, including key differences between ICD-10 and ICD-11 and the problematic use of language in diagnostic classifications, which is at odds with the social model of disability. Important stages of a multidisciplinary assessment of NDDs include a detailed developmental history, a psychosocial history, observation of the child, an assessment of the child’s communication and learning and supplementary rating scales. The role of professionals such as Community Paediatricians, Speech and Language Therapists, Occupational Therapists, teachers and Educational Psychologists is highlighted. Features of the main NDDs are outlined, including Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Specific Disorders of Development and Language and Tic disorders. Finally, an overview of treatment approaches and their evidence base is explored.
The treatment response for the negative symptoms of schizophrenia is not ideal, and the efficacy of antidepressant treatment remains a matter of considerable controversy. This systematic review and meta-analysis aimed to assess the efficacy of adjunctive antidepressant treatment for negative symptoms of schizophrenia under strict inclusion criteria.
Methods
A systematic literature search (PubMed/Web of Science) was conducted to identify randomized, double-blind, effect-focused trials comparing adjuvant antidepressants with placebo for the treatment of negative symptoms of schizophrenia from database establishment to April 16, 2025. Negative symptoms were examined as the primary outcome. Data were extracted from published research reports, and the overall effect size was calculated using standardized mean differences (SMD).
Results
A total of 15 articles, involving 655 patients, were included in this review. Mirtazapine (N = 2, n = 48, SMD −1.73, CI −2.60, −0.87) and duloxetine (N = 1, n = 64, SMD −1.19, CI −2.17, −0.21) showed significantly better efficacy for negative symptoms compared to placebo. In direct comparisons between antidepressants, mirtazapine showed significant differences compared to reboxetine, escitalopram, and bupropion, but there were no significant differences between other antidepressants or between antidepressants and placebo. No publication bias for the prevalence of this condition was observed.
Conclusions
These findings suggest that adjunctive use of mirtazapine and duloxetine can effectively improve the negative symptoms of schizophrenia in patients who are stably receiving antipsychotic treatment. Therefore, incorporating antidepressants into future treatment plans for negative symptoms of schizophrenia is a promising strategy that warrants further exploration.
Electroconvulsive therapy (ECT) is one of the most effective treatments for depression, but worries about cognitive side effects remain. This retrospective study evaluated cognitive outcomes and the antidepressant efficacy of ECT in a real-life sample of patients with treatment-resistant uni- or bipolar depression.
Methods
We included 90 depressed inpatients aged 49 ± 13.8 (SD) years who underwent 10 ± 2.1 (SD) unilateral or bitemporal ECT treatments and completed an extensive pre- and post-treatment psychological test battery. The Hamilton Depression Rating Scale (HAMD) and the Mini-Mental State Examination (MMSE) were evaluated as main outcomes pre-/post-ECT treatment.
Results
There was no significant change in MMSE scores between pre-/post-treatment assessments (β = 0.10, 95% confidence interval [CI] [−0.44, 0.25], p = 0.58), indicating no negative effect on global cognition. A minority of patients (N = 3) experienced a reduction of ≥5 points in the MMSE. Most cognitive tests showed no difference; however, some domains revealed statistically significant improvements (visual learning and motoric reaction time), whereas one domain showed a significant decline (verbal learning). Higher age and higher stimulus doses predicted worse outcomes in some cognitive domains. While ECT significantly reduced depressive symptoms measured by HAMD (β = −5.51, 95% CI [−7.08, −3.94], p < 0.001), depressive symptoms were not associated with cognitive outcomes.
Conclusions
No major cognitive changes were observed. While test results indicated deterioration in verbal learning and improvement in visual learning and motoric reaction time, effect sizes were small, and other cognitive tests showed no significant changes. The main limitation is the absence of retrograde memory assessment.
Two years on from the implementation of the Assisted Decision-Making (Capacity) Act (ADMCA) 2015, significant legal uncertainty persists in Ireland’s acute hospitals for the care of people who lack capacity to consent to treatment. Consultation-liaison psychiatrists must navigate a legal landscape where clear lacunae have emerged in the regulation of frequently encountered clinical scenarios. We identify three of these – eating disorders requiring refeeding, refusal of life-saving treatment, and unsafe discharges – where neither the ADMCA nor the Mental Health Act 2001 provide legal authority to intervene. In such cases, the Inherent Jurisdiction of the High Court has become the default mechanism for authorising treatment or deprivation of liberty, raising serious concerns about proportionality, clinical delays and uncertainty, cost, and consistency. We also consider a fourth category of patients who require immediate life-saving treatment, and the legal status of Advance Healthcare Directives in this context. Many of the patients who fall into these categories will have an established or suspected mental illness requiring the clinical input of a consultation-liaison psychiatry team.
We contrast Ireland’s evolving capacity legislation with developments in England and Wales. Reflecting on these comparisons, we consider the proposed Protection of Liberty Safeguards may provide some clarification but also contain potential risks of becoming unwieldy and bureaucratic and still fail to provide a workable statutory basis for authorising medical treatment in acute hospital settings. A proportionate, patient-centred, and clinically usable legal framework remains urgently needed.
This chapter explores the role of functional connectivity (FC), as measured by FMRI, in the neural processes involved in the recovery from aphasia following left hemisphere strokes. It distinguishes between normalization (restoration of typical connectivity patterns) and compensation (reorganization and recruitment of new regions and connections). The chapter organization is based on two methodological dimensions. One is the type of connectivity measured: resting-state vs. task-based FC. The second is the study design: a single time-point scan, examining the correlation between connectivity and language performance across individuals; or a pre/post-treatment design, examining changes in connectivity within participants. While the results of many studies show that normalization of left hemisphere connectivity contributes to language performance, there is also evidence for compensatory processes in both hemispheres and in interhemispheric connectivity, as involved in language recovery. The chapter also highlights the role of connectivity with domain general networks in aphasia studies, beyond the language network. Studies measuring large scale networks show mixed evidence regarding the contribution of integration across networks vs. segregation and specialization of networks to language recovery. The chapter emphasizes the importance of considering factors like patient heterogeneity, lesion characteristics, and the type of FC analysis when interpreting results.
Neurological disorders are the leading cause of disability worldwide. Restoring function through the modulation of brain networks has been a cornerstone in the field of functional restoration. Deep brain stimulation (DBS) along with neuroprosthetics such as cochlear implants have significantly improved the quality of life for patients with functional restoration. However, there remains a large population of patients who cannot benefit from existing approved medical technologies. Brain–machine interfaces (BMI) show great promise in addressing the unmet need in diagnostic and functional needs for patients with neurological disorders and disabilities. To date, more humans have received clinical benefit from the Utah Array than from any other BMI, but this also had several limitations. Recent advances in BMI address these limitations, showing improvements in invasiveness, longevity, signal quality, and usability. This chapter provides an overview of BMI and discusses the evolving technology in the field of BMI, which provides a novel dimension to the existing neurosurgical armamentarium modulating neurological function beyond the conventional neurosurgical treatment.
Patients diagnosed with hypertension (HT) are at high risk for end-organ damage. With changing living conditions and access to healthcare facilities worldwide, the rate of diagnosis in childhood is increasing. In this study, healthy children were compared with a group of pediatric patients diagnosed with hypertension. Cardiac findings in the hypertensive group were compared at presentation and at six months. We aimed to determine the discriminatory value of epicardial adipose tissue (EAT) measurements as an early imaging marker for cardiac involvement in children with HT compared to healthy children and to determine its prognostic feature for HT treatment response.
Methods:
Fifty-nine primary hypertension patients and 76 control patients aged 0-18 years were compared. EAT values measured between the healthy group and the patient group and at the beginning of treatment and subsequent follow-ups in the patient group were evaluated with M-mode measurements.
Results:
There was no difference between the groups in terms of sex, and age. EAT was found to be significantly higher in the patient group than in the healthy group. There was a statistically significant difference between the EAT measurements evaluated before and after treatment in the patient group.
Conclusions:
Hypertension is an important cause of morbidity and mortality. Using EAT measurements as a noninvasive parameter may provide information about early cardiac involvement due to HT. EAT is promising as an imaging marker that can be used in diagnosis and follow-up.
Hallucinations and other unusual sensory experiences (USE) are common in people with psychosis. Yet access to effective psychological therapies remains limited. We evaluated if we can increase access to psychological therapy by using a brief treatment, focused only on understanding and dealing with hallucinations (Managing Unusual Sensory Experiences; MUSE), delivered by a less trained but more widely available workforce that harnessed the benefits (engaging content, standardisation) afforded by digital technology. The delivery of this in a real-world setting was considered within the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework.
Method:
Thirty-eight people with psychosis and distressing hallucinatory experiences were offered sessions of MUSE, delivered by trained and supervised assistant psychologists. MUSE was evaluated within an uncontrolled study conducted in routine clinical practice. Assessments pre- and post-treatment enabled consideration of the impact of the real-world intervention.
Results:
There was good uptake (88.4%), and receipt of MUSE (89% received four or more sessions). On average participants received 8.69 sessions. The participants reported significant reductions in voice hearing, paranoia, as well as improved quality of life. The feedback from the participants indicated that MUSE delivered by a less trained workforce was acceptable and beneficial.
Conclusions:
In a real-world setting we were able to offer and deliver sessions of a brief psychological psycho-education and coping skills enhancement package to people with distressing USE in the context of psychosis. The delivery of MUSE when considered against the NASSS framework appears to be a good candidate for adoption in services.
Human babesiosis is a disease transmitted by the bite of an infected tick or via blood transfusions involving contaminated blood products; in humans, it can lead to severe complications and even death, depending on the clinical history, age and health status of the affected patient. Babesiosis is caused by members of the Babesia spp., protozoan parasites whose life cycle includes sexual reproduction in the arthropod vector and asexual reproduction in the mainly mammalian host. Cases of human babesiosis have been rare, but there are increasing reports of human babesiosis associated with climatic changes affecting the geographical distribution of the parasite and tick vector, enhanced vector–human interactions and improved awareness of the disease in humans. Diagnostics and treatment options for humans are based around discoveries in veterinary research, such as point-of-care testing in cases of bovine babesiosis, and include direct diagnosis by blood smears, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) technologies, and indirect diagnosis by ELISA, immunofluorescence tests (IFAT) and fluorescent in situ hybridisation. Treatment involves a combination of drugs such as azithromycin and atovaquone, or clindamycin and quinine, but more effective options are being investigated, including, but not limited to, trans-chalcones and tafenoquine. Improved surveillance, awareness and diagnosis, as well as advanced technologies to interrupt vector–host interactions, are crucial in managing the increased threat posed by this once-neglected disease in humans.
Catatonia is a complex neuropsychiatric disorder characterized by motor, affective and cognitive-behavioral symptoms, presenting significant challenges for both psychiatrists and neurologists. It occurs in 5–18% of patients in inpatient psychiatric units and in 3.3% of those in neurology or neuropsychiatric tertiary care inpatient settings. Despite its relatively high prevalence, catatonia is often underdiagnosed and inadequately treated, which can lead to substantial disadvantages for patients and may be associated with potentially life-threatening conditions. This comprehensive guide is designed to assist clinicians, researchers, and students in understanding and treating catatonia. It navigates through the history of the condition, exploring its phenomenology, clinical manifestations and pathophysiology, before delving into effective treatment strategies. By providing a clear and thorough overview, this guide simplifies the recognition of catatonia and promotes prompt and accurate treatment, encouraging future research endeavours in catatonia.
Understanding the factors influencing alcohol use disorder (AUD) treatment outcomes is essential. More knowledge about patient characteristics that predict treatment outcomes can help personalise interventions, improve treatment planning and address the needs of specific subgroups. The frequency of treatment attendance may also affect drinking outcomes after treatment. Despite research efforts, uncertainty remains about how patient factors and treatment attendance influence treatment outcomes.
Aims
To examine how patient factors and treatment attendance predict high- or low-risk drinking at the end of treatment.
Method
We used data (N = 92) from a multisite observational study of treatment-seeking individuals with AUD attending group treatment. Sociodemographic measures, alcohol and substance use measures, cognitive functioning, psychological distress, personality functioning and quality of life were screened in univariate analyses. Significant variables were entered into a binary logistic regression model.
Results
Individuals with a higher percentage of treatment attendance (odds ratio 0.96 [95% CI 0.93, 0.96]) and with greater responsiblity scores on the Severity Indices of Personality Functioning (odds ratio 0.30 [95% CI 0.14, 0.64]) had a decreased likelihood of high-risk drinking at treatment end. Substance use, psychological distress and cognitive functioning were not associated with drinking levels at the end of treatment.
Conclusion
A higher percentage of treatment attendance has a minor effect on drinking levels. Being more responsible, as reflected in higher scores on the responsibility domain, reduces the likelihood of high-risk drinking at the end of treatment. Clinicians are encouraged to screen and assess personality functioning when planning treatment for individuals with AUD.
Adolescents are at a heightened risk of suicide reattempts following hospital discharge, but few evidence-based interventions exist. This study evaluated the efficacy of the self-awareness of mental health (SAM) program combined with treatment as usual (TAU) versus TAU alone in reducing reattempts among high-risk adolescents.
Methods
A randomized clinical trial was conducted across nine Spanish hospitals (January 2021–March 2024) with 261 adolescents (12–17 years) who had attempted suicide within the last 15 days. Participants were assigned to SAM + TAU (n=128) or TAU (n=133), with 12-month follow-up. The primary outcome was suicide reattempts within 12 months; secondary analyses examined time to reattempt and associated risk factors.
Results
After 12-months, no significant differences were found in reattempt rates [22.6% (SAM) versus 27.8% (TAU); OR=0.610, 95%CI (0.321–1.151), p=0.127] or time to reattempt [HR=0.606, 95%CI (0.390–1.021), p=0.060]. In SAM, attentional impulsivity emerged as a significant risk factor [HR=1.126, 95% CI (1.004–1.263), p=0.043], while nonplanning impulsivity was protective [HR=0.878, 95%CI (0.814–0.948), p<0.001]. In TAU, increased suicide risk was linked to suicidal intentionality [HR=1.341, 95%CI (1.009–1.782), p=0.044] and more prior attempts [HR=1.230, 95%CI (1.039–1.457), p=0.016]. Conversely, fewer psychiatric diagnoses emerged as a protective factor [HR=0.821, 95%CI (0.677–0.996), p=0.045].
Conclusions
While no significant differences were found between groups, SAM identified important psychological factors influencing suicide risk. These findings provide a foundation for targeted interventions to prevent reattempts in adolescents.
Peripartum depression (PPD) is a prevalent mental health disorder in the peripartum period. However, a recent systematic review of clinical guidelines relating to PPD has revealed a significant inconsistency in recommendations.
Aims
This study aimed to collect up-to-date evidence on the effectiveness of interventions and provide recommendations for prevention, screening and treating PPD.
Method
A series of umbrella reviews on the effectiveness of PPD prevention, screening and treatment interventions was conducted. A search was performed in five databases from 2010 until 2023. The guidelines were developed according to the GRADE framework and AGREE II Checklist recommendations. Public stakeholder review was included.
Results
One hundred and forty-five systematic reviews were included in the final analysis and used to form the guidelines. Forty-four recommendations were developed, including recommendations for prevention, screening and treatment. Psychological and psychosocial interventions are strongly recommended for preventing PPD in women with no symptoms and women at risk. Screening programmes for depression are strongly recommended during pregnancy and postpartum. Cognitive–behavioural therapy is strongly recommended for PPD treatment for mild to severe depression. Antidepressant medication is strongly recommended for treating severe depression in pregnancy. Electroconvulsive therapy is strongly recommended for therapy-resistant and life-threatening severe depression during pregnancy. Other recommendations are offered to healthcare professionals, stakeholders and researchers in managing PPD in different contexts.
Conclusion
Treatment recommendations should be implemented after carefully considering clinical severity, previous history, risk–benefit for mother and foetus/infant and women’s values and preferences. Implementation of evidence-based clinical practice guidelines within country-specific contexts should be facilitated.
In “Everything is Tuberculosis,” author John Green assesses the intricacies of the communicable condition, TB, as a source of significant morbidity and mortality globally over centuries. Despite available vaccines, treatments, and protocols, tens of millions are infected and over a million persons will die from TB in 2025 alone. In searching for answers to mitigate this global scourge, however, Green looks past a key factor — specifically the role of law — as a primary tool for prevention and control.
To describe the process of the development of evidence-based guidelines on the assessment and clinical management of internal contamination with transuranic actinides (specifically plutonium, americium, and curium) in incidents where workers, emergency responders, and the public might uptake these radionuclides internally through inhalation, ingestion, or wound contamination.
Methods
The World Health Organization (WHO) set up a guidelines development group (GDG) that follows the protocol required for producing evidence-based recommendations as described elsewhere. The GRADE® approach was applied throughout the process, including developing research questions formulation, prioritization and rating the importance for the outcomes, assessing the certainty of the evidence, considering contextual factors, and making recommendations.
Results
Through 3 working group meetings held 2023-2024, the GDG defined and rated patient-important health outcomes, and evidence gathered through systematic reviews and its certainty rating, working towards formulating the recommendations using an evidence-to-recommendation (EtR) framework.
Conclusions
The WHO protocol for developing health care management guidelines uses a transparent and robust evidence-based GRADE® approach. Once published, these guidelines will provide the first evidence-based recommendations for assessment and clinical management of internal contamination with transuranic actinides.