Arkin

Background/Objectives: Mindfulness-based interventions show promise for treating childhood ADHD, yet the mechanisms through which they produce effects remain unclear. This study provides the first direct comparison of treatment mechanisms between a mindfulness-based family intervention (MYmind) and methylphenidate. Methods: Data were drawn from a preregistered trial combining randomized and preference arms, comparing MYmind (2-month parallel parent-child mindfulness training) with 4-month methylphenidate in children aged 8-18 with ADHD (N = 120 children, 224 parents). Families were assessed at baseline, 2, 4 and 10 months. Multilevel mediation analyses tested whether treatment effects on ADHD symptoms were transmitted through 111 treatment-to-mediator-to-outcome pathways across three mechanism categories: child emotion regulation and coping (all children); adolescent self-regulation and mindfulness (ages 11+); and parent-level mechanisms, including mindful parenting, parental mindfulness, parenting style and self-compassion. Results: Direct treatment effects favored methylphenidate for ADHD symptom reduction at 4 months, with mindfulness catching up by 10 months. MYmind produced significantly greater improvements than methylphenidate in adolescent healthy self-regulation, parental self-compassion, mindful parenting and over-reactive parenting. Treatment did not differentially affect the remaining mechanisms. Across model sets, observed emotion regulation, maladaptive coping, parental self-compassion and mindful parenting each predicted ADHD outcomes. Across 111 pathways tested in 18 models, numerous significant individual pathways were consistent with theoretical predictions, yet no complete mediation chains reached statistical significance. Conclusions: MYmind engages distinct psychological and family-level processes compared to methylphenidate that are separately associated with ADHD symptom improvement. The absence of significant mediation effects likely reflects power limitations. These findings support mindfulness-based family intervention as a viable alternative to medication and highlight the need for larger-scale mechanism research.

Brain network architecture is anticipated to influence future grey matter loss in individuals at Clinical High Risk (CHR) for psychosis. However, existing studies on grey matter structural network properties in CHR are scarce and constrained by small sample sizes. Here, we examined network topology differences comparing a) CHR versus healthy controls (HC); b) CHR who transitioned to psychosis (CHR-T) versus those who did not (CHR-NT); and c) different subsyndromes. We included structural scans from 1842 CHR individuals and 1417 HC individuals from 31 sites within the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) consortium. At the global level, CHR individuals exhibited lower structural covariance (q < 0.001; Cohen's d = 0.164) and less optimal structural network configuration than HC (lower global efficiency and clustering coefficient, d = 0.100,0.087, qs <= 0.027). Though no global difference between CHR-T and CHR-NT, network distinctiveness of the frontal and temporal surface area networks was higher in CHR-T than CHR-NT (d = 0.223,0.237) and HC (d = 0.208,0.219) (qs < 0.001). Network distinctiveness of the frontal cortical thickness network was lower in CHR-T (d = 0.218, q < 0.001) than CHR-NT and HC (d = 0.165, q < 0.001). Importantly, higher network distinctiveness was associated with worse positive symptoms in CHR-NT (frontal surface area, q = 0.008, R2 = 0.013) and at trend with worse negative symptoms in CHR-T (frontal thickness, q = 0.063, R2 = 0.049). Further, the brief intermittent psychotic syndrome subgroup showed more severe network alterations. Together, brain structural networks inform symptoms and the risk of transition to psychosis in CHR individuals.

In measurement-based care or routine outcome monitoring self-report questionnaires are used to monitor how a patient fares in therapy. Interpretation and utilization of test results are improved and communication facilitated when raw scores are converted to common metrics, such as standard scores (T-scores) and percentile rank scores. Both types of common metrics are described and reviewed and a warning is issued that percentiles may be misinterpreted at the tails of the scale. Data from the Manchester Short Assessment (MANSA) was used to investigate various approaches to obtain T-scores. The study analyzed cross-sectional data from two normative samples: a representative sample of the Dutch general population (N = 11,789) and a clinical sample (N = 9987) of patients with substance use disorder. Linear, normalized, and IRT-based T-scores were compared.Results revealed that T-scores derived from a linear conversion were biased at the lower end of the scale. Normalizing raw test scores through either Rankit normalization or by an IRT approach yielded improved and quite similar T-scores. For all possible raw scores on the MANSA, corresponding normalized T-scores are presented, as well as Percentile Rank scores for the two reference groups. Finally, cut-off values for reliable change and clinically significant change are presented for raw scores and T-scores. Practical guidance is offered for converting raw test scores into two common metrics: normalized T-scores and Percentile Rank scores. For T-scores, simple linear conversions yielded biased results. These findings have implications for test developers, practitioners, and researchers who want to express test results in valid and unbiased common metrics. The online version contains supplementary material available at 10.1007/s10862-025-10266-0.

BackgroundSocial functioning, symptoms, cognition and well-being are all considered important recovery domains for patients with schizophrenia spectrum disorders (SSD). In the current study, we investigated to what extent longitudinal changes in one recovery domain moderated changes in another recovery domain, and which personal, clinical or social patient characteristics influence changes in recovery domains for patients with SSD.MethodsWe investigated data from GROUP, a prospective, longitudinal six-year study of patients with SSD. We analyzed longitudinal changes in 15 outcomes (i.e., subdomains of symptoms, social functioning, cognition, quality of life or well-being), through a linear mixed-effects model analysis. Changes in other outcomes, patients’ duration of illness (DOI), and personal, clinical, or social patient characteristics at baseline were treated as covariates in the analyses.ResultsWe observed long-term improvement in all outcomes, except for depressive symptoms and subjective well-being. Larger improvements in positive symptoms, social functioning and executive functioning were indicated for patients with a short DOI. We found multiple, moderating effects, mainly for patients with a short DOI, between changes in cognition, social functioning, symptoms and quality of life. Limited moderating effects were indicated between these recovery domains and well-being. Baseline levels of outcomes, schizophrenia diagnosis, education level, ethnicity, living situation, employment status and marital status were all moderators for changes in most outcomes.ConclusionsSymptoms, social functioning, cognition and quality of life often concurrently improved over the course of SSD. These longitudinal changes were mostly driven by social patient characteristics, such as education level, ethnicity, living situation, employment status and marital status.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07700-8.

Childhood trauma has been associated with accelerated biological aging, such as early pubertal development and cellular aging. Less is known about the impact of childhood trauma on brain aging, particularly across mental disorders. This cross-sectional study tested the hypothesis that childhood trauma severity is linked to accelerated brain aging using a large discovery MRI dataset. Another independent dataset was included to replicate findings. The discovery dataset included 495 participants (248 bipolar-I, 126 schizophrenia-spectrum, 121 controls). To replicate findings, we used an independent dataset (n = 163; 80 schizophrenia-spectrum, 83 healthy individuals). Brain age gap estimate (BrainAGE; predicted brain age minus chronological age) was evaluated from T1-weighted MRI scans using pre-trained machine learning models to quantify brain aging, reflecting the difference between brain-predicted and actual age. Linear regressions were performed to assess the relationships between childhood trauma and BrainAGE across samples. In the discovery dataset, higher childhood trauma severity was associated with increased BrainAGE (β = 0.09, P= .048), independent of diagnosis A categorical approach to trauma confirmed a dose-response pattern, with increased BrainAGE in individuals reporting multiple trauma types and across quartiles of cumulative trauma scores. The replication dataset showed similar results. The dimension of deprivation, but not threat, was associated with increased BrainAGE, in both datasets. Educational attainment moderated the effect of deprivation on BrainAGE in the discovery dataset only. This large transdiagnostic study suggests that individuals exposed to childhood trauma, especially deprivation, may undergo a process of accelerated brain aging, independent of psychiatric diagnosis.

At its core, pathologising is choosing the language of pathology to describe suffering. In youth mental health, the prevailing choice is to use diagnostic labels such as ADHD and autism when describing the problems young people face. A key, yet poorly visible risk of such diagnostic labelling is disorderism - a relative neglect of context introduced by the tendency to interpret peoples struggles through the lens of disorders of the individual. At the same time, diagnostic labels serve important functions. Among others, they help families access care and find information, allow researchers to compare findings, and aid policymakers organise funding. Put simply, the functions are too valuable to outright discard, yet the risks too great to ignore. We find ourselves stuck - locked inside our own language. We argue that a path forward lies in recognising the primary way diagnostic labels may cause harm: by sidelining other forms of understanding. Rather than reimagining the labels entirely, a way out of the deadlock could involve profound epistemic humility. If we deflate the labels - removing weight and certainty - we create space for other kinds of understanding.

Abstract This pre-registered ‘ADHD: Medication or Meditation’ trial presents the effects on parental outcomes comparing a mindfulness-based intervention (MYmind) for both parents and children with medication (methylphenidate) for children’s ADHD. Additionally, we examined correlations between meditation practice and outcomes in the mindfulness group. Parental scores were compared across treatments at four time points (pre-test, 2-, 4- and 10-months follow-ups). MYmind consisted of 8 weekly group-based 1,5 h mindfulness sessions for children and parallel mindful parenting for their parents, and a booster 2 months later. Medication treatment consisted of 4 months short-acting methylphenidate. Parents (70 mothers and 29 fathers) filled out self-reports on four domains: Parental stress (general stress, parenting stress and competence, parenting discipline styles), mindfulness (general mindfulness, mindful parenting, self-compassion), parental ADHD (hyperactivity/impulsivity, inattention), and parental well-being (overall well-being, externalizing and internalizing symptoms, attention problems, sleep). Regression analyses of significant interaction effects for time and condition showed that mothers in the mindfulness group improved more than mothers in the medication group on levels of overreactive parenting, self-compassion and quality of sleep. Fathers in the mindfulness group had larger improvements over fathers in the medication group on parental stress, mindful parenting, self-compassion, internalizing and attention problems. Positive relations were found for mothers only between amount of meditation practice and general mindfulness, parental stress, internalizing symptoms and sleep. All improvements between groups favored the family mindfulness intervention over medication. Our findings suggest that parents fair far better when families of children with ADHD take part in a mindfulness-based program compared to treating only the child with medication.

People with complex psychosis admitted to inpatient mental health rehabilitation units (IMRU) constitute a low volume, high need, high cost group with a complicated recovery process. To generate hypotheses regarding successful delivery of guideline care to patients with complex psychosis in IMRUs, based on clinical profiles and (historical) patterns of care delivery. A retrospective passive consent chart study of patients with complex psychosis in IMRUs in The Netherlands, mapping sociodemographic and clinical profiles, care trajectories and delivery of pharmacological (focusing on clozapine delay), psychological and social guideline interventions. We assessed relationships between non-delivery of psychological and social interventions, delay in clozapine treatment, and current symptom severity. The 62 included patients had a mean illness duration of 21.6 years (SD 9.4); 89% were diagnosed with a schizophrenia spectrum disorder. They exhibited severe symptoms (GAF-s: mean 33, SD 12.2), substantial functional impairment (GAF-f: mean 32, SD 9.5), a history of physical violence (74%) and/or severe substance use problems (61%), and limited or absent insight (87%). Care trajectories showed long-term instability of living environment, and frequent current compulsory care (76%). Of 54 patients with a clozapine treatment indication, 65% currently used it, of whom 94% started in IMRU setting, and 43% had one or more earlier aborted trials. Support in developing day activities was accepted by 87% of total sample, including patients without a day activity goal on beforehand. 66% developed day activities. We found associations between symptom severity, clozapine delay, declining psychological treatment, and not having day activity goals. For some people with complex psychosis, clozapine treatment and psychosocial interventions may only materialize in specialized, long term, high structure settings offering continuity of care. Support in developing day activities may present a pathway to collaborative engagement. Early identification of those in need remains a challenge.

Introduction: Self-disturbance phenomena are increasingly recognized as fundamental and debilitating features for patients with a schizophrenia spectrum disorder (SSD). The concept of personal recovery describes the process of building a meaningful and satisfying life despite persistent symptoms or challenges related to mental illness. No previous study has investigated the association between self-disturbance phenomena and personal recovery in patients with SSD. Understanding the impact of self-disturbance could strengthen the therapeutic alliance with patients and contribute to the development of treatment strategies supporting their recovery. Aim: The aim of this study was to investigate whether severity of self-reported self-disturbance phenomena is associated with the level of self-reported personal recovery in patients with SSD, their unaffected siblings, and healthy controls. Methods: In a cross-sectional design with 522 patients with SSD, 608 unaffected siblings, and 369 healthy controls, the frequency and distress of self-disturbance phenomena was measured with the Self-Experience Lifetime Frequency Scale (SELF). Personal recovery was assessed with the Recovery Assessment Scale (RAS-24). Spearman’s rank correlation coefficients between both scales were examined. Subsequent multiple hierarchical regression analyses were conducted to assess additional explained variance in personal recovery by severity of self-disturbance phenomena, adjusting for positive, negative, and general symptomatology. Results: Significant correlations were reported between higher SELF and lower RAS-24 scores for patients (ρ = −0.20, p < 0.001), siblings (ρ = −0.24, p < 0.001), and controls (ρ = −0.16, p < 0.005). The severity of self-disturbance phenomena significantly albeit modestly predicted total personal recovery score after adjusting for positive, negative, and general symptoms for patients (R2 change = 0.035, β = −0.19, p < 0.001). Conclusion: Current findings suggest that self-reported self-disturbance phenomena are relevant for the personal recovery of patients with SSD. Healthcare practitioners are urged for attention to patients’ first-person perspectives, including experiences of self-disturbance.

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are the preferred pharmacological treatment for obsessive–compulsive disorder (OCD). However, insufficient response is common and it remains unclear whether specific patient-level factors influence the likelihood of treatment response.AimsTo determine the efficacy and acceptability of SSRIs in adult OCD, and to identify patient-level modifiers of efficacy.MethodsWe conducted an individual patient data meta-analysis (IPDMA) of industry-sponsored short-term, randomised, placebo-controlled SSRI trials submitted for approval to the Dutch regulatory agency to obtain marketing approval for treating OCD in adults. We performed a two-stage meta-analysis, using crude data of available trials. The primary outcome was the difference in Yale–Brown Obsessive–Compulsive Scale (YBOCS) change between active treatment and placebo. Secondary outcomes were differences in response (defined as the odds ratio of ≥35% YBOCS point reduction) and acceptability (defined as the odds ratio for all-cause discontinuation). We examined the modifying effect of baseline characteristics: age, gender, illness severity, depressive symptoms, weight, illness duration and history of antidepressant use.ResultsAfter excluding three trials because of missing data, we analysed results from 11 trials (79% of all submitted trials, n = 2372). The trial duration ranged from 10 to 13 weeks. Mean difference of SSRIs relative to placebo was 2.65 YBOCS points (95% CI 1.85–3.46, p < 0.0001), equalling a small effect size (0.33 Hedges’ g). The odds ratio for response was 2.21 in favour of active treatment (95% CI 1.72–2.83, p < 0.0001), with a number needed to treat of seven. Patient characteristics did not modify symptom change or response. Acceptability was comparable for SSRIs and placebo.ConclusionsOur IPDMA showed that SSRIs are well accepted and superior to placebo for treating OCD. The effects are modest and independent of baseline patient characteristics.