Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes. A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA. The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups. Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.

Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to be an effective and well tolerated treatment for depression, and it is being investigated also for other indications. This study presents the Swedish National Quality Register for rTMS (Q-rTMS). The registry comprises epidemiological data, data from standardized rating scales, details on treatment settings, and a registry-specific patient questionnaire. A presentation of the Q-rTMS including the types of data collected, the organizational structure of the register, as well as a brief overview of the volume of data accumulated between the registry's inception in 2018 and the end of 2024. As of 2024, the register contained data from a total of 3083 unique individuals and 3842 treatment series, collected from 27 different rTMS providers. The most common indication for rTMS was depression (International Classification of Diseases, Tenth Revision diagnoses (ICD-10): F32-F34, 74.1%) followed by bipolar affective disorder (ICD-10: F31, 14.2%). The average age was 43.2 years, and 56.5% were women. The register included matched pre- and post-treatment data exceeding 60% completeness for the Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), the Clinical Global Impression-Severity (CGI-S), and the EuroQol five-dimensional questionnaire (EQ-5D-5L). The Q-rTMS combines high coverage with longitudinal documentation of clinically relevant outcome measures and may hence contribute to population-based real-world effectiveness research in rTMS for depression.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Antipsychotics are widely used for neuropsychiatric symptoms (NPSs) in dementia including Alzheimer's disease (AD), yet balancing efficacy and safety remains a major clinical challenge. Relevant randomized controlled trials were identified through a comprehensive literature search of CENTRAL, PubMed, CINAHL, and ClinicalTrials.gov. We conducted a dose-response model-based network meta-analysis to evaluate the efficacy as the change in overall NPS severity and the tolerability as treatment discontinuation due to adverse events of aripiprazole, brexpiprazole, risperidone, quetiapine and olanzapine at varying doses in patients with dementia including AD. Twenty trials involving 5844 participants were included. Most of the included antipsychotics exhibited a generally positive dose-response relationship with respect to both efficacy and tolerability, except for olanzapine, which showed a bell-shaped curve in terms of efficacy. Only aripiprazole 10 mg, brexpiprazole 1-2.5 mg, risperidone 1-2 mg, and olanzapine 2.5-5 mg were significantly more effective than placebo. Tolerability did not significantly decrease compared to placebo for aripiprazole up to 10 mg, brexpiprazole up to 3 mg, risperidone up to 1 mg, olanzapine up to 2.5 mg and at 15 mg, and quetiapine up to 200 mg. Furthermore, significant differences in efficacy and tolerability were observed between certain doses of several antipsychotics. Aripiprazole 10 mg, brexpiprazole 1-2.5 mg, risperidone 1 mg, and olanzapine 2.5 mg were both effective and well tolerated, indicating their potential as favorable treatment options. As the present model incorporates several sources of uncertainty, its findings should be interpreted with caution and regarded as a provisional framework to support clinical decision-making.

ABSTRACTBackgroundMaternal attention‐deficit/hyperactivity disorder (ADHD) has been associated with various pregnancy outcomes, but the degree to which that association is explained by concomitant mental disorders and smoking during pregnancy remains unclear.ObjectiveTo investigate the association between maternal ADHD and pregnancy outcomes.MethodsThrough the Swedish Medical Birth Register, we identified 977,266 women who gave birth to a live singleton between January 1, 2006, and December 1, 2020 (1,617,121 pregnancies). Of these, 1.3% (12,553 women; 17,434 pregnancies) had an ADHD diagnosis prior to pregnancy. The primary outcome was preterm birth (< 37 weeks), with secondary outcomes being postterm birth (> 41 weeks), small for gestational age, large for gestational age, birth weight (≤ 2500, 2501–3500, > 4500 g), acute and planned cesarean section, assisted vaginal delivery, preeclampsia, and gestational diabetes. Generalized linear mixed‐effects models adjusted for maternal age, year of childbirth, maternal education, comorbid mental disorders, and smoking during pregnancy.ResultsThere were 1089 (6.6%) preterm births among women with ADHD, and 73,423 (4.9%) preterm births among women without an ADHD diagnosis, corresponding to a crude OR of 1.33 (95% CI 1.25, 1.42). This association attenuated to nonsignificance after adjusting for maternal age, year of childbirth, maternal education, and comorbid mental disorders (adjOR = 1.06, 95% CI: 0.99, 1.13). Fully adjusted models revealed that ADHD was associated with an increased risk of having a large for gestational age baby (adjOR = 1.16, 95% CI: 1.06, 1.26) and undergoing a planned caesarean section (adjOR = 1.16, 95% CI: 1.06, 1.26). Sensitivity analyses using a broader ADHD definition suggested associations with preterm birth (adjOR = 1.09, 95% CI: 1.04, 1.15) and acute caesarean section (adjOR = 1.09, 95% CI: 1.04, 1.13).ConclusionsAfter adjustments for comorbid mental disorders and smoking during pregnancy, maternal ADHD was not associated with preterm birth. An increased risk of delivering large for gestational age babies and undergoing planned caesarean sections was found in women with ADHD.

ABSTRACTIntroductionADHD is often associated with comorbid psychiatric conditions. Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead. ADHD diagnosis and appropriate ADHD treatment potentially reduce the need for medication of the other disorder. Reaching high adherence to and persistence with ADHD medication is challenging. This nationwide cohort study aimed to describe not only ADHD medication use but also the use of other drugs in ADHD patients compared to controls.MethodsNationwide care and prescription registers were used to identify incident ADHD patients of any age between 2015 and 2020. Four controls were matched to each ADHD patient by age, gender, and residence. Analyses included data from 1.1.2010 to 31.12.2021.ResultsStudy cohort included 66,146 ADHD patients and 256,270 controls, with a total follow‐up of 1,123,412 years. Sustained and extended‐release methylphenidate were the two most commonly used first‐line ADHD drugs across all age groups. Simultaneous use of different ADHD drugs was rare. Primary adherence was very high, with 95% of the patients purchasing their prescribed medication in general and 80% doing so within 10 days. Persistence with medication was the highest among the youngest patients. A decrease in purchases was observed during the summer holidays in school‐age children and adolescents. In adults, antidepressant use often preceded ADHD diagnosis and decreased after ADHD treatment initiation, unlike in controls at the same time. In young children, antibiotics and anti‐inflammatory drug use was higher in ADHD patients than in controls, especially before ADHD identification.ConclusionAs far as we know, this is the first study to describe changes in the use of non‐ADHD medications in relation to ADHD identification. In adults, antidepressant use decreased after ADHD treatment initiation, and in children, antibiotic and anti‐inflammatory use showed more prominent decrease compared to controls of the same age. The data indicated high primary adherence to ADHD medication, and the youngest children remained on continuous ADHD medication the longest. The effect of summer holidays was visible in the purchase data.

ABSTRACT Introduction Bipolar disorder (BD) is a chronic and recurrent psychiatric illness characterized by alternating episodes of mania and/or hypomania and depression. The endocannabinoid system (ECS) is a vast network of chemical signals and cellular receptors that are densely packed throughout the brain. It is involved in the most critical central nervous system functions, such as learning and memory, and also mood regulation. Despite this, there is only anecdotal evidence on the potential role of the ECS in the pathophysiology of BD. Objectives This study aims to retrospectively assess clinical and sociodemographic variables of patients who presented a manic episode that was chronologically associated with the suspension of cannabis use, compared to patients with a manic episode with no relation to cannabis use or suspension. The objective of the study is to investigate the presence of a specific group of patients with BDs, with potential clinical and therapeutic implications. Methods We retrospectively evaluated all admitted patients to the acute psychiatry unit at Hospital Clinic of Barcelona from 2015 to 2019 who were hospitalized for a manic episode. Cannabis withdrawal‐induced mania (CWIM) was considered if cessation of regular cannabis use up to 21 days before the initial manic symptoms was mentioned in clinical and toxicological history and symptoms were prolonged for longer than 15 days after cessation. We used descriptive statistics to extract most of the information. Results Between 2015 and 2019, 282 patients were admitted to the acute psychiatry unit with a diagnosis of a manic episode. Twenty of them (7.09%) met criteria for CWIM, and they were compared retrospectively with the rest of the patients with non‐cannabis related manic ( n = 262). Patients with CWIM group were more frequently men ( p = 0.015) and younger ( p &lt; 0.001), were not married or in a relationship ( p = 0.018) and less frequently had somatic illnesses ( p = 0.041) compared to patients with non‐cannabis‐related manic. Moreover, patients with CWIM had their first manic episode and had their first psychiatry admission at a significantly younger age compared with the other group ( p = 0.008 and p = 0.004, respectively). Previous treatment with any antipsychotic medication was significantly less frequent in the CWIM group ( p = 0.022). According to follow‐up, there were no significant differences in relapse after 3 years ( p = 0.936) among the two groups. Conclusions This study found a new clinical profile of patients who are more suggestive to have a manic episode in the context of cannabis withdrawal among bipolar patients. The existence of such a profile, mainly young men with no previous psychiatric history, might be in relation to the role of the ECS, almost neglected in BD until now. These characteristics suggest a substance‐secondary origin of manic episodes, with presumably less genetic charge and a better outcome if primary prevention substance‐related therapies are taken into consideration during treatment. Our data could encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB‐based options as probable treatment approaches.

ABSTRACTIntroductionObjective and subjective cognitive impairment are highly prevalent in mental disorders and transdiagnostic phenomena. Cognitive impairment is associated with poorer functional outcomes and therefore requires treatment, but little guidance is available for clinicians. The aim of this article is to provide guidance for formulating an individual's cognitive profile and how this can be used to personalise treatments for optimum cognitive and functional outcomes.MethodsWe first critique current models of psychopathology in relation to assessing and addressing cognitive functioning in the clinic. This is followed by a description of key methods for assessing objective and subjective cognitive functioning and how this information can be used to formulate a patient's cognitive profile and tailor treatment.ResultsWithin current models of psychopathology, cognition is inadequately or simplistically represented, is only viewed from a deficit lens without considering strengths, does not consider subjective perceptions of cognitive functioning, and therefore, generally does not provide utility for guiding clinical practice. Both the profile of cognitive functioning (strengths and weaknesses) and estimated change from premorbid levels are key considerations for tailoring cognitive and functional treatments. Cognitive profile and change can be assessed using standardised cognitive tests through normative and idiographic methods, respectively. Subjective perception of cognitive functioning is a neglected but important additional aspect of cognitive functioning that warrants assessment. The complete cognitive profile can be used to guide the selection of cognition‐focused treatments, including psychoeducation, lifestyle adaptations, cognitive remediation, compensatory strategies, environmental supports, psychological therapy, and medication review.ConclusionsWe propose that cognition should be assessed in addition to presenting psychopathology because it is an independent transdiagnostic predictor of functional outcomes, which can enhance personalised clinical care. We recommend assessing both objective and subjective cognitive functioning to formulate the personalised treatment for optimal functional outcomes and promote a culture of recovery that includes cognitive health.