2026-04-02
Selin Karakaya, Bedriye Öncü
IntroductionAttention-deficit/hyperactivity disorder (ADHD) in adults often co-occurs with eating disorders (EDs), potentially through shared difficulties in emotional regulation, and executive functions. This study explored the associations between cognitive flexibility as a component of executive functions, core adult ADHD symptom dimensions and emotional eating-related eating behaviorsin adults with ADHD and healthy controls, within the framework of executive functions.MethodsThis case-control study included 76 adults with ADHD and 69 healthy controls. Participants completed the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS), Emotional Eating Questionnaire (EEQ), Hospital Anxiety and Depression Scale, Cognitive Control and Flexibility Questionnaire (CCFQ), and Berg’s Card Sorting Test. Group differences were tested with t-tests, correlations with Spearman’s ρ, and hierarchical regression (Approval No: I11-798-23).ResultsThe ADHD group had significantly higher EEQ scores (t = 5.39, p =0.001). The ADHD group also showed lower CCFQ total score (t (125) = –5.52, p <0.001). EEQ scores were positively correlated with SR-WRAADDS Attention Deficit (ρ =0.331, p =0.003), and CCFQ Cognitive Control over Emotion (ρ = −0.256, p =0.02). Regression analysis identified attention deficit as the only significant predictor of the EEQ total scorein the ADHD group.DiscussionOur findings suggest that impairments in executive functioning—including cognitive flexibility, attentional regulation, and emotion-related control mechanisms—may play a more central role in the relationship between ADHD and emotional eating-related eating behaviors. Longitudinal studies are warrented to further elucidate these mechanisms.
DOI: 10.3389/fpsyt.2026.17619152026-04-02
Güleser Akpınar, Mehtap Sarıoğlu, Gözde Girgin, Terken Baydar, Hande Sipahi
AimThis study investigated the effects of tryptophan (TRP) metabolism, kynurenine pathway (KP) and neopterin levels in heroin use disorder (HUD) in relation to neurotoxicity, treatment processes and psychiatric recovery.MethodThe study groups consisted of patients with HUD who sought treatment at the hospital and received treatment, and a healthy control (C) group. The levels of neopterin, tryptophan and kynurenine in the participants’ serum were determined, and the pre- and post-treatment results in the groups were compared with the controls.ResultsNeopterin levels, reflecting immune system activation, were observed to decrease in HUD group after treatment (p = 0.021). Similarly, a decrease in levels of tumor necrosis factor-alpha (TNF-α), a pro-inflammatory cytokine, was also detected after treatment (p 0.05). The total scores of the Addiction Profile Index (API-K), which measures the severity of addiction, decreased significantly after treatment (p < 0.001). At the same time, improvement was observed in the general symptom level (GSI) and all subscales (including depression, anxiety, obsessive-compulsive disorders, and somatization) of the Symptom Checklist-90-Revised (SCL-90-R) scale, which assesses general psychopathology. Regression analyses revealed that the two strongest factors negatively affecting treatment success in the HUD group were duration of use (p = 0.028) and high neopterin levels (p = 0.020).ConclusionThis study highlights the critical role of immunological and neuroinflammatory processes in the success of HUD treatment. The findings indicate that biochemical recovery progresses in parallel with psychiatric recovery during treatment, and that changes in the KYN/TRP ratio and IL-6 levels have strong diagnostic and prognostic value. Neopterin, kynurenine, and tryptophan, on the other hand, have moderate prognostic value.
DOI: 10.3389/fpsyt.2026.17854772026-04-02
Diana S. M. Rosales-Gurmendi, Sadam Hussain, Eduardo de Avila-Armenta, Gerardo A. Fumagal-González, Jorge A. Garza-Abdala, Alma A. Pedro-Pérez, Jasiel Toscano, Jose G. Tamez-Peña
IntroductionSchizophrenia is conceptualized as a disorder of brain network dysconnectivity, yet relationships between neural alterations, cognitive deficits, and genetic risk remain unclear.MethodsWe examined 86 participants: schizophrenia patients (SCZ), unaffected siblings (SCZ-SIB), healthy controls (CON), and control siblings (CON-SIB). We used a multiscale graph-theoretic analysis of task-based fMRI during N-back working memory and unsupervised clinical-cognitive clustering.ResultsWe found that reduced cerebellum-sensorimotor (CER-SM) and cerebellum-cingulo-opercular (CER-CO) connectivity during the 1-back condition robustly discriminated SCZ from CON (AUC = 0.89). Critically, these dysconnectivity patterns were linked to clinical state, present in SCZ vs. SCZ-SIB but absent in SCZ-SIB vs. CON-SIB, suggesting illness expression rather than familial risk. Unsupervised clustering revealed three data-driven subtypes with distinct cognitive- symptomatic profiles: subtype 1 with relative preservation of verbal abilities (predominantly controls), subtype 2 with marked fluid cognitive impairment (enriched in SCZ), and subtype 3 with intermediate performance with working memory sparing (mixed composition). Cerebellar-cortical hypoconnectivity showed graded alignment across these profiles.DiscussionThese findings demonstrate that cerebellar dysconnectivity is most detectable under moderate cognitive load, tracks with clinical state, and covaries with transdiagnostic cognitive profiles, advancing circuit-based understanding of schizophrenia heterogeneity.
DOI: 10.3389/fpsyt.2026.17965992026-04-02
Fawad Taj
The approval of the first non–dopamine-blocking therapy for schizophrenia marks a defining moment in psychiatry. Muscarinic M1/M4 modulation, alongside emerging TAAR1 and glutamatergic pathways, signals a shift beyond dopamine dominance toward circuit-level integration. These advances embody mechanistic humility: the scientific courage to prioritize clinical signal over mechanistic certainty. It is the scientific curiosity to revisit older hypotheses, question single-pathway models, and integrate multiple mechanisms. Building on the recognition of dopamine blockade’s experiential burdens, this new era guides psychiatry toward a pluralistic framework. The challenge for 2026 is not to replace dopamine, but to rebalance it, moving from receptor blockade dominance to circuit modulation informed pluralistic treatment. This evolution aims to restore harmony not just among neural circuits, but within the lived experience of patients.
DOI: 10.3389/fpsyt.2026.17696132026-04-01
Shu-lan Liu, Ya Chen, Xiao-di Bai, Ting Xu, He-yao Xu, Si-yu Lin, Xin-yao Zhou, Yun-lan Jiang
BackgroundSleep is a pivotal component of cardiovascular health. However, clinical efforts in coronary heart disease (CHD) disproportionately focus on sleep-disordered breathing, while insomnia, the most prevalent sleep disorder among adults, remains underdiagnosed and undertreated.AimsThis meta-analysis systematically evaluates the prevalence of insomnia and its influencing factors in patients with CHD to inform clinical prevention and management strategies.MethodsTen databases were searched from inception to 7 September 2025. The prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) were extracted to evaluate the prevalence of insomnia and its influencing factors in patients with CHD. RevMan 5.4 and Stata 15.0 software was used for data processing. Subgroup analyses, meta-regression, and sensitivity analyses were performed.ResultsNineteen studies involving 5928 patients with CHD were included. The overall pooled prevalence of insomnia was 51.8% (95% CI: 0.446–0.590, P < 0.001). Significant risk factors identified were female sex(OR = 2.00, 95% CI: 1.58–2.52, P < 0.001), anxiety (OR = 1.61, 95% CI: 1.36–1.91, P < 0.001), depression (OR = 2.15, 95% CI: 1.48–3.13, P < 0.001), CHD duration ≥3 years (OR = 1.73, 95% CI: 1.25–2.40, P = 0.001), diabetes (OR = 1.50, 95% CI: 1.45–1.56, P < 0.001), and gastritis (OR = 2.24, 95% CI: 1.62–3.11, P < 0.001).Conclusioninsomnia has a substantial prevalence in patients with CHD. Clinicians should prioritize early identification and intervention targeting modifiable risk factors (anxiety, depression, diabetes, and gastritis), particularly in female patients and those with a CHD duration ≥3 years.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024617785.
DOI: 10.3389/fpsyt.2026.17482932026-04-01
Haotian Chen, Haiqin Chen, Jianfeng Xu, Yue Mao, Fei Yin, Jingfen Jin
BackgroundInternet addiction (IA) has become a growing concern, particularly among adolescents, due to its adverse effects on mental health, physical well-being, and future development. Adolescents with suicidal ideation (SI) are particularly vulnerable to IA, which may be associated with a higher risk of engaging in suicidal behaviors. However, the relationship and underlying mechanisms between SI and IA remain unclear. This study, grounded in the cognitive-behavioral model of pathological internet use, investigates the relationship and explores the roles of self-esteem (mediator) and school connectedness (moderator) in this association.MethodsIn this cross-sectional study, 462 Chinese adolescents with SI (79.0% female) were recruited from psychiatric outpatient clinics between June 2024 and September 2025. Validated instruments measured SI, self-esteem, school connectedness, and IA. Structural equation modeling with bootstrapping procedures was used to test the mediation effect of self-esteem on the relationship between SI and IA. The moderating role of school connectedness was examined using PROCESS Model 8.ResultsSI was positively associated with IA (β = 0.224, p < 0.001). SI was negatively associated with self-esteem (β = -0.464, p < 0.001), and self-esteem was further negatively associated with IA (β = -0.448, p < 0.001). Self-esteem partially mediated the relationship between SI and IA, with an indirect effect of 0.208 (95% CI: 0.154-0.271). School connectedness significantly moderated the direct association between SI and IA (β = -0.005, p = 0.001), but did not moderate the association between SI and the mediator, self-esteem (β = 0.004, p = 0.202).ConclusionThis study identifies a significant positive association between SI and IA among adolescents with SI, with self-esteem partially mediating this link. Furthermore, school connectedness showed a very weak buffering effect on the direct association between SI and IA, and it does not moderate the association between SI and self-esteem. These findings enhance our understanding of the mechanisms underlying IA in this vulnerable population and suggest potential targets for interventions.
DOI: 10.3389/fpsyt.2026.17759492026-04-01
Hongmei Zhu, Hongwen You, Yuting Nie, Yangfan Sun, Liyan Duan, Peiyu Yan, Yingqi Chen, Ming Zhou
BackgroundDepression and anxiety are among the most prevalent psychiatric disorders in clinical practice. Their high comorbidity and the inherent subjectivity of self-report screening tools have motivated efforts to identify objective, physiology-based digital phenotypes.ObjectivesTo rigorously evaluate the diagnostic performance of an artificial intelligence visual analysis platform based on head–neck micro-vibration signals for screening depression and anxiety, to compare its differences and complementarities with traditional self-report scales, and to develop and explore the potential utility of a combined “AI broad screening + scale refinement” approach.MethodsWe conducted a single-center prospective diagnostic study enrolling 98 outpatients. A psychiatrist-administered structured interview grounded in DSM-5 served as the clinical diagnosis. All participants completed Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) assessments in parallel with testing by the AI psychophysiological analysis system. We constructed confusion matrices, calculated F1 scores, and generated receiver operating characteristic curves and decision curve analyses to quantify and compare the screening and stratification performance of each tool and of the combined models.ResultsFor depression-risk screening, the AI tool demonstrated very high sensitivity (95.9%), exceeding that of the SDS (83.6%). The combined “AI + SDS” model further increased sensitivity to 98.6%, demonstrating a minimized false-negative rate in this cohort. For anxiety, integrating AI with the SAS increased recall by 50.0% (to 69.2%) and improved the F1 score by 25.4%. In-depth analyses revealed that the AI system was particularly effective at identifying “silent patients” with alexithymia or prominent somatization, whereas the scales aligned more closely with clinical judgment for fine-grained severity grading. ROC and decision curve analyses consistently showed that the combined “AI + SDS/SAS” model achieved the best overall discrimination and greatest net clinical benefit.ConclusionsThis study demonstrates that an AI tool based on head–neck micro-vibration signals can serve as a high-sensitivity, objective sentinel, mitigating the risk of missed cases associated with subjective self-report scales in specific populations. AI and self-report measures capture complementary facets of psychopathology. A tiered workflow of “AI broad screening + scale refinement” may constitutes a translationally promising paradigm to facilitate earlier, more objective, and efficient screening and to support more precise interventions in psychiatric disorders.
DOI: 10.3389/fpsyt.2026.17293032026-04-01
Jonathan Stellmacher, Christopher Schmidt, Helena D. Aicher, Kae Eichel, Eva-Lotta Brakemeier, Uwe Herwig
Research on the therapeutic effects of psychedelics in psychiatry, commonly referred to as Psychedelic-Assisted Therapy (PAT), has expanded substantially in recent years. The context-dependent nature of psychedelics has sparked discussion about the importance of the psychotherapeutic environment in achieving beneficial outcomes. This study explores the contribution of psychotherapeutic factors on PAT in Switzerland, where psychedelic treatments can be implemented within long-term clinical frameworks. Seven semi-structured interviews were conducted with Swiss therapists to explore how they frame psychedelic treatments and the role of the psychotherapeutic setting in facilitating therapeutic outcomes. Thereby, individual experiences of the patients as reported by the therapists, were particularly considered. Thematic analysis identified two main themes, each with several sub-themes. The first theme revealed that while psychotherapeutic techniques are adapted to PAT, they retain similarities to non-psychedelic psychotherapy practices, supporting patients in having meaningful therapeutic experiences. The second theme describes a synergistic relationship between psychedelics and psychotherapy, amplifying underlying general psychotherapeutic factors such as trust, a sense of profundity, and the emergence of therapeutic experiences. The interviewed therapists agreed that psychedelics work as unspecific catalysts for psychotherapeutic processes, while still acknowledging the potential for psychopharmacological effects or the interaction between psychedelics and psychotherapy to create unique psychotherapeutic processes. Findings from our sample suggest that, for specific indications, incorporating psychedelics into long-term psychotherapeutic treatment may strengthen therapeutic processes. Future research could investigate the efficacy of PAT within the framework of specific psychotherapeutic modalities or in different settings, including prospective quantitative assessments of outcomes. Ultimately, clarifying mechanisms of action of PAT may help to enhance its efficacy and potentially to integrate psychedelic treatments into mainstream mental health care.
DOI: 10.3389/fpsyt.2026.17717262026-04-01
Yunus Akkeçili
Panic disorder (PD) exhibits marked clinical heterogeneity, and individual differences in autistic traits may contribute to variability in symptom severity and treatment course. This study examined whether autistic traits are associated with panic severity and agoraphobic avoidance during pharmacological treatment. In this retrospective observational study, 41 adults with DSM-5-diagnosed PD receiving guideline-based pharmacotherapy were followed over six months. Symptom trajectories were assessed using the Panic Disorder Severity Scale (PDSS) at baseline, one month, and six months, while autistic traits were measured using the Autism Spectrum Quotient (AQ) at the six-month visit. Linear mixed-effects models and repeated-measures ANCOVA examined associations between autistic traits and symptom burden while adjusting for age and sex. PDSS total and agoraphobia scores declined significantly over time (p <.001). Higher AQ total scores were associated with greater overall PD severity (p = .043) and more pronounced agoraphobic avoidance (p = .015) across assessments. Exploratory analyses indicated that attention switching and social skills were associated with overall severity, whereas reduced imagination was specifically linked to agoraphobic severity. Age was independently associated with agoraphobic severity but not with overall panic severity. No significant Time × AQ interactions were observed, indicating comparable symptom improvement across trait levels during the six-month treatment period. These findings suggest that elevated autistic traits are associated with persistently higher symptom burden during treatment without altering pharmacological response.
DOI: 10.3389/fpsyt.2026.17531422026-03-31
Bari Ay, Umut Balatacı
BackgroundAttention-deficit/hyperactivity disorder (ADHD) has been associated with low-grade systemic inflammation and autonomic dysregulation, but it remains unclear whether these alterations are accompanied by subclinical ventricular electrical heterogeneity in medicated pediatric patients. This study investigated inflammatory markers and the frontal QRS-T angle (fQRS-T) in children and adolescents with ADHD receiving methylphenidate and examined the association between inflammatory burden and fQRS-T.MethodsThis single-center retrospective cross-sectional study included 75 children and adolescents with DSM-5 ADHD who had received continuous methylphenidate treatment for at least 6 months and 75 age- and gender-matched healthy controls. Participants with chronic inflammatory, autoimmune, cardiovascular, systemic, or psychiatric comorbidities were excluded. Complete blood count-derived inflammatory indices, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), were calculated. Standard 12-lead electrocardiograms were used to assess heart rate, QT, QTc, QRS duration, and fQRS-T.ResultsThe ADHD and control groups were similar in age and gender distribution. Conventional ECG parameters, including heart rate, QT, QTc, and QRS duration, did not differ significantly between groups. In contrast, the fQRS-T angle was significantly wider in the ADHD group than in controls (31.05° ± 32.03° vs. 18.62° ± 20.02°; p = 0.038). Among inflammatory measures, neutrophil count, SII, and PIV were significantly higher in the ADHD group. Within the ADHD group, fQRS-T was positively correlated with SII (r = 0.363, p = 0.030) and treatment duration (r = 0.340, p = 0.036). Treatment duration was also positively correlated with SII (r = 0.322, p = 0.040). In linear regression analysis, both SII (B = 0.012, 95% CI: 0.002 to 0.022; p = 0.019) and treatment duration (B = 0.945, 95% CI: 0.203 to 1.687; p = 0.014) were associated with fQRS-T.ConclusionChildren and adolescents with ADHD receiving methylphenidate showed a higher inflammatory burden and a wider fQRS-T angle than healthy controls. The association of fQRS-T with SII suggests a possible link between low-grade systemic inflammation and subclinical ventricular electrical heterogeneity in this population. However, because of the retrospective cross-sectional design and the inclusion of only methylphenidate-treated patients, these findings should be interpreted cautiously and considered hypothesis-generating.
DOI: 10.3389/fpsyt.2026.17047572026-03-31
Carla Occhipinti, Marco Di Paolo, Ilaria Zampieri, Pietro Pietrini
Brain diseases may determine the development of focal neurological deficits and behavioral anomalies. In some cases, behavioral alterations may lead to illicit demeanours which, in turn, may have potential serious legal consequences as well. We report the case of a male gynecologist in his seventies sued by a young female patient for sexual violence. The man had no significant premorbid medical history and was a respected medical doctor with several decades of professional activity. Months after the sexual violence episode, he began to manifest symptoms indicative of cognitive impairment, which led to a neurological examination including a Magnetic Resonance Imaging (MRI) brain scan exam. Brain MRI revealed two frontal meningiomas with mass effects and vasogenic oedema on the surrounding brain parenchyma, for which the patient underwent a neurosurgical operation. Following surgery, partial improvement in selected cognitive and behavioral domains was observed, suggesting that the frontal lesions may have contributed significantly, though not exclusively, to the clinical picture. In light of this evidence, the question arises whether and to what extent the mental capacity of the subject at the time of sexual offense could have been compromised by the presence and location of the tumors, that is, as a potential “precipitating factor” impinging on a brain with underlying neurodegenerative and/or vascular lesions.
DOI: 10.3389/fpsyt.2026.16922132026-03-31
Dong-Yang Liu, Ya-Hui Yi, Na Li, Fang-Ming Luo, Wei-Jing Gong
Serotonin syndrome (SS) is a potentially life-threatening condition resulting from excessive serotonergic activity in the central nervous system. We present a fatal case of SS complicated by multiple organ failure in a 72-year−old patient with Parkinson’s disease following the sequential administration of two selective serotonin reuptake inhibitors (sertraline and escitalopram) while on a stable regimen of the monoamine oxidase-B inhibitor rasagiline. Pharmacogenomic testing revealed a homozygous CYP2D6*10/*10 genotype, conferring an intermediate metabolizer phenotype, which is postulated to have contributed to serotonergic drug accumulation and resultant toxicity in combination with other significant pharmacodynamic and pharmacokinetic interactions. This case was distinguished by three key features: first, the sequential serotonergic challenge from two different SSRIs in combination with rasagiline; second, the unprecedented severity of clinical manifestations, including rhabdomyolysis, acute hepatic and renal injury, and a disseminated intravascular coagulation-like state; and finally, the pharmacogenetic findings that provide a partial mechanistic explanation for the extreme drug sensitivity. This report underscores the critical importance of pre-emptive pharmacogenomic screening in patients receiving complex polypharmacy, particularly when combining drugs with serotonergic properties. It also serves as a critical warning that even selective MAO-B inhibitors can precipitate life-threatening interactions with SSRIs in genetically susceptible individuals, thereby informing more stringent personalized therapeutic strategies.
DOI: 10.3389/fpsyt.2026.1750596