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Psychedelic drugs, including lysergic acid diethylamide (LSD) and other agonists of the serotonin 2A receptor (5HT2A-R), induce drastic changes in subjective experience, and provide a unique opportunity to study the neurobiological basis of consciousness. One of the most notable neurophysiological signatures of psychedelics, increased entropy in spontaneous neural activity, is thought to be of relevance to the psychedelic experience, mediating both acute alterations in consciousness and long-term effects. However, no clear mechanistic explanation for this entropy increase has been put forward so far. We sought to do this here by building upon a recent whole-brain model of serotonergic neuromodulation, to study the entropic effects of 5HT2A-R activation. Our results reproduce the overall entropy increase observed in previous experiments in vivo, providing the first model-based explanation for this phenomenon. We also found that entropy changes were not uniform across the brain: entropy increased in all regions, but the larger effect were localised in visuo-occipital regions. Interestingly, at the whole-brain level, this reconfiguration was not well explained by 5HT2A-R density, but related closely to the topological properties of the brain’s anatomical connectivity. These results help us understand the mechanisms underlying the psychedelic state and, more generally, the pharmacological modulation of whole-brain activity.

Background Identification of patient-related factors associated with Health-Related Quality of Life (HRQoL) and Quality of Life (QoL) at the start of treatment may identify patients who are prone to a decrease in HRQoL and/or QoL resulting from chemotherapy. Identification of these factors may offer opportunities to enhance patient care during treatment by adapting communication strategies and directing medical and psychological interventions. The aim was to examine the association of sociodemographic factors, personality traits, and depressive symptoms with HRQoL and QoL in patients with advanced-stage lung cancer at the start of chemotherapy. Methods Patients ( n  = 151) completed the State-Trait Anxiety Inventory (trait anxiety subscale), the Neuroticism-Extraversion-Openness-Five Factor Inventory (NEO-FFI), the Center for Epidemiologic Studies Depression (CES-D), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Simple linear regression analyses were performed to select HRQoL and QoL associated factors (a P  ≤ 0.10 was used to prevent non-identification of important factors) followed by multiple linear regression analyses ( P  ≤ 0.05). Results In the multiple regression analyses, CES-D score (β = − 0.63 to − 0.53; P -values < 0.001) was most often associated with the WHOQOL-BREF domains and general facet, whereas CES-D score (β = − 0.67 to − 0.40; P -values < 0.001) and Eastern Cooperative Oncology Group (ECOG) performance status (β = − 0.30 to − 0.30; P -values < 0.001) were most often associated with the scales of the EORTC QLQ-C30. Personality traits were not related with HRQoL or QoL except for trait anxiety (Role functioning: β = 0.30; P  = 0.02, Environment: β = − 0.39; P  = 0.007) and conscientiousness (Physical health: β = 0.20; P -value < 0.04). Conclusions Higher scores on depressive symptoms and ECOG performance status were related to lower HRQoL and QoL in patients with advanced-stage non-small cell lung cancer. Supportive care interventions aimed at improvement of depressive symptoms and performance score may facilitate an increase of HRQoL and/or QoL during treatment.

The COVID-19 pandemic has drastically impacted many aspects of society and has indirectly produced various psychological consequences. This systematic review aimed to estimate the worldwide prevalence of posttraumatic stress disorder (PTSD) in children due to the COVID-19 pandemic, as well as to identify protective or risk factors contributing to child PTSD. We conducted a systematic literature search in the PubMed, ProQuest, PsycINFO, Embase, Web of Science, WanFang, CNKI, and VIP databases. We searched for studies published between January 1, 2020 and May 26, 2021, that reported the prevalence of child PTSD due to the COVID-19 pandemic, as well as factors contributing to child PTSD. Eighteen studies were included in our systematic review, of which 10 studies were included in the meta-analysis. The estimated prevalence of child PTSD after the COVID-19 outbreak was 28.15% (95% CI: 19.46-36.84%,  = 99.7%). In subgroup analyses for specific regions the estimated prevalence of post-pandemic child PTSD was 19.61% (95% CI: 11.23-27.98%) in China, 50.8% (95% CI: 34.12-67.49%) in the USA, and 50.08% in Italy (95% CI: 47.32-52.84%). Factors contributing to child PTSD were categorized into four aspects: personal factors, family factors, social factors and infectious diseases related factors. Based on this, we presented a new framework summarizing the occurrence and influence of the COVID-19 related child PTSD, which may contribute to a better understanding, prevention and development of interventions for child PTSD in forthcoming pandemics.

Background Personality disorders (PDs) are highly prevalent, impairing, and societally burdening conditions which can be treated effectively. Specialist psychotherapies are the first-choice treatment, but accessibility is hampered by implementation and sustainability issues. Manualised generalist treatments were designed as active control conditions to specialist psychotherapies in several effectiveness trials; their comparable performance led to them being regarded as more accessible alternatives to specialist psychotherapies. The Guideline-Informed Treatment for PDs (GIT-PD) is such a generalist treatment, which has shown promise and is broadly disseminated in the Netherlands and Belgium. However, there is an urgent need for controlled head-to-head comparisons of generalist and specialist treatments for PDs. Therefore, this study poses three main questions: 1) Is generalist treatment non-inferior compared to specialist treatment for severe PDs? 2) Is generalist treatment cost-effective compared to specialist treatment? 3) Which combination of patient characteristics predicts differential treatment outcomes between generalist and specialist treatments? Methods P-DAET is a pragmatic multicentre randomised controlled non-inferiority trial. In total, 358 adult treatment-seeking participants with severe PDs will be included in five Dutch mental healthcare institutions. Participants are equally randomised to manualised generalist (GIT-PD) or specialist treatment (Mentalisation-Based Treatment/Schema Therapy). The primary outcome is improvement in personality functioning, assessed through assessor-blinded clinical interviews and supplemented with self-report questionnaires. Symptom severity and psychosocial functioning are important secondary outcomes. Participants complete assessments at 7 time-points: baseline (T0), 3 (T1), 6 (T2), 12 (T3), 18 (T4), 24 (T5), and 30 months (T6) after the start of treatment. The primary endpoint is at 18 months. An economic evaluation will be executed alongside the RCT. Differential treatment response based on candidate predictors at the patient level will be explored using a personalised advantage index (PAI). Discussion P-DAET will determine the (cost-)effectiveness of generalist versus specialist treatment for severe PDs. This study will provide novel insights into the applicability of these treatments and their differential treatment response, enabling effective and personalised allocation of limited specialist treatment resources, while contributing to more accessible and good-enough care for individuals with severe PDs. Trial registration ClinicalTrials.gov: NCT06789380. Retrospectively registered on February 5, 2025.

Longitudinal trajectories of posttraumatic stress disorder (PTSD) after physical trauma were evaluated. A risk profile for ASD and PTSD was subsequently determined. Overall, only psychological characteristics determined ASD and PTSD. No clinical characteristics were found. The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients' sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen's d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91-12.25). Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.

Background To determine the psychometric properties and minimal clinically important differences (MCIDs) of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) in advanced stage lung cancer patients. Methods Patients ( n  = 153) completed the WHOQOL-BREF and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Confirmatory factor analysis (CFA) was performed and reliability and construct validity determined. MCIDs were estimated with two distribution-based methods (0.5 standard deviation (SD) and 1 standard error of measurement (1 SEM)). Results CFA confirmed WHOQOL-BREF domain structure. All domains demonstrated good internal consistency (α > 0.70), except Social Relationships (α = 0.57). Nineteen of the 24 WHOQOL-BREF items had correlations of ≥ 0.40 with their intended domain. Four items had higher correlations with a domain other than their intended domain. Moderate to strong correlations were observed for corresponding domains of the two questionnaires, except for the social domains ( r  = 0.07). For 0.5 SD, MCIDs ranged from 0.88 to 1.55, and for 1 SEM MCIDs ranged from 1.76 to 2.72. Conclusions The WHOQOL-BREF has satisfactory psychometric properties in patients with advanced stage lung cancer, whereas the observed MCIDs provide a method for interpretation of scores.

IntroductionPrevious evidence lacked a thorough review of the disparities of autoimmune diseases (AD) burdens among countries and regions, which led to an insufficient basis for developing country-specific developmental level relevant preventive measures. This study aimed to analyse disparities and trends of global, regional and national burden of common ADs in children and adolescents from 1990 to 2019 and to investigate the associations between specific ADs and varied country indexes.MethodsAll data for four major ADs were obtained from the Global Burden of Diseases Study 2019. Age period-cohort modelling was conducted to disentangle age, period and birth cohort effects on AD incidence from 1990 to 2019. Local regression smoothing models were used to fit the correlation between AD burdens and sociodemographic index (SDI). Pearson’s correlation was used to investigate varied country-level risk factors for disease burden.ResultsA global increase in four common ADs incidence was observed from 1.57 million to 1.63 million between 1990 and 2019 in the 0–24 age group. The age-standardised incidence rate of overall four ADs showed substantial regional and global variation with the highest incidence in high SDI regions. The age, period and cohort distributions of AD incidence varied significantly, especially in high SDI countries. Relative to the expected level of age-standardised incidence associated with SDI, the distribution varied by regions depending on the specific ADs. Countries with higher levels of socioeconomic development, better quality of life and easier access to healthcare and the healthcare system showed lower disease burdens of ADs.ConclusionsThe incidence patterns and disease burdens of ADs varied considerably according to age, time period and generational cohort, across the world between 1990 and 2019. Incidences of ADs in children and adolescents were significantly correlated with indexes involving risks of the environment, human rights and health safety and quality of life.

Background S-1 is first-line therapy for advanced gastric cancer in Asia and is used with increased frequency in Western counties. We conducted a meta-analysis to investigate the efficacy and toxicity of S-1-based therapy compared with 5-fluorouracil (5-FU)/capecitabine-based therapy and S-1-based combination therapy compared with S-1 monotherapy. Methods MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, American Society of Clinical Oncology meeting abstracts, European Society for Medical Oncology meeting abstracts and ClinicalTrials.gov were searched for randomized clinical trials until May 2015. Data were extracted for overall survival (OS), progression-free-survival (PFS), objective response rate (ORR) and grade 1–2 and grade 3–4 adverse events. Stratified OS data for subgroups were extracted. Results S-1 was not different from 5-FU (eight studies, n  = 2788) in terms of OS [hazard ratio (HR) 0.93, 95 % confidence interval (CI) 0.85–1.01] and PFS (HR 0.87, 95 % CI 0.73–1.04), whereas ORR was higher (risk ratio 1.43, 95 % CI 1.05–1.96). There was no subgroup difference in efficacy among Asian and Western patients, but in Western patients S-1 was associated with a lower rate of febrile neutropenia, toxicity-related deaths and grade 3–4 stomatitis and mucositis compared with 5-FU. S-1 showed no difference in efficacy compared with capecitabine (three studies, n  = 329), but was associated with a lower rate of grade 3–4 neutropenia and grade 1–2 hand–foot syndrome. S-1-combination therapy was superior to S-1 monotherapy (eight studies, n  = 1808) in terms of OS (HR 0.76, 95 % CI 0.65–0.90), PFS (HR 0.68, 95 % CI 0.56–0.82) and ORR (risk ratio 1.20, 95 % CI 1.04–1.38) but was more toxic. Survival benefit of S-1 combination therapy over S-1 monotherapy was most pronounced in patients with non-measurable disease, diffuse-type histological features and peritoneal metastasis. Conclusions S-1 is effective and tolerable as first-line therapy for advanced gastric cancer in both Asian and Western countries.

Background The first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions. Methods This study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks. Discussion This study would develop school-based mental health promotion policy recommendations to improve Chinese rural children’s mental health. This study can provide solid evidence for the promotion of school-based intervention in general. Trial registration ChiCTR2300069405, Registered on 15 March 2023.

Background and Objectives: Prevalent Post-traumatic Stress Disorder (PTSD) negatively affected individuals during the COVID-19 pandemic. Using network analyses, this study explored the construct of PTSD symptoms during the COVID-19 pandemic in China to identify similarities and differences in PTSD symptom network connectivity between the general Chinese population and individuals reporting PTSD. Methods: We conducted an online survey recruiting 2858 Chinese adults. PTSD symptoms were measured using the PCL-5 and PTSD was determined according to the DSM-5 criteria. Results: In the general population, self-destructive/reckless behaviours were on average the most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) avoidance of thoughts and avoidance of reminders, 2) concentration difficulties and sleep disturbance, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviours, and 5) hypervigilance and exaggerated startle responses. Besides, negative connections were found between intrusive thoughts and trauma-related amnesia and between intrusive thoughts and self-destructive/reckless behaviours. Among individuals reporting PTSD, symptoms such as flashbacks and self-destructive/reckless behaviours were on average most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) concentration difficulty and sleep disturbance, 2) intrusive thoughts and emotional cue reactivity, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviour, and 5) detachment and restricted affect. In addition, a negative connection was found between intrusive thoughts and self-destructive/reckless behaviours. Conclusion: Our results indicate similarly positive connections between concentration difficulty and sleep disturbance, negative beliefs and negative trauma-related emotions, and irritability/anger and self-destructive/reckless behaviours in the general and PTSD-reported populations. We argue that self-destructive/reckless behaviours are a core symptom of COVID-19 related PTSD, worthy of more attention in future psychiatric programmers. The most central symptom for the general group was self-destructive/reckless behaviours and for the PTSD subgroup was flashbacks. Results matched the hybrid model of PTSD and were important for prevention and intervention for PTSD related to COVID-19.