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During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings.This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones.The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment.Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.

BackgroundAlthough cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented.MethodsThe aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.ResultsBased on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy.ConclusionsOverall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.

Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms. However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.

BackgroundImpairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings.MethodsIn this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice.ResultsExpert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis.ConclusionThe comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery.

There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.

The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services. We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases. We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare. Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.

Background Entrustable professional activity (EPA) presents trainees’ tasks or responsibilities which are entrusted to the unsupervised execution once they have attained sufficient specific competence. EPAs evaluation emphasize the integrity of medical behavior, directly reflecting the clinical ability of trainees and reflect the trust of trainers. Compared with other evalution method, EPAs evaluation is more close to clinical practice and can better reflect clinical competence. Our study conducted a multi-center study in Qilu Hospital of Shandong University to evaluate EPAs among residents. This study was to evaluate EPAs of residents and identify problems in the residency training in Shandong Province, so as to put forward constructive suggestions in futrue. Methods This is a cross-sectional study. An assessment survey comprised of 15 EPAs was invented and carried out in Department of Obstetrics and Gynecology, Qilu hospital of Shandong Province. Each resident conducted self-assessment and director-assessment through by internet questionnaire of Wenjuanxing. Results In our study, 132 residents and 45 directors were totally enrolled. Both self- and director- assessment had an increased scores trend year by year in each EPAs. However, for PGY1 and PGY2 residents, self-assessment and director-assessment results were relatively consistent. Compared with director-assessment, significant difference was found in self-assessment on admit a patient, select and interpret auxiliary examinations, compose medical documents, perform basic operation and perform health education. Among the four different position of residents (social training residents, entrusted training residents, professional master and permanent staff), permanent staff has the highest EPA scores in this EPAs-evaluation study. In this study, we found significant difference between self-assessment and director-assessment in PGY2 and PGY3 ( p  < 0.05). Conclusions EPAs are practically useful in assessment of OB &GYN residents. EPA4, EPA7, EPA1 and EPA15 need to be improved in future training. Individualized feedbacks should be provided based on the difference between self-assessment and director- assessment.

Background Entrustable Professional Activities (EPAs) translate competency domains into observable clinical tasks and support workplace-based assessment in undergraduate Oral and Maxillofacial Surgery (OMFS). This study aimed to develop a context-specific set of OMFS EPAs for final-year BDS students and evaluate their quality and reliability using the Queen’s EQual rubric. Methods A consensus-generating mixed-methods design was employed using a purposive expert panel ( n  = 10). The Nominal Group Technique was used to generate and prioritise EPAs, followed by structured rating on a 5-point Likert scale and iterative refinement. EPA quality was evaluated using the 14-item EQual rubric. Analyses included descriptive statistics, Cronbach’s alpha, generalizability theory (phi coefficient), and intraclass correlation coefficients (ICC). Results Ten experts (60% male; five specialists, four general dentists, and one medical educationist) completed all study phases. Ten EPAs were developed. The highest consensus (9/10) was achieved for history-taking, diagnostic testing and imaging, informed consent, and non-surgical care, whereas lower consensus was observed for preventive and follow-up care (3/10) and orofacial pain and anxiety management (4/10). Most EPAs (8/10) were judged by a majority as not requiring revision; however, the EPAs addressing orofacial pain and anxiety management and preventive and follow-up care were most frequently identified for refinement ( n  ≥ 6; mean ratings 3.60 and 3.40, respectively). All EPAs exceeded the predefined EQual cut score (4.07), with overall mean scores ranging from 4.26 to 4.41 (SD 0.16–0.23) and high internal consistency (Cronbach’s alpha = 0.89). Reliability evidence indicated excellent dependability (phi = 0.987 for specialists; 0.888 for general dentists) and strong inter-rater agreement (ICC = 0.969 [95% CI 0.914–0.996] for specialists; 0.964 [0.900–0.996] for general dentists; p  < 0.001). Conclusions A 10-item EPA framework for undergraduate OMFS demonstrated acceptable structural quality and strong reliability. Refinement priorities were identified for EPAs related to preventive and follow-up care and orofacial pain and anxiety management. This framework provides a structured basis for workplace-based assessment and curriculum alignment in undergraduate OMFS training.

Objective To construct precise learner personas for medical students by integrating social sensing data with the Entrustable Professional Activities (EPAs) framework, thereby informing targeted pedagogical strategies. The study aims to address the gap in integrating behavioral data with competency assessment for multidimensional learner characterization. Methods Purposive sampling was employed to recruit 45 clinical interns (June–December 2024) based on data saturation principles. Data collection combined semi-structured interviews, social sensing technology (multimodal data from medical forums and clinical sensor arrays with AES-256 encryption for privacy protection), and EPA-based clinical observations. Thematic analysis via NVivo 12 Plus was used to extract features, with manual coding validating theoretical saturation after 45 interviews. Results A four-dimensional persona framework (learning attitude, clinical competence, social interaction, self-improvement awareness) was discovered, yielding five archetypes: Proactive Achievers (28.89%), Skilled Practitioners (20.00%), Social Collaborators (17.78%), Passive Followers (24.44%), and Ambiguous Improvers (8.89%). Intergroup differences in EPA-assessed clinical skills were significant (ANOVA, p  < 0.05 for all dimensions). Conclusion The multimodal framework enables data-driven learner characterization, providing evidence for personalized medical education. Future work will validate persona utility in educational interventions.

Most students who pursue a career in archaeology will find employment in cultural resource management (CRM), rather than in academia or traditional fieldwork.It is CRM, the protection and preservation of archaeological and other resources, that offers the jobs and provides the funding.