Acute behavioural disturbance (ABD) is a contested term describing severe agitation and behavioural dysregulation, often preceding sudden death. Concerns regarding diagnostic clarity, racial bias and law enforcement restraint have been raised, and its clinical and forensic utility have been questioned.

To characterise fatal ABD cases following substance use to inform clinical management, forensic interpretation and policy.

Fifty-one deaths consistent with ABD were identified from the National Programme on Substance Use Mortality (NPSUM) using textual screening and Royal College of Emergency Medicine and Faculty of Forensic & Legal Medicine criteria.

All cases met Royal College of Emergency Medicine criteria and most met Faculty of Forensic & Legal Medicine (84.3%) criteria. Agitation was the most frequently observed sign (86.3% of cases). Stimulants, particularly cocaine and amphetamines, were also detected in 86.3% of cases, but not necessarily in the same cases, and the rate of stimulant detection was almost three times higher than that in in the broader NPSUM cohort (32.1%). Cocaine concentrations were higher in ABD cases than in all NPSUM cocaine-related deaths (0.848 mg/L v. 0.105 mg/L). Compared with the NPSUM cohort, ABD decedents were significantly younger (30.2 ± 7.5 v. 40.5 ± 13.4) and more likely to be male (92.2 v. 73.4%), from racially minoritised backgrounds (21.7 v. 3.9%) and living in deprived areas (87.0 v. 75.9%).

Variability in diagnostic criteria highlights a need for clearer ABD definitions. Toxicology testing may assist in refining the ABD construct, but its results must be interpreted within broader clinical and social contexts. These findings support avoiding use of ABD as a stand-alone cause of death but retaining it as a clinical descriptor prompting urgent treatment, monitoring and reduced reliance on prolonged restraint.

Since the full-scale Russian invasion in 2022, health facilities and healthcare workers in Ukraine have been systematically targeted. Despite growing calls to prioritise their mental health, robust evidence on the magnitude of the problem and its determinants remains limited.

To estimate the prevalence of mental health problems among doctors and nurses in Ukraine, and examine their association with key exposures.

We conducted a cross-sectional survey between May and September of 2025, in a non-probabilistic sample of doctors and nurses working in Ukraine. The survey included validated self-report instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and suicidal thoughts, as well as workplace risk factors (bullying, sexual harassment, violent threats, physical violence) and protective factors (social support, purpose and meaning at work). Associations were examined using multilevel regression models with extensive sensitivity analyses, including Bayesian models and survey raking weights.

Among 23 805 respondents, 1 in 3 doctors and 1 in 4 nurses reported symptoms compatible with probable depression, 1 in 4 doctors and 1 in 6 nurses reported symptoms compatible with probable anxiety, and about 1 in 10 doctors and nurses reported suicidal thoughts. Workplace violence – particularly bullying – was strongly associated with depression and anxiety, whereas physical violence showed the strongest association with suicidal thoughts. Purpose and meaning at work were consistently associated with better mental health. Associations were overall high and similar across regions with different levels of active conflicts. Estimates were robust across analytic approaches.

Elevated prevalences and strong associations with workplace factors support a zero-tolerance approach to violence and the implementation of scalable mental health strategies that also strengthen protective factors.

Concurrent psychiatric care in medical in-patients is associated with adverse hospital stay outcomes, but data from low- and middle-income countries is limited.

We aimed to investigate the association between psychiatric diagnosis–medication concordance and discharge disposition outcomes in acute medical in-patients.

This was a retrospective cross-sectional analysis of 16 868 adults presenting to the Department of Internal Medicine at Aga Khan University Hospital, Karachi, Pakistan (2018–2022) with specified acute care conditions. Patients were classified into four groups based on presence of a psychiatric diagnosis and/or psychiatric medication use: neither, medication without diagnosis, diagnosis without medication and both. Primary adverse outcomes were in-hospital mortality and leaving against medical advice. Multinomial logistic regression was used, adjusting for age, gender, Charlson Comorbidity Index score, medication burden and individual acute medical conditions.

A total of 2527 (15.0%) patients had a documented psychiatric diagnosis; however, 6279 (37.2%) received at least one psychiatric medication. Referencing patients with neither exposure, those receiving psychiatric medications without a documented diagnosis had the highest adjusted odds of mortality (adjusted odds ratio (aOR) 1.95, 95% CI 1.74–2.19, p < 0.001) and higher odds of leaving against medical advice (aOR 1.21, 95% CI 1.06–1.39, p = 0.006). Patients with a documented diagnosis but no psychiatric medications had higher odds of leaving against medical advice (aOR 1.28, 95% CI 1.04–1.57, p = 0.022) without a significant increase in mortality (aOR 1.21, 95% CI 0.98–1.49, p = 0.076). Patients with both a diagnosis and psychiatric medication usage showed no significant change in either outcome.

Diagnosis–treatment concordance may be associated with in-patient prognosis in acute care conditions.

Compulsory Community Treatment (CCT) is any intervention that mandates community psychiatric care. Despite Australia’s high use of CCT compared to other countries, there is no standardised national reporting framework, limiting transparency and comparability across jurisdictions.

To determine rates of CCT orders per 100 000 population, individuals subject to CCT per 100 000 population and the proportion of all community mental healthcare contacts that were involuntary between 2016–2017 and 2023–2024. We also sought to identify and document differences in reporting practices across CCT reporting bodies.

Publicly available data were extracted from annual reports of state and territory Mental Health Review Tribunals or Civil and Administrative Tribunals, Offices of the Chief Psychiatrist and the Australian Institute of Health and Welfare. Rates of CCT orders per 100 000 population, individuals subject to CCT per 100 000 population and the proportion of all community mental healthcare contacts that were involuntary were calculated and compared across jurisdictions.

Marked differences were identified in CCT terminology, reporting scope and data completeness across jurisdictions and reporting bodies. Only three jurisdictions reported the number of individuals subject to CCT and none reported incidence data. Rates of CCT increased in most jurisdictions, except Western Australia, which showed a decline and the lowest rate of all jurisdictions. The proportion of involuntary community contacts ranged from 3 to 26% nationally.

Australia’s fragmented CCT reporting landscape impedes accurate national monitoring. A standardised national CCT data-set that incorporates prevalence and incidence indicators is urgently needed to enable transparent, comparable reporting.

The present study investigated the management of predominant negative symptoms in hospitalized patients and assess the impact of targeted pharmacological and psychological interventions.

This longitudinal, prospective, multicenter cohort study was conducted across multiple hospitals in Slovakia, focusing on inpatients, with assessments at admission and discharge. Eligible participants were hospitalized adults (18–65) diagnosed with schizophrenia and predominant negative symptoms. Treatment effectiveness was measured using the modified Short Assessment of Negative Domain, Self-evaluation of Negative Symptoms, Personal and Social Performance, and Clinical Global Impression scales. Means changes and effect sizes were calculated from baseline to final assessment. Differences in the perception of negative symptoms between patients and doctors were examined.

At discharge, patients showed significant improvements in symptom severity and functioning on all scales. Primary and secondary negative symptoms significantly decreased, especially those linked to positive and affective symptoms. Functioning improved, with fewer severe impairments in daily life. Most patients were on antipsychotic polytherapy throughout hospitalization, with around 85% receiving multiple antipsychotics at admission and at discharge. Non-pharmacological interventions were also widely used, with nearly nine out of ten patients receiving at least one such therapy during hospitalization.

Negative symptoms in schizophrenia pose a major treatment challenge, leading to functional impairment and poor quality of life. While positive symptoms often trigger hospitalizations, negative symptoms have a lasting impact on prognosis. Results suggest both D3-receptor–targeted pharmacotherapy, particularly cariprazine, and integrated non-pharmacological interventions may contribute to meaningful improvements in negative symptoms during hospital care.

Perinatal depression and/or anxiety (depression–anxiety) have been associated with developmental disruptions. Less attention has been paid to preconception mental health, which could also contribute to adverse outcomes.

To examine whether preconception mental health is associated with developmental vulnerability in children who were either exposed or unexposed to prenatal depression.

A population-based, retrospective cohort including 130 631 births to 108 340 pregnant people from British Columbia (Canada) between 1 January 2001 and 31 December 2012, with child development data in the form of the Early Development Instrument (EDI). Logistic regression using cluster-robust standard errors was used to compare the odds of vulnerability on EDI domains.

Children born to pregnant people in all groups with depression–anxiety preconception history were more likely to be considered vulnerable on all developmental domains, except for communication skills and general knowledge, than those without prenatal depression and no preconception depression–anxiety. After adjusting for confounders, effect size was largest for children born to a person with prenatal depression who had persistent depression–anxiety before they conceived on the domains of physical health and well-being (adjusted odds ratio 1.73 [95% CI: 1.56–1.92]). Children born to people with prenatal depression but no preconception depression–anxiety were probably more vulnerable on social competence and emotional maturity domains than those without prenatal depression and no preconception depression–anxiety.

Preconception mental health is associated with child development, even after accounting for depression in pregnancy. We hypothesise that it is picking up on different experiences of mental illness through the life course and represents slightly different fetal exposures.

Limited data exist on factors influencing the length of hospital stay (HLoS) in patients with schizophrenia.

This study aimed to identify and quantify patient characteristics associated with HLoS.

A retrospective study was conducted on patients diagnosed with schizophrenia (F20, ICD-10) admitted to the County Emergency Hospital of Cluj-Napoca, Romania, from 2018 to 2022. Demographics, comorbidities, symptom severity (Positive and Negative Syndrome Scale/Brief Psychiatric Rating Scale), antipsychotic treatment and adverse effects data were collected from medical charts. Predictors of HLoS for patients with one hospitalisation were assessed using negative binomial regression.

The sample comprised 288 patients aged 18–65 years, with 75% over 30 years and a balanced gender distribution. Most patients had no comorbidities (64.24%) whereas 49.46% reported addictions. Men had higher rates of tobacco use (62.00 v. 53.49%) and self-reported use of substances/drugs (15.49 v. 3.91%). Independent predictors of HLoS (P < 0.05) in the multivariable model included gender, being retired, experiencing fear or violence in the context of psychotic decompensation, percentage score reduction in symptom severity score, first-generation antipsychotics treatment and the presence of reasons for late discharge. Men had an expected HLoS 39% longer than women. Experiencing fear (adjusted incidence rate ratio (aIRR) 1.13, 95% CI [1.01; 1.27]) and violence in the context of psychotic decompensation (aIRR 1.19, 95% CI [1.06; 1.34]), and first-generation antipsychotics treatment (aIRR 1.17, 95% CI [1.02; 1.35]) were associated with longer stay, whereas being retired predicted shorter HLoS (aIRR 0.83, 95% CI [0.70; 0.98]).

The length of hospital stay in patients with schizophrenia is influenced by demographic, clinical and treatment factors. Targeted interventions addressing these predictors may optimise the duration of hospitalisation.

Withholding or withdrawing life-sustaining therapies (WLST) was introduced in France in 2005 through the Leonetti law to prevent futile treatments and “unreasonable obstinacy.” In France, WLST decisions affect 8.5–14% of ICU patients, according to the literature. The 2016 Claeys–Leonetti law updated the previous legislation, but debates surrounding end-of-life care persist.

To describe WLST patients and practices under current legislation, we conducted a multicenter, prospective, observational study in ICUs across Eastern France. Eligible adult patients facing WLST decisions were included, requiring written consent from the patient or a trusted person. Patients were followed for 1 month. We described the decision-making process and assessed family satisfaction using the FS-24R-ICU questionnaire.

Between May 3rd and October 3rd, 2023, 73 patients were included (mean age 69 years). The majority of admissions were medical (72.7%), and 50.7% of patients had neurological impairments. ICU staff initiated WLST discussions primarily due to poor survival or quality of life prospects. Only 12.5% of patients had written advance directives, and 59.1% had designated a trusted person. External consultation was not involved in 19.1% of decisions. Families were informed in 91.7% of cases. Decisions to withhold therapies occurred in 68.1% of cases, with resuscitation during cardiac arrest being the most commonly withheld intervention (98.0%). Treatment withdrawal occurred in 31.9% of cases. Family satisfaction was generally positive.

WLST management in Eastern French ICUs is partially compliant with the Claeys–Leonetti law. Improved law application and public awareness could enhance end-of-life care management in France.

Newfoundland and Labrador (NL) introduced Canada’s first excise tax on sugar-sweetened beverages (SSB) in 2022. Industry marketing practices in response to SSB taxation may affect public health impacts. We examined changes in posted beverage pricing and marketing of taxable and non-taxable beverages in NL before and after the SSB tax was implemented.

Pre-/post-observational study with in-store audits of beverage prices and marketing. Changes including pricing discounts and promotions were assessed at the individual beverage level for pre/post-tax implementation years.

Eighty food stores (grocery, convenience, drug and dollar) in NL, Canada.

There was no evidence of a change in posted shelf prices between pre/post years. There was a significant increase (+2·5 %, χ2 = 9·693, P = 0·002) in proportion of discounted taxable SSB with no change in non-taxable beverages (P = 0·350). There were no significant differences in change of number of promotions for taxable SSB (+5·2 [−0·1, 10·5], F = 3·789, P = 0·053) nor non-taxable beverages (+3·4 [–1·0, 7·7], F = 2·268, P = 0·134).

The lack of change in posted prices of taxable SSB indicates that the NL SSB tax was not communicated at the point of decision-making. While some marketing changes post-tax were observed, results should be interpreted cautiously as they cannot be attributed definitively to the tax. Existing literature implies that industry may adapt marketing conduct to counteract beverage taxes. Such changes were limited in NL, suggesting retailers may have opted not to display the tax rather than attempt to actively counteract it. Lack of transparency surrounding the tax may neutralise intended behavioural effects.

The risk factors for post-traumatic stress disorder (PTSD) in children and adolescents following mass violence incidents, such as terrorist attacks, remain incompletely understood. In the aftermath of the 14 July 2016, terrorist attack in Nice, France, a dedicated paediatric consultation centre was established at the Children’s University Hospital, the Nice Pediatric Psychotrauma Center (NPPC).

This 2-year longitudinal study aims to identify and understand the influence of pre-trauma, trauma-related and post-trauma risk factors associated with the development of PTSD in children and adolescents following the 2016 terrorist attack in Nice.

Participants under 18 years of age at the time of the attack were recruited from the NPPC over 2 years, between 21 November 2017 and 22 November 2019. Assessments included semi-structured diagnostic interviews with children and/or parents, standardised clinical questionnaires for both parents and children and cognitive tests exclusively for children.

Two hundred and seventy-one children (mean age 8.10 years; 48.7% female) directly impacted by the terrorist attack, were assessed. Pre-traumatic factors (age, gender assigned at birth and cognitive functioning) failed to predict PTSD. Two trauma-related factors, subjective fear intensity and lifetime number of traumatic events emerged as significant predictors. Concerning post-trauma factors, maternal symptoms (anxiety, depression and PTSD), child somatic symptoms and comorbid DSM-5 diagnoses played a crucial role in child PTSD. The final regression model demonstrated an 84% accuracy in predicting PTSD in children and adolescents (χ2[3] = 2.4, P < 0.001).

These findings highlight the importance of assessing specific risk factors for PTSD in children and adolescents to deliver specialised and targeted care to young people and their parents following a terrorist attack.

Suicide rates in the United States have been increasing, necessitating an understanding of demographic variations by ethnicity, age, sex and method to inform effective prevention strategies.

To dissect suicide rates in the US population from 2001 to 2023 by age, sex, ethnicity, and method.

This retrospective observational study utilized suicide data and population statistics from the CDC’s WISQARS database for the years 2001 (n = 30,418), 2018 (n = 48,132), 2020 (n = 45,721) and 2023 (n = 49,014). Cases were stratified by age, sex, ethnicity, and suicide method to assess trends and demographic differences.

From 2001 to 2023, the overall US suicide rate rose from 10.7 to 14.6 per 100,000, with a temporary decrease in 2019 and 2020 (14.4 and 13.8, respectively). The primary driver of the increase was firearm-related suicides among White males, contributing 25.8% of the rise from 2001 to 2018 and 51.6% from 2020 to 2023. Decline between 2018 and 2020 was mainly due to reductions in firearm and drug-related suicides among White males, but firearm suicides surged again from 2020 to 2023. Additionally, firearm suicides among ethnic minorities, especially Black/African-American males, accounted for 14.0% of the increase during 2020–2023. Drug-related suicides also increased by 8.6% among White females aged 45 and older in the same period.

Firearm suicides are the leading factor in the changing suicide rates in the United States from 2001 to 2023, alongside rising drug-related suicides among White females. These trends highlight the necessity for targeted prevention efforts that consider demographic-specific factors and method accessibility.