Recent advancements in the development of novel therapies to treat phenylketonuria (PKU) have fueled a call for new assessment tools that are sensitive to PKU-related neurocognitive disruptions. The present study evaluated the NIH Toolbox, a computer-administered battery of neurobehavioral measures, for assessing cognitive function in children and adults with early-treated PKU.

Data were examined from 91 individuals with PKU (aged 8–55 years) enrolled in an ongoing NIH-funded longitudinal study of hyperphenylalaninemia. Participants completed the NIH Toolbox as well as several validation instruments including the Wechsler Abbreviated Scale of Intelligence-Second Edition, Cambridge Neuropsychological Test Automated Battery (CANTAB), and Conners’ Continuous Performance Test.

Consistent with prior research, crystallized cognition was intact in both children and adults. In contrast, fluid cognition deficits were observed primarily in younger children while older children and adults generally performed within expectations. NIH Toolbox composite scores demonstrated strong concurrent validity with Wechsler indices and moderate correlations with other established measures.

The NIH Toolbox shows promise as a valid and practical measure of neurocognitive function in PKU, supporting its potential integration into clinical trials and research protocols. Future research should prioritize longitudinal designs to assess test–retest reliability, sensitivity to change, and subgroup differences related to treatment modalities. Ongoing efforts, such as the PHEFREE consortium, will be critical for establishing the NIH Toolbox as a robust outcome measure for PKU intervention studies.

Recent studies indicate that anxiety is one of the most prevalent mental health challenges faced by children and adolescents diagnosed with autism spectrum disorder (ASD).

For young individuals with concurrent Intellectual disability disorder, these rates are projected to be significantly elevated.

Despite the estimated high prevalence of anxiety among young individuals with co-occurring ASD and intellectual developmental disorder (IDD), significant uncertainty remains in the field about the most effective methods for identifying, diagnosing, and treating anxiety in this distinct group.

The main objective of this narrative review is to examine the current literature on effective strategies and adjustments for evaluating and treating anxiety in children and adolescents who have co-occurring ASD and IDD, aiming to support professionals engaged with this significantly neglected group.

Test anxiety affects up to 40% of university students and is associated with academic failure, depression and suicidal ideation, yet clinical screening and high-frequency research designs remain hampered by the burden of 20-item instruments such as the Test Anxiety Inventory (TAI). Although brief measures exist (e.g. the ten-item Westside Test Anxiety Scale and the five-item TAI), a validated, gender-invariant hierarchy of ultra-short forms tailored to contemporary undergraduates is lacking.

To develop and validate a hierarchy of brief TAI versions (ten-item Short Form, five-item Ultra-Short Form and three-item Micro Form) suitable for systematic screening and ecological monitoring in student mental health contexts.

A large sample of Israeli undergraduates (N = 1803) completed the Hebrew TAI. Items were selected based on exploratory factor analysis loadings. Structural validity and gender measurement invariance were confirmed via confirmatory factor analysis.

The five-item Ultra-Short Form showed excellent fit (comparative fit index (CFI) = 0.995, root mean square error of approximation (RMSEA) = 0.05) and the three-item Micro Form exhibited strong standardised factor loadings (≥0.79). Strict scalar invariance was established across genders for all versions. All versions maintained high internal consistency (α ≥ 0.85) and strong correlations with the full scale (r ≥ 0.88). Selected items prioritised somatic over cognitive distress, suggesting contemporary students experience test anxiety as a visceral, physiological ‘survival threat’ rather than cognitive rumination.

These validated brief measures offer a promising toolkit for ‘agile assessment’ in student mental health settings, enabling early identification of at-risk students, pending external criterion validation and independent replication.

Secure psychiatric services (SPS) are vital for people with severe mental disorders who pose significant risks, yet national evidence on referral pathways, acceptance and timeliness of admission is limited. Delays and variability in access are especially concerning in prisons, where mental health crises are frequent and alternatives limited.

This study presents the first national analysis of SPS referral and admission patterns in England following the introduction of provider collaboratives. It identifies predictors of referral acceptance and delays across the referral-to-admission pathway to inform equity and performance improvement.

Data were drawn from 149 low-secure and 98 medium-secure services across 15 provider collaboratives, encompassing 1356 referrals. Multivariable models examined predictors of acceptance and delay, benchmarked against national policy standards.

Almost half of referrals originated from prisons (46%, n = 529), with 55% accepted. Acceptance was associated with gender, legal status, Mental Health Act status, prior secure admission, diagnosis, referral origin and reason for referral, but not with ethnicity or urgency. Substantial site-level variation reflected local practice and resources. Delays were widespread: fewer than a third of urgent referrals were assessed within 2 days, and only 19–25% of accepted prison referrals met recommended assessment and admission targets. Although prison referrals were processed more quickly than community or SPS referrals, national standards were seldom achieved.

Access to SPS remains inconsistent, with substantial variation in acceptance and widespread delays across referral pathways. Despite faster processing of prison referrals, national assessment and admission standards were rarely met, particularly for this group. These findings highlight gaps between policy expectations and practice, indicating a need for improved adherence to national timeframes, greater standardisation of decision-making and enhanced system oversight, to reduce inequities in access.

Cancer-related fatigue (CRF) is a distressing symptom in terminally ill patients with cancer. While many studies have been conducted on the relationship between fatigue and quality of life (QOL) among patients undergoing treatment, only a few have been conducted to measure fatigue from multiple perspectives or clarify its impact on patients in advanced stages or those receiving palliative care.

To examine the impact of fatigue on QOL in terminally ill patients with cancer, using a questionnaire that measures CRF from 3 perspectives.

CRF and QOL were measured using the Cancer Fatigue Scale (CFS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative (EORTCQLQ-C15-PAL), respectively, and the correlation between them was evaluated. Web-based questionnaires were completed by patients receiving hospice and palliative care.

Twenty-nine participants provided valid responses. Median CFS and global health status/QOL scores were as follows: total fatigue 25.0, physical fatigue 11.0, affective fatigue 9.0, cognitive fatigue 5.0, and global health status/QOL 50.0. QOL showed significant correlations with total fatigue (rs = −0.44, p = 0.017, 95% CI: −0.70, −0.09) and physical fatigue (rs = −0.38, p = 0.038, 95% CI: −0.66, −0.02), but none with affective fatigue (rs = −0.02, p = 0.917, 95% CI: −0.38, 0.35) and cognitive fatigue (rs = −0.33, p = 0.074, 95% CI: −0.63, 0.03).

Of the 3 aspects of fatigue, physical fatigue may be most closely related to QOL; however, its accurate assessment may depend on the scale used. Therefore, it is necessary to select an appropriate scale for patients with terminal cancer.

Assessing depression symptoms in people with a chronic illness is challenging due to possible bias from overlapping somatic symptoms associated with both depression and chronic illnesses. Previous studies, however, have found that people with a chronic illness do not report more somatic symptoms on depression measures than people without a chronic illness with similar levels of mood and cognitive symptoms. The reason for this surprising finding is unknown. Our primary objective was to evaluate differences in mean sum scores of Patient Health Questionnaire-8 (PHQ-8) somatic symptom items (sleep disturbances, fatigue, appetite changes) in people with a chronic illness when the items were administered outside the context of a depression questionnaire versus as part of the PHQ-8. Secondary objectives were to evaluate individual somatic item scores. We hypothesised that people who completed somatic items outside of a depression assessment would have significantly higher scores than those who completed items as part of a depression assessment.

We conducted a randomised controlled experiment within the Scleroderma Patient-centred Intervention Network (SPIN) Cohort, a multinational cohort of people with systemic sclerosis. SPIN Cohort participants were randomly allocated to complete the PHQ-8 with somatic items (sleep disturbances, fatigue, appetite changes) presented separately from psychological items and without any indication that they were part of a depression questionnaire (Reordered Items arm) or in standard format (Standard PHQ-8 arm). Participants were automatically randomised when they logged into the SPIN Cohort platform to complete routine research assessments. The primary outcome was the mean sum score of PHQ-8 somatic items. Secondary outcomes were the mean scores of individual somatic items. Differences were assessed using between-groups t-tests.

In total, 851 participants were included (N = 428 in Reordered Items arm, N = 423 in Standard PHQ-8 arm). Mean (SD) PHQ-8 score was 6.0 (5.3) for all participants. We found no statistically significant differences in PHQ-8 somatic item sum scores (0.05 points; 95% confidence interval [CI]: −0.29 to 0.38) or in mean scores for item 3 (sleep disturbances; 0.04 points; 95% CI: −0.09 to 0.19), item 4 (fatigue; 0.03 points; 95% CI: −0.11 to 0.16) and item 5 (appetite changes; −0.03 points; 95% CI: −0.15 to 0.10).

We did not find evidence that responses to PHQ-8 somatic items were influenced by whether participants were aware they were responding to items about depression. This finding supports the validity of self-reported questionnaires for depression symptom assessment in people with chronic medical conditions.