Psychiatric inpatient care is a high-resource component of mental health systems. Understanding the diagnoses driving inpatient care is essential for evidence-based service planning. This study describes psychiatric inpatient bed use in Ireland from 2013 to 2023 by diagnosis, sex, and age group.

National descriptive analyses using aggregated data from the National Psychiatric Inpatient Reporting System, covering acute inpatient admissions in Ireland. The outcome was total number of inpatient bed days, categorised by ICD-10 diagnostic group. Primary analyses focused on public services, with private services reported separately. We additionally report on child and adolescent mental health services (CAMHS), adult services, and sex-stratified results.

Between 2013 and 2023, there were k=3,993,628 public and k=1,879,877 private inpatient bed days. In public services, schizophrenia spectrum disorders accounted for 41.9% of bed days (k=1,673,529), more than twice as many as the next most prevalent diagnosis. Men accounted for 51.2% of acute public bed days. In private adult services, depressive disorders accounted for the largest proportion of bed days (28.5%, k=513,166). In public and private CAMHS, eating disorders accounted for the largest proportion of bed days (25.6%, k=46,850 and 24.4%, k=18,775), respectively.

This national analysis demonstrates that schizophrenia spectrum disorders represent, by far, the largest diagnostic group, accounting for 42% of public acute psychiatric inpatient beds days, highlighting the sustained, intensive service demands associated with these disorders. These data provide a clear empirical basis for future service planning, highlighting where targeted enhancements to community-based care could most effectively reduce the need for hospitalisation.

Adults with mental disorders more frequently report getting into serious trouble with the police and the law than do adults with no mental health diagnosis. The mechanisms underlying this statistical association remain unclear.

The study used data from a US population survey to examine whether the previously recognized association between psychiatric diagnosis and getting into serious police or legal trouble is mediated by impaired psychosocial function or psychiatric symptoms. The predictor variable was psychiatric diagnosis. The mediator variables were two forms of psychosocial function, social and role-emotional, and the presence of recent symptoms. The outcome variable was police or legal trouble.

When known risk factors are included as covariates, the association between mental disorder and serious police or legal trouble over the past year is maintained and is significantly mediated (p < 0.05) both by social and role-emotional function (social, excess relative risk [ERR] 1.42 [95% CI: 0.96, 1.88]; role-emotional, ERR 1.45 [95% CI: 0.98, 1.91]) and by recent symptoms(ERR 1.63 [95% CI: 1.13, 2.13]). The contribution of mediation varies by diagnosis.

Previous research suggested that it is unusual for psychiatric symptoms to lead directly to violence. These results suggest that symptoms and signs of mental disorder nevertheless contribute indirectly to violence and other adverse outcomes. The identification of these mediators may, in turn, suggest new approaches to reducing the risk of those outcomes. Future research should further examine and describe the mechanisms that underlie these and other forms of mediation.

There has been growing interest in developing a clinical staging model for eating disorders (EDs). The aim of this scoping review is to investigate the extent, range, and nature of research that can inform clinical staging approaches for EDs.

This review was conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA extension for Scoping Reviews. A search of PubMed, PsycINFO, MEDLINE and Web of Science databases was conducted. Sixty studies were included for review, and data were extracted according to revised pre-published criteria. Studies were summarized using narrative synthesis.

Thirty-six of the included manuscripts were quantitative, 18 were qualitative, and six were conceptual/review papers. The included studies primarily focused on anorexia nervosa in white, female samples and compared only two stages of illness, equating to “early” and “longstanding” or “severe and enduring” EDs. “Middle” stages or transitions between stages were not well-defined. Stages have mostly been conceptualized using duration of illness or other behavioral or clinical parameters, with few (neuro) biological studies identified. Factors that may modify illness stage have not yet been integrated into ED staging literature.

There is growing consensus that early- and later-stage EDs have distinct characteristics and treatment requirements; however, these distinctions require clearer definition. Recommendations for future research are outlined, emphasizing integration of psychosocial and biological research, focused investigation of illness phases outside of early and longstanding phases, and evaluation of personalized, stage-based treatments. A tentative staging model for EDs is proposed.

Hypopharyngeal cancer is characterised by low survival rates because of the prevalence of the advanced stage. This study aims to analyse the pathways to the diagnosis of hypopharyngeal cancer.

A retrospective observational cohort study of 434 patients diagnosed with hypopharyngeal cancer extracted from the Head and Neck cancer multidisciplinary team database in the West of Scotland over 14 years.

There were 434 patients with a mean age 67.3 years. The Urgent Suspicion of Cancer referral pathway had 237 patients (54.6 per cent), while 87 patients (20 per cent) had urgent or routine general practitioner referral, 101 (23.3 per cent) were referred by secondary care specialities and 55 (12.7 per cent) presented as emergencies. The majority of patients, 288 (66.3 per cent), experienced symptoms for 3 months before referral and 180 of patients (41.5 per cent) had an ENT clinic appointment within 2 weeks after referral.

Diagnostic pathways to hypopharyngeal cancer are efficient despite a variety of clinical presentations. However, most patients present with short symptom duration and advanced disease, highlighting its aggressive nature.

Despite being common and linked to significant morbidity and mortality, personality disorders (PD) are underdiagnosed. Stigma, professionals’ therapeutic nihilism and lack of effective treatments are contributing factors. This survey aimed to explore the experiences of a service user group of being assessed for and receiving a diagnosis of personality disorder and to examine the impact of the diagnosis and the disorder on their life.

Patients under the care of two consultant-led teams who had received a diagnosis of personality disorder using Structured Clinical Interview for DSM-5 PD (SCID-5-PD) in 2019 and 2020 were invited by email to complete a qualitative survey. Responses were analysed using thematic analysis.

Participants were predominantly aged 41–50 years, with most discharged over three years previously. Borderline personality disorder was most commonly reported. Thematic analysis identified three themes: Understanding and Being Understood – highlighting variable levels of comprehension and agreement with the diagnosis; A turning point – describing both abandonment and access to targeted treatment; and Restriction – capturing stigma, secrecy, and perceived negative impacts on care, relationships, and functioning.

Findings highlight the complexity of delivering diagnoses in a meaningful and therapeutic way. Participants reported limited understanding, underscoring the need for clear, repeated psychoeducation and collaborative formulation while others described positive experiences leading to self understanding and recovery. Many were relieved to get the diagnosis after significant delays and lack of appropriate treatment. Revisiting formulation over time and linking diagnosis to treatment pathways appear crucial for acceptance, empowerment, and positive outcomes.

Depressive disorder (DD) is a widespread mental illness that lacks objective diagnostic biomarkers, complicating early detection and personalised treatment. This study investigated the diagnostic value of serum interferon-gamma (IFN-γ), nerve growth factor (NGF), and their ratio, alongside thyroid peroxidase antibody (TPOAb) and glial fibrillary acidic protein (GFAP), in patients with DD compared to healthy controls.

A total of 238 participants (118 with DD and 120 controls) were enrolled. Depression severity was assessed using DSM-5 and HAM-D criteria. Serum biomarkers were measured using enzyme-linked immunosorbent assays (ELISA), and receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance.

DD patients exhibited significantly lower IFN-γ and higher NGF levels than controls (both p < 0.001), resulting in a markedly reduced IFN-γ/NGF ratio. The IFN-γ/NGF ratio achieved the highest diagnostic accuracy (AUC = 0.858, sensitivity = 82.20%, specificity = 77.50%), outperforming IFN-γ (AUC = 0.766) and NGF (AUC = 0.848) alone. TPOAb and GFAP levels did not differ significantly between groups.

The IFN-γ/NGF ratio is a promising biomarker for depressive disorder, offering superior diagnostic accuracy over individual immune or neurotrophic markers. This composite index may support more objective and biologically informed diagnosis in clinical psychiatry.

Linguistic abnormalities in schizophrenia (SCZ) span morphological, syntactic, semantic, and discourse levels. Converging cross-linguistic evidence suggests that SCZ may involve semantic narrowing alongside reduced syntactic differentiation, yet how these changes co-occur across linguistic domains and whether they represent core, task-general disturbances remains unclear. We applied a multilevel NLP framework to a large Japanese dataset to identify structurally related linguistic markers of SCZ across elicitation contexts.

Speech from 104 patients with SCZ and 101 healthy controls was collected through semi-structured interviews. Transcripts from free conversation, storytelling, and picture description were analyzed using GiNZA, Word2Vec, TF-IDF, and SentenceBERT to extract 76 morphosyntactic, semantic, and discourse features. Factor analysis identified representative features independent of diagnosis, which were tested using generalized estimating equations and validated with bootstrap and permutation procedures. Cross-task stability was examined to determine core linguistic markers.

In free conversation, reduced Case-particle (Kakujoshi) and Adverb use and increased Mean Pairwise Word Similarity were strongly associated with SCZ (AUC = 0.87, 95% CI: 0.74–0.97). Adverbial, case-particle, and semantic-network measures functioned as cross-task markers.

SCZ involves multidimensional language disturbances characterized by a tripartite linguistic phenotype of diminished morphosyntactic explicitness, semantic narrowing, and reduced modification-based contextual modulation in spontaneous discourse. Extending cross-linguistic evidence, our results indicate that lexical-semantic contraction co-occurs with reduced overt marking of argument relations in Japanese, alongside weakened adverbial elaboration and framing – suggesting convergent, largely task-general dimensions of SCZ language pathology, most evident in free conversation.

To evaluate the validity and correlates of inaccurate clinically diagnosed moderate/severe ICD-10 major depressive disorder (MDD) and psychiatric comorbidities in adult inpatients.

The multicenter Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D) study enrolled 18- to 75-year-old inpatients with MDD who underwent assessments for clinical, illness, and treatment characteristics, including the Mini-International-Neuropsychiatric-Interview (MINI). False-positive clinically MDD diagnoses were characterized via MINI. Diagnostic agreement between clinical and MINI-based psychiatric comorbidities was assessed with kappa-statistic.

Among 401 patients (median age = 33.0 years; female = 57.1%), 42 (10.5%) were false positive for MDD (i.e., different primary diagnosis). Reasons for misdiagnosing MDD exclusive to false-positive cases included bipolar disorder (45.2%), subsyndromal depression (16.7%), and physical illness-related/substance use disorder (SUD)-related depression (4.8%), whereas missed diagnoses that could also occur in true-positive, MINI-based MDD patients included primary SUDs (23.8%) and primary anxiety disorders (9.5%). Among comorbidities, greatest disagreement between clinical and MINI-based research diagnoses existed for antisocial personality disorder (0% vs. 5.2%, κ =0), followed by anxiety disorders (7.5% vs. 45.1%, κ =0.17), obsessive-compulsive disorder (3.0% vs. 8.7%, κ =0.27), SUDs (11.0% vs. 28.4%, κ =0.29), eating disorders (3.5% vs. 7.2%, κ =0.39), and posttraumatic stress disorder (10.7% vs. 23.7%, κ =0.40).

Bipolar depression and SUDs contributed to two thirds of misdiagnosed MDD. Missed comorbidities included mostly anxiety disorders, SUDs, and PTSD. Accurate diagnostic assessment, including longitudinal history, is essential to reduce misdiagnosis and ensure guideline-based treatment for psychiatric disorders in MDD inpatients.

Recent proposals for revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) aim to improve psychiatric diagnosis. While these efforts reflect substantial ambition, they continue to operate within assumptions embedded in the DSM’s underlying classificatory logic. This editorial examines whether such incremental revision is sufficient.

We provide a critical analysis of the recently published DSM roadmap and accompanying subcommittee commentaries. Drawing on contemporary literature, we identify five structural blind spots in the current reform agenda: public mental health, scientific inference, lived experience, epistemic governance, and the function of diagnosis. Based on this analysis, we propose an alternative dialogical redesign for the DSM.

We argue that current revision considerations risk increasing complexity without resolving fundamental limitations in psychiatric classification. Specifically, our analysis highlights several areas that warrant further consideration, including the relationship between diagnostic expansion and societal conditions, the applicability of group-level scientific findings to individual care, the incorporation of experiential knowledge, participatory governance in revision processes, and the identity-related implications of diagnosis. In response, we propose redesigning the DSM as a hybrid dialogical system that retains coarse-grained classificatory categories for pragmatic purposes while shifting diagnostic practice toward contextual interpretation, collaborative meaning-making, relational understanding, and individualized care formulation.

The challenges facing psychiatric diagnosis require more than incremental refinement. We therefore argue for a dialogical redesign of the DSM that better reflects the context-dependent, experiential, and relational nature of mental health conditions, positioning diagnosis as a starting point for collaborative inquiry.