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• Yoga was associated with significant improvements in PTSD and depression symptoms. • TCTSY, Kundalini, Satyananda, and Holistic yoga were most effective for PTSD. • No serious adverse events were indicated in the six studies that reported them. Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted. [ABSTRACT FROM AUTHOR]

• The 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) produced significantly greater improvements than conventional psychoeducation and usual care only in levels of medication adherence and insight into illness/treatment in patients with early-stage psychosis over 12 months. • AIM-AT participants also showed significantly greater improvements in psychotic symptoms, psychosocial functioning, satisfaction with service, length of rehospitalizations, and total number of patients hospitalised, when compared with the other two study groups over the 12-month follow-up. • The positive study results of this trial support the integration of the multicomponent AIM-AT into routine community mental healthcare service for adults with early-stage psychosis. • Future research should explore the therapeutic components and mechanism of actions of the AIM-AT program using various study designs, such as qualitative interviews and observation studies. This study aimed to test the effectiveness of an acceptance-based medication adherence intervention for people with early-stage psychosis. An assessor-blind, three-arm randomized controlled trial design was used. One hundred and twenty-six participants who were adults with ≤3 years of psychosis were recruited from four district Integrated Community Centers for Mental Wellness in Hong Kong. They were randomly assigned to receive a 10-session acceptance-based, insight-inducing medication adherence therapy (AIM-AT) intervention, a conventional psychoeducation group program, or usual treatment (n = 42 per group). Primary outcomes were medication adherence and insight into the illness/treatment. All study outcomes were measured at recruitment and immediately, 6 months, and 12 months post-intervention. Participants in the AIM-AT experienced statistically significant improvements in the primary outcomes (levels of medication adherence and insight into illness/treatment), when compared to those in the other two groups over the 12-month follow-ups. The AIM-AT group also had significantly greater improvements in psychotic symptoms, psychosocial functioning, service satisfaction, length of rehospitalization, and total number of patients hospitalized over the follow-up period. These findings support the effectiveness of the AIM-AT to improve medication adherence, psychosocial health, and service satisfaction in people with early-stage psychosis. [ABSTRACT FROM AUTHOR]

• Only 6 % of randomized trials of antidepressants assess the prevention of relapse. • Only 28 % of randomized trials of antidepressants assess functional remission. • Most randomized trials of antidepressants have stringent eligibility criteria. • 84 % of randomized trials of antidepressants exclude older adults. • Modification of the design of trials of antidepressants should be considered. The purpose of this study was to analyze the key aspects of the design of contemporary placebo-controlled randomized clinical trials (RCTs) of antidepressants enrolling patients with major depressive disorder (MDD) aged 18 years or older, especially the outcome measures and the eligibility criteria. The study included 122 RCTs registered with ClinicalTrials.gov and started from 2008 through 2022. Most RCTs assessed only clinical remission, with proportion of trials with outcome measures related to functional remission being rather low (n = 34; 28 %). Clinical remission was mostly evaluated in acute phase of depression, and only 7 (6 %) trials assessed the prevention of relapse. Proportion of trials utilizing self-report questionnaires that provide important information complementary to clinician-rated scales was moderate (n = 66; 54 %). Another problem in included RCTs was common use of stringent eligibility criteria. For instance, minimal symtpom severity required for the patient's inclusion was listed in 104 RCTs (85 %), and 41 RCTs (34 %) excluded patients based on comorbid anxiety disorders. Most RCTs (n = 103; 84 %) excluded older patients, and only 6 (5 %) trials were dedicated exclusively to them. To ensure optimal development of clinical pharmacotherapy of MDD, the investigators should consider modification of some of the key aspects of the design of RCTs of antidepressants. [ABSTRACT FROM AUTHOR]

• This is the first cost-effectiveness analysis for yoga in patients with depression. • A yoga intervention was added to treatment as usual for young women with MDD. • Adding yoga was likely to be cost-effective compared to treatment as usual only. • This was mainly due to decreased work absenteeism. In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD. [ABSTRACT FROM AUTHOR]

• Multi-domain cognitive improvements were found following low-intensity rTMS. • The majority of cognitive improvements sustained at 6 months. • Cognitive improvements were not correlated with psychotic improvement. Cognitive impairments are a core symptom of schizophrenia. Although low-intensity repetitive transcranial magnetic stimulation (rTMS) also has cognitive improving effect like the commonly used high-intensity rTMS, it has not been applied in schizophrenia yet. To fill this gap, inpatients with schizophrenia were randomized to receive 20 sessions of daily adjunctive active low-intensity rTMS in 4 weeks, or sham treatment. At baseline, 4 weeks, and 6 months, the Positive and Negative Syndrome Scale (PANSS) was used to assess psychotic symptom severity, while the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Stroop Color and Word Test (SCWT) were used to assess cognitive functions. Compared to the sixty-nine patients receiving sham treatment, those fifty-nine patients receiving active rTMS performed better in all cognitive domains at post-treatment with small to large effect sizes. This superiority of active rTMS over sham treatment remained significant at 6-month follow-up, with small to large effect sizes, except for visuospatial function and delayed memory. The reduction in PANSS scores were not correlated with cognitive improvements. Our findings provide evidence for using low-intensity rTMS to ameliorate cognitive impairments in schizophrenia. More research are needed to determine the optimal intensity for each domain of cognitive functions. [ABSTRACT FROM AUTHOR]

• This is the first study to explore the therapeutic effect of 1 Hz rTMS over right orbitofrontal cortex (OFC) in patients with first-episode schizophrenia. • 1Hz rTMS applied to the right orbitofrontal cortex can improve psychotic symptoms and cognitive deficits in patients with drug-naïve, first-episode schizophrenia. Repetitive transcranial magnetic stimulation (rTMS) has been used in the treatment of patients with schizophrenia. The conventional targets of rTMS treatment are the dorsolateral prefrontal cortex (DLPFC) and temporoparietal cortex (TPC). However, the efficacy of these two treatment strategies was quite heterogeneous. Structural and functional abnormalities of the orbitofrontal cortex (OFC) in schizophrenia are closely related to negative symptoms. We sought to determine whether 1 Hz rTMS over the right OFC is effective in treating patients with first-episode schizophrenia. In this study, eighty-nine patients with drug-naïve, first-episode schizophrenia were randomly divided into the rTMS (n = 47) or sham stimulation (n = 42) groups, with both groups receiving twenty sessions of 1 Hz rTMS treatment. The PANSS was assessed at baseline, day 10, and day 20, and MATRICS Consensus Cognitive Battery (MCCB) was implemented to assess the cognitive impairment at baseline and day 20. Results showed that patients in the active rTMS group had more improvement in clinical symptoms and cognitive deficits than patients in sham group at day 20. In conclusion, 1 Hz rTMS over OFC can improve psychotic symptoms and cognitive functions in schizophrenic patients. Our study provides a new alternative for the treatment of negative symptoms and cognitive deficits in schizophrenia. [ABSTRACT FROM AUTHOR]

• Modernized collaborative care for depression did not change plasma BDNF. • Modernized collaborative care improved depressive symptom clusters. • Changes in BDNF did not mediate the intervention effect on either symptom cluster. • Other mechanisms are responsible for the beneficial intervention effects. Brain-derived neurotrophic factor (BDNF) levels are lower in people with depression and are normalized following pharmacological treatment. However, it is unknown if psychological treatments for depression improve BDNF and if change in BDNF is a mediator of intervention effects on depressive symptoms. Therefore, using data from the eIMPACT trial, we sought to determine the effect of modernized collaborative care for depression on 12-month changes in BDNF and cognitive/affective and somatic depressive symptom clusters and to examine whether BDNF changes mediate intervention effects on depressive symptoms. 216 primary care patients with depression from a safety net healthcare system were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. Plasma BDNF was measured with commercially available kits, and depressive symptom clusters were assessed by the Patient Health Questionnaire-9. The intervention did not influence BDNF but did improve both the cognitive/affective and somatic clusters over 12 months. Changes in BDNF did not mediate the intervention effect on either cluster. Our findings suggest that modernized collaborative care is an effective treatment for both the cognitive/affective and somatic symptoms of depression and that the mechanism of action is not improvements in BDNF. ClinicalTrials.gov Identifier: NCT02458690 [ABSTRACT FROM AUTHOR]

• PTSD with MDD is common and can cause impairment among active duty service members. • Compared CPT with behavioral activation versus CPT alone. • Significant improvements in depression and PTSD outcomes in both treatments. • Attendance and patient satisfaction ratings were high in both treatment conditions. • Both treatments may be effective psychotherapy options for comorbid PTSD and MDD. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) frequently co-occur and can cause significant impairment. Data are lacking as to whether interventions targeting both PTSD and MDD may improve treatment outcomes among individuals with this comorbidity compared with existing evidence-based PTSD treatments alone. This randomized trial compared the effectiveness of cognitive processing therapy (CPT) enhanced with behavioral activation (BA+CPT) versus CPT among 94 service members (52 women and 42 men; age M = 28.5 years) with comorbid PTSD and MDD. The primary outcome was clinician-administered depression symptom severity on the Montgomery-Åsberg Depression Rating Scale (MADRS) from pretreatment through 3-month follow-up. Intent-to-treat analyses using multilevel models showed statistically and clinically significant decreases in MADRS scores for both conditions over time, with no significant differences between BA+CPT and CPT. Secondary depression and PTSD symptom outcomes followed a similar pattern of results. For diagnostic MDD and PTSD outcomes using available data, no statistically significant differences between treatments emerged at posttreatment or 3-month follow-up. Sessions attended, dropout rate, and treatment satisfaction did not significantly differ between treatments. Outcomes were comparable for both treatments, suggesting that BA+CPT and CPT were similarly effective psychotherapy options for comorbid PTSD and MDD. [ABSTRACT FROM AUTHOR]

• Nitrous oxide displays pro-cognitive effect on executive function for treatment-resistant depression. • The pro-cognitive effect of nitrous oxide might be independent from improvements in depressive symptoms. • No pro-cognitive effects of nitrous oxide in subjective cognitive function, processing speed, and attention. Nitrous oxide (N 2 O) has demonstrated an antidepressant effect for treatment-resistant depression (TRD), but no studies investigated the effects of N 2 O on different cognition domains. This study aimed to test whether N 2 O would display pro-cognitive effects. We conducted a double-blinded, placebo-controlled, randomized controlled trial, 44 patients with TRD were randomized to N 2 O group (one-hour inhalation of 50% N 2 O/50% oxygen) or placebo group (50% air/50% oxygen). Thirty-four patients completed cognitive tests at the pre-treatment phase, 1-week, and 2 weeks post-treatment including subjective cognitive function, processing speed, attention, and executive function. Although the antidepressant effect of N 2 O was not significant at 1 week, patients still showed better performance of executive function at 1 week after receiving N 2 O compared with the placebo. Moreover, this significant improvement still existed at 1 week after controlling for the change in depressive symptoms over-time. Additionally, no significant difference was observed in subjective cognitive function, processing speed, and attention between these two groups across the 2-week follow-up period. As the first study investigating the treatment effects of N 2 O on improving cognitive function in TRD patients, the current study indicated that N 2 O has a potential pro-cognitive effect on executive function and this effect might be independent from improvements in depressive symptoms. [ABSTRACT FROM AUTHOR]

• HD-tDCS applied over the DLPFC improved white matter integrity. • Effects were identified in the corpus callosum and corona radiata. • Enhanced white matter integrity was associated with cognitive change in schizophrenia. • HD-tDCS may be effective therapy for cognitive deficits in schizophrenia. Schizophrenia is a disabling major mental disorder, which includes critical deficits in cognitive function, for which no effective intervention currently exists. The aim of our double-blind, randomized, sham-controlled trial was to evaluate the effects of high-definition transcranial direct current stimulation (HD-tDCS) on the cognitive deficits in schizophrenia. This study sample consisted of 56 individuals with chronic schizophrenia, randomly allocated to either the active stimulation or sham group. The treatment consisted of ten consecutive days of HD-tDCS, 20 min/day, applied over the left dorsolateral prefrontal lobe. Changes in clinical outcomes, cognitive assessments, and diffusion tensor imaging were evaluated pre- to post-intervention. Matched-healthy controls (HCs) were included to identify white matter changes in patients with schizophrenia before treatment. Compared to HCs, schizophrenia was associated with reduced integrity of the white matter tracts of the corpus callosum and corona radiata. HD-tDCS enhanced integrity in the corpus callosum and anterior and superior corona radiata, which was associated with the change in cognitive performance. HD-tDCS offers a potential approach to improve cognition deficits in schizophrenia through a modulatory effect on white matter tracts. Given the lack of approved treatments for cognitive deficits, these findings are clinically relevant. [ABSTRACT FROM AUTHOR]

This 3-month randomized psychoeducation-controlled trial (RCT) of exercise was undertaken in young adolescents with subthreshold depression to examine the impact on gut microbiota. Participants (aged 12–14 years) were randomly assigned to an exercise or a psychoeducation-controlled group. The exercise intervention arm took moderate-intensity exercise, comprised of 30 min of running per day, 4 days a week for 3 months. Psychoeducation intervention consisted of 6 sessions of group activity including gaming, reading, and singing. The gut microbiota was assessed by metagenomic sequencing. After 3-month moderate-intensity exercise, the intervention group increased the relative abundance of Coprococcus, Blautia, Dorea, Tyzzerella at the genus level, as well as Tyzzerella nexilis, Ruminococcus obeum at species level when compared to the psychoeducation-controlled group. Moreover, EggNOG analyses showed that the defense and signal transduction mechanism were highly enriched after the active intervention, and changes were correlated with improvements in depressive symptoms measured by Chinese Patient Depression Questionnaire 9. The KEGG pathway of neurodegenerative diseases was depleted in the microbiome in young adolescents with subthreshold depression after exercise intervention. This 3-month RCT suggests that at both the genus and species levels, aerobic group exercise intervention improved in depressive symptoms and revealed changes in gut microbiota suggesting beneficial effects. [ABSTRACT FROM AUTHOR]

• A single inhalation of 50% nitrous oxide has an antidepressant effect for treatment-resistant depression. • The antidepressant effect of 50% nitrous oxide lasts for no more than one week. • Nitrous oxide is safe for patients with treatment-resistant depression. Nitrous oxide (N 2 O), an N-methyl-D-aspartate glutamate receptor antagonist, has demonstrated a rapid-onset antidepressant effect for treatment-resistant depression (TRD) preliminarily in the United States. This study aimed to test the efficacy and safety of N 2 O for TRD patients in China. In this double-blinded, placebo-controlled trial, 44 patients with TRD were randomized to receive a one-hour inhalation of a mixture of either 50% N 2 O/50% oxygen (N 2 O group) or 50% air/50% oxygen (placebo group). The primary outcome was the change on the 17-item Hamilton Depression Rating Scale (HDRS-17) over a course of two weeks. Using modified intention-to-treat analysis, the between group difference was found in the HDRS-17 score at two hours and 24 h after inhalation treatment, while no significant difference was found in week one and week two. Patients receiving N 2 O reported a significantly higher number of adverse events. All the adverse events lasted for no more than 24 h. No serious adverse events were reported. A single inhalation of 50% N 2 O effectively alleviates depression in patients with TRD in China. The efficacy lasts for no more than one week. N 2 O is safe for patients with TRD. [ABSTRACT FROM AUTHOR]

• Factors increasing total MET were younger age, reduced BPRS positive symptoms and increased BPRS hyperactivity symptoms. • Treated patients have almost 8 times the likelihood to show an increase of the total and walking MET. • Receiving the experimental intervention increased the frequency of vegetables consumption and reduced the likelihood of eating junk food. • Factors influencing vegetables' consumption included higher levels of cognitive functioning. • A better cognitive functioning was positively associated to a significant reduction in junk food consumption. Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p <.001) and of the walking MET (OR: 7.68; p <.001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p <.05) and to reduce that of junk food (OR:0.23; p <.05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living. [ABSTRACT FROM AUTHOR]

• Cerebellum plays an important role in the pathophysiology of schizophrenia. • Cerebellar theta burst stimulation may improve negative symptoms of schizophrenia. • The intervention effect may be extended to 24 weeks after the end of treatment. Given the importance of the cerebellum in the pathophysiology of schizophrenia, the cerebellar vermis has been proposed as a new rTMS stimulation site for negative symptoms. In this study, 64 patients from 7 psychiatric hospitals were randomized into the study (n=32) or control (n=32) group. Intermittent theta burst stimulation (iTBS) (or sham stimulation) to the cerebellar midline was administered 5 times/week for 2 weeks. Psychotic symptoms were assessed with the Positive and Negative Symptoms Scale (PANSS) at baseline, the end of treatment, and 2, 6, 12, and 24 weeks after the treatment. Regarding the negative symptoms, the interaction effect between group and time was statistically significant, with the scores in the study group significantly lower than those in the control group at the 4 follow-ups after treatment, and the group difference was maximal at 24 weeks of follow-up. The main effect of time was significant; however, the main effect of group did not show statistical significance. Our study revealed that cerebellar iTBS may improve negative symptoms in schizophrenia patients, and the effect was more pronounced at 24 weeks after the end of treatment, which provides preliminary empirical evidence for the maintenance of efficacy after stimulation of this new site. [ABSTRACT FROM AUTHOR]