Recently, resurgent personalist regimes and geopolitical instabilities have amplified concerns about psychopathic personality traits in high office. Yet, psychopathic traits and their associated correlates remain explicitly underexamined within the dynamics of international conflict, particularly nuclear flashpoints, where individual decision-making could entail disproportionate consequences. As part of a cumulative project on functional and psychological factors in Cold War leadership, preliminary psychopathic trait estimates were generated for 13 leaders central to the Suez Crisis (1956), the Cuban Missile Crisis (1962), and the Yom Kippur War (1973). Subject-matter experts ( = 149) rated leaders at-a-distance using an adapted 33-item Comprehensive Assessment of Psychopathic Personality-Lexical Rating Scale, a dimensional, non-diagnostic inventory suitable for non-clinicians. Inferred from over 5,000 item-level responses (155 total ratings;  = 11.9/leader), trait profiles revealed domain-specific and between-leader accentuations, many of which converged with historical and behavioural evidence. Representing disparate political systems, higher-scoring leaders exhibited pronounced "Dominance", "Self", and "Behavioural" dimensions (M ≈ 2.04-3.00; 1-4 scale), suggesting recurring tendencies and transideological psychopathic trait manifestations. Strong average-measure interrater reliability supported the robustness of these exploratory estimates, notwithstanding possible respondent artefacts. Accordingly, this study further demonstrates the methodological feasibility of retrospective psychopathic trait evaluations, underpinning future triangulation and potential investigations into their conflict-relevant intersections.

After musing over the possible reasons for our persistent preoccupation with the 'future of psychiatry', I formulate twelve arbitrary questions on this topic, and venture into their possible answers in two ways: first, what I would thirty years hence (a playful fantasy); and second, what I thirty years hence (a putative projection). These questions range from: will psychiatry survive, as psychiatry, to: What about Low-and Middle-Income Countries? While gazing into this crystal ball armed with the current state of knowledge, attitude and practices, in the end it becomes clearer to me that, whatever psychiatry will experience over the ensuing decades, it should be imperative to sustain the essential core of psychiatry, both as a science and as an art of therapy: socioecological and political-commercial determinants of mental health along with its burgeoning biological determinants; the need for effective communication and relation at every level; and that precious thing called therapeutic alliance or bonding. The value of these will continue to exist, and perhaps increase, over the years and decades, provided we value these values and nurture these as essential components of psychiatric training.

Depressive disorders with onset during adolescence and young adulthood are common, disabling, and often difficult to diagnose due to their heterogeneous and developmentally specific presentation. Compared with adult depression, young people more frequently display irritability, somatic complaints, and behavioural problems, which can obscure recognition and delay treatment. This narrative review aims to synthesize current evidence on depressive disorders in young people, while highlighting implications for treatment and prevention. The keywords ("youth" OR "adolescent" OR "childhood" OR "child" OR "young") AND ("depression" OR "depressive symptoms" OR "mood disorder" OR "depressed mood") were entered in the main databases and combined through Boolean operators. Findings confirm that youth depression presents with distinct clinical features and strong sociocultural influences, is frequently comorbid with other psychiatric disorders, and follows a recurrent and impairing course. Psychotherapy remains the most effective intervention, with selective serotonin reuptake inhibitors indicated for moderate-to-severe cases. Preventive and school-based strategies show promising results but are unevenly implemented. In conclusion, depressive disorders in young people require early detection and developmentally sensitive, multimodal treatment strategies. Future work should prioritize scalable interventions that integrate psychosocial, pharmacological, and digital tools, with special attention to prevention and to the influence of cultural and contextual factors.

Major depressive disorder (MDD) significantly impairs adolescents' development, with increasing rates of treatment resistance and suicide risk. Ketamine has emerged as a promising, rapid-acting antidepressant in adults, but its efficacy and safety in adolescents remain unclear. This systematic review and meta-analysis aimed to evaluate short-term outcomes of ketamine administration in youth with mood disorders. Following PRISMA guidelines and PROSPERO registration (CRD42024568658), four studies were included, comprising 272 adolescents aged 12-18 years. Three studies (n = 189) contributed data to the meta-analysis. At 24 hours post-administration, ketamine showed a small, non-significant effect on depressive symptoms compared to placebo (SMD = -0.19; 95% CI: -0.41 to 0.04). Clinical response and remission were not significantly different between groups, but ketamine was associated with a significantly higher rate of suicidal ideation remission (RR = 1.49; 95% CI: 1.06 to 2.08). Adverse events were generally mild, transient, and consistent with known pharmacological effects. While findings support ketamine's potential role in acute presentations, current evidence is preliminary. Larger randomized controlled trials with extended follow-up are needed to clarify the clinical utility, optimal protocols, and long-term safety of this approach in adolescent populations.

India, with its vast sociocultural diversity faces unique and complex mental health challenges that reflect profound regional, economic, and demographic variations. This paper examines the current landscape and future directions of mental health practices in India, arguing that a paradigm shift is essential to move beyond traditional, clinic-based approaches toward integrated, community-oriented care models. It highlights key challenges including significant treatment gaps, urban-centric service delivery, stigma, and insufficient workforce capacity. In response, the paper proposes a reimagined role for psychiatry - one that embraces multidisciplinary collaboration, leverages digital health technologies, and prioritizes culturally resonant frameworks. By anchoring mental health care within communities, strengthening primary care integration, and adopting scalable, socially responsive interventions, Indian psychiatry can not only address its own systemic challenges but also emerge as a leader in global mental health, particularly for low- and middle-income countries. The recommendations underscore the need for policies that support task-sharing, innovative training, and public engagement to build a more inclusive, effective, and resilient mental health ecosystem for India's future.

Frontotemporal dementia (FTD) often presents with complex behavioural and communication changes that are frequently misinterpreted as primary psychiatric disorders, contributing to delayed diagnoses, inappropriate interventions, and caregiver distress. This commentary explores overlapping clinical features of psychiatric and language symptoms in FTD and highlights the important role that speech-language pathologists (SLPs) can play in early identification, care planning, and psychosocial support. Drawing on two illustrative vignettes, an individual living with behavioural variant frontotemporal dementia (bvFTD) and another living with semantic variant primary progressive aphasia (svPPA), this paper examines how communication impairments overlap psychiatric conditions and how SLP-led interventions can clarify diagnoses, reframe behaviours, and foster functional participation. These cases emphasise the importance of SLP involvement in interdisciplinary teams, not only for language rehabilitation but also for caregiver education and relational scaffolding. Despite a growing understanding of FTD, clinical frameworks often fail to integrate speech-language assessment early into pathways, particularly in younger individuals. This paper advocates for earlier SLP referral, structured caregiver supports, and formal recognition of communication disorders as diagnostic and therapeutic entry points for neurodegenerative disease. Enhanced awareness of the communicative dimensions of FTD may improve diagnostic accuracy, reduce stigma, and promote more holistic and relationship-centred models of care.

Agitation and abnormal motor behaviors are common, distressing symptoms of Frontotemporal Dementia (FTD). While these symptoms currently lack efficacious and safe pharmacological treatments, case reports in FTD and a clinical trial in Alzheimer's disease suggest that patients may benefit from lithium treatment. We designed a randomized, double-blind, placebo-controlled, 12-week clinical trial to evaluate low-dose lithium for the treatment of agitation and abnormal motor behaviors in FTD. However, the trial did not meet its recruitment target (n = 60). This report assesses the trial's feasibility and tolerability using recruitment, study completion, and safety metrics. Sixteen adults with FTD (median age 59.5 years; 69% female) were enrolled from 2017 to 2021. Fourteen participants (88%) completed the trial. The majority of participants on lithium were taking the maximum daily dose by Week 12 (600 mg), had median (interquartile range) final serum lithium levels of 0.42 (0.37-0.57), and reported minimal side effects, including drowsiness, diarrhea, constipation and insomnia. Preliminary data from intended efficacy outcomes showed no median pre-post changes between treatment groups. Low-dose lithium is feasible and well-tolerated in an FTD population. Further systematic study of lithium and its efficacy to treat agitation and abnormal motor behaviors in FTD is warranted.

The emergence of new psychopathological constructs, e.g. "modern-type depression" (MTD), arose concerns in diagnosis and treatment of youth depression. Our study explored the role of MTD within an Italian youth sample (n = 273; aged 14-25) with major depressive disorder (MDD), through MINI 7.0.0, BDI-II, TACS-22 and TEMPS-M. Around 49.8% of MTD depression was found, specifically among females (p < 0.001). Only depressive and cyclothymic temperaments together with TACS-22 "complaint" subscale were found positive predictors of depressive severity (F(4,170)=55.872, p < 0.001, R=0.568). Binomial logistic regression analyses found sex differences in the explanatory effects of affective temperamental profiles on the likelihood of developing MTD depression. In males, both depressive and cyclothymic temperaments (both, p = 0.004) are risky factors, while hyperthymic temperament is a protective factor (p = 0.010). In females, only cyclothymic temperament was found to be a positive predictor (p = 0.018). According to our findings, MTD may have a clinical relevance in youth MDD. There is the need to routinely include MTD assessment in clinical practice for a better MDD characterization and for offering tailored therapeutic approaches to MTD depression, based on sex differences and affective temperamental profile.

Psychiatry is a discipline emergent from parts of other disciplines. This places it in a precarious position in society. Its practitioners must work with great uncertainty, formulate complex problems and respond to issues that fall outside the scope of other disciplines. Knowledge is always being added across psychiatry's biopsychosocial domains, and its purpose is constantly evolving in response to shifting societal perspectives on its role. Change in the coming decades will span data and knowledge, contexts of care, roles and relationships, as well as treatment advances. These changes will not manifest as obvious examples of linear progress, but instead as twists and turns characterised by rejections and revisions of ideas. This paper aims to explore how early career psychiatrists might navigate such changes by drawing on the enduring core skills and contributions of psychiatry. In doing this, one realises that while there may be observable differences in 30 years' time, at a deeper level, much may remain the same. This is not a pessimistic view, but instead one of optimism which highlights the continuous value psychiatry in the complex terrain of mental health care amongst its many other practitioners, systems and structures. In times of growth, our roots will be our guide.

From 1995 to 2025, psychiatry evolved from a primarily syndromic discipline toward a field increasingly shaped by neuroscience, digital technology, globalization, and shifting social expectations surrounding mental health. This transformation included major advances in diagnostic frameworks, brain imaging and genomics, psychopharmacology, evidence-based psychotherapies, and global mental health initiatives. The COVID-19 pandemic accelerated the adoption of telepsychiatry and exposed critical gaps in mental health infrastructure, while growing recognition of health disparities brought social determinants and equity to the forefront of research and clinical priorities.

Antisocial and criminal behavior is an underrecognized aspect of neurodegenerative diseases. These behaviors are defined as behaviors and actions that violate the basic rights of others. Antisocial behaviors are seen in relatively high rates in behavioral variant frontotemporal dementia, but can be seen in other conditions. Several recent tools have been developed in attempt to quantify antisocial behaviors and neuroimaging studies have helped identify likely brain regions and networks involved in the genesis of antisocial behaviors. These regions include the anterior insula, ventral striatum, orbitofrontal cortex, and prefrontal cortices. The management of such symptoms is challenging with limited high quality studies available at this time. The recognition of antisocial behaviors can help limit complications. Further work is needed to more clearly delineate the pathophysiology of antisocial behavior.

This paper overviews the future of clinical practice in psychiatry, covering diagnosis, treatment, and public health. We consider recent advances and new controversies as psychiatry moves from a categorical to a dimensional approach to diagnosing and classifying mental illness; as well as the potential pitfalls of overdiagnosis, underdiagnosis, and misdiagnosis. We also review some of the most exciting new developments in treatment modalities, such as psychedelic treatments, ketamine, and new antipsychotics. The potential of interventional psychiatry using technology, and review techniques including neuromodulation, neurofeedback, brain-computer interfaces, AI-assisted psychotherapy, and virtual reality is also discussed in the context of future of public mental health strategy, including the important issue of online disinformation and how it can influence the public's understanding of mental health. Finally, we consider the evolving understanding of addiction, particularly behavioural and technological addictions. We conclude with a brief discussion of how best to influence the political leadership in using these new advances to develop evidence-based, scientifically-informed healthcare policy.

This narrative review probes the future trends of psychiatry from the perspectives of professionals working in the field of early intervention for psychosis and youth mental health. The review is co-constructed by a diverse group of clinicians and researchers, including those with lived experience, working in high- to low-resource settings in the Asia-Pacific. Grounded in the consideration of psychiatry When the early intervention lens is applied to the state of psychiatry itself, several 'at-risk' factors have been observed: dilution of the doctor-patient relationship, lack of a robust integrated model of the human person and psychopathology, increased commercialisation, excessive reliance on other professionals, disconnection of knowledge generation and transmission, and tension between the healing and public safety roles of psychiatry. The complexity of mental illness, coupled with high stigma and low resources (even in relatively affluent populations), continues to undermine the proper functioning of psychiatry as a medical speciality. These challenges are likely to intensify in the future. Psychiatry as a profession needs to consolidate a robustly integrated medical approach to mental illness that resists splitting into 'biomedical' and 'psychosocial' perspectives, in the form of a biopsychosocially-informed medical psychotherapeutic practice. It will need to work with other stakeholders in the broader landscape of public mental health without diluting the healing roles in treating mental disorders. Behind a number of recent changes, the 'invisible hand' of the market economy is potentially driving psychiatry towards more inequity and escalating costs. Some of these have been fuelled by decreased effectiveness of the conventional academic platform and the rise of new information platforms that are increasingly challenging to manage. A thoughtful, prudent, and coordinated approach by the profession is essential in ensuring a healthy trajectory for the future of mental health care.

In Pakistan, mental health disorders constitute an escalating global burden of disease. Under-resourced healthcare systems coupled with recent economic and environmental challenges exacerbate mental health distress and impedes the recovery of those suffering from mental health issues. Psychosocial rehabilitation provides a sustainable pathway to strengthen health systems capacity by focusing on functional recovery and community reintegration. Since 1971, Fountain House has been providing psychosocial rehabilitation to people suffering from mental health issues in Pakistan through its community-based social services. Poverty is both a cause and consequence of mental illness. Akhuwat, a non-profit organization, aims to address this gap by providing interest-free micro loans, vocational training and subsidized health and housing assistance to those deprived of formal financial services. This article explores early outcomes of a collaborative venture between Fountain House and Akhuwat, working at the intersection of poverty and mental health with the combined goal of psychosocial rehabilitation and economic empowerment.

Frontotemporal dementia (FTD) is one of the most frequent forms of early-onset neurocognitive disorders worldwide. Behavioral variant FTD (bvFTD), the most common FTD phenotype, is frequently associated with neuropsychiatric symptoms (NPS) such as apathy, depression, impulsivity, and repetitive behaviors that lead to diminished quality of life for patients and their loved ones. Common NPS in bvFTD are also similar to symptoms that can be present in psychiatric disorders, complicating diagnosis. The present review describes the clinical significance of NPS in bvFTD, provides guidance to psychiatrists with differentiating NPS due to bvFTD from psychiatric disorders along with an overview of tools that may aid clinical evaluations, and presents direction on future avenues of research into improving the care of patients with NPS due to bvFTD.

Eating disorders (EDs) are complex conditions at the interface of mental and physical health, associated with high morbidity, mortality, and chronic disability. Historically, ED psychiatry has shifted from early medical observation to psychiatric formulation and, more recently, to psychology- and nursing-led service models. Despite advances in evidence-based psychological therapies and community expansion, outcomes remain modest and access to treatment is limited. Recent workforce growth centred on allied health professionals has not been paralleled by investment in psychiatric training, academic capacity, or consultant posts, resulting in limited specialist expertise. This imbalance has produced fragmented care and a two-tier system in which child and adolescent services have advanced while adult provision remains critically underfunded. Future progress will depend on revitalising eating-disorder psychiatry through sustained investment in training, workforce, and translational research. Integrating metabolic psychiatry, neurobiology, behavioural science, and digital health offers a path toward comprehensive, equitable, and improved treatments.

Research indicates that sociodemographic, clinical, and global functioning are associated with autism spectrum disorder (ASD). To measure and compare sociodemographic, clinical, and global functioning vulnerability profiles of a sample of Mexican children and adolescents with and without ASD. The study was done at two outpatient institutions in Mexico City. The assessment used semi-structured interviews with rating scales, and -tests and chi-squared () tests were run to evaluate group comparisons. A latent class analysis was executed to generate probabilistic vulnerability profiles. A total of 103 participants were recruited, 22 with ASD (21.3%, mean age 12.8 ± 3.17, 77.27% male). Those without ASD showed a significantly special education placement ( = 3.91,  = 0.048), had oppositional and defiant symptoms ( = 3.32,  = 0.001), and lower global functioning as measured by the Children's Global Assessment Scale ( = 11.78;  = 0.001) and the World Health Organization Disability Assessment Schedule 2.0 ( = -4.10;  = 0.001). Vulnerability was identified in a subgroup of participants with ASD due to increased psychosocial and psychopathological symptoms and lower global functionality. Mexican children and adolescents with ASD experience special education placement and impaired global functioning.

The phenocopy syndrome of behavioural variant frontotemporal dementia (phFTD) refers to patients exhibiting clinical features of the behavioural variant of frontotemporal dementia (bvFTD), but lacking objective functional decline and neuroimaging abnormalities consistent with bvFTD. Although symptoms do not progress into dementia, they are disruptive and cause long-term family dysfunction. This case study aims to explore the social, biographical and demographic features of 8 patients with phFTD and their partners. The feasibility and subjective experience of a support group were explored. Eight phFTD patients and their partners completed self-report questionnaires assessing quality of life, family functioning, and coping styles. Most phFTD patients had some psychological vulnerability or reported a positive family history for psychiatric disorders. All couples showed challenges within family functioning and low quality of life (QOL) in both patients and their spouses. PhFTD patients predominantly utilized passive coping strategies whereas their partners tended to employ more active coping strategies. Our explorative study supports the hypothesis of a multifactorial biopsychosocial vulnerability in phFTD patients. In contrast to bvFTD patients, phFTD patients selfreport low quality of life. The discrepancy in coping styles between patients and their partners possibly contributes to the heavy impact on expressed burden.

Psychological trauma is a universal experience among humans; when suffered during developmental ages it might affect development and be at the base of psychopathology. Having a parent diagnosed with cancer is a highly distressing experience for a child and may influence the development of future psychopathology. This PRISMA-adhering systematic review focused on studies of children with a parent diagnosed with cancer and reporting psychiatric diagnoses or clinically significant symptoms assessed with validated instruments. The review included 25 studies spanning from 1994 to 2025. Studies found increased prevalence of anxiety, depressive, and posttraumatic stress disorder in children and adolescents with a parent affected by cancer compared to controls. Internalizing problems were higher than externalizing problems in children and adolescents, especially girls. There have been few implemented programs for children with a parent with cancer, despite recognition of higher psychopathological risk. The few psychotherapeutic trials yielded results with small effect sizes, while there is a dearth of pharmacological trials that does not allow drawing conclusions. There is need to prioritize programs that take care of children with parents with cancer so to reduce future psychopathology. Psychotherapeutic interventions must target the internalizing and externalizing symptoms and address the posttraumatic aspects of the child's suffering.

Neuropsychiatric symptoms (NPS) are core features of behavioral variant frontotemporal dementia (bvFTD), but their association with functional decline is incompletely understood.