Schema therapy (ST) is an integrative psychotherapeutic treatment that may be as effective as cognitive behavioural therapy in treating depression. Novel approaches are focusing on augmenting psychiatric treatments with brain stimulation techniques, like repetitive transcranial magnetic stimulation (rTMS), to enhance efficacy. Therefore, this randomized, sham-controlled, prospective and double-blind study (for two of the three treatment groups) will aim to evaluate the effects of augmenting ST with bilateral theta burst stimulation (TBS), a specialized rTMS protocol, in patients with major depression receiving routine ST inpatient or day-hospital care. We hypothesize that active TBS will show a greater reduction in depressive symptoms than sham and no TBS (control). Approximately 120 patients with major depression who are undergoing 8- to 10-week ST will be randomly assigned to additionally receive 4-weeks of bilateral active TBS, bilateral sham TBS, or no TBS. TBS will be administered as intermittent TBS (iTBS) to the left side of the dorsolateral prefrontal cortex to increase and continuous TBS (cTBS) to the right to decrease excitability. Depressive symptoms will be assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Beck Depression Inventory-II (BDI-II). Functional levels will be assessed with the Global Assessment of Functioning (GAF) scale, and therapy-specific changes with the Young Schema Questionnaire (YSQ-S3R). Differences in efficacy between groups will be analyzed by linear mixed model repeated measures. This forthcoming study is expected to provide important insights into potential benefits of combining ST with bilateral TBS in patients with major depression and may lead to more effective therapeutic strategies. Trial registration: DRKS00039152 registered 10/02/2026.

Oculomotor dysfunction is well-documented in the psychosis spectrum, particularly deficits in smooth pursuit eye movements. These disruptions are thought to serve as endophenotypic markers of psychosis vulnerability and more recent work has linked oculomotor dysfunction with alterations in agency, a core feature of the psychosis spectrum. Understanding this link between oculomotor impairment, agency, and psychosis can provide insight into key mechanisms of psychosis vulnerability. To address this gap, we utilized an eye tracking paradigm to examine smooth and predictive pursuit in 100 young-adults, recruited with an enriched sampling strategy to represent a range of severity of distress associated with psychotic-like experiences. Relationships with positive psychotic-like experiences, agentic symptoms, depression, anxiety, and cognitive symptoms were investigated. There was a significant relationship between distress associated with overall positive psychotic-like experiences and bizarre experiences with frequency of catch-up saccades on both smooth pursuit (r = 0.25, p = 0.012; r = 0.27, padj=0.036) and predictive pursuit (r = 0.29, p = 0.004; r = 0.36, padj=0.002) trials, and distress from positive psychotic-like experiences with phase difference on predictive pursuit trials (r=-0.23, p = 0.023). There were no significant relationships between anomalous self-experiences and performance on either task. Performance on the predictive pursuit task was related to cognitive performance (r = 0.22, p = 0.039), but relationships between psychotic-like experiences and predictive pursuit remained significant after controlling for cognitive performance. No other secondary clinical symptoms were related to performance on either task. The current study supports theory suggesting smooth pursuit as an endophenotypic marker of psychosis risk and presents predictive pursuit as a promising paradigm for assessment in psychosis vulnerability populations.

Electroconvulsive therapy (ECT) remains one of the most effective treatments in psychiatry, but cognitive side effects still pose a clinical concern. Delayed postictal reorientation is linked to worse cognitive outcomes, adversely affecting patient-perceived treatment tolerability and acceptability, while also increasing post-ECT and post-anesthesia care demands. Despite its clear clinical and operational relevance, comparative evidence on anesthetic effects remains scarce. This study therefore investigates the impact of different anesthetic agents (S-ketamine, propofol, etomidate, thiopental, and the combination of S-ketamine and propofol) on reorientation time following ECT. Retrospective data from 5148 ECT sessions were analyzed using a linear mixed-effects model controlling for age, sex, diagnosis, stimulation dose, electrode placement, seizure quality, ECT session number, need for restimulation, ECT duration, and postictal agitation. Compared with S-ketamine, propofol reduced reorientation time by 6.2 min, and the combination of S-ketamine and propofol reduced reorientation time by 1.5 min. Neither thiopental nor etomidate differed significantly from S-ketamine. The differences may be attributed to the distinct pharmacodynamic profiles of the anesthetic agents. The findings demonstrate that anesthetic choice is a significant and independent determinant of reorientation time following ECT, with propofol and the combination of S-ketamine and propofol associated with markedly faster cognitive recovery compared to S-ketamine.

The PANSS Autism Severity Score (PAUSS) is a commonly used measure for autistic features in early psychosis, including in adolescents at Clinical High Risk (CHR). However, no research examining its psychometric properties in this at-risk population has been published to date. Therefore, we explored reliability, validity, and longitudinal course of PAUSS scores in a sample of young CHR individuals treated in an early intervention service in Italy during 2 years of follow-up. Participants completed the Autism-spectrum Quotient (AQ) and the Positive And Negative Syndrome Scale (PANSS) at baseline and annually during the follow-up. Cronbach's α statistics were used for internal consistency, while Cohen's k statistics and Spearman's correlation coefficients (ρ) were used for convergent validity with AQ scores and longitudinal stability. In the 214 recruited CHR participants, Cronbach's value was 0.849, but the PANSS G5 item showed unacceptable inter-item and item-total correlations. Furthermore, Cohen's k value in relation to AQ scores was unacceptable (0.022), as were ρ (< 0.750) and k (< 0.600) values for longitudinal stability. The results of this research suggest that the PAUSS may not be a valid tool for assessing autistic characteristics in CHR individuals. In fact, it may detect attenuated psychotic symptoms and their transient psychopathological severity, rather than being a reliable indicator of autistic features. Alternatively, its poor discriminatory ability could also reflect contamination of autism measurement by concurrent psychopathology. Therefore, it should never replace careful clinical judgment and the use of appropriate instruments for the diagnosis of ASD.