Psychiatric disorders are among the leading contributors to the global burden of disease. Impaired emotion regulation has been hypothesized to be a transdiagnostic feature of psychiatric disorders, but this has not been proven across all classes of psychopathology. We sought to systematically review and meta-analyze emotion regulation impairment across major psychiatric disorders to determine if impairment is truly transdiagnostic. Selected studies compared healthy controls and individuals with a psychiatric disorder. Emotion regulation was assessed by the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and two other scales. Differences between cases and controls were estimated using Hedges' g for each disorder and scale. 188 studies were included, representing 563 case-control comparisons across 15 diagnoses with 11,201 cases and 9609 controls. For the DERS, case-control differences were large and significant for all 12 disorders analyzed, with effect sizes ranging from 0.94 (95% CI: 0.67-1.21) for bipolar disorder to 2.55 (95% CI: 2.28-2.83) for borderline personality disorder (BPD); BPD had a significantly larger case-control effect size than most other disorders. For the ERQ, use of cognitive reappraisal (an adaptive form of emotion regulation) was reduced in all disorders except panic disorder and use of expressive suppression (a maladaptive form of emotion regulation) was greater in all disorders except ADHD and OCD. Overall, individuals with major psychiatric disorders demonstrated reduced capacity to regulate their emotions across diagnoses and measures, suggesting that interventions which improve emotion regulation could be beneficial to prevent or treat many psychiatric disorders.

Anxiety disorders are common and impairing mental health conditions. Using data from 26,378 adults in the German National Cohort Study (NAKO), we investigated psychosocial and neuroimaging predictors of generalized anxiety disorder (GAD) symptoms and panic attacks. We conducted machine-learning analyses of 246 regions of interest from whole-brain imaging data in combination with psychosocial variables. Neuroimaging data alone showed suboptimal classification performance, whereas psychosocial variables alone - particularly depressive symptoms, stress, and childhood trauma - achieved the strongest discrimination for GAD symptoms and panic attacks. Adding neuroimaging features to psychosocial models modestly improved unbalanced accuracy and specificity by reducing false-positive classifications, indicating a conditional and complementary contribution of neuroanatomical information. Within the multivariate models, features from anxiety-related circuits, including the amygdala and superior parietal lobule, were consistently selected. Overall, these findings suggest that psychosocial factors dominate classification of anxiety outcomes, while structural MRI measures may provide complementary information within multimodal frameworks aimed at refining classification and supporting the development of individualized risk profiles to guide tailored therapeutic and preventive strategies.

In public emergency management, both medical and informational resources play crucial roles in shaping disease spreading dynamics. To enrich the literature on resource allocation in the context of disease spread, this paper proposes a mUAU-DKD-rSIS model to investigate how emotion-driven resource allocation influences the coupled evolution of rumor dissemination, panic-buying behavior adoption, and disease spreading in multiplex networks. First, we examine the impact of emotional heterogeneity on resource allocation, hypothesizing that anxious individuals tend to provide more informational resources but fewer medical resources than calm individuals. Second, to capture the functional heterogeneity of resources across different individual states, informational resources are classified into learning and review types, while medical resources are divided into protective and curative categories. Third, the source of resources is extended from the individual level to the group level by incorporating common pool resources. Using the microscopic Markov chain approach (MMCA) and numerical simulations, our analysis shows that rational resource allocation is essential for effective disease control. Notably, learning informational resources give rise to a meta-critical point that modulates the coupling strength in multiplex networks. In contrast, curative medical resources exhibit a second-order phase transition and an optimal utilization rate. These findings provide theoretical insights that may inform resource allocation strategies in public health emergencies.

Panic disorder is a prevalent and disabling condition marked by recurrent panic attacks and high treatment resistance. While previous research has focused on dysfunction within canonical fear circuits, the neurobiological basis of panic disorder may involve broader alterations across multiple brain systems. Here, we conducted a meta-analysis of functional neuroimaging experiments to identify consistent patterns of altered brain activity in panic disorder. We found increased activity in a prefrontal-hippocampus-brainstem axis, which was not confined to traditional fear-related regions. This pattern showed robust spatial associations with serotonergic and dopaminergic receptor distributions and was significantly explained by gene expression profiles of candidate genes, accounting for over one-third of the variance and supporting a polygenic model of the disorder. Further enrichment analyses revealed that the brain pattern is characterized by low neurodevelopmental and evolutionary expansion and reduced oxygen metabolism, consistent with theories of brainstem-based hypersensitivity. Functional annotation linked the identified brain pattern to emotional arousal, memory, learning, and goal-directed behavior, suggesting that panic disorder reflects psychophysiological interactions of higher-order cognitive systems and evolutionary older biological processes. These findings suggest that panic disorder involves widespread neural alterations beyond fear circuitry and highlight potential molecular and functional targets for future mechanistic and therapeutic research.

Intergenerational transmission of trauma (ITT) has been documented among offspring of parents exposed to war, genocide, and interpersonal violence, yet little is known about ITT among families of World Trade Center responders (WTC-R). The aftermath of 9/11 terrorist attacks provides a unique naturalistic context for examining long-term psychological outcomes among now-adult offspring raised during periods of parental trauma exposure and recovery. The WTC-R cohort comprised traditional first responders (i.e., law enforcement officers) and nontraditional recovery workers, among whom those with PTSD were invited to complete an online survey and recruit their adult offspring. Parents and offspring completed standardized assessments of mental health, including depression, anxiety, PTSD, panic disorder, substance use, and lifetime traumatic experiences, as well as measures of social support, family relationships, and quality of life. Generalized Estimating Equations (GEE) models were used to examine associations between parental 9/11-related exposure, current parental psychopathology, and offspring mental health outcomes, with moderation by responder occupational category. Greater parental 9/11 exposure was associated with a higher likelihood of PTSD, anxiety, and panic symptoms among adult offspring. Current parental PTSD and depression were significantly associated with offspring PTSD and depression, respectively. Poor parent-offspring relationships were associated with offspring depression, PTSD, and alcohol use disorder. Several associations were moderated by occupational subgroup, suggesting differential vulnerability linked to the nature and context of exposure. These findings demonstrate enduring intergenerational mental health effects more than two decades after 9/11, highlighting how parental trauma exposure, ongoing psychopathology, and family relational functioning collectively shape outcomes in WTC-R offspring.

Brain cholinergic systems changes are implicated in the pathophysiology of postural instability and gait difficulties in Parkinson's disease. The presence of postural instability and gait difficulties is associated with cholinergic terminal deficits or downregulation of cholinergic neurotransmission. Preservation or upregulation of cholinergic neurotransmission may mitigate other Parkinson's disease-associated deficits to prevent postural instability and gait difficulties that are dependent on effective sensorimotor, cognitive, and emotional integration functions. Emerging evidence also suggests that dopaminergic neurotransmission is up- and downregulated in extra-striatal regions. This expanded view of complex whole brain up and downregulatory cholinergic and dopaminergic interactive processes requires a re-appraisal of pathophysiologic changes underlying mobility disturbances in Parkinson's disease. The goal of this review is to propose a novel expanded heuristic model of dynamic cholinergic and dopaminergic systems changes underlying habitual and goal-directed motor behaviors in Parkinson's disease. We hypothesize a hierarchical topographic whole-brain model where variable combinations of up- and down-regulation of cholinergic and dopaminergic neurotransmission differentially explain habitual and goal-directed motor behavior abnormalities underlying axial motor impairments. We propose that levodopa-unresponsive freezing of gait is the culmination of combined cholinergic and dopaminergic losses in selective thalamic, (para-) limbic, thalamic complex, upper tectum, upper tegmental (especially periaqueductal gray), and cerebellar brain regions. This model is based on a comparison of literature findings of cholinergic topographic deficits underlying postural instability and gait difficulties motor findings, complemented by emerging and preliminary evidence of extra-striatal dopaminergic system changes across the spectrum of Parkinson's disease. In contrast, different topographic cholinergic system deficits, associated with freezing of gait, such as the mesencephalic and cerebellar locomotor regions, diffuse striatal, and peri-central cortices - that are key pathways of dopaminergic-dependent habitual motor behaviors - are seen with levodopa-responsive but not with unresponsive freezing of gait. Cholinergic upper tegmental, including periaqueductal gray, and limbic deficits associated with levodopa-unresponsive freezing of gait also plays a role in emotional regulation. Failure of this circuitry may lead to a context-dependent downward spiral of fear of falling, which in turn compromises the motivation to move and worsens or triggers levodopa-unresponsive freezing of gait. Cholinergic losses in the periaqueductal gray upper tegmental region may acutely block goal-directed motor behavior, contributing to the panic disorder subtype of freezing of gait. Such a freezing of gait subtype may be a naturally protective defense mechanism that, in the context of the high inherent risk of freezing of gait-associated falling, becomes counterproductive. Future research should test this heuristic model.

Background and Objectives: Idiopathic ventricular arrhythmias commonly occur in patients without structural heart disease and most often present as premature ventricular contractions (PVCs). Although generally considered benign, a high PVC burden may cause symptoms, reduce quality of life, and lead to reversible PVC-induced cardiomyopathy. This study aimed to evaluate long-term outcomes after radiofrequency catheter ablation of idiopathic outflow tract PVCs. Materials and Methods: This single-center retrospective study included 101 patients with idiopathic PVCs who underwent radiofrequency catheter ablation. PVC burden and clinical outcomes were assessed at baseline and during follow-up at 3 months, 12 months, and 5 years. Procedural success, predictors of success, and changes in antiarrhythmic drug therapy were analyzed. Results: During follow-up, a marked reduction in PVC burden was observed compared with baseline values. The median PVC burden decreased from 21.89% at baseline to 0.79% at 3 months, 0.23% at 12 months, and 0.09% at the 5-year follow-up after ablation. Acute procedural success was achieved in 88.1% of patients. Long-term success at 5 years was observed in 80.2% of patients. The use of antiarrhythmic drugs decreased during follow-up. Left ventricular ejection fraction remained stable, with no significant difference between baseline and 5-year values. Monomorphic PVC morphology and procedural success at 12 months were identified as independent predictors of long-term success. Conclusions: Radiofrequency catheter ablation provides effective and sustained reduction in PVC burden in patients with idiopathic outflow tract PVCs, with high acute success rates, durable long-term outcomes, and reduced reliance on antiarrhythmic drug therapy.

Heart rate variability (HRV) refers to variations in the time intervals between consecutive heart beats. Changes in HRV reflect changes in either sympathetic or decreased parasympathetic tone that can originate in the brain. This brain-heart connection has led to the proposal that HRV may have utility in the diagnosis of psychiatric conditions and/or be a predictor of the response to psychiatric medications. There have been attempts to improve the correlation between HRV and psychological and psychiatric conditions by using artificial intelligence or specific machine learning algorithms. The objective of this review is to synthesize data on the use of machine learning to improve accuracy in differentiating psychological conditions such as mental stress, as well as distinguishing persons with anxiety disorders, panic disorders, major depression disorders and schizophrenia from health subjects. Reported accuracies for the identification of mental stress vary from 42 to 94%, while accuracies for anxiety vary from 67 to 98%, panic disorders from 71 to 93% and depression from 71 to 95%. The ability of HRV to differentiate different psychological or psychiatric conditions from each other requires more investigation. The 'best' machine learning algorithm varied between studies, with some reporting the k-nearest neighbor algorithm, support vector machine, random forest, or neural networks to be the best. A number of studies combined HRV with other variables such as respiration, EEG, or electromyography to obtain a composite index, but in doing so obscured the independent contribution of HRV. In summary, HRV has shown promise in detecting abnormalities in a range of psychological and psychiatric conditions. The use of machine learning algorithms improves diagnostic accuracy.

Panic provocation tests have been widely used to investigate the biological underpinnings of panic disorder (PD). However, their diagnostic specificity remains uncertain, as several agents can also induce panic-like reactions in healthy individuals. This meta-analysis estimated and compared diagnostic odds ratios (DORs) across different provocation methods. Random-effects meta-analyses were conducted using the Hartung-Knapp adjustment. Based on 123 studies including 5693 participants, sodium lactate infusion showed the highest pooled DOR (24.77, 95% CI 19.03-32.25, GRADE certainty = High), followed by isoproterenol (18.85, 95% CI 12.39-28.66, GRADE certainty = Moderate), cholecystokinin tetrapeptide (CCK-4; 15.03, 95% CI 7.83-28.84, GRADE certainty = Moderate), meta-chlorophenyl piperazine (m-CPP; 14.51, 95% CI 4.67-45.07, GRADE certainty = Low), caffeine (14.11, 95% CI 4.79-41.54, GRADE certainty = Moderate), hyperventilation (11.89, 95% CI 6.51-21.73, GRADE certainty = High), carbon dioxide inhalation (CO2; 11.12, 95% CI 8.63-14.32, GRADE certainty = High), and yohimbine (7.87, 95% CI 1.12-55.13, GRADE certainty = Very low). Breath holding, fenfluramine and flumazenil did not demonstrate statistically significant discriminative ability. Meta-regression analysis confirmed that sodium lactate yielded significantly higher DORs than m-CPP, hyperventilation, CO2, fenfluramine, flumazenil, and yohimbine. No substantial between-study heterogeneity or publication bias was identified across the pooled analyses. These findings suggest that provocation methods targeting acid-base balance, especially sodium lactate infusion, are associated with superior diagnostic discrimination between individuals with PD and healthy controls.