Social cognitive deficits and altered multi-brain dynamics during problem-solving in heroin abstainers: An fNIRS hyperscanning study

Despite extensive research on the neurobiology of addiction, little is known about how repeated drug use and withdrawal are related to social functioning impairments in humans, a highly social species. This obscures the broader societal impact of drug addiction and limits treatment efficacy. This study examined social cognitive impairment and its multi-brain neural underpinnings during socially interactive problem-solving in heroin use disorder (HUD), and further explored their co-occurrence with protracted withdrawal symptoms.

The Unspoken Toll: Why Exam Pressure Must Be Part of the Youth Mental Health Discussion

A Conversation with Tatum Redmond and Amanda van der Vyver-Anderson from Community Keepers, South Africa


By Mai El Shoush, Partnerships Campaign Manager, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute


Community Keepers is an award-winning organization based in Stellenbosch, South Africa, which works to improve the social and emotional well-being of learners and their caregivers. The SNF Global Center at the Child Mind Institute works with the organization to further advance the comprehensive mission of transforming schools into safe spaces where student well-being is prioritized alongside academic achievement. This includes strengthening the workforce to expand evidence-based support and brief interventions through low-intensity psychological therapy approaches.

While addressing the workforce gaps, the partnership has yielded valuable insight into the essential competencies front line workers require to effectively support young people experiencing mental health challenges. Together with other NGOs, Community Keepers has also been instrumental in strengthening the process of developing context-sensitive and culturally appropriate training materials scheduled for pilot implementation in South Africa later this year – representing an important step towards strengthening mental health care systems for underserved communities. The partnership also extends beyond training development, as the SNF Global Center at the Child Mind Institute continues to collaborate closely with Community Keepers on an upcoming randomized control trial (RCT). The scientific evaluation will assess both the feasibility of establishing a virtual clinic for young people and the effectiveness of remotely delivered cognitive behavioral therapy (CBT) interventions via video consultations. The research is intended to expand access to equitable and quality mental health care for young people across South Africa. Tatum Redmond has been a care facilitator in one of the Community Keepers’ high school-based offices, while Amanda van der Vyver-Anderson is an educational psychologist and heads the training and development of Mental Health First Aiders for internal and external staff.

Amanda van der Vyver-Anderson

How important is it to approach issues such as academic pressure within the wider conversation around youth mental health in South Africa, and beyond?

It is critical to integrate discussions of exam stress into the broader dialogue surrounding youth mental health, both here in South Africa and internationally. We see countless students under immense pressure to not only pass, but also secure their future prospects and meet family expectations. This is unfortunately often dismissed as “just school” or a “normal” experience. However, it impacts a substantial number of young people, often more severely than we acknowledge. And the level of support available is not equitable across the board. Addressing this is crucial because of the detrimental effects on core cognitive functions — and ultimately, academic performance — as well as the significant toll on mental health. This can manifest as anxiety, burnout, and even depression.

In what ways can exam-related stress connect to broader mental health challenges?

While a certain level of stress can serve as a beneficial motivator, severe distress can lead to cognitive shutdown. This specifically impacts the executive functions — planning, organizing, prioritizing, working memory, focus, and concentration — that are fundamental to preparing for exams. This shutdown can then create a detrimental, ongoing cycle of heightened stress about exams or the future, coupled with a decline in the ability to take effective action.

It’s vital to recognize that exam stress does not merely stay in the exam room — it can be a gateway to larger mental health challenges. Constant stress regarding school performance, marks, or the fear of failure can escalate into conditions like anxiety, chronic overwhelm, or depression. Students may experience sleep disruption, poor nutrition, and feelings of inadequacy. And these symptoms often persist long after the test is over. Compounding this is the reluctance of most students to seek help because they believe their feelings are normal or fear appearing weak. Yet, if left unaddressed, sustained pressure along with these symptoms can profoundly affect their psychological well-being.

Tatum Redmond

What role do community-focused organizations such as Community Keepers play in linking academic stress to systematic youth mental health support and improvement?

Organizations like Community Keepers play a truly pivotal role — not merely as emergency responders but as an integrated support system within educational institutions as well. Crucially, they move beyond immediate crisis response by collaborating with schools to develop long-term support and to provide safe spaces to engage in dialogue. They offer genuine attention and care when learners are struggling with school demands, exams, and family pressures.

The approach is not just “addressing stress today” but asking, “How can we create an enduring environment where young people feel safe, supported, and connected?” Doing this requires collaboration with the learners themselves, educators and school staff, as well as parents, caregivers, and community leaders.

What factors make schools uniquely positioned to be safe and supportive spaces?
Schools are exceptionally well-positioned to serve as safe and supportive spaces for students for several key reasons:

  • Learners spend a substantial portion of their day at school, making it a primary setting where adults can observe signs of distress, anxiety, or coping difficulties.
  • Schools have the opportunity to house critical personnel — teachers, counselors, and external partners like Community Keepers — who are on hand to offer support or a listening ear.
  • The curriculum can extend beyond academic skills and learning. It can include mental health and emotional literacy, stress management, and peer support.
  • When a school actively fosters an environment of safety, respect, and validation, it fundamentally alters how learners navigate pressure, stress, or complex personal problems. Having a guaranteed safe space at school is deeply stabilizing for the mind.

How can the goal of securing mental health support as a pillar of education be reached?
Achieving the goal of establishing mental health support as a solid, non-negotiable pillar of education requires several strategic commitments:

  • Schools must actively allocate resources for it, ensuring adequate numbers of support staff, rather than relying on minimal provision. Teachers need training to recognize signs of distress and respond helpfully and appropriately.
  • Mental health literacy must be integrated into the curriculum. Instead of only focusing on academic subjects, topics like stress management, emotional intelligence, and maintaining healthy relationships should be covered.
  • The government must demonstrate a serious commitment, including mental health support in education budgets, developing clear policies, and ensuring rigorous follow-through.

How have your practices and initiatives in promoting and supporting schools as safe spaces made meaningful change?
We’ve observed tangible change in the learners’ attitudes; those who feel comfortable expressing their emotions are generally happier and more resilient because they have established a safe, non-judgmental space where trust is built.

What role can teachers and school leadership play as partners in creating an evidence-based supportive learning environment? Where are the gaps in building capacity and how can they be better supported?
Educators and school leadership are essential partners in establishing an environment that successfully supports learner mental health and cultivates a culture of well-being. They can do so by:

  • Prioritizing both the physical space and curriculum time necessary for learners to engage with support services.
  • Serving as role models who embody and encourage emotional regulation and actively normalize help-seeking behaviour.
  • Remaining deeply cognisant of factors that contribute to learner distress so as to not inadvertently exacerbate it.

Investing in staff wellness and support, capacity building, and policy reform is not merely beneficial, but a foundational requirement to capacitate educators effectively. This allows them to sustainably support the mental health of their entire school community.

The SNF Global Center’s work in South Africa is carried out through the Child and Adolescent Mental Health Initiative (CAMHI South Africa). We are proud to expand the partnership with Community Keepers and value their collaboration towards co-creating scalable, school-centered mental health approaches that authentically respond to the diverse lived-experiences of young people.

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Beyond dopamine blockade: mechanistic humility and the rise of muscarinic, TAAR1, and glutamatergic pathways in schizophrenia

The approval of the first non–dopamine-blocking therapy for schizophrenia marks a defining moment in psychiatry. Muscarinic M1/M4 modulation, alongside emerging TAAR1 and glutamatergic pathways, signals a shift beyond dopamine dominance toward circuit-level integration. These advances embody mechanistic humility: the scientific courage to prioritize clinical signal over mechanistic certainty. It is the scientific curiosity to revisit older hypotheses, question single-pathway models, and integrate multiple mechanisms. Building on the recognition of dopamine blockade’s experiential burdens, this new era guides psychiatry toward a pluralistic framework. The challenge for 2026 is not to replace dopamine, but to rebalance it, moving from receptor blockade dominance to circuit modulation informed pluralistic treatment. This evolution aims to restore harmony not just among neural circuits, but within the lived experience of patients.

Associations between adult ADHD core symptoms, cognitive flexibility, and emotional eating: a case-control study

IntroductionAttention-deficit/hyperactivity disorder (ADHD) in adults often co-occurs with eating disorders (EDs), potentially through shared difficulties in emotional regulation, and executive functions. This study explored the associations between cognitive flexibility as a component of executive functions, core adult ADHD symptom dimensions and emotional eating-related eating behaviorsin adults with ADHD and healthy controls, within the framework of executive functions.MethodsThis case-control study included 76 adults with ADHD and 69 healthy controls. Participants completed the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS), Emotional Eating Questionnaire (EEQ), Hospital Anxiety and Depression Scale, Cognitive Control and Flexibility Questionnaire (CCFQ), and Berg’s Card Sorting Test. Group differences were tested with t-tests, correlations with Spearman’s ρ, and hierarchical regression (Approval No: I11-798-23).ResultsThe ADHD group had significantly higher EEQ scores (t = 5.39, p =0.001). The ADHD group also showed lower CCFQ total score (t (125) = –5.52, p <0.001). EEQ scores were positively correlated with SR-WRAADDS Attention Deficit (ρ =0.331, p =0.003), and CCFQ Cognitive Control over Emotion (ρ = −0.256, p =0.02). Regression analysis identified attention deficit as the only significant predictor of the EEQ total scorein the ADHD group.DiscussionOur findings suggest that impairments in executive functioning—including cognitive flexibility, attentional regulation, and emotion-related control mechanisms—may play a more central role in the relationship between ADHD and emotional eating-related eating behaviors. Longitudinal studies are warrented to further elucidate these mechanisms.

Narcolepsy as an immune-associated hypothalamic encephalopathy: orexin dysfunction and implications for precision sleep medicine

Narcolepsy can no longer be adequately conceptualized by excessive sleepiness and cataplexy. It is increasingly recognized as a multisystem hypothalamic encephalopathy, rooted in the selective loss or dysfunction of orexin neurons, yet extending across motor, psychiatric, metabolic, and autonomic domains. Over the past two decades, convergent genetic, neuropathological, and immunological evidence has positioned narcolepsy type 1 as increasingly consistent with the spectrum of immune-mediated neurological diseases while challenging the validity of current classifications that hinge on cataplexy or multiple sleep latency testing. Borderland phenotypes, variable orexin biology, and post-infectious or secondary forms underscore the limitations of rigid categorical nosologies and support a spectrum-based framework. Advances in immunology, imaging, and systems biology highlight the limitations of purely symptomatic treatment and support the exploration of mechanism-based interventions, including orexin receptor agonism, immune-targeted strategies in early disease, and regenerative or circuit-repair approaches. In this narrative review, based on literature identified through searches of PubMed, Web of Science, and Scopus through December 2025, we synthesize evidence across epidemiology, pathophysiology, diagnosis, and therapy, and propose an integrative clinical algorithm that moves beyond categorical diagnoses toward a phenotype–biomarker–mechanism stratification model. We suggest that narcolepsy should no longer be considered a rare curiosity of sleep medicine but rather a model disorder illuminating the vulnerability of hypothalamic circuits and the complex interplay between sleep, emotion and immunity.

CABG-AI-Supported Discharge Education

Conditions: Coronary Artery Disease; Postoperative Care; Patient Discharge; Recovery of Function; Anxiety; Pain; Stress, Physiological; Surgical Nursing; Nursing; Discharge Education

Interventions: Behavioral: AI-Supported Individualized Discharge Education; Behavioral: Standard Discharge Education

Sponsors: Hasan Kalyoncu University

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