The edition · Psychiatry
Every infection severe enough for admission leaves a psychiatric shadow
A million matched pairs show raised two-year psychiatric and neurological risk after hospitalisation with infection at any body site, worst after encephalitis. Also: excess COVID mortality in severe mental illness never came down, and where to aim TMS for smoking cessation.
The edition in brief
A retrospective multicohort study using propensity-matched TriNetX records from 62 US health organisations followed 1,062,722 matched pairs hospitalised between 2014 and 2018 for two years. Infections at any of 10 body systems were associated with raised risk of most of 14 psychiatric and neurological outcomes: ratios of restricted mean time lost exceeded 1 in 116 of 140 infection-disorder tests. The largest relative risk was encephalitis (cardiac infections, median RMTL ratio 6.54, 95% CI 3.78-11.31) and the largest absolute difference was cognitive deficits (cardiac infections, 19.08% vs 6.71%, difference 12.37 percentage points). Children showed raised risks with significantly smaller absolute differences than adults. Infectious encephalitides were the leading risk factor for 7 of 14 disorders. A whole-country English cohort of 13,463,945 people with COVID-19, of whom 160,190 (1.19%) had severe mental illness, found higher all-cause mortality with severe mental illness overall (adjusted HR 1.56, 95% CI 1.53-1.59). The gap widened rather than narrowed across pandemic stages: 1.27 (1.22-1.32) before vaccination, 1.56 (1.51-1.61) during roll-out and 1.55 (1.50-1.59) afterwards. Vaccination coverage started higher in severe mental illness (73.2% vs 67.4%) but ended lower (79.4% vs 87.2%). Excess COVID-19 mortality was partially attenuated by vaccination (aHR 1.25, 1.17-1.34). The FDA has recorded a supplemental action dated 10 August 2026 on Dr Reddy's Laboratories' generic olanzapine (ANDA 076255); the record does not state its content. In 72 people with tobacco use disorder given TMS across 243 stimulation sites, connectivity between the site and a lesion-derived addiction remission circuit predicted withdrawal improvement, with the data-driven circuit closely matching the lesion-based one (r = -0.74).
Infection at any site raises two-year psychiatric and neurological risk
Hospitalisation with infection at any body site was associated with raised two-year psychiatric and neurological risk against non-infectious admission — encephalitis worst by far, and cognitive deficits the largest absolute excess.
The COVID mortality gap in severe mental illness widened after vaccines arrived
Excess mortality after COVID-19 in severe mental illness never fell — it widened from a hazard ratio of 1.27 to 1.55 — while vaccination coverage went from ahead of the general population to eight points behind it.
FDA logs a supplemental action on generic olanzapine
The FDA has logged a supplemental action on Dr Reddy's generic olanzapine without stating its content — no reason to change prescribing, but worth noting if a patient reports their tablets have changed.
The vaccination question belongs in the psychiatric review
Put immunisation status on the physical health monitoring form for severe mental illness and close the loop with primary care yourself — the coverage gap comes from disengagement, not refusal.
Where to aim TMS for smoking cessation, from two independent lines of evidence
TMS sites better connected to a lesion-derived addiction remission circuit produced greater withdrawal improvement, and the two circuits converged — a rational basis for choosing a target, not evidence about cessation rates.
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