The edition · Psychiatry
Who your patient sits next to, and what their HbA1c is doing
Six hundred thousand Finnish adolescents show peer environments tracking mental health a decade on; esketamine fails a postoperative anxiety trial; and a 26-study meta-analysis puts a mortality figure on depression with diabetes.
The edition in brief
A Finnish register cohort of 604,819 people born 1985-2000 followed 234,117 incident mental disorder diagnoses from age 17. Exposure to peers' family-based genetic risk scores was associated with the same disorder later, strongest for externalising disorders in upper secondary school (HR 1.34, 95% CI 1.29-1.38); exposure to peers' own diagnoses was strongest for internalising disorders (HR 1.17, 1.15-1.18). In weight-restored anorexia nervosa, a within-participant randomised study using an ingestible vibrating capsule found impaired gut interoception (perceptual accuracy Cohen d -0.98, 95% CI -1.51 to -0.44), and several markers predicted relapse at six months - initial priors OR 3.82 (1.02-15.91), response bias OR 5.37 (1.15-32.04) - on small numbers with very wide intervals. A randomised trial of esketamine in 173 analysed patients with preoperative anxiety having major abdominal tumour surgery found no anxiety benefit at day 3 (response 39.5% against 42.5%, risk ratio 0.93, 95% CI 0.65-1.33) with a small secondary signal on depressive symptoms at day 30. A Lancet Psychiatry personal view separates AI scribe output into narrative, mental state observation and diagnostic reasoning, arguing each carries a different failure mode, consent requirement and liability exposure. The edition closes on a meta-analysis of 26 studies from nine regions in which people with depressive disorder and diabetes had higher all-cause mortality than those with diabetes alone (RR 1.30, 95% CI 1.21-1.39), higher cardiovascular mortality (1.15, 1.02-1.29) and more complications (1.28, 1.18-1.40), with metabolic complications the largest signal (1.63, 1.33-1.99).
Peer environment at seventeen tracked mental disorder risk for the next decade
Add the peer group to the adolescent history as a routine item, and treat clusters from a single school as worth a coordinated response rather than separate referrals.
Gut signals were harder to read in weight-restored anorexia, and the difficulty predicted relapse
Weight restoration is not recovery - ask about interoceptive symptoms at follow-up and treat difficulty reading hunger and fullness as a marker worth tracking.
Esketamine did not reduce postoperative anxiety in anxious surgical patients
Esketamine is not a treatment for perioperative anxiety - the trial missed its primary outcome, and the drug's case remains in depression.
An AI scribe does three different jobs, and only one of them is transcription
Treat the three parts of a scribe's output differently: verify the history, rewrite the formulation, and do not trust a mental state examination the model was never told.
The metabolic review nobody owns
Name the person responsible for metabolic monitoring in writing when you prescribe, and take the baseline measurements in your own clinic before the first dose.
Depression with diabetes carried a third higher mortality than diabetes alone
In any patient with depression and diabetes, ask for the HbA1c and the date of the last retinal screen at psychiatric review, and escalate when either is missing - this group's excess mortality sits in glycaemic and cardiovascular control, not in the depression itself.
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