Metacognition refers to the cognitive ability to control, monitor and modulate cognitive processes thus guiding and orienting behavior: a continuum of mental activities that ranges from more discrete ones, such as the awareness of the accuracy of others’ judgment, to more integrated activities, such as the knowledge of cognitive processes. Metacognition impairment in schizophrenia, which is considered a core feature of the illness, has become a growing research field focusing on a wide range of processes including reasoning, autobiographical memory, memory biases, cognitive beliefs and clinical insight. There is a well-established relationship between metacognition and schizophrenia symptoms severity, as well as between impaired metacognitive functioning and specific symptomatic sub-domains, such as positive symptoms, negative symptoms, or disorganization. The development of specific cognitive-derived psychotherapies for metacognitive deficits in schizophrenia has been ongoing in the last years. Although sharing a metacognitive feature, these treatments focus on different aspects: false or unhelpful beliefs for metacognitive therapy; cognitive biases for metacognitive training; schematic dysfunctional beliefs for cognitive behavioral therapy (CBT) for psychoses; metacognitive knowledge and sense of identity for MERIT; interpersonal ideas or events triggering delusional thinking for MIT-P. This article reviews the instruments designed to assess metacognitive domains and functions in individuals with schizophrenia, providing mental health professionals with an overview of the heterogeneous current scenario ranging from self-administered scales to semi-structured interviews, which are supported by a variety of theoretical frameworks. Future directions may address the need for more specific and refined tools, also able to follow-up psychotherapeutic-induced improvements.

Background/Objectives: Eating disorders (EDs) are complex psychopathological conditions involving dysfunctional eating behaviors, excessive body image concerns, and impaired emotional regulation. Among moral emotions, guilt plays a significant role in ED dynamics, influencing both symptomatology and interpersonal relationships. This study examines specific guilt subtypes (normative and altruistic guilt) using a specific psychometric tool. Methods: Forty-three adults with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were recruited from the Eating Disorder Center of the University of Campania “Luigi Vanvitelli” or referred by psychotherapists. Diagnoses followed DSM-5 criteria. Participants completed the Moral Orientation Guilt Scale (MOGS), assessing guilt subtypes, and the Eating Disorder Inventory-2 (EDI-2), measuring ED symptomatology. Spearman’s rank correlation and stepwise multiple regression analyses were used to identify relationships between guilt dimensions and ED-related symptoms. Results: MOGS subscales were positively correlated with ED symptomatology. Normative guilt was significantly associated with binging and purging (ρ = 0.26, p < 0.05), while altruistic guilt predicted higher interpersonal distrust (t = 3.4, p < 0.01). Regression analysis revealed that age negatively influenced interpersonal distrust (t = −2.9, p < 0.01). Conclusions: In the population examined, guilt significantly influences ED symptomatology and interpersonal functioning, with specific dimensions linked to distinct behaviors and traits. Therapeutic interventions targeting guilt may enhance treatment outcomes by addressing ED emotional underpinnings. However, the results should be interpreted with caution due to the small sample size and lack of longitudinal data to establish causality. Further research with larger samples and longitudinal designs is necessary to validate these findings.

Anhedonia, defined as the diminished ability to experience or anticipate pleasure, is a core symptom of major depressive disorder (MDD) and bipolar depression (BD), and associated with depression severity, suicidality and poor treatment outcomes. Conventional antidepressants demonstrate limited efficacy against anhedonia. Esketamine nasal spray (ESK-NS) - a novel NMDA receptor antagonist approved for treatment-resistant depression - has demonstrated rapid antidepressant effects, though its specific impact on anhedonia remains underexplored. This multicenter, observational, real-world study included 253 treatment-resistant patients (199 with unipolar depression/TRD; 54 with bipolar depression/B-TRD). All participants received repeated administrations of ESK-NS adjunctive to their current medication regimen. Anhedonia was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) anhedonia subscale at baseline, after one month (T1), and three months (T2). Response was defined as a ≥50 % reduction in MADRS anhedonia subscale score from baseline. Adverse effects were systematically monitored. Significant improvements in anhedonia were observed in both TRD and B-TRD groups, and these effects were distinct from overall depressive symptom reduction (p < 0.001). Response rates at T2 were 51.92 % in B-TRD and 38 % in TRD patients. Drop-out rates were 12.96 % in B-TRD and 14 % in TRD, primarily due to inefficacy or side effects. Safety profiles were comparable between groups, with minimal incidence of manic switches (B-TRD 5.6 %, TRD 2.0 %, p = 1.000). Repeated administration of ESK-NS effectively reduces anhedonia in both unipolar and bipolar depression patients in real-world settings, suggesting a targeted, transdiagnostic anti-anhedonic effect beyond general antidepressant action.

Background/Objectives: Intranasal esketamine has emerged as an effective treatment for patients with treatment-resistant depression (TRD), providing rapid symptom relief when conventional antidepressant strategies fail. While its pharmacological efficacy has been demonstrated in randomized controlled trials, less attention has been paid to the organizational, relational, and multidisciplinary aspects that influence its real-world implementation and clinical effectiveness. While practical recommendations for intranasal esketamine services exist, an implementation-ready framework integrating psychiatry, nursing, and psychotherapy across treatment phases is still lacking. This narrative review synthesizes the clinical and real-world evidence and proposes a phase-based integration framework with explicit role delineation and measurable implementation/fidelity indicators. Methods: We conducted a narrative review informed by a structured literature search in major databases from inception to the most recent update. Search terms combined ‘esketamine’/‘Spravato’ with ‘treatment-resistant depression’, ‘nursing’, ‘psychotherapy’, ‘multidisciplinary’, and ‘implementation’. Outcomes prioritized in the synthesis included depressive symptom severity/response, relapse prevention, safety/tolerability, anhedonia, suicidality monitoring, functional outcomes, and patient-reported experience/retention. Based on this evidence, an integrated, phase-based multidisciplinary framework for esketamine treatment was developed. Results: Available evidence supports the efficacy of intranasal esketamine in reducing depressive symptoms in TRD, with growing real-world data confirming its effectiveness and safety. Beyond global symptom improvement, studies highlight benefits on clinically relevant domains such as anhedonia and suicidality trajectories, as well as meaningful patient-reported outcomes. However, the complexity of esketamine delivery requires structured clinical pathways. The proposed model delineates complementary roles for medical supervision, nursing care, and psychotherapy across pre-treatment assessment, induction and session delivery, post-session integration, and maintenance phases, emphasizing safety, continuity of care, and patient-centred monitoring. Conclusions: Intranasal esketamine represents not only a pharmacological innovation but also a treatment that necessitates an integrated multidisciplinary approach. A structured phase-based multidisciplinary approach may support safer, more acceptable delivery of intranasal esketamine and potentially improve retention and patient experience; however, prospective implementation and comparative studies are needed to evaluate clinical effectiveness, feasibility, and cost-effectiveness.

Background: The integration of digital health technologies has transformed mental healthcare, particularly for young adults with First-Episode Psychosis (FEP). Digital interventions, such as telepsychiatry and mobile applications, address barriers like social stigma, restricted access to services, and the urgency of timely care. Methods: A systematic literature review was conducted using PubMed and APA PsycINFO. Included studies focused on randomized controlled trials, cohort studies, and open studies of digital interventions for FEP rehabilitation. Exclusion criteria included meta-analyses, reviews, and irrelevant studies. Results: Smartphone applications like Horyzons-Canada facilitated peer support and symptom management, while tools such as My Journey 3 emphasized the need for better user engagement. Digital innovations, including Cognitive Behavioral Therapy for insomnia (CBT-I) and telepsychiatry, demonstrated improvements in recovery and treatment adherence. Discussion: Digital interventions significantly enhance the accessibility and quality of FEP care, supporting functional recovery and patient engagement. Future research should prioritize longitudinal studies, user engagement strategies, and advanced analytics to develop personalized, scalable solutions.