Background/Objective: Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with growing relevance in psychiatry. Its ability to measure cortical hemodynamics positions it as a potential tool for monitoring neurofunctional changes related to treatment. However, the specific features and level of consistency of its use in clinical psychiatric settings remain unclear. A scoping review was conducted under PRISMA-ScR guidelines to systematically map how fNIRS has been used in monitoring treatment response among individuals with psychiatric disorders. Methods: Forty-seven studies published between 2009 and 2025 were included based on predefined eligibility criteria. Data was extracted on publication trends, research design, sample characteristics, fNIRS paradigms, signal acquisition, preprocessing methods, and integration of clinical outcomes. Reported limitations and conflicts of interest were also analyzed. Results: The number of publications increased sharply after 2020, predominantly from Asia. Most studies used experimental designs, with 31.9% employing randomized controlled trials. Adults were the primary focus (93.6%), with verbal fluency tasks and DLPFC-targeted paradigms most common. Over half of the studies used high-density (>32-channel) systems. However, only 44.7% reported motion correction procedures, and 53.2% did not report activation direction. Clinical outcome linkage was explicitly stated in only 12.8% of studies. Conclusions: Despite growing clinical interest, with fNIRS showing promise as a non-invasive neuroimaging tool for monitoring psychiatric treatment response, the current evidence base is limited by methodological variability and inconsistent outcome integration. There is a rising need for the adoption of standardized protocols for both design and reporting. Future research should also include longitudinal studies and multimodal approaches to enhance validity and clinical relevance.

Background/Objectives: Therapeutic drug monitoring (TDM) of antipsychotic medications plays an important role in optimizing treatment efficacy, reducing adverse effects, and supporting adherence. While Ultra-High Performance Liquid Chromatography–Tandem Mass Spectrometry (UHPLC–MS/MS) has long been the gold standard for antipsychotic quantification, recent advances in automated platforms and microsampling raise questions about its current clinical practicality. This systematic review evaluated the clinical applicability and analytical performance of UHPLC-based methods for monitoring antipsychotic drugs, focusing on precision, recovery, matrix effects, and suitability across various biological matrices. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for studies published between 2013 and 2024 involving UHPLC-based quantification of antipsychotics in clinical samples from adult patients. Data on analytical parameters, sample matrices, and study characteristics were extracted. A custom quality checklist was used to assess methodological rigor. In addition to qualitative synthesis, non-traditional quantitative approaches were applied, including descriptive aggregation of recovery, matrix effects, and precision across studies, as well as correlation analyses to explore relationships among performance parameters. Results: Twelve studies were included, spanning a range of typical and atypical antipsychotics and metabolites. Plasma and serum demonstrated the highest analytical reliability (recovery >90%, minimal matrix effects), while dried blood spots (DBSs), whole blood, and oral fluid showed greater variability. Clinically, UHPLC–MS/MS enabled more accurate dose adjustments and identification of non-adherence, outperforming immunoassays in sensitivity, specificity, and metabolite detection. Microsampling methods showed promise for outpatient and decentralized care but require further clinical validation. Conclusions: UHPLC–MS/MS remains the most robust and reliable method for TDM of antipsychotics, especially when quantification of active metabolites is required. While logistical barriers remain, technological advances may enhance feasibility and support broader integration into routine psychiatric care.

Background/Objectives: Electroconvulsive therapy (ECT) remains the most effective biological treatment for treatment-resistant depression. Although its efficacy has been consistently demonstrated, the influence of seizure characteristics and treatment parameters on clinical outcomes in routine practice remains incompletely understood. This study aimed to evaluate the effectiveness of seizure threshold-titrated ECT in patients with treatment-resistant depression and to describe treatment outcomes in relation to seizure expression and technical treatment variables. Methods: We conducted a retrospective naturalistic study at the Department of ECT, Dr. Gh. Preda Clinical Psychiatric Hospital, Sibiu, Romania. Consecutive patients treated with ECT for treatment-resistant depressive episodes between March 2022 and December 2025 were included. Clinical outcomes were assessed before and after treatment using the Montgomery–Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), and Global Assessment of Functioning Scale (GAF). Information regarding electrode placement, seizure threshold, seizure duration, the number of ECT sessions, and concomitant psychotropic medication was collected from medical records. Results: Nineteen acute ECT courses were available for outcome analysis. Depressive symptom severity improved significantly following treatment, with median MADRS scores decreasing from 38 (IQR 36–41) to 20 (IQR 9.5–24) (p < 0.001). A clinical response was observed in 57.9% of courses, while 36.8% achieved remission. Similar improvements were noted in self-reported depressive symptoms and overall functioning, with median BDI scores decreasing from 38 to 16 and median GAF scores increasing from 55 to 65. MMSE scores remained stable throughout treatment. Considerable variability was observed in both motor and EEG seizure durations; however, no consistent relationship between seizure duration and antidepressant response was identified. Discussion: The observed outcomes are consistent with previous evidence supporting ECT as an effective intervention for severe depressive illness. Functional improvement accompanied symptom reduction, while no decline in global cognitive performance, as assessed by the MMSE, was observed. In this cohort, seizure duration alone did not appear to provide meaningful information regarding treatment response. Conclusions: Seizure threshold-titrated ECT was associated with substantial clinical improvement in patients with treatment-resistant depressive episodes, accompanied by improved functioning and stable global cognitive performance. These findings support the continued use of individualized ECT protocols in routine clinical practice and highlight the need for further research on neurophysiological predictors of treatment outcome.

Background: Electroconvulsive therapy (ECT) is used as an augmentation strategy in treatment-resistant schizophrenia, but real-world data on individualized seizure threshold-guided treatment remain limited. This study evaluated clinical outcomes of seizure threshold-titrated ECT and described seizure expression and technical treatment parameters during acute ECT courses. Methods: A retrospective naturalistic study included acute ECT courses performed between March 2022 and December 2025 at the ECT Department of the Dr. Gh. Preda Clinical Psychiatric Hospital, Sibiu, Romania. We assessed clinical outcomes at baseline and post-treatment using the PANSS Positive Subscale (PANSS-P), Global Assessment of Functioning (GAF), and Mini-Mental State Examination (MMSE). ECT was delivered using individualized seizure threshold titration alongside stable psychotropic treatment. Electrode placement, stimulation parameters, and motor and electroencephalographic (EEG) seizure characteristics were recorded throughout the treatment course. Results: Seventeen acute ECT courses with paired assessments were analyzed. Median PANSS-P scores decreased from 45 (IQR, 39–48) at baseline to 16 (IQR, 14–20) following ECT (p < 0.001), with a Hodges–Lehmann estimated paired reduction of 26 points. Median GAF scores increased from 44 (IQR, 40–45) to 60 (IQR, 60–65), while median MMSE scores changed from 26 (IQR, 26–28) to 29 (IQR, 28–30). Motor and EEG seizure durations varied substantially across courses and sessions. Right unilateral and bilateral electrode placements were used with similar frequency. Discussion: Our results align with the existing literature on ECT as an augmentation strategy for persistent positive symptoms in treatment-resistant schizophrenia. Improvement in positive psychotic symptoms was accompanied by better global functioning, while the MMSE detected no deterioration in global cognitive performance. The considerable variability in motor and EEG seizure durations further suggests that seizure duration alone may provide limited information regarding clinical improvement. Conclusions: In this retrospective naturalistic cohort, individualized seizure threshold-titrated ECT alongside stable pharmacotherapy was associated with substantial improvement in positive psychotic symptoms and global functioning, without detectable deterioration in global cognitive performance. Given the small sample, the observational design, and absence of a control group, these findings remain preliminary and require confirmation in larger prospective controlled studies.