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.

Eating disorders (EDs) disproportionately affect women and are associated with substantial morbidity, chronicity, and mortality. While established psychological models focus on the content of maladaptive cognitions related to body weight, shape, and eating behaviors, growing evidence suggests that additional process-level mechanisms contribute to symptom persistence and treatment resistance. Metacognitive models emphasize how individuals relate to their thoughts, emotions, and internal experiences, highlighting maladaptive beliefs about thinking and the resulting cognitive–attentional patterns (e.g., repetitive negative thinking, self-focused attention, and inflexible attentional control) as potential maintaining factors across psychopathology. This narrative review synthesizes the theoretical and empirical literature on metacognitive dysfunction in EDs, with a focus on mechanisms that may be particularly relevant for women. We integrate epidemiological data and gender-sensitive frameworks, and review evidence on metacognitive beliefs and cognitive–attentional syndrome (CAS)-related processes across anorexia nervosa, bulimia nervosa, and binge-eating disorder. Overall, studies indicate that dysfunctional beliefs about the uncontrollability and danger of thoughts, alongside perseverative cognitive styles, are associated with greater ED symptom severity. We discuss diagnosis-relevant patterns as clinically useful heuristics, interactions with sociocultural and emotional vulnerability factors, and implications for assessment, treatment integration, and prevention. The evidence base is largely correlational and derived from predominantly female samples, underscoring the need for longitudinal research and studies that explicitly test sex/gender as a moderator.

Background/Objectives: Although obsessive–compulsive disorder (OCD) is clinically heterogeneous, it is unclear whether specific metacognitive belief domains are differentially associated with particular symptom dimensions in adults with confirmed OCD. This systematic review synthesised the available clinical evidence and explored its implications for dimension-informed case formulation and treatment planning. Methods: In March 2026, PubMed/MEDLINE, Scopus, Cochrane CENTRAL and Google Scholar were searched without date or language restrictions. Eligible studies enrolled adults with a confirmed diagnosis of OCD, administered at least one validated metacognitive instrument (MCQ-30/65, TFI, TAF, BARI, SSQ or OBQ-based subscales) and reported associations with validated dimensional OCD measures. The review was preregistered on PROSPERO (CRD420261338178). Due to methodological heterogeneity, the findings were synthesised narratively in accordance with SWiM guidance. Results: Ten studies, including 1320 adults with OCD, were included. These studies were conducted across five countries between 2010 and 2025. Negative beliefs about thought uncontrollability and danger (MCQ-30 NB) showed the broadest associations across the synthesis, particularly with the checking/harm avoidance and the unacceptable thought dimensions. Thought-fusion constructs (TAF/TFI) were most consistently associated with checking/harm avoidance and unacceptable thought presentations. Beliefs about rituals and stop-signal criteria (BARI/SSQ) were most relevant to symmetry/ordering. In contrast, contamination/washing and hoarding exhibited weaker and less consistent metacognitive profiles. Conclusions: The available evidence suggests that metacognitive belief profiles in OCD are not dimensionally uniform. Harm-relevant metacognitions appear to be the most salient factor in the checking and unacceptable thought dimensions, whereas ritual-regulation metacognitions appear to be more relevant to the symmetry/ordering dimension. While these findings may inform dimension-sensitive case formulation and generate testable hypotheses for future metacognitive and exposure-based treatment research, they do not yet justify prescriptive, dimension-specific treatment algorithms. The evidence base remains predominantly cross-sectional and methodologically diverse.