Cognitive impairment is common in people with mental disorders, leading to transdiagnostic classification based on cognitive characteristics. However, few studies have used this approach for intellectual abilities and functional outcomes.

The present study aimed to classify people with mental disorders based on intellectual abilities and functional outcomes in a data-driven manner.

Seven hundred and forty-nine patients diagnosed with schizophrenia, bipolar disorder, major depression disorder or autism spectrum disorder and 1030 healthy control subjects were recruited from facilities in various regions of Japan. Two independent k-means cluster analyses were performed. First, intelligence variables (current estimated IQ, premorbid IQ, and IQ discrepancy) were included. Second, number of work hours per week was included instead of premorbid IQ.

Four clusters were identified in the two analyses. These clusters were specifically characterised in terms of IQ discrepancy in the first cluster analysis, whereas the work variable was the most salient feature in the second cluster analysis. Distributions of clinical diagnoses in the two cluster analyses showed that all diagnoses were unevenly represented across the clusters.

Intellectual abilities and work outcomes are effective classifiers in transdiagnostic approaches. The results of our study also suggest the importance of diagnosis-specific strategies to support functional recovery in people with mental disorders.

Psychiatric comorbidities, including depressive and anxiety disorders, are common in individuals with autism spectrum disorder (ASD). Use of conventional therapies for treating depression and anxiety are of limited efficacy in individuals with ASD making treatment a challenging field. Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and efficacious technique in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD.

The aim of this case study is to present the effectiveness of rTMS in a 17 year old patient diagnosed with ASD and comorbid major depression disorder with anxiety symptoms.

This is a case study of a male adolescent aged 17, diagnosed with ASD and comorbid major depression disorder with anxiety symptoms, suicidal ideation and aggressive behavior. The protocol applied was 4 weeks of daily rTMS sessions. This involved rTMS to the left dorsomedial prefrontal cortex (10 Hz, 3.000 pulses/120% motor threshold) to treat depressive symptoms and to the right (50Hz, 600 pulses/ 120%motor threshold) to treat anxiety symptoms. Assessments were conducted using the BDI, PHQ-9 and GAD-7 scales at baseline and one month follow up. Suicidal ideation and aggressive behavior were assessed by a clinician at same intervals.

Patient showed overall improvement in scores both in depression and anxiety scales. Suicidal Ideation and aggressive behavior showed significant reduction. No side effects were recorded during therapy.

Our findings suggest that the use of rTMS therapy in adolescents in the autistic spectrum and comorbid major depression disorder and anxiety symptoms is an efficacious and safe therapeutic treatment option.

The microbiota–gut–brain axis, especially the microbial tryptophan (Trp) biosynthesis and metabolism pathway (MiTBamp), may play a critical role in the pathogenesis of major depressive disorder (MDD). However, studies on the MiTBamp in MDD are lacking. The aim of the present study was to analyze the gut microbiota composition and the MiTBamp in MDD patients.

We performed shotgun metagenomic sequencing of stool samples from 26 MDD patients and 29 healthy controls (HCs). In addition to the microbiota community and the MiTBamp analyses, we also built a classification based on the Random Forests (RF) and Boruta algorithm to identify the gut microbiota as biomarkers for MDD.

The Bacteroidetes abundance was strongly reduced whereas that of Actinobacteria was significantly increased in the MDD patients compared with the abundance in the HCs. Most noteworthy, the MDD patients had increased levels of Bifidobacterium, which is commonly used as a probiotic. Four Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologies (KOs) (K01817, K11358, K01626, K01667) abundances in the MiTBamp were significantly lower in the MDD group. Furthermore, we found a negative correlation between the K01626 abundance and the HAMD scores in the MDD group. Finally, RF classification at the genus level can achieve an area under the receiver operating characteristic curve of 0.890.

The present findings enabled a better understanding of the changes in gut microbiota and the related Trp pathway in MDD. Alterations of the gut microbiota may have the potential as biomarkers for distinguishing MDD patients form HCs.