Aims: Research on family functioning in psychosis has typically focused on specific family-related factors and their impact on symptomatology, finding strong associations between high expressed emotion and poor outcomes, especially in those with long-term illness. The objective of this review is to examine the impact of a broad range of family-related factors and their relationship with clinical, social, occupational, and relational outcomes in first-episode psychosis (FEP). Method: A systematic search of databases PsycInfo, Pubmed, Embase and CINHAL between 1990 and August 2023 was completed. In total, 1408 articles were screened, and study quality was assessed using the JBI Critical Appraisal Checklists for Analytical Cross-Sectional Studies and Cohort Studies. A narrative synthesis approach was used to analyse the data. Results: Of the 1408 identified articles, 80 full-text articles were screened. Fifteen studies were included for data extraction. The objectives and scope of the selected studies varied considerably. Studies consisted of cross-sectional and prospective cohort designs. Participants consisted of FEP patients and family members, with the patient age range varying from 15.9 to 30.8 (MD=24.5). Significant associations were identified between family factors (high EE, family environment and carer burden) and symptom and social outcomes. Discussion: While findings emphasised the significant impact of family factors on symptomatic and social outcomes, the literature had significant limitations due to the absence of underlying theoretical models and understanding of the dynamics of distress in families within FEP. Future research should seek to develop a model accounting for such processes.

Background: Individuals with psychosis symptoms are at high risk for suicidality. The prevalence and correlates of suicidality in clinical high risk for psychosis (CHR-P) have yet to be clarified. This study reports on the prevalence and clinical correlates of suicidality in a clinical CHR-P sample. Method: Participants (n = 135) included CHR-P clients at a CHR-P community specialty clinic, who participated in a clinical assessment between 2017 and 2022. Assessments measured attenuated psychosis symptoms, suicidality, clinical covariates, and functioning. Frequency analyses assessed the prevalence of lifetime suicidal ideation and attempts and T-test and Chi-square identified clinical correlates. Logistic regression assessed the relationship between significant clinical correlates and lifetime suicide attempts. Results: Sixty five percent of participants at CHR-P endorsed lifetime suicidal ideation, while 22.2% reported at least one lifetime attempt. Correlates for lifetime suicidal ideation included self-reported gender expansive identity, hopelessness, depression, trauma, obsessive compulsive symptoms, insight: reflectiveness, trauma diagnoses, mood disorder diagnoses, and perceptual abnormalities/hallucinations. Significant correlates for lifetime suicide attempts included self-reported hopelessness, depression, trauma diagnosis and mood disorder diagnosis. Conclusion: CHR-P clients are at a higher risk for suicidal ideation and attempts compared to the general population. Correlates of suicidality may be diagnostically heterogeneous and therefore interventions should be tailored to specific clinical needs. Clients with trauma-disorder diagnoses may be at highest risk for suicidality. Continued intervention and longitudinal research is needed to clarify causal risk factors and establish evidence-based treatments for suicidality in CHR-P.

Title Do non-clinical services help to improve functional outcomes among young adults with mental disorders? A systematic review. Aim This systematic review aims to examine and synthesise the evidence for non-clinical services on improving functional outcomes for young adults with mental disorders. Methods The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Only 17 studies met the inclusion criteria. Nine studies were focussed on vocational support services and seven of these examined the impact of the well-established Individual Placement and Support model. Most studies reported increased rates of employment of young adults similar to studies in general adult populations. Six studies reported on lifestyle interventions including a combination of physical activities, nutrition education, health coaching and motivation and behaviour change. The measures of functioning used by the studies were too varied to determine whether lifestyle interventions may be useful in improving functional outcomes for young adults. There were only two studies on family and network support services for young adults. Conclusion Given the importance of improving functional outcomes among young adults with mental disorders to improve daily activities, quality of life and recude future disability, further research is needed to understand the impact of non-clinical services on functioning. This evidence will provide pragmatic guidance for service planners to invest in supports and interventions that make a meaningful difference to the lives of young adults living with mental illness.

Background: Trauma plays an important role in the development and maintenance of psychosis. However, it is still under-examined in daily clinical practice. The current study investigated the rates of recording of trauma-exposure in the clinical histories of a first-episode psychosis (FEP) cohort attending an early intervention psychosis service. Methods: This study used a retrospective chart review methodology in a six-year epidemiologically complete (FEP) first-episode psychosis cohort attending an early intervention psychosis service. The Trauma and Life Events Checklist was used to define the rate and types of trauma exposure reported in clinical histories. The relationships were examined between recorded trauma-exposure and positive and negative symptoms, depression, and duration of untreated psychosis at first assessment. Results: A high rate of recorded trauma exposure was found, indicating that clinicians are recording trauma-exposure in daily practice through clinical histories. Childhood trauma exposure was recorded in 47.4% of the sample. No significant relationships between the recorded trauma-exposure and symptom measures were found. A significant relationship was found between interpersonal stressors and positive symptoms, and work-related stress and negative symptoms, highlighting the important of proximal stressful life events. Discussion: Even though clinicians were not assessing trauma systematically using standardised instruments, this study found that clinicians were recording trauma-exposure in daily practice. The high rates of trauma-exposure highlighted the need for trauma to be systematically diagnosed, assessed and treated in planning services for people with psychosis. This study found no significant relationship between recorded trauma-exposure and symptomology.

Accurate and appropriate cognitive screening has the potential to significantly enhance early psychosis care, yet no screening tools have been validated for the early psychosis population and little is known about current screening practices, experiences, or factors that may influence implementation. Using a hybrid type 1 design, the CogScreen study aims to validate two promising screening tools with young people with first episode psychosis (primary aim) and to understand the context for the implementation of cognitive screening in early psychosis settings (secondary aim). The present protocol outlines the implementation study, which aims to explore the experiences and practices, acceptability, feasibility, and determinants of cognitive screening in early psychosis settings from the perspective of key stakeholders. Young people with first episode psychosis (n=350), caregivers (minimum n=10), and service providers (minimum n=12) will be recruited from primary and specialist early psychosis services in Melbourne, Adelaide, and Sydney, Australia. Grounded in implementation science, two theoretical frameworks inform data collection and analysis: the Theoretical Framework of Acceptability and the Consolidated Framework for Implementation Research. A mixed methods design will be employed to collect and analyse data from questionnaires with young people with first episode psychosis, interviews with all stakeholder groups, and administrative processes. Quantitative data will be analysed using descriptive statistics. Qualitative data will be analysed through content analysis using deductive and inductive coding. Together with accuracy findings, results from the present implementation study will provide new insights about the practices, experiences, enablers and barriers to cognitive screening in early psychosis services.

Objectives: The prodromal phase of a psychotic disorder is a period of altered functioning before the onset of the acute state; several interviews have been developed to determine whether individuals present with prodromal symptoms. The 16-item Prodromal Questionnaire (PQ-16) is a screening tool for evaluating those at risk of developing a psychotic disorder. The study aimed to evaluate the psychometric properties of the Latvian version of the PQ-16 in a sample of help-seeking adolescents referred for diagnostic assessment and look for possible associated socio-demographic and health-related factors. Methods: A cross-sectional study included patients admitted for evaluation between November 2022 and February 2023 in Riga’s Children’s Clinical University Hospital Child Psychiatry clinic. The data were collected during outpatient consultations by mental health professionals. We used the Latvian translation of PQ-16 and the socio-demographic and health-related factors questionnaire. Data were analyzed with IBM SPSS 28; the scale’s diagnostic accuracy and internal validity were examined. Results: The study involved 107 adolescents aged 12 to 17, 80.5% female, with a mean age of 14.98 (CI 14.70-15.26). Socio-demographic data and health-related variables did not significantly differ between the sexes (p>.05). The Latvian PQ-16 demonstrated excellent internal reliability with a Cronbach’s Alpha of 0.890. All 16 items were found to be valid with p<.001. A significant number of participants (73.8%) scored above the current cut-off of ≥6 with a mean of 9.17 (95% CI 8.41-9.93). Certain socio-demographic factors, such as female gender (p<.001), fair school performance (p=.048), and recent changes in school performance (p<.001), demonstrated a significant association with higher scores. Additionally, there were found significant associations between positive screening and health-related factors such as obstetric complications (p=.044), smoking (p=.002), alcohol consumption (p=.021), history of bullying in school (p<.001), and emotional abuse at home (p=.011). Conclusions: Latvian translation of PQ-16 showed high internal reliability and validity levels. Positive PQ-16 screening was associated with female gender, worsened school performance, obstetric complications, substance abuse, and experienced emotional violence. The average score of 9.17 positive answers and 73.8% of participants screening positive for attenuated psychotic symptoms is significantly higher than in recent studies under similar conditions.

INTRODUCTION: Mental health conditions are prevalent among university students, putting them at elevated risk for dropout. Universities offer an array of peer programs, and students often share their concerns with peers before professionals. A well-specified peer intervention to help sustain academic persistence that colleges can directly offer their undergraduates with mental health conditions should benefit this population. The Peer Academic Supports for Success coaching model was developed to address this need. OBJECTIVE: This study’s goal was to conduct a feasibility study of the Peer Academic Supports for Success model and feasibility of randomized controlled trial research methods. METHODS: Seventy-two undergraduate students with academically impairing mental health conditions were randomized to receive Peer Academic Supports for Success versus an active control condition. Survey data were collected at baseline and at the end of the next two semesters. Official transcripts were obtained. Intervention implementation data were assessed through coach and participant report. RESULTS: Peer Academic Supports for Success was delivered with fidelity, successfully attracted and retained students, and was safe. Randomized controlled trial methods proved feasible. Findings revealed significant treatment effects on several of the targeted proximal outcomes. CONCLUSIONS: The findings suggest Peer Academic Supports for Success is a promising university-based intervention to support young adult students with mental health conditions and should be tested in a robust clinical trial.

Introduction. Young people’s participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future, and feeling that things are improving in their lives. This study reports on young people’s session experiences over time and by key demographics for headspace youth mental health services. Methods. The sample comprised 16,484 young people aged 12 to 25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. Results. Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. Conclusion. Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

Background: The study was designed to assess the role of coping style and self-esteem in the context of different phases of schizophrenia. Methods: Recurrent Schizophrenia (ReSch) , first-episode schizophrenia patients (FEP), ultra-high risk for psychosis (UHR) patients, and healthy controls (HC) (40 per group) were subjected to in-person clinical interviews. The results of these interviews were then used to gauge coping style and self-esteem using the Coping Styles Questionnaire (CSQ) and the Rosenberg’s Self-Esteem Scale (RSES). Data were analyzed through ANCOVAs and logistic regression analyses. Results: The result s found that positive coping style (CSQ problem-solving and CSQ seeking for help) generally decline with progression through the HC, UHR, and FEP groups,while negative coping style(CSQ fantasy,CSQ repression and CSQ self-blame) generally increase with progression through the HC, UHR,and FEP groups (except that UHR group was slightly lower than HC group in CSQ self-blame).Results for members of ReSch group were in line with those of members of the FEP group in coping style. At the level of self-esteem, the UHR group was similar to the HC group and significantly higher than the FEP group and the ReSch group. Logistic regression analyses indicated that UHR group patients exhibited increased negative coping styles (CSQ fantasy) relative to members of the HC group, but had greater Positive coping style (CSQ problem-solving) than did members of the FEP group. Conclusion: These findings suggest that both UHR individuals experience impaired negative coping styles which expands the understanding of the psychological characteristics of the prodromal group. Further explorations are warranted to develop optimal psychosocial interventions.

Intro: psychotic disorders (PD) and eating disorders (ED) both are highly invalidating, costly and associated with premature death. Researchers call for early detection and intervention. Little is known about co-occurrence and associations between the at risk mental state for psychosis (ARMS) and ED. Objectives: to explore the prevalence of and associations between ARMS and ED-risk. To gain a first explorative insight into the similarities and differences of ARMS profiles in individuals with and without an ED risk score (EDr versus EDnr). Method: a cross sectional observational prevalence study (N=736) in secondary mental health care with a qualitative examination of ARMS profiles (N=47), using an ED screener (SCOFF), psychosis prodromal screener (PQ16) and CAARMS interview (detection of ARMS). We analyzed prevalences, associations (using Fisher’s exact test), and conditional probabilities of frequencies for CAARMS and SCOFF outcomes. We explored differences in ARMS profiles between EDr and EDnr by inspection of CAARMS reports. Results: ARMS and EDr are common across all psychiatric conditions. ED appear to remain largely undetected. Findings demonstrated no significant or conditional association of frequencies between CAARMS and EDr/nr outcome. ARMS items ‘guilt/punishment’ and ‘ideas of reference’ stood out in the EDr group. Conclusions: Be aware of ARMS and psychosis in ED. Pay more attention to possible ED. ARMS and psychosis are equally prevalent in EDr and EDnr, and vice versa. Researchers are encouraged to conduct studies on severity associations and profiles of psychosis spectrum symptoms in the various manifestations of ED.

Introduction. Psychotic disorders are associated with academic difficulties. Supported Employment Program (SEP) guidelines have become the gold standard to improve occupational functioning in psychotic disorders. More recently, these guidelines have been adapted to education. In Canada, several community organizations and hospital programs offer supported education to young people with psychotic disorders. However, SEP guidelines are not systematically used. The objective of this study was to assess the fidelity of 6 Canadian (Quebec) organizations offering supported education services to young people with psychotic disorders to the SEP guidelines adapted to education. Methods. Six sites offering educational services to young people with psychotic disorders were recruited. Semi-structured interviews were conducted with one supported education professional and one manager of each site, using the Quality of Supported Education Implementation Scale (QSEDIS). This new scale has been developed from the Quality of Supported Employment Implementation Scale. The QSEDIS assesses the fidelity of the quality of the implementation of supported education programs, using three subscales (Employees, Organization and Services). Results. Acceptable fidelity scores were observed in the three QSEDIS subscales for all six sites combined. The Services subscale received the highest score of fidelity (4.4./5), followed by the Supported Education Employee (4.1/5) and the Organization (3.7/5). Conclusion. The results suggest that supported education services offered to young people with psychotic disorders in the six sites are generally consistent with SEP guidelines adapted to education. Further research is warranted to validate whether acceptable SEP guidelines fidelity according to the QSEDIS translates into educational outcomes.

Objective: This case series explored the integration of smartwatches in a community mental health service to support severe mental illness (SMI) management and intervention. We examined whether biometric data provided by smartwatches could help to predict relapse and inform treatment decisions. Method: Four SMI patients were selected from a prior study. Clinicians accessed patients’ biometric data (activity, sleep, heart rate, and electrodermal activity) through smartwatches. Results: Changes in circadian rhythm and electrodermal activity preceded hospitalization in two cases. Additionally, smartwatch data was effectively used to guide targeted interventions, improving patient treatment outcomes. Conclusion: Integrating smartwatches in community mental health services offers promise as adjunct tools for severe mental illness management. However, ethical considerations on data privacy and technology reliance require further evaluation.

Background Children, adolescents and young adults are experiencing an increase in the prevalence of depressive and anxiety symptoms. Aerobic training (AT) has been shown to be effective at reducing symptoms, but the efficacy of resistance training (RT) in reducing anxiety and depression levels in young individuals is unclear. Aim To quantify the change in depressive or anxiety symptoms following RT in young individuals. Methods We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to February 2022 for randomised controlled trials (RCT) that included at least 4 weeks of RT, with participants aged 26 years or younger. A random-effects meta-analysis was used to calculate a pooled effect size of RT pre-and post-intervention compared to control groups and the quality of evidence was assessed using a Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. Results Ten RCTs were eligible for inclusion in the analysis. RT was associated with a significant reduction with a large-sized mean effect in depressive (Hedge’s g= -1.06, 95% CI -1.61 to -0.51, p<.001) and anxiety symptoms (Hedge’s g = -1.02, 95% CI -1.50 to -0.54, p <.001). Sensitivity analyses on the training variables were not conducted due to the small sample and large heterogeneity, however, a summary of the trials with a large effect size (≥-1.0) was conducted. Conclusion RT significantly reduces depression and anxiety symptoms in young people. Future studies exploring the effect RT training intervention with adequate detail and in various mental health treatment treating settings are warranted.

Objectives: The present study aimed to evaluate data from patients admitted to the first-episode psychotic (FEP) outpatient clinic at the Hospital of Clinics of the Federal University of Pernambuco from July 2018 to July 2021, seeking to identify factors related to better clinical outcomes. Methods: This study was conducted using a convenience sample, including all patients between 15 and 65 years of age who were admitted to the FEP outpatient clinic from July 2018 to July 2021. Descriptive statistical analysis was performed using mean and standard deviation or median and interquartile range for continuous quantitative variables, and absolute number/percentage for qualitative variables. Paired T-test, a parametric test, was used to compare PANSS scores upon admission and after 6 months. Spearman’s correlation test was employed to assess the correlation between duration of untreated psychosis (DUP) and treatment response with other variables. Results: The sample consisted of 85.3% male individuals, with 50% of patients aged between 19-30 years, and 82% residing in the metropolitan area of Recife. Seventy percent of patients responded to the treatment implemented by the outpatient clinic, and only 30% required psychiatric hospitalization within 6 months of follow-up. The majority of patients had a history of psychoactive substance use (82.4%); however, the use of these substances did not impact the prognosis within the analyzed sample. The median DUP was 4 weeks, and a shorter DUP was associated with a lower probability of psychiatric hospitalization and a greater treatment response (reduction >50% in PANSS). Conclusion: A shorter DUP was associated with a lower likelihood of psychiatric hospitalization and a greater treatment response. Furthermore, the specialized early psychosis outpatient clinic itself appears to yield positive outcomes, as 70% of the treated patients exhibited a positive treatment response.

Aim: Psychotic disorders and obsessive-compulsive disorder (OCD) commonly co-occur. Likewise, subthreshold psychosis symptoms (clinical high risk for psychosis; CHR-p) and obsessive-compulsive symptoms (OCS) commonly overlap and may be difficult to differentiate. Previous work suggests some notable differences between OCS and psychosis include insight and the content of thoughts and experiences. Methods: The current study explored the overlap between OCS and psychosis symptoms in a CHR-p sample. Results: Results demonstrated 13.5% of the sample experienced co-morbid OCD and CHR-p. Individuals with comorbid OCD and CHR-p experienced no other significant differences in presenting concerns, including psychosis symptoms, social or role functioning, anxiety, or depression. Exploratory factor analyses conducted on the CFOCI-A revealed two subtype factors: 1) checking and counting, and 2) intrusive thoughts and images of harm/guilt. The checking and counting factor was significantly correlated with depression and social anxiety. The intrusive thoughts and images of harm/guilt factor was significantly correlated with unusual thought content, suspiciousness and persecutory ideas, attenuated positive symptoms, and social anxiety. Conclusions: These findings suggest individuals who experience intrusive thoughts and images may be more likely to rate on positive symptoms, while individuals with checking and counting symptoms may not rate on positive symptoms, though may experience greater levels of depression.

Introduction Emergent mental illness during adolescence affects daily functioning, causing disruption to daily activities, routines, and patterns. Multiple inter-related personal, social and environmental determinants influence the onset, nature and subsequent course of those difficulties. Research suggests a bi-directional relationship exists between mental health and activity choices. Activity-focused interventions such as occupational therapy may improve adolescent mental health related outcomes. In this study, we identify and select which activity-related determinants should be prioritised in the development of an occupation therapy-based intervention for adolescents with emerging mental health difficulties using expert consensus. Method A modified two-round Delphi survey method was conducted with occupational therapists and researchers to ascertain a consensus opinion on the prioritisation of specific activity-related determinants that influence 16-to 17-year-olds’ Results Eighty-nine determinants were identified and prioritised. Fourteen of these were personal activity-related determinants including ‘types of activity’ in which young people engage, the ‘balance of activities’ in which they engage, their ‘over and under consumptions of activities’, and their ‘underdeveloped occupation-based coping skills’. The expert panel prioritised ‘personal self-confidence’, ‘values’, and ‘perception of confidence’ in relation to the activities adolescents do. Conclusions This study generated a detailed picture of the activity-related determinants that are important in adolescence, and aligns with the adolescent model of occupational choice. Our findings have potential to inform activity-related intervention development and policy. Further research is needed, particularly to understand young people’s perspectives on these determinants and to investigate the determinants that would benefit from further empirical research.

Aim. Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognised, caregivers also play a significant role in these pathways. Caregiver’s familiarity with mental health issues may influence an adolescent’s PtC. This study explores the relationship between a caregiver’s prior suicidality and mental health treatment on their children’s pathways to entering a specialist suicide prevention treatment program. Method. Caregivers ( n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child’s onset of symptoms, help-seeking, PtC and the caregiver’s prior suicidality and mental health treatment. Results. Parents were the source most likely to recognise the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. Conclusion. Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver’s prior experience of suicidality to these pathways. These complexities warrant further exploration to minimise obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers. Keywords. Pathways to care; delay in treatment; caregiver familiarity; suicide; adolescent.

Background: Most young adults experiencing psychosis enter early intervention services for psychosis (EIS) via inpatient services and emergency departments. Referral in this manner is believed to increase young adults’ risk for adverse outcomes while in EIS such as diminished trust and engagement in services. However, little research has empirically examined the impact of young adults’ referral and help-seeking experiences on their subsequent views towards EIS and engagement to services. Methods: This qualitative study involved semi-structured interviews with 12 young adults (mean age = 24.83) within 3-12 months following acceptance to an EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. Data were analyzed using the Interpretative Phenomenological Analysis approach. Results: 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Events. Participants with referral pathways involving urgent care services, particularly through involuntary hospitalization, described more adversity during their referral pathway and were more likely to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. Conclusions: The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants’ accounts. Sense making was further contextualized by participants’ illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users’ dignity and for EIS to provide opportunities for patients to process past negative healthcare experiences to strengthen engagement.