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.

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.

Objectives: Early trauma exposure is common among young adults receiving public mental health services, posing increased risk for PTSD. While d supports the feasibility of PTSD screening, clinicians often fail to screen for PTSD in this population. This study aimed to examine the demographic factors, psychiatric comorbidity, and predictors of charted PTSD diagnosis among treatment-seeking young adults with positive PTSD screens in a community mental health care system. Methods: Screening for trauma history and PTSD symptoms was implemented among clients receiving community mental health services. There were 266 treatment seeking young adults (aged 18-35) endorsed at least one traumatic event and had a score of at least 45 on the DSM-IV PTSD Checklist (PCL), indicating probable PTSD. Results: Treatment-seeking young adults with positive PTSD screens were predominantly female (68%), minority (69%), and diagnosed with mood disorders (66%), with nearly 25% diagnosed with major depressive disorder. Of the young adults with positive PTSD screens (PCL >=45), only 15% had a chart diagnosis of PTSD. Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. Conclusion: Routine PTSD screening and early trauma intervention for treatment-seeking young adults with mental health conditions should be prioritized to address the long-term impact of trauma. Keywords: schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder (PTSD), trauma screening, community mental health care

Aims: The objective of this study is to underline the impact of Gaming Disorder on the clinical evolution of patients with First Episode Psychosis. The specific aims of the study are to determine the prevalence of gaming disorder among those patients and assess the consequences of gaming on their clinical trajectory. Methods: This is a prospective multicenter cohort study that will enroll 800 patients diagnosed with a first episode psychosis, with a follow-up period of up to 3 years. Using a systematic screening procedure for gaming disorder, the clinical staff will assess patients gaming habits at admission and every 6 months thereafter. Information from patients’ medical records will also be extracted using the same timeframe. Results: The patients’ characteristics at admission and during follow-up will be presented in the form of descriptive statistics and compared between different subgroups of patients using uni- and multivariate logistic regression models. Repeated measures ANCOVA will also be performed to analyze the impact of gaming disorders on patients’ clinical path as assessed by the Positive and Negative Syndrome Scale and the Clinical Global Impression scale, considering covariates such as psychiatric diagnosis, pharmacological treatment, age, sex/gender, and duration of untreated psychosis. Conclusion: These findings will guide the development of prevention, detection, and treatment strategies for the comorbidity between gaming disorder and first episode psychosis, ultimately improving the patients’ recovery.

Aim: Patient-reported outcome measures (PROMs) provide valuable information and promote shared decision-making but are infrequently used in psychosis. Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH) are single-item PROMs in which respondents rate their health and mental health from ‘poor’ to ‘excellent’. We examined the psychometric properties of the SRH and SRMH in early intervention for psychosis contexts in Chennai, India and Montreal, Canada. Methods: Assessments were completed in Tamil/English in Chennai and French/English in Montreal. Test-retest reliability included data from 59 patients in Chennai and Montreal. Criterion validity was examined against clinician-rated measures of depression, anxiety, positive and negative symptoms, and a quality-of-life PROM for 261 patients in Chennai and Montreal. Results: SRH and SRMH had good to excellent test-retest reliability (ICC>0.63) at both sites and in English and Tamil (but not French). Results for criterion validity were mixed. Whereas in Montreal, low SRH was associated with not being in positive symptom remission, and poorer functioning and quality of life, SRH was associated only with functioning in Chennai. No associations were found for SRMH in Montreal. In Chennai, however, low SRMH was associated with not being in positive symptom remission and poorer functioning. Conclusions: Our work advances knowledge of more feasibly integrating single-item PROMs into clinical settings. Importantly, it highlights how PROMs may perform differently across languages and contexts. More critical work is needed to understand if discrepancies between PROMs and CROMs are indicative of poor validity of PROMs or “valid” differences between patient and clinician perceptions.

Introduction: Aberrant salience and psychotic-like experiences have been proven to be linked. Moreover, anxiety is a key symptom in psychosis prone subjects and in most psychotic patients. We propose a mediation model that attempts to interpret the role of psychotic-like experiences in the association between aberrant salience and anxiety among healthy controls and psychotic patients. Materials and Methods: Demographic and psychometric data (Aberrant Salience Inventory, Community Assessment of Psychic Experiences, Symptom Check List-90-revised) from 163 controls and 27 psychotic patients was collected. Descriptive statistics, correlations and a mediation analysis with covariates were subsequently performed. Results: Aberrant salience correlated with more frequent positive psychotic-like experiences and higher anxiety levels in both patients and controls. However, positive psychotic-like experiences’ frequency mediated the relationship between aberrant salience and anxiety only among controls. Conclusions: The preservation of insight onto their psychotic-like experiences among controls with high aberrant salience, and its partial or complete loss in psychotic patients seems to be the most probable hypothesis to explain why psychotic-like experiences linked to aberrant salience appear to induce anxiety among the former group but not the latter.

Aims: Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Incorporating Information and Communication Technologies (ICT) has improved the information patients receive and the relationship between health professionals and patients. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. Methods: A cross-sectional quantitative study was carried out by experts in psychosis and technologies. 41 patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. Results: An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. Conclusions: Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.

Introduction- Cannabis use disorders are global emerging problem nowadays, with high prevalence and morbidity. Though cognitive impairments are one of the most replicated findings in individuals with cannabis dependence, but there are very few studies assessed cognitive functioning as a risk factor for cannabis use disorder. In this study, we assessed cognitive functioning as an endophenotype in cannabis use disorders. Methodology- In this study comparison of cognitive functioning was done among three groups- patients with cannabis dependence syndrome, their first degree relative (FDR) and normal healthy controls (HC). Each group included 30 participants. Individuals of all three groups were assessed in domains of complex attention, executive functions, language, learning and memory and perceptual-motor. Results- Performance of patients with cannabis dependence was impaired in attention, verbal memory, executive functions compared to both other groups. Attention, semantic verbal fluency and memory were found to be an endophenotype as both patient and FDR group performed poorly than HC group. Verbal memory was impaired in patients’ group compared to group of first-degree relatives, whose performance in-turn impaired than normal healthy controls. Performances of verbal and visual memory were correlated positively with age of onset and negatively with frequency of cannabis intake. Age of first-degree relatives was inversely correlated with verbal memory. Conclusion- Performance of individuals with cannabis dependence was impaired than normal healthy controls in all domains of cognitive functioning. As per definition, verbal memory could be considered as an endophenotype marker in cannabis use disorders.

Aim: Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment to determine common trajectories of care. Methods: We collected health record data for all individuals treated by early intervention teams in two NHS mental health trusts in England. We collected data on individuals’ primary mental health care provider for 52 weeks after the end of their treatment and calculated common trajectories of care using sequence analysis. Results: We identified 2224 eligible individuals. For those discharged to primary care we identified four common trajectories: Stable Primary Care, Relapse and return to CMHT, Relapse and return to EIP, and Discontinuity of Care. We also identified four trajectories for those transferred to alternative secondary mental health care: Stable Secondary Care, Relapsing Secondary Care, Long-term Inpatient, and Discharged Early. The Long-term Inpatient trajectory (1% of sample) accounted for 29% of all inpatient days in the year follow-up, with Relapsing Secondary Care (2% of sample and 21% of inpatient days), and Relapse and return to CMHT (5% of sample, 15% of inpatient days) the second and third most frequent. Conclusions: Individuals have common care pathways at the end of early intervention in psychosis treatment. Understanding common individual and service features that lead to poor care pathways could improve care and reduce hospital use.