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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., (© 2025 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Despite 75% of people who experience a first episode of psychosis (FEP) reaching clinical remission, this population continue to face lower rates of vocational recovery. This review aimed to identify the factors which help and hinder individuals' employment and post-secondary education engagement post-FEP. Three electronic databases (Psych INFO, Medline and Social Science Database) were searched up to 21st August 2023. Primary research on employment/education status or engagement within FEP populations ages 18-40 were included. A narrative synthesis was applied to the findings. Of the 10,575 articles screened, 18 were included in the final review. Younger age, non-affective psychotic diagnoses and stigma were identified as common barriers to engagement. Ceasing substance use and having family/financial support were reported as facilitators. Conflicting findings were reported as to the impact of positive and negative symptoms. The range of factors emerging from this review highlight several potential barriers and facilitators for individuals seeking employment or further education opportunities post-FEP. This underlines the need for further research into how and why they influence employment and educational outcomes, with a view to improving treatment outcomes by incorporating these factors into care planning., (© 2025 International Union of Psychological Science.)

Aim: The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans-diagnostically assessed the prevalence and co-occurrence of at-risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr., Method: This cross-sectional and observational-prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16-35 who were referred for various kinds of non-psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities., Results: Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED-consistent and ED-inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference., Conclusions: From a trans-diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co-morbid ED in other kinds of psychopathology is being overlooked., (© 2024 John Wiley & Sons Australia, Ltd.)

Introduction: Early intervention represents an opportunity to contain psychological distress and intervene promptly on conditions that, otherwise, could assume a chronic course. Based on these observations, an early intervention programme for people 18-25 years old, the 'Progetto Giovani' (Youth Project), was implemented in two adult mental health services (AMHSs) in the northwest of Italy., Methods: This study aims to describe the socio-demographic and clinical characteristics of the patients included in the Youth Project from 1 January 2013 to 31 December 2022. A retrospective observational design was used., Results: In 10 years, 323 patients were taken into care. More than half (56.3%) were females; the mean age was 20.7 years (SD 2.3). The most frequent diagnosis was anxiety disorder (38%). Seventy per cent of subjects benefitted from psychological treatment, and 60.8% had a pharmacological prescription. In 87.8% of cases, the care pathway was ≤ 24 months, and more than two-thirds of the subjects did not go to another AMHS after discharge. More than 90% of subjects did not require hospitalisation in the psychiatric diagnostic and treatment service., Conclusions: These findings suggest that early intervention programmes may be a valuable tool for AMHSs to improve patient outcomes and reduce the burden on the healthcare system., (© 2024 John Wiley & Sons Australia, Ltd.)

Background: Universal, classroom-based mental health literacy (MHL) curricula are associated with improved mental health knowledge, attitudes, and help-seeking behaviors. Young adolescents are an ideal target given their need for and receptivity toward MHL education., Methods: We conducted a scoping review to identify universal, school-based MHL programs primarily for students aged 10-14 years, with adequate descriptions of curriculum implementation and content, and measured outcomes., Findings: Thirty-one articles describing 24 programs met the inclusion criteria. The content and educational strategies varied, with no two programs having the same curriculum. The studies show promising results for improvement in mental health knowledge, attitudes, help-seeking, and student mental health., Implications for School Health Policy, Practice, and Equity: Collaborative work between educational and mental health professionals, along with rigorous study of outcomes, aiming to reach a consensus on a core MHL curriculum and best implementation practices, will advance efforts to improve MHL., Conclusions: This scoping review confirmed that existing universal, school-based MHL programs for middle school-aged students improve mental health knowledge. The programs are diverse, and their outcomes are often challenging to compare. Ongoing study in this field to optimize design and implementation for improved effectiveness is needed., (© 2024 American School Health Association.)

Background: Studies have shown associations between polygenic risk scores for educational attainment (PRS EA ), cognitive reserve (CR), cognition, negative symptoms (NS), and psychosocial functioning in first-episode psychosis (FEP). However, their specific interactions remain unclear. This study aimed to investigate the mediating roles of CR, cognition, and NS in the relationship between PRS EA and psychosocial functioning one year after a FEP. Additionally, we sought to explore the impact of two NS subtypes on this relationship: diminished Expression (EXP-NS) and Motivation and Pleasure (MAP-NS)., Methods: A total of 138 FEP participants, predominantly male (70%), with a mean age of 24.77 years (SD = 5.29), underwent genetic, clinical, and cognitive assessments two months after study enrollment. Functioning evaluation followed at one-year follow-up. To investigate the mediating role of CR, cognition, and NS in the relationship between PRS EA and functioning, a serial mediation model was employed. Two further mediation models were tested to explore the differential impact of EXP-NS and MAP-NS. Mediation analysis was performed using the PROCESS macro version 4.1 within SPSS version 26., Results: The serial mediation model revealed a causal chain for PRS EA  > CR > cognition > NS > Functioning (β = -3.08, 95%CI [-5.73, -0.43], p = 0.023). When differentiating by type of NS, only EXP-NS were significantly associated in the casual chain (β = -0.17, 95% CI [-0.39, -0.01], p < 0.05)., Conclusions: CR, cognition and NS -specifically EXP-NS- mediate the association between PRS EA and psychosocial functioning at one-year follow-up in FEP patients. These results highlight the potential for personalized interventions based on genetic predisposition., (© 2024 The Author(s). Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

Most wearable biosensors aimed at capturing psychological state target stress biomarkers in the form of physical symptoms that can correlate with dysfunction in the central nervous system (CNS). However, such markers lack the specificity needed for diagnostic or preventative applications. Wearable biochemical sensors (WBSs) have the potential to fill this gap, however, the technology is still in its infancy. Most WBSs proposed thus far target cortisol. Although cortisol detection is demonstrated as a viable method for approximating the extent and severity of psychological stress, the hormone also lacks specificity. Multiplex WBSs that simultaneously target cortisol alongside other viable stress-related biochemical markers (SBMs) can prove to be indispensable for understanding how psychological stress contributes to the pathophysiology of neuropsychiatric illnesses (NPIs) and, thus, lead to the discovery of new biomarkers and more objective clinical tools. However, none target more than one SBM implicated in NPIs. Till this review, cortisol's connection to dysfunctions in the CNS, to other SBMs, and their implication in various NPIs has not been discussed in the context of developing WBS technology. As such, this review is meant to inform the biosensing and neuropsychiatric communities of viable future directions and possible challenges for WBS technology for neuropsychiatric applications., (© 2024 The Author(s). Advanced Science published by Wiley‐VCH GmbH.)

Objective: To identify pain phenotypes in patients with endometriosis and investigate their associations with demographics, clinical characteristics, comorbidities and pain-related quality of life (QoL)., Design: Cross-sectional, single-centre, population-based study., Setting: Referral university centre in Quebec City, Canada., Population: Patients diagnosed with endometriosis were enrolled consecutively between January 2020 and April 2024., Methods: Latent class analysis was used to identify pain phenotypes. A three-step approach of latent class analysis, involving logistic regression models, was applied to assess the associations between pain phenotypes and demographics, clinical characteristics, comorbidities and pain-related QoL., Main Outcome Measures: Pain phenotypes; demographic, clinical and comorbidity predictors of phenotype membership; association between QoL and pain phenotypes., Results: A total of 352 patients were included. Two pain phenotypes were identified with distinct clinical presentations: one (54% of the participants) with more severe and frequent pain symptoms and poorer QoL and the other (46% of the participants) with mild and less frequent pain symptoms. The high pain phenotype was associated with previous treatment failure, painkiller use, familial history of endometriosis, low annual family income and comorbidities, including painful bladder, fibromyalgia, migraines, lower back pain, irritable bowel syndrome, anxiety and depression or mood disorders. The presence of endometrioma was associated with the low pain phenotype. Phenotype membership was associated with distinct QoL profiles (p < 0.001). The mean QoL score was higher in the high pain phenotype (59; 95% CI, 56-62) than in the low pain phenotype (33; 95% CI, 29-37)., Conclusion: Patients with endometriosis can be categorised into two distinct phenotypes that correlate with QoL and patient characteristics. Validation in other populations is necessary and could aid the development of specialised or personalised interventions., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Caregivers of young people with borderline personality disorder (BPD) or BPD features experience significant burden and distress and often lack effective coping strategies. A family environment of pervasive invalidation can contribute to the disorder and work against effective coping. Consequently, some psychotherapy interventions for young people with BPD or BPD features aim to incorporate caregivers in treatment to varying degrees. This review synthesised results of existing studies that included caregivers in psychotherapy alongside their young person and that examined caregiver outcomes using quantitative measures. The review and literature search were conducted in accordance with PRISMA guidelines. Searches of five databases returned a total of 2988 articles, of which 10 met inclusion criteria and only two of which were RCTs. Seven used a dialectical behaviour therapy approach, two used brief psychoeducation, and one was an online social group. Articles examined changes in caregivers regarding treatment feasibility and satisfaction, emotion communication, perceived knowledge of BPD and caregiver mental health, burden and stress. Although there are few studies and results are limited by considerable methodological limitations, results suggest that including caregivers in treatment alongside young people, even in a brief capacity, may improve caregiver outcomes on several measures. Inclusion of caregivers is conceptually particularly pertinent for BPD for young people, and this review reveals important clinical implications and clear future research directions., (© 2024 John Wiley & Sons Ltd.)

Introduction: Mental disorders during young adulthood can significantly impair functioning in daily activities. Non-clinical support services aim to improve functioning by helping people to build social and life skills, participate in education and employment and improve physical health. This study aims to examine and synthesise the evidence for non-clinical services on improving functional outcomes for young adults with mental disorders., Methods: A systematic search was undertaken to identify quantitative and qualitative studies reporting on a non-clinical service component (vocational support, peer support, youth development, lifestyle interventions, family and network support) and examining functional outcomes (e.g., outcomes focussed on work and education, life skills, relationships and healthy behaviours)., Results: Seventeen studies met inclusion criteria. Identified studies focussed on vocational support services (n = 9), lifestyle interventions (n = 6) and family and network support services (n = 2). No studies on peer-support services or youth development services were found. More than half of the vocational support service studies reported increased employment rates among young adults (n = 6). Studies focussing on lifestyle interventions included a combination of physical activity, nutrition education, health coaching and motivation and behaviour change. However, the measures of functioning used across studies were too varied to determine whether lifestyle interventions may be useful in improving functional outcomes for young adults., Conclusion: 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 disorders., (© 2024 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of "temporal determinism". Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific markers, relying on a more "mechanistic" or "statistical" form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification's own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services., Methods: We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up., Results: Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met., Conclusions: We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement., (© 2024 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Schizophrenia (SCZ) is a severe neurodevelopmental disorder affecting 1% of populations worldwide with a grave disability and socioeconomic burden. Current antipsychotic medications are effective treatments for positive symptoms, but poorly address negative symptoms and cognitive symptoms, warranting the development of better treatment options. Further understanding of SCZ pathogenesis is critical in these endeavors. Accumulating evidence has pointed to the role of mitochondria and metabolic dysregulation in SCZ pathogenesis. This review critically summarizes recent studies associating a compromised mitochondrial function with people with SCZ, including postmortem studies, imaging studies, genetic studies, and induced pluripotent stem cell studies. This review also discusses animal models with mitochondrial dysfunction resulting in SCZ-relevant neurobehavioral abnormalities, as well as restoration of mitochondrial function as potential therapeutic targets. Further understanding of mitochondrial dysfunction in SCZ may open the door to develop novel therapeutic strategies that can address the symptoms that cannot be adequately addressed by current antipsychotics alone., (© 2020 WILEY Periodicals, Inc.)

Scope: Cerebral ischemia-reperfusion (IR) injury stands as a prominent global contributor to disability and mortality. Nervonic acid (NA), a bioactive elongated monounsaturated fatty acid, holds pivotal significance in human physiological well-being. This research aims to explore the prophylactic effects and fundamental mechanisms of NA in a rat model of cerebral IR injury., Methods and Results: Through the induction of middle cerebral artery occlusion, this study establishes a rat model of cerebral IR injury and comprehensively assesses the pharmacodynamic impacts of NA pretreatment. This evaluation involves behavioral analyses, histopathological examinations, and quantification of serum markers. Detailed mechanisms of nervonic acid's prophylactic effects are revealed through fecal metabolomics and 16S rRNA sequencing analyses. Our findings robustly support nervonic acid's capacity to ameliorate neurological impairments in rats afflicted with cerebral IR injury. Beyond its neurological benefits, NA demonstrates its potential by rectifying metabolic perturbations across diverse pathways, particularly those pertinent to unsaturated fatty acid metabolism. Additionally, NA emerges as a modulator of gut microbiota composition, notably by selectively enhancing vital genera like Lactobacillus., Conclusion: These comprehensive findings highlight the potential of incorporating NA as a functional component in dietary interventions aimed at targeting cerebral IR injury., (© 2024 Wiley‐VCH GmbH.)

Aim: Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune-metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. Thus, we aimed to investigate underlying drivers of metabolic dysfunction and premature cardiovascular disease in young people in the early phases of common mood disorders., Methods: We evaluated the relationships between insulin resistance (assessed by HOMA2-IR) and body mass index (BMI), sex, diagnosis, medication, inflammatory markers and hormonal factors in 327 inpatients with emerging affective and major mood disorders admitted to the Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney., Results: While HOMA2-IR scores were positively associated with BMI (r s  = 0.465, p < .001), they were also higher in those prescribed mood stabilizers (p = .044) but were not associated with specific diagnoses, other medication types or the number of prescribed medications. Further, high-sensitivity C-reactive protein levels (but not thyroid-stimulating hormone and ferritin levels) were positively associated with HOMA2-IR (r s  = 0. 272, p < .001) and BMI (r s  = . 409, p < .001)., Conclusions: In addition to BMI, other non-specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders., (© 2021 John Wiley & Sons Australia, Ltd.)

Introduction: Due to the significant burden associated with mental disorders that have their onset in youth, there is a critical need to improve treatments and treatment outcomes. Given the evidence for physical activity (PA) as an effective intervention for reducing depression and anxiety symptoms in young people, we examined young people's attitudes towards and acceptability of PA as part of mental health treatment, predictors of current engagement in PA and predictors of attitudes towards PA as a treatment option., Methods: Participants in this cross-sectional study were 88 young people (15-25 years) who were engaged in treatment at youth mental health services in Melbourne, Australia., Results: Young people's attitudes towards PA as a treatment option were generally positive. The acceptance of PA as a treatment option was predicted by fewer perceived barriers and more benefits to exercise, higher autonomous motivation and lower amotivation; whereas, the only significant predictor of current engagement in PA was autonomous motivation., Discussion: The integration of PA interventions within mental health treatment appears to be acceptable to young people; however, acceptance of PA as a treatment option is influenced by perceived barriers and benefits of PA and autonomous motivation. A focus on increasing autonomous motivation by enhancing the perceived value of PA and choosing preference-based, enjoyable activities may assist in addressing the complex range of factors that impact the ability of these young people to become more physically active. Addressing these factors may assist with implementing PA interventions within psychological treatments for mental disorders., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Voice hearing in the context of Borderline Personality Disorder (BPD) has traditionally been regarded as transient and an experience that lacks legitimacy. Consequently, there are no evidence-based treatments for the voices reported by BPD patients. Contrary to the traditional view, there is a growing literature suggesting that voice hearing in the context of BPD can be an enduring and distressing experience which shares similarities with voice hearing in the context of psychosis. Given these similarities, the aim of this study was to explore whether brief Coping Strategy Enhancement developed in the context of psychosis can be used to treat distressing voice hearing in the context of BPD., Method: This was a service evaluation carried out in a specialist NHS service delivering psychological therapies for distressing voices. Patients with either a BPD (n = 46) or a psychosis diagnosis (n = 125) received four sessions of Coping Strategy Enhancement (CSE). The primary outcome was voice-related distress. The pre-post outcomes for BPD patients were explored and compared with those achieved by the psychosis patients., Results: Both the BPD and psychosis groups experienced a significant reduction in voice-related distress after CSE compared with baseline. The interaction between diagnosis group and time was small and statistically non-significant., Conclusion: These findings suggest a brief CSE intervention developed in the context of psychosis can be an effective starting point in the treatment of distressing voice hearing in the context of BPD. Such interventions have the potential to be integrated into broader BPD treatment programmes for those who hear voices., (© 2021 John Wiley & Sons, Ltd.)

Aim: Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first-episode psychosis (FEP) across a 2-year follow-up period., Methods: Participants (n = 104; 18-50 years) were recruited within the 'Parma-Early Psychosis' program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed-design analysis of variance (ANOVA) and Kaplan-Maier survival analysis (as drop-out measure) were performed., Results: A significant effect of time on all BPRS, HoNOS and GAF scores along the follow-up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed-design ANOVA results showed a significant 'time x group' interaction effects on BPRS 'Disorganization', HoNOS 'Psychiatric Symptoms' and GAF scores in FEP participants with PHB. Kaplan-Meyer survival analysis showed a longer survival mean for FEP patients with PHB., Conclusions: Our results support the applicability of a PHB model within an 'Early Intervention in Psychosis' program in public community mental health services., (© 2021 John Wiley & Sons Australia, Ltd.)

A more dynamic perspective of threats to the self may contribute to an enhanced understanding of the processes that develop and maintain anxiety and thus, potentially inform psychological interventions. This article presents the looming vulnerability model of anxiety, which stresses the threat or risk prospection and dynamic mental simulation of the course of threat. Individuals do not become anxious simply because they picture distant or static possible threats that represent threats to the self. Rather, their anxiety results from interpreting potential threats as dynamic, growing, and approaching. Following a review of a wide range of literature from clinical, personality, and social psychology, we present the looming vulnerability model and its underpinnings in evolution and examine its applications to cognitive vulnerability to anxiety and its therapeutic alleviation [Correction added on 6 August 2019, after first online publication: Abstract text has been corrected to 'looming vulnerability model' in two places.]. We also address the associations of the model to other self-related concepts that are involved in anxiety., (© 2019 Wiley Periodicals, Inc.)

Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes., Aim: The primary aim of the study is, in a population of young people with first-episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence-based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24-months follow-up., Methods: Our single-blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2-year period in 180 remitted first-episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow-up., Results: This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017., Conclusion: This study will provide evidence as to whether an antipsychotic dose-reduction recovery treatment leads to improved functioning and safer outcomes in first-episode psychosis patients. In addition, it will be the first-controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population., (© 2018 John Wiley & Sons Australia, Ltd.)

Grey matter (GM) volume alterations have been repeatedly demonstrated in patients with first episode psychosis (FEP). Some of these neuroanatomical abnormalities are already evident in the at-risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous. Thus, we evaluated associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in antipsychotic-naïve ARMS and FEP patients. Data from 59 ARMS and 31 FEP patients, collected within the prospective Früherkennung von Psychosen study, were analysed. Structural T1-weighted images were acquired using a 3 Tesla magnetic resonance imaging scanner. VLM was assessed using the California Verbal Learning Test and its factors Attention Span, Learning Efficiency, Delayed Memory and Inaccurate Memory. FEP patients showed significantly enlarged volumes of hippocampus, pallidum, putamen and thalamus compared to ARMS patients. A significant negative association between amygdala and pallidum volume and Attention Span was found in ARMS and FEP patients combined, which however did not withstand correction for multiple testing. Although we found significant between-group differences in subcortical volumes and VLM is among the most impaired cognitive domains in emerging psychosis, we could not demonstrate an association between low performance and subcortical GM volumes alterations in antipsychotic-naïve patients. Hence, deficits in this domain do not appear to stem from alterations in subcortical structures., (© 2019 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)