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Aim: Major depressive disorder (MDD) has far reaching impacts for young people, their families and society. Cognitive behavioural therapy (CBT) is one of the first‐line treatments for young people experiencing MDD; however, there is limited research examining how young people with MDD experience CBT. The aim of this study was to explore their experience and their views of this intervention. Methods: We employed a qualitative research design, with semi‐structured interviews and thematic analysis. Eight participants aged between 17 and 24 years who received CBT for MDD in a randomized controlled trial were recruited. Results: Five themes were identified: the importance of relationship with clinician; the range of useful components within CBT; the ability for CBT to accommodate different techniques and presenting issues; the importance of checking in with clients during the process of therapy; and the impacts of MDD on therapy. Conclusions: The findings highlight the importance of clinicians having a youth friendly and collaborative approach that allows a modular delivery of a range of CBT techniques to suit the client's presenting issue and formulation. There is a need to continually check how young people are responding to interventions, and to be aware of potential cognitive deficits and adjust therapy accordingly. This is a small study that provides insight into how young people with MDD experience CBT and avenues to explore for tailoring provision of CBT to enhance the therapeutic experience for this population. [ABSTRACT FROM AUTHOR]

Objective: Comorbid social anxiety is common in psychotic disorders and is associated with multiple negative consequences. However, the long‐term effects of persistent social anxiety versus fluctuating or no anxiety on social functioning and health‐related quality of life (HR‐QoL) have received scant attention. Therefore, we aimed to examine the prevalence of persistent social anxiety to determine its effect on social functioning and HR‐QoL in first‐episode psychosis (FEP). Methods: One hundred and eight individuals with remitted FEP were classified into three groups (persistent, fluctuating or no social anxiety) according to the Social Interaction Anxiety Scale over an 18‐month follow‐up period. The three groups were then compared at 18 months follow‐up to assess the influence of social anxiety on social functioning and HR‐QoL before and after controlling for confounders. Results: Of the 108 individuals with FEP, 25 (23.1%) had persistent social anxiety. This group presented lower social functioning and HR‐QoL levels compared to the groups with fluctuating or no anxiety symptoms. The effect on HR‐QoL remained significant after controlling for positive psychotic and depressive symptoms. Conclusions: In this study, nearly one‐quarter of young people with remitted FEP experienced persistent social anxiety symptoms, which had a negative impact on HR‐QoL. Thus, individuals with persistent social anxiety constitute a highly vulnerable group and may require targeted interventions to improve their social functioning and HR‐QoL. [ABSTRACT FROM AUTHOR]

Background: Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up‐skill patients and their families. The benefits of SEI over the first few years have been demonstrated. While early recovery can be expected to translate to better long‐term outcomes by analogy with other illnesses, there is limited evidence to support this from follow‐up studies. The current study involves the long‐term follow‐up of a sub‐set of first episode psychosis (FEP) patients, with a range of diagnoses, who were first treated at Orygen's Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. The aim of this paper is to present the methodology for this follow‐up study. Methods: Between January 1998 and December 2000, 786 patients between the ages of 15–29 years were treated at EPPIC, located in Melbourne, Australia. Our cohort consists of 661 people (82 were transferred/discharged and 43 were not diagnosed with a psychotic disorder at time of discharge). The 18‐month treatment characteristics of this cohort have been extensively examined in the First Episode Psychosis Outcome Study (FEPOS). The ≥15 year outcomes of this cohort are being examined in this study, known as FEPOS15. Results: Participant follow‐up is ongoing. In order to extend and assess broader outcomes of the cohort, data linkage with health‐related databases will be conducted. Conclusion: This study will provide a comprehensive evaluation of the long‐term trajectory of psychotic disorders after treatment for FEP in a SEI service. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre–post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. Methods: The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15–25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer‐to‐carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow‐up. Multiple indicators of acceptability, usability and safety were utilized. Results: Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow‐up. Sixty‐six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. Conclusion: Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background: First‐episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well‐being (EWB), or positive self‐development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. Aim: Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. Methods: Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. Results: Studies comprised six RCTs, eight prospective follow‐up studies and three case‐controlled studies. Self‐esteem and self‐efficacy were the most commonly measured components. A meta‐analysis of RCTs revealed no statistically significant effect of interventions on self‐esteem. The extant research indicates that character strengths may be associated with higher EWB. Self‐esteem may be lower in FEP compared with age matched controls but not different from ultra‐high risk patients. Self‐esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. Conclusions: The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the feasibility and acceptability of Horyzons, an online social media platform designed to facilitate relationship development among, and introduce therapeutic content to, first‐episode psychosis (FEP) clients. We also evaluated whether participation in the platform was related to reduced loneliness, improved social integration and increased psychological well‐being. Methods: Twenty‐six participants diagnosed with a schizophrenia spectrum disorder were provided access to the moderated Horyzons platform for 12 weeks. During the intervention period, participants were encouraged to access therapeutic content and social components embedded within the site. Participants were recruited from three first‐episode coordinated specialty care clinics in North Carolina and assessed at four time points: baseline, mid‐treatment, post‐treatment and 1‐month follow‐up. Results: Findings indicated that Horyzons was both feasible and very well tolerated, with a 92.3% retention rate and 79.2% of participants actively engaged in the platform. The most commonly identified personal strengths selected by Horyzons users were creativity (61.5%), curiosity (42.3%) and courage (38.5%). Feedback from participants indicated Horyzons could be improved by the development of a smartphone application, expanding the size of the Horyzons community and facilitating private messages between users. Preliminary results with engaged participants showed the greatest improvements in psychosis‐related symptoms, followed by self‐reported experience of negative emotions, depressive symptoms and loneliness. Conclusions: This open trial found that Horyzons is both feasible and acceptable to FEP persons early in the course of illness living in the United States. [ABSTRACT FROM AUTHOR]

Aim: We conducted a single‐group pilot study to evaluate the feasibility, acceptability and safety of a novel online intervention (entitled EMBRACE) that includes expert and peer moderation, therapeutic comics and social networking features. The cognitive‐behavioural‐based intervention was specifically designed to treat social anxiety as a primary treatment target in youth with first‐episode psychosis (FEP). Methods: The 10 participants (17‐26 years; Mage = 23 years) had a diagnosis of FEP and experienced significant levels of social anxiety as defined by exceeding a sub‐threshold clinical score (>30) on the Social Interaction Anxiety Scale (SIAS). They had access to the EMBRACE intervention for 2 months. Results: In total, seven out of ten participants completed eight modules or more (total of 12 modules). All participants rated the intervention as positive and safe, and endorsed recommending it to others who experience social anxiety. Improvement in pre‐post social anxiety symptoms, as measured via the SIAS (d = −1.70, P =.0005) and the Liebowitz Social Anxiety Scale (d = −1.35, P =.002) were found. No statistically significant pre‐post improvements were found for depressive or loneliness symptoms. Conclusion: EMBRACE was shown to be a feasible, acceptable, and safe online intervention to specifically target social anxiety as a primary treatment concern in young people with FEP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Implementation of targeted e‐mental health interventions offers a promising solution to reducing the burden of disease associated with youth depression. A single‐group pilot study was conducted to evaluate the acceptability, feasibility, usability and safety of a novel, moderated online social therapy intervention (entitled Rebound) for depression relapse prevention in young people. Methods: Participants were 42 young people (15–25 years) (50% men; mean age = 18.5 years) in partial or full remission. Participants had access to the Rebound platform for at least 12 weeks, including the social networking, peer and clinical moderator and therapy components. Results: Follow‐up data were available for 39 (92.9%) participants. There was high system usage, with 3034 user logins (mean = 72.2 per user) and 2146 posts (mean = 51.1). Almost 70% of users had ≥10 logins over the 12 weeks, with 78.5% logging in over at least 2 months of the pilot. A total of 32 (84%) participants rated the intervention as helpful. There was significant improvement between the number of participants in full remission at baseline (n = 5; none of whom relapsed) relative to n = 19 at 12‐week follow‐up (P < 0.001). Six (14.3%) participants relapsed to full threshold symptoms at 12 weeks. There was a significant improvement to interviewer‐rated depression scores (Montgomery–Asberg Depression Rating Scale (MADRS); P = 0.014, d = 0.45) and a trend for improved strength use (P = 0.088, d = 0.29). The single‐group design and 12‐week treatment phase preclude a full understanding of the clinical benefits of the Rebound intervention. Conclusions: The Rebound intervention was shown to be acceptable, feasible, highly usable and safe in young people with major depression. [ABSTRACT FROM AUTHOR]