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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 psychosis services 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. 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, low SRMH was associated with not being in positive symptom remission and poorer functioning. Conclusions: Patient‐reported outcome measures may perform differently across contexts as a potential function of variations in sociodemographics, illness characteristics/course, understandings of health/mental health, and so forth. More work is needed to understand if discrepancies between PROMs and CROMs indicate poor validity of PROMs or 'valid' differences between patient and clinician perceptions. Our work suggests that single‐item PROMs can be feasibly integrated into clinical settings. [ABSTRACT FROM AUTHOR]

Background: Data from high-income countries (HICs) show a high risk of suicidal thoughts and behaviors (STBs) in first-episode psychosis (FEP). It is unknown, however, whether rates and associated factors differ in low- and middle-income countries (LMICs). Aims: We therefore aimed to compare the 2-year course of STBs and associated factors in persons with FEP treated in two similarly structured early intervention services in Chennai, India and Montreal, Canada. Method: To ensure fit to the data that included persons without STBs and with varying STBs' severity, a hurdle model was conducted by site, including known predictors of STBs. The 2-year evolution of STBs was compared by site with mixed-effects ordered logistic regression. Results: The study included 333 FEP patients (168 in Chennai, 165 in Montreal). A significant decrease in STBs was observed at both sites (OR = 0.87; 95% CI [0.84, 0.90]), with the greatest decline in the first 2 months of follow-up. Although three Chennai women died by suicide in the first 4 months (none in Montreal), Chennai patients had a lower risk of STBs over follow-up (OR = 0.44; 95% CI [0.23, 0.81]). Some factors (depression, history of suicide attempts) were consistently associated with STBs across contexts, while others (gender, history of suicidal ideation, relationship status) were associated at only one of the two sites. Conclusions: This is the first study to compare STBs in FEP between two distinct geo-sociocultural contexts (an HIC and an LMIC). At both sites, STBs reduced after treatment initiation, suggesting that early intervention reduces STBs across contexts. At both sites, for some patients, STBs persisted or first appeared during follow-up, indicating need for suicide prevention throughout follow-up. Our study demonstrates contextual variations in rates and factors associated with STBs. This has implications for tailoring suicide prevention and makes the case for more research on STBs in FEP in diverse contexts. [ABSTRACT FROM AUTHOR]

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Aim: Despite their emphasis on engagement, there has been little research on patients' and families' experiences of care in early intervention services for psychosis. We sought to compare patients' and families' experiences of care in two similar early psychosis services in Montreal, Canada and Chennai, India. Because no patient‐ or family‐reported experience measures had been used in a low‐ and middle‐income context, we created a new measure, Show me you care. Here we present its development and psychometric properties. Methods: Show me you care was created based on the literature and stakeholder inputs. Its patient and family versions contain the same nine items (rated on a 7‐point scale) about various supportive behaviours of treatment providers towards patients and families. Patients (N = 293) and families (N = 237) completed the measure in French/English in Montreal and Tamil/English in Chennai. Test–retest reliability, internal consistency, convergent validity, and ease of use were evaluated. Results: Test–retest reliability (intra‐class correlation coefficients) ranged from excellent (0.95) to good (0.66) across the patient and family versions, in Montreal and Chennai, and in English, French, and Tamil. Internal consistency estimates (Cronbach's alphas) were excellent (≥0.87). The measure was reported to be easy to understand and complete. Conclusion: Show me you care fills a gap between principles and practice by making engagement and collaboration as central to measurement in early intervention as it is to its philosophy. Having been co‐designed and developed in three languages and tested in a low‐and‐middle‐income and a high‐income context, our tool has the potential for global application. [ABSTRACT FROM AUTHOR]

Background There exist few direct studies of delusional content in psychosis across geo-cultural contexts, especially those in which treatment protocols and measures are comparable. To directly examine an illness outcome that is potentially culturally mediated, this study investigated the baseline presentation and longitudinal trajectory of delusions in first-episode psychosis (FEP) across 2 similar treatment settings in Montréal (Canada) and Chennai (India). Study Design Patients entering an early intervention program for FEP in Chennai (N = 168) and Montréal (N = 165) were compared on site-level differences in the presentation of delusions across specific time points over 2 years of treatment. Delusions were measured using the Scale for Assessment of Positive Symptoms. Chi-square and regression analyses were conducted Study Results At baseline, delusions were more frequent in Montréal than in Chennai (93% vs 80%, respectively; X 2 (1) = 12.36, P <.001). Thematically, delusions of grandiosity, religiosity, and mind reading were more common in Montréal than in Chennai (all P <.001); however, these baseline differences did not persist over time. Regression revealed a significant time-by-site interaction in the longitudinal course of delusions, which differs from the trajectory of other FEP-positive symptom domains. Conclusions To the best of our knowledge, this is the first direct comparison of delusions in similar programs for FEP across 2 different geo-cultural contexts. Our findings support the notion that delusion themes follow consistent ordinal patterns across continents. Future work is needed to unpack the differences in severity that present at baseline and minor differences in content. [ABSTRACT FROM AUTHOR]

Megha Majumdar A Burning New York. Alfred A. Knopf. 2020. 293 pages. MEGHA MAJUMDAR'S debut novel, A Burning, narrates the ramifications of a terrorist attack--as indicated by the title, the [...]

Aim: To compare social, recreational and independent functioning among persons with psychosis across two geo‐cultural contexts, we adapted the well‐established Social Functioning Scale (SFS) and translated it into French and Tamil. We present the development and psychometric testing of this adaptation, the SFS‐Early Intervention. Methods: Sixteen items were added to reflect contemporary youth activities (e.g., online games) and 31 items adapted to enhance applicability and/or include context‐specific examples (e.g., 'church activity' replaced with 'religious/spiritual activity'). Psychometric properties and participant feedback were evaluated. Results: Test–retest reliability (ICCs) ranged from 0.813 to 0.964. Internal consistency (Cronbach's α) ranged from.749 to.936 across sites and languages. Correlations with original subscales were high. The scale was rated easy to complete and understand. Conclusions: The SFS‐Early Intervention is a promising patient‐reported measure of social, recreational and independent functioning. Our approach shows that conceptually sound existing measures are adaptable to different times and contexts. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. Methods: Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). Results: The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). Conclusions: This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes. [ABSTRACT FROM AUTHOR]

The evaluation and usefulness of lightning prediction for the Indian subcontinent are demonstrated. Implementation of the lightning parameterizations based on storm parameters, in the Weather Research and Forecasting (WRF) Model, with different microphysics schemes are carried out. With the availability of observed lightning measurements over Maharashtra from the lightning detection network (LDN), lightning cases have been identified during the pre-monsoon season of 2016–18. Lightning parameterization based on cloud top height defined by a reflectivity threshold factor of 20 dBZ is chosen. Initial analysis is carried out for 16 lightning events with four microphysical schemes for the usefulness in lightning prediction. Objective analysis is carried out and quantitative model performance (skill scores) is assessed based on observed data. The skills are evaluated for 10- and 50-km2 boxes from the 1-km domain. There is good POD of 0.86, 0.82, 0.85, and 0.84, and false alarm ratio (FAR) of 0.28, 0.25, 0.29, and 0.26 from WSM6, Thompson, Morrison, and WDM6, respectively. There is an overestimation in lightning flash with a spatial and temporal shift. The fractional skill score is evaluated as a function of spatial scale with neighborhoods from 25 to 250 km. These high skill scores and high degree of correlation between observations and model simulation gives us confidence to use the system for real-time operational forecast over India. The skill for 2019 and 2020 pre-monsoon are calculated to address the predictability of operational lightning prediction over India. Significance Statement: A high-resolution model, namely, the Weather Research and Forecasting (WRF) Model, with multiple microphysics parameterization schemes and lightning parameterization is used here. The objective analysis is carried out for the lightning cases over India and the quantitative performance is assessed. The results highlight that there is fairly good probability of detection (POD) of 0.86, 0.82, 0.85, and 0.84 and false alarm ratio (FAR) of 0.28, 0.25, 0.29, and 0.26 from four different microphysical schemes (WSM6, Thompson, Morrison, and WDM6, respectively). These high skill scores and high degree of correlation between observations and model simulation gives us confidence to use the system for real-time operational forecast. The validation of lightning forecast system deployed over India for five pre-monsoon months in real time is carried out, which gives POD of 0.90, FAR of 0.64, hit rate of 0.57, and POFD of 0.50 for the whole Indian region. [ABSTRACT FROM AUTHOR]

Skillful seasonal prediction of lightning is crucial over several global hotspot regions, as it causes severe damages to infrastructures and losses of human life. While major emphasis has been given for predicting rainfall, prediction of lightning in one season advance remained uncommon, owing to the nature of problem, which is short‐lived local phenomenon. Here we show that on seasonal time scale, lightning over the major global hotspot regions is strongly tied with slowly varying global predictors (e.g., El Niño and Southern Oscillation). Moreover, the sub‐seasonal variance of lightning is highly correlated with global predictors, suggesting a seminal role played by the global climate modes in shaping the local land‐atmosphere interactions, which eventually affects seasonal lightning variability. It is shown that seasonal predictability of lightning over the hotspot is comparable to that of seasonal rainfall, opens up an avenue for reliable seasonal forecasting of lightning for special awareness and preventive measures. Plain Language Summary: Lightning, atmospheric hazards have an impact on the loss of human life, forest fire, health, agriculture, and economy across the globe. However, due to its chaotic nature, the tendency of seasonal forecasting of lightning is considered not viable as the understanding of the predictability of lightning is still incomplete. Here, we have explored the possibility of seasonal forecasting of lightning activity and provided a scientific basis as the lightning flashes are found to be tied with slowly varying remote forcings (e.g., El Niño and Southern Oscillation, or other global predictors). Correlation of flash count with different indices (Nino, Pacific decadal oscillation, North Atlantic oscillation, and Extra tropics, etc.) demonstrate the potential of seasonal forecasting of lightning. The multiple regression analysis enhances the skill. The climatology of lightning flash density from the Goddard Earth observing system model is compared with observation. The pattern correlation between observation and model is very high (∼0.7) over global tropics hints at the predictability of lightning flashes on a seasonal time scale. Therefore, better climate models that capture crucial couplings between ocean, atmosphere, and land processes could make skillful predictions of lightning and opens up a possibility for lightning forecast in one season advance. Key Points: Possibility of reliable seasonal forecasting of lightning over global hotspots is demonstratedLightning flashes are found to be tied with slowly varying remote global predictors (e.g., El Niño and Southern oscillation, Atlantic multidecadal oscillation, North Atlantic oscillation, Pacific decadal oscillation, and extra tropics)Multiple regression analysis demonstrates that seasonal lightning and associated rainfall is predictable during pre‐monsoon and monsoon [ABSTRACT FROM AUTHOR]

Background: Purported superior outcomes for treatment of psychosis in low- and middle-income (LMICs) compared with high-income (HICs) countries have not been examined in the context of early intervention services (EIS).Aims: To compare 2-year clinical outcomes in first-episode psychosis (FEP) treated in EIS in Chennai (LMIC) and Montreal (HIC) using a similar EIS treatment protocol and to identify factors associated with any outcome differences.Method: Patients with FEP treated in EIS in Chennai (n = 168) and Montreal (n = 165) were compared on change in level of symptoms and rate and duration of positive and negative symptom remission over a 2-year period. Repeated-measures analysis of variance, and logistic and linear regression analyses were conducted.Results: Four patients died in Chennai compared with none in Montreal. Family support was higher for Chennai patients (F = 14.05, d.f. = 1, P < 0.001, ƞp2 = 0.061) and increased over time at both sites (F = 7.0, d.f. = 1.915, P < 0.001, ƞp2 = 0.03). Negative symptom outcomes were significantly better in Chennai for level of symptoms (time × site interaction F = 7.36, d.f. = 1.49, P = 0.002, ƞp2 = 0.03), duration of remission (mean 16.1 v. 9.78 months, t = -7.35, d.f. = 331, P < 0.001, Cohen's d = 0.80) and the proportion of patients in remission (81.5% v. 60.3%, χ2 = 16.12, d.f. = 1, P < 0.001). The site differences in outcome remained robust after adjusting for inter-site differences in other characteristics. Early remission and family support facilitated better outcome on negative symptoms. No significant differences were observed in positive symptom outcomes.Conclusions: Patients with FEP treated in EIS in LMIC contexts are likely to show better outcome on negative symptoms compared with those in HIC contexts. Early remission and family support may benefit patients across both contexts. [ABSTRACT FROM AUTHOR]

Objectives: Views on who bears how much responsibility for supporting individuals with mental health problems may vary across stakeholders (patients, families, clinicians) and cultures. Perceptions about responsibility may influence the extent to which stakeholders get involved in treatment. Our objective was to report on the development, psychometric properties and usability of a first-ever tool of this construct. Methods: We created a visual weighting disk called 'ShareDisk', measuring perceived extent of responsibility for supporting persons with mental health problems. It was administered (twice, 2 weeks apart) to patients, family members and clinicians in Chennai, India (N = 30, 30 and 15, respectively) and Montreal, Canada (N = 30, 32 and 15, respectively). Feedback regarding its usability was also collected. Results: The English, French and Tamil versions of the ShareDisk demonstrated high test–retest reliability (r s =.69–.98) and were deemed easy to understand and use. Conclusion: The ShareDisk is a promising measure of a hitherto unmeasured construct that is easily deployable in settings varying in language and literacy levels. Its clinical utility lies in clarifying stakeholder roles. It can help researchers investigate how stakeholders' roles are perceived and how these perceptions may be shaped by and shape the organization and experience of healthcare across settings. [ABSTRACT FROM AUTHOR]

Numerical simulations of a thunderstorm event that occurred in the pre‐monsoon season over the North‐Eastern region of India (NEI) and Bangladesh are performed using Weather Research and Forecasting (WRF) Advanced Research Weather Research and Forecasting Model (ARW, version 3.8.1). Doppler weather radar indicates severe convective activity lasted for more than 10 hr. These extremely deep convective clouds with minimum cloud‐top temperature −70 °C at 19 km were triggered by the mixing of a moist air mass transported from the Bay of Bengal in the south and dry air transported from the northwest. A cyclonic circulation observed over the Tibetan plateau is likely to be associated with the strong southerly low‐level wind over NEI, as the plateau acts as a source of heat‐lows during the pre‐monsoon season. The coexistence of ice particles and supercooled water in the storms resulted in a large number of lightning flashes during the storm as observed from the Tropical Rainfall Measuring Mission Lightning Imaging Sensor (TRMM‐LIS). Co‐location of supercooled cloud water droplets helps in forming graupel through riming that plays a vital role in these convective systems. Lightning flashes calculated from WRF simulation using the Morrison microphysical and cloud top height based dynamical lightning parametrization scheme was found comparable with the observed flashes from TRMM‐LIS. Since the WRF model could simulate the thunderstorm, we recommend using this state‐of‐the‐art regional model in thunderstorm and lightning predictions for northeast India which would be useful in preparedness for such extreme events. [ABSTRACT FROM AUTHOR]

Background: Understanding the concept of recovery in severe mental illnesses such as schizophrenia from the social and cultural aspects is important as it will help in developing models of recovery and appropriate interventions. Client and caregiver perspectives on recovery play a significant role in shaping these models and interventions. Hence, the aim of this study was to understand how clients with schizophrenia and their caregivers perceive recovery and to examine the differences between male and female clients with schizophrenia. Materials and methods: A total of 100 clients with schizophrenia and 80 caregivers of clients with schizophrenia were included in the study after written informed consent. A semi-structured proforma was used to collect the sociodemographic profile and illness variables. A questionnaire was developed to assess the indicators of recovery from mental illness and was administered to study participants. Descriptive statistics including frequency and percentages were used along with the chi-square test for analysis. Results: The most common indicators of recovery for the clients with schizophrenia were absence of symptoms (88%), no relapse (70%) and going back to work (70%), while for the caregivers were absence of symptoms (100%), becoming independent (92.5%) and no relapse (91%). Indicators of recovery were similar between male and female clients with schizophrenia except for the need to stop medication as an indicator of recovery observed significantly more in females (p =.006). Most clients used internal validation of indicators to assess their recovery (79%). Conclusion: Results indicate that clients and caregivers from India perceive recovery as being symptom free, able to go back to work and being independent. Clients with schizophrenia use internal validation to assess recovery. Gender does not play a role in the perceptions toward recovery in schizophrenia. These results will help in developing models of recovery for severe mental illness in Indian context leading to tailored interventions. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to examine how existing mental health within the city of Chennai, India manages first‐episode psychosis, to determine lacunae and barriers in providing effective early intervention and to make appropriate recommendations to improve the care of first‐episode psychosis patients. Methods: Interviews were held with 15 health professionals to capture information on current practices and facilities available for the management of first‐episode psychosis. Results: No specialized clinic or services were available for individuals with first‐episode psychosis in Chennai, except one. Pharmacotherapy was the main treatment modality with psychological support to patients and families. Most common drugs used were Risperidone, Olanzapine, and Haloperidol in their recommended doses. General practitioners and paediatricians, due to inadequate training in mental health, referred patients with psychosis to mental health professionals. Conclusions: Equipping the existing mental health services to manage FEP and training all health professionals on psychosis will improve FEP management in Chennai. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to follow-up the individuals with first-episode psychosis (FEP) for a period of 1 year to assess their medication adherence rates and to identify the association between medication adherence and psychopathology. Materials and Methods: In a 1 year longitudinal study, 59 individuals with FEP were assessed for their sociodemographic profile and medication adherence at 1 month and 12-month follow-up period using a semi-structured per forma. Positive and negative symptoms were assessed by positive and negative syndrome scale (PANSS) while the functioning by global assessment of functioning (GAF) scale. Results: Nearly 85% of the individuals were adherent with medications during the 1-month follow-up period, 32.2% were poorly adherent at the end of 12 months. Among various factors examined for association with medication adherence, positive and negative symptoms, and global functioning of the individuals at the end of 12 months were found to significant associated with poor medication adherence. Conclusion: There is a high rate of medication nonadherence in individuals with FEP at 12-month follow-up, and factors affecting nonadherence should be addressed specifically to improve medication adherence in these individuals. [ABSTRACT FROM AUTHOR]

ABSTRACT Polydimethylsiloxane (PDMS) has many biomedical applications, since it is biocompatible, easy to fabricate and inexpensive. The response of biological cells and tissues is affected by the mechanical properties of the PDMS surface, which can be controlled by varying the crosslinking percentage. It is essential to find reliable ways to measure elastic properties of PDMS prepared with different surface conditions or stiffness gradients. In this paper, the elastic modulus of PDMS was measured at different scales as a function of the crosslinking percentage varied from 2% to 9%. Macroscopic compression and tension tests were used and compared with the nano-JKR (Johnson-Kendall-Roberts) method applied to a microindentation test. Depending on the test, the PDMS elastic modulus increased from 10 to 85 fold with the crosslinking percentage change from 2% to 9%. The PDMS elastic modulus varied as a sigmoid function with the crosslinking percentage for each type of test. The compression macroscale test is the easiest way to estimate the elastic modulus of stiffer PDMS with higher crosslinking percentage. For the more compliant and tacky PDMS samples with lower crosslinking percentage the nano-JKR test is more suitable, as it is sensitive and accounts for the surface adhesion forces. The samples with the lower crosslinking percentage are much less stiff in tension than in compression, resembling liquid-like behavior. © 2015 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2015, 132, 42680. [ABSTRACT FROM AUTHOR]

Combinatorial and high-throughput approaches to screening cell responses to material properties accelerate the speed of discovery and facilitate the identification of cell instructive cues or trends that may be missed by discrete sampling. However, these technologies have not yet been widely applied to materials with tissue-like stiffness. The fabrication of monotonically varying surface chemistry gradients on polydimethylsiloxane, an elastic biomaterial, and the influence of these engineered surfaces on protein adsorption and adherent cell morphology were explored in this study. Crosslinked networks of polydimethylsiloxane were functionalized with a hydrophobic self-assembled monolayer and then modified by spatiotemporally regulated ultraviolet ozonolysis to obtain gradients of oxygenated species ranging from ∼10° to ∼100° in water contact angle. Automated microscopy and image analysis of fibroblast cell morphology revealed a strong correlation between cell spreading and hydrophobicity. However, structural and functional analysis of the fibronectin interface indicated a proportional increase in cell spreading with adsorption, but a biphasic relationship with fibronectin conformation, underscoring the complexity of the adhesive interface. This work demonstrates the development of an elastomer surface modification platform that can be extended to future combinatorial studies of biological responses to chemical and mechanical material properties. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 103A: 2066-2076, 2015. [ABSTRACT FROM AUTHOR]

The article discusses a study on the feasibility of writing a psychiatric advance statement (PAS) in an Indian population. A stratified sampling was utilized to derive the final sample for inclusion in the study after obtaining informed consent. Data were entered and analysed using Statistical Package for the Social Sciences statistics software. It is said that capacity to consent to be involved in the study was different from their capacity to write a PAS.

Reduced heart rate variability (HRV) is an independent predictor of cardiac morbidity and mortality in hypertension. Studies examining the effects of angiotensin converting enzyme inhibitors on HRV produced controversial results. We investigated the effect of chronic lisinopril administration on HRV in spontaneously hypertensive rats. Frequency-domain analysis of the RR-intervals was performed to quantify the indices of HRV: low-frequency power (LF, 0.25-1Hz) and high-frequency power (HF, 1-4Hz). Data represents a weekly average of measurements obtained from 30 minutes beat-beat recording during night time (active period). Lisinopril (20 mg/Kg/day) administration for 12 weeks caused significantly lower mean arterial pressure (74 ±5.3 vs 140. ±5.3 mmHg) and higher HR (319 ± 6 vs 291± 5 bpm) compared to the untreated rats. In addition, HRV power spectral density (PSD) of treated rats was increased significantly at LF (0.73±0.1 vs 0.6±0.02 sec²/Hz) and at HF (0.53 ± 0.03 vs ± 0.41±0.002 sec²/Hz) resulting in overall increase in total PSD (2.0±0.001 vs 2.2±0.003 sec²/Hz). Our findings demonstrate that, in addition to the benefit of reducing blood pressure, lisinopril enhanced HRV indices related to sympathetic and vagal tones with minimal changes in sympathovagal tone. [ABSTRACT FROM AUTHOR]

Objective: Given the paucity of functional recovery measures for young people with psychosis, we developed and conducted psychometric testing of the Functional Outcomes Interview (FOI) and the Roles and Aspirations Among Youth scale (RAY; a much-needed patient-reported outcome measure). Method: Both measures were developed in English, Tamil, and French through discussions with professionals, participants, and families at early psychosis programs in Canada and India. The FOI assesses the number and tenure of functional roles and allows the nuanced assessment of each role in terms of performance, need for support, and quality of social contacts. The roles include work, school, household responsibilities, parenting/caregiving, and efforts to return to work/school. The RAY is a self-report of current roles and future aspirations. Test–retest reliability, internal consistency, factorial validity, and concurrent validity for the RAY; and inter-rater reliability (IRR), internal consistency, and concurrent validity for the FOI were assessed. Results: The RAY had adequate internal consistency and temporal stability and was unidimensional in factor analysis. The FOI had acceptable IRR and internal consistency, as evinced by comparable performance ratings across functional roles. Significant associations between our novel measures and well-established measures of functioning and negative symptoms indicate concurrent validity. Conclusions and Implications for Practice: The FOI and RAY were designed to be youth friendly, assess aspirations, and acknowledge individuals as desiring and holding multiple roles. They thus represent a significant advancement in assessing functional recovery in first-episode psychosis. Having been tested in two distinct settings, these measures show promise for wider deployment across geo-cultural contexts. Impact and Implications: This study advances the assessment of functional recovery in first-episode psychosis through its development and testing of measures that capture a wide spectrum of functional roles (work, school, household responsibilities, parenting/caregiving, efforts to return to work/school) and unique dimensions such as aspirations. Their youth friendliness will facilitate their broad uptake in the field as will the fact that they were tested in two culturally and economically distinct settings and three languages. [ABSTRACT FROM AUTHOR]

Objective: There have been very few studies of first-episode psychoses or early intervention programmes in India. This paper describes a pilot intervention programme for first-episode psychosis at the Schizophrenia Research Foundation, India. Methods: A total of 47 patients with the first episode of psychosis were followed up for 2 years. Based on the Positive and Negative Syndrome Scale for schizophrenia and Global Assessment of Functioning Scale scores, the data from 2 groups of patients, those who had remission and those who did not, were identified and compared. Assessments done at 3,6,12 and 24 months after recruitment enabled computation of time to achieve remission. Results: Complete data were available for 38 patients (28 patients in remission group and 10 patients in non-remission group) at 2 years. Baseline scores were not significantly different between the groups. In the remission group, more than 50% attained maximal improvement at 3 months, another 30% at 1 year, and the remaining 20% at 2 years. Maximal reduction in the mean Positive and Negative Syndrome Scale score was seen between 3 and 6 months after recruitment. Conclusions: With regular treatment, most patients with early psychosis achieve remission within 2 years. Negative symptoms persisting for longer than 6 months could be an indicator of long-term outcome. Early intervention is feasible and effective in developing countries. [ABSTRACT FROM AUTHOR]