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Abstract Aims Adolescence is a critical developmental phase during which young people are vulnerable to the experiences of mental ill-health and social exclusion (consisting of various domains including education and employment, housing, finances and social supports and relationships). The aims of this study were to (i) obtain an understanding of the relationships between social exclusion, mental health and wellbeing of young people; and (ii) identify potentially modifiable targets, or population groups that require greater or targeted supports. Methods Data were obtained from the Mission Australia 2022 Youth Survey, Australia’s largest annual population-wide survey of young people aged 15–19 years (n = 18,800). Participants’ experiences of social exclusion in different domains were explored (e.g., prevalence, co-occurrence and controlling for differences in demographic characteristics). Multivariable linear regression models were used to map the relationships between social exclusion domains and mental health and wellbeing, controlling for confounding factors where necessary. Results Sixty per cent of all young people experienced social exclusion in at least one domain, 25% in multiple. Young people who identified as gender diverse, Indigenous, living in a remote/rural or socio-economically disadvantaged area and with a culturally diverse background were more likely to report social exclusion. A strong association was seen between all domains of social exclusion and poor mental health (e.g., higher psychological distress and loneliness, reduced personal wellbeing, reduced sense of control over their life and a more negative outlook on the future). Notably, difficulties in socialising and obtaining social support were critical factors linked to increased psychological distress and reduced wellbeing. Conclusions Findings underscore the need to address multiple domains of social exclusion concurrently, and in collaboration with youth mental healthcare. Prevention efforts aimed at early identification and intervention should be prioritised to support young people vulnerable to social exclusion. Screening approaches are needed to identify individuals and groups of young people in need of support, and to facilitate care coordination across multiple providers.

Abstract Background First-episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown that the antioxidant amino acid N-acetylcysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2 g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-ups. Methods/design ENACT is a 26-week, randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15–25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of: inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Discussion Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12618000413224. Registered on 21 March 2018.

Dual careers (DCs) are challenging trajectories followed by athletes willing to develop their academic/professional career with their athletic careers. These trajectories usually entail additional stressors, which can decrease athletes' mental health or even increase their risk of mental ill‐health. While existing research has recognized the importance of psychological and social factors in both of these areas separately, we lack systematic knowledge on which factors are associated with European DC athlete mental health outcomes, making evidence‐based practice more challenging. In this regard, to advance the European DC tradition and to provide a strong base for researchers and practitioners working within this field, this systematic review aims to appraise this evidence identifying and categorizing the psychological and social factors associated with the European DC athletes' mental health. We conducted this review according to Preferred Reporting for Systematic Reviews and Meta‐Analysis guidelines and performed the systematic search in six databases, finding 56 eligible articles. Our analysis identified 35 different psychological and social factors, most showing significant associations with athletes' mental health. Notably, affect, stress, motivational climate, mindfulness, resilience, perfectionism, goal orientation, motivation, and basic psychological need satisfaction showed the strongest evidence associated with mental health. Overall, this review provides a comprehensive synthesis of psychological and social factors, advancing the holistic ecological approach in dual careers and athlete mental health. Yet, our results highlight the need to strengthen the evidence regarding these factors and provide specific research avenues, such as focus on DC‐specific factors and consideration of DC athlete definition and career trajectories. Highlights: Our systematic review analyzed the psychological and social factors affecting European dual career (DC) athletes' mental health, yielding 56 relevant articles.We identified 35 distinct factors, organized into four psychological (Identity, Expectations, and Beliefs; Emotional and Affective Responses; Motivation and Goal‐oriented Behavior; and Competencies and Coping Resources) and three social categories (Sport and Academic Climates; DC‐Specific Demands; and Interactions with DC Agents). We narratively developed each category and synthesized the findings into a DC development environment working model.Our findings illustrate nine factors with the most robust associations with mental health. For future research, we emphasize the need for more detailed characterizations of DC athletes, deeper explorations of DC competencies, and a focus on longitudinal and replication studies to enhance our understanding of DC mental health in Europe. [ABSTRACT FROM AUTHOR]

Background: Integrated youth services are an emerging delivery model in Canada that addresses siloed and fragmented youth mental health and other services. Youth engagement is viable for developing integrated youth services when purposefully built. However, it is not always clear how youth are involved in service transformation as decision‐makers, and it requires an exploration of how to work with youth authentically and intentionally in the codesign process. Methods: This study reflects on the development of HOMEBASE, a network of integrated youth service delivery in Saskatchewan, Canada, and documents the process of actively and authentically engaging with youth through distributive leadership in the codesign process. Findings: Youth are actively and eagerly willing to participate in the codesign process of developing integrated services when there is a shared responsibility, and they are authentically involved and informed within the decision‐making process. This requires time to form trust, build relationships and provide youth with low‐pressure environments to foster healthy debates. Conclusion: By utilizing a distributive leadership approach, the Youth Codesign Team has been engaged in various levels of decision‐making. By following these guiding principles, policymakers, youth development workers and researchers can engage youth in meaningful ways to improve the design and development of integrated care. Patient or Public Contribution: Five youths from the HOMEBASE Provincial Youth Co‐Design Team collaborated in writing this article based on their experiences of being engaged at varying levels of decision‐making in a distributive leadership approach to building integrated youth services. [ABSTRACT FROM AUTHOR]

Objectives: Despite high levels of mental ill‐health amongst young people (aged 15–30), this group demonstrates low help‐seeking and high drop‐out from mental health services (MHS). Whilst shared decision‐making can assist people in receiving appropriate and effective health care, young people frequently report that they do not feel involved in treatment decisions. The current study focused on co‐design of a clinical education and participant information programme for the Brain and Mind Centre Youth Model of Care. This model, which articulates a youth‐focused form of highly personalised and measurement‐based care, is designed to promote shared decision‐making between young people and clinical service providers. Methods: We conducted workshops with 24 young people (16–31; MAge = 21.5) who had accessed mental health services. Participants were asked what advice they would give to young people entering services, before giving advice on existing materials. Workshops were conducted and transcripts were coded using thematic analysis by two lived experience researchers and a clinical researcher. Results: Young people found it empowering to be educated on transdiagnostic models of mental illness, namely clinical staging, which gives them a better understanding of why certain treatments may be inappropriate and ineffective, and thus reduce self‐blame. Similarly, young people had limited knowledge of links between mental health and other life domains and found it helpful to be educated on multidisciplinary treatment options. Measurement‐based care was seen as an important method of improving shared decision‐making between young people and health professionals; however, to facilitate shared decision‐making, young people also wanted better information on their rights in care and more support to share their expertise in their own needs, values and treatment preferences. Conclusions: These findings will inform the delivery of the further development and implementation of a youth‐specific clinical education and participant information programme for the BMC Youth Model. Patient or Public Contribution: Workshops were facilitated by researchers with lived expertise in mental ill‐health (A.H. and/or C.G.) and a clinical researcher (who has expertise as an academic and a clinical psychologist). A.H. and C.G. were also involved in conceptualisation, analysis, interpretation, review and editing of this paper. [ABSTRACT FROM AUTHOR]

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.)

Attachment is the evolutionarily-established process through which humans create bonds with others to receive care from them. The phenomenon is as essential to our physical survival as it is to our psychological development. An increasing number of studies demonstrates that in sensitive periods during the early years of life, our brain circuitry is programmed in the interactions with our caregivers, with the imprinting of information over multiple attachment dimensions. Adopting a basic brain-computer analogy, we can think of this knowledge as the psycho-social firmware of our mind. According to a recently proposed extension of the classical three-dimensional view, one attachment dimension -- somaticity -- concerns the caregiver's task of reflecting and confirming the child's (internal) states -- such as sensations, emotions, and representations -- to support the child's ability to identify and define those entities autonomously. Relying on multidisciplinary evidence -- from neuroscientific, developmental, evolutionary, and clinical sources -- we suggest that somaticity (H1) has the adaptive function to modulate our tendency to comply and affiliate with a reference group but also (H2) increases the vulnerability to developing Social Anxiety (SA) and Eating Disorders (EDs). We evaluate H1-H2, (1) indicating the evolutionary role of somaticity in modulating our affiliation tendency to optimize the ancestral threat-opportunity balance coming from infectious diseases and (2) showing the deep connection between SA-EDs and the features most closely related to somaticity -- interoception and parenting style. Finally, we discuss three relevant implications of H1-H2: (A) Bringing into research focus the adaptive role of our firmware knowledge system versus the hardware (neural substrate) and software (higher cognition) ones. (B) Complementing the well-grounded Objectification and Allocentric Lock Theories, allowing us to integrate multiple levels of explanation on the etiology of psychopathology. (C) Suggesting the design of new psychological treatments. While not aiming to prove H1-H2, our analysis supports them and encourages their direct testing. [ABSTRACT FROM AUTHOR]

Acer truncatum Bunge is a type of maple that is unique to China. Its fruit setting rate and seed oil content are both high. The oil is mainly composed of C16–C24 fatty acids and contains 5%–7% nervonic acid (NA). NA and its derivatives can delay ageing and prevent and treat disorders such as senile dementia and Alzheimer's disease. The content of NA ethyl ester prepared by the seed oil of A. truncatum Bunge is 5.84%. We report a new process for the enrichment of NA ethyl ester by urea inclusion (UI) and molecular distillation (MD), with the aim of obtaining highly pure NA ethyl ester. First, based on the difference in fatty acid ethyl ester saturation and carbon chain length, unwanted compounds such as oleic acid ethyl ester, linoleic acid ethyl ester, and sterol were removed by one‐stage UI, the content of NA ethyl ester was increased to 18.69%. The oil in the UI compound was used as a feed, and differences in the mean molecular free paths between the components were exploited to separate the C16–C20 fatty acid ethyl esters (FAEEs) by two‐stage MD. The total content of C16–C20 FAEEs decreased to 3.69% and the purity of NA ethyl ester increased to 47.47%. A new purification process of UI‐MD‐UI was established and NA ethyl ester could be purified to 91.8%. The combination of MD and UI has an important reference value for the industrialization of producing high‐purity NA ethyl ester. [ABSTRACT FROM AUTHOR]

Alterations in fMRI-based brain functional network connectivity (FNC) are associated with schizophrenia (SCZ) and the genetic risk or subthreshold clinical symptoms preceding the onset of SCZ, which often occurs in early adulthood. Thus, age-sensitive FNC changes may be relevant to SCZ risk-related FNC. We used independent component analysis to estimate FNC from childhood to adulthood in 9,236 individuals. To capture individual brain features more accurately than single-session fMRI, we studied an average of three fMRI scans per individual. To identify potential familial risk-related FNC changes, we compared age-related FNC in first-degree relatives of SCZ patients mostly including unaffected siblings (SIB) with neurotypical controls (NC) at the same age stage. Then, we examined how polygenic risk scores for SCZ influenced risk-related FNC patterns. Finally, we investigated the same risk-related FNC patterns in adult SCZ patients (oSCZ) and young individuals with subclinical psychotic symptoms (PSY). Age-sensitive risk-related FNC patterns emerge during adolescence and early adulthood, but not before. Young SIB always followed older NC patterns, with decreased FNC in a cerebellar-occipitoparietal circuit and increased FNC in two prefrontal-sensorimotor circuits when compared to young NC. Two of these FNC alterations were also found in oSCZ, with one exhibiting reversed pattern. All were linked to polygenic risk for SCZ in unrelated individuals (R2 varied from 0.02 to 0.05). Young PSY showed FNC alterations in the same direction as SIB when compared to NC. These results suggest that age-related neurotypical FNC correlates with genetic risk for SCZ and is detectable with MRI in young participants. [ABSTRACT FROM AUTHOR]

Psychotic disorders are severe mental illnesses that cause distress and hopelessness for individuals who experience them. However, hope marks the beginning of psychological recovery from a psychotic disorder. This study aims to explore the role of narrative-approach art therapy in increasing hope for young people with psychotic disorders. The research was conducted using an A-B-A single-case design. Participants were recruited based on the following criteria: (1) psychotic outpatients currently in the recovery phase, (2) adolescents or young adults aged between 15-30 years, (3) able to communicate, and (4) consenting to participate in the research. The Hope Scale and daily hope condition were used to measure the level of hope three times, namely before, during, and follow-up. Visual inspection indicates that there was an increase in hope after the intervention, both on the Hope Scale and in the average score of daily hope condition. Two participants showed a sustained impact up to two weeks following the intervention, while the remaining participant experienced a decrease in hope during the followup. Factors that could potentially influence these results will be discussed. This study provides evidence of the feasibility of narrative art therapy for individuals with psychosis. [ABSTRACT FROM AUTHOR]

The main aim of this research study is to determine the design of emergency warning system related to the public health emergencies. This research study based on the primary data analysis for determines the research study used specific questions related to the emergency warning system and public health emergencies. For measuring the research study develop open ended and closed ended questions included mcqs. For determine the research study used SPSS software and generate informative results. The descriptive statistical analysis, the chi square, one-way ANOVA test analysis, sample T statistic values, control chart, also present that linear regression analysis between variables. the emergency warning system is main independent and the public health emergencies is dependent variables. The overall research study founded that the emergency warning system play a vital role for public health emergencies. The result found that there are positive and significant link of emergency warning system for public health emergencies. [ABSTRACT FROM AUTHOR]

Few studies have explored the differences in clinical psychopathology between youth at high risk for psychosis and those at familial high risk for psychosis. This study seeks to describe and compare the sociodemographic, clinical, and functional characteristics of At-Risk Mental State (ARMS) for psychosis youth and those with a first- or second-degree relative with psychosis (Familial High-Risk: FHR) in a Mexican sample. Twenty-one ARMS individuals and 21 with FHR were evaluated for sociodemographic characteristics, psychopathological symptoms, and functional impairment. ARMS individuals were significantly younger, had fewer years of schooling, and were more likely to be male than those in the FHR group. Groups did not differ as regards marital status or occupation. The ARMS group showed greater severity of prodromal symptoms, schizotypal personality traits, and general psychopathology than the FHR group. In addition, they reported more premorbid adjustment deficit from early adolescence than the FHR group. Current overall social and role functioning was significantly lower in the ARMS group. Findings are consistent with ARMS studies from other countries. First- or second-degree relatives of patients with psychosis should be considered a vulnerable group as they display several symptoms of general psychopathology and may experience social adjustment problems in their adult lives. The lack of early detection and intervention psychosis programs in Mexico underlines the need to prioritize the development of preventive strategies to help close the care gap. [ABSTRACT FROM AUTHOR]

The authors would like to add in two references to the above article: On page 5, paragraph 6, a citation should have been included in the third sentence to read: "However, there is strong evidence pointing to a high level of continuity between childhood/ adolescent and adult psychopathology (McGorry, 2011)." Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles - CORRIGENDUM Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. [Extracted from the article]

Past studies have consistently shown functional dysconnectivity of large-scale brain networks in schizophrenia. In this study, we aimed to further assess whether multivariate pattern analysis (MVPA) could yield a sensitive predictor of patient symptoms, as well as identify ultra-high risk (UHR) stage of schizophrenia from intrinsic functional connectivity of whole-brain networks. We first combined rank-based feature selection and support vector machine methods to distinguish between 43 schizophrenia patients and 52 healthy controls. The constructed classifier was then applied to examine functional connectivity profiles of 18 UHR individuals. The classifier indicated reliable relationship between MVPA measures and symptom severity, with higher classification accuracy in more severely affected schizophrenia patients. The UHR subjects had classification scores falling between those of healthy controls and patients, suggesting an intermediate level of functional brain abnormalities. Moreover, UHR individuals with schizophrenia-like connectivity profiles at baseline presented higher rate of conversion to full-blown illness in the follow-up visits. Spatial maps of discriminative brain regions implicated increases of functional connectivity in the default mode network, whereas decreases of functional connectivity in the cerebellum, thalamus and visual areas in schizophrenia. The findings may have potential utility in the early diagnosis and intervention of schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: To estimate lifetime prevalence of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens ages 15–65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate lifetime prevalence of common DSM‐IV mental disorders. Results: Estimated lifetime prevalence of any DSM‐IV/CIDI disorder is 34.2% and lifetime morbid risk is 38.0%. Anxiety disorders are by far the most prevalent (23.2%) followed by disruptive behavior (11.2%), mood (9.3%), eating (6.1%), and substance use (4.0%) disorders. Synthetic estimates of cohort effects suggest that prevalence of many disorders has increased in recent cohorts. Onsets typically occur in childhood for a number of anxiety and disruptive behavior disorders and in adolescence or early adulthood for most other disorders, although age‐of‐onset distributions for drug abuse is much later (median age of 31) than in CIDI surveys carried out in other high‐income countries. Conclusions: Lifetime mental disorders are highly prevalent in Saudi Arabia and typically have early ages‐of‐onset. [ABSTRACT FROM AUTHOR]

PPARD has been suggested to contribute to the etiology of schizophrenia (SCZ) with the underlying mechanisms largely unknown. Here, we first collected and analyzed the PPARD expression profile from three groups: (1) 18 healthy control (HC) subjects, (2) 14 clinical high-risk (CHR) patients, and (3) 19 early onset of SCZ (EOS) patients. After that, we conducted a systematical pathway analysis to explore the potential mechanisms involved in PPARD exerting influence on the pathological development of SCZ. Compared to the HC group, the expression of PPARD was slightly decreased in the EOS group (LFC = − 0.34 ; p = 0.23) and increased in the CHR group (LFC = 0.65 ; p = 0.20). However, there was a significant difference between the EOS group and the CHR group (LFC = − 0.99 ; p = 0.015), reflecting the amount of variation in PPARD expression before and after the onset of SCZ. Pathway analysis suggested that overexpression of PPARD may regulate ten proteins or molecules to inhibit the pathological development of SCZ, including the deactivation of eight SCZ promoters and stimulation of two SCZ inhibitors. Our results support the association between PPARD and SCZ. The pathways identified may help in the understanding of the potential mechanisms by which PPARD contributes to the etiology of SCZ. [ABSTRACT FROM AUTHOR]

Family members caring for a young person diagnosed with the onset of mental health problems face heightened stress, depression, and social isolation. Despite evidence for the effectiveness of family based interventions, sustaining access to specialist family interventions is a major challenge. The availability of the Internet provides possibilities to expand and sustain access to evidence-based psychoeducation and personal support for familymembers. In this paper we describe the therapeuticmodel and the components of our purpose-built moderated online social therapy (MOST) program for families. We outline the background to its development, beginning with our face-to-face EPISODE II family intervention, which informed our selection of therapeutic content, and the integration of recent developments in positive psychology. Our online interventions for carers integrate online therapy, online social networking, peer and expert support, and online social problem solving which has been designed to reduce stress in carers. The initial version of our application entitled Meridian was shown to be safe, acceptable, and feasible in a feasibility study of carers of youth diagnosed with depression and anxiety. There was a significant reduction in self-reported levels of stress in caregivers and change in stress was significantly correlated with use of the system. We have subsequently launched a cluster RCT for caregivers with a relative diagnosed with first-episode psychosis. Our intervention has the potential to improve access to effective specialist support for families facing the onset of serious mental health problems in their young relative. [ABSTRACT FROM AUTHOR]

Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change. [ABSTRACT FROM AUTHOR]

Caregivers of patients with first-episode psychosis are often with little knowledge about the illness and experience more burden of care. Psychoeducation to caregivers has shown to be effective in improving outcomes of patients and possibly reduce stress of the caregivers. This has been recommended as one of the key psychosocial interventions for specific early intervention for psychosis service. However, the accessibility of the service, high case load of the health care professionals and self-stigma of caregivers are often the barriers of implementation of these programs in the real world. Incorporating the convenience of information access via internet and the concept of self-management approach, an interactive internet-based self-help psychoeducation program (iPEP) (www.ipep.hk) for the caregivers of patients with psychosis was established targeting the caregivers of patients with psychosis at early stage in Hong Kong. It provides a comprehensive online resource center in both written and video format on knowledge about psychosis, skills of care, and information of local resources. It also has a forum facilitate information exchange between healthcare professionals and the caregivers, allowing for self-management. Over 800 caregivers have joined the program as members. The evaluation of the subset of the members/users of the iPEP suggested that the iPEP program has been well received and appreciated by the caregivers of patients with first episode psychosis locally. It can potentially serve as a platform for future development of specific manual-based psychoeducation program for caregivers targeting at the needs of different groups. [ABSTRACT FROM AUTHOR]

We know a great deal about schizophrenia, but the current state of the art is one of uncertainty. Researchers are confused, and patients feel misunderstood. This situation has been identified as due largely to the fact that the dominant neurobiological perspective leaves out the person. The aim of the present article is to review and integrate a series of clinical, phenomenological, historical, cultural, epidemiological, developmental, epigenetic, and therapeutic phenomena in support of a suggestion that schizophrenia is above all a disorder of the person rather than of the brain. Specifically, we review seven phenomena, beginning with the conception of schizophrenia as a particular disorder of the self. We continue by looking at its recent origin, as a modern phenomenon, its juvenile onset, related to the formation of the self, the better prognosis in developing countries compared to developed countries, and the high incidence of the disorder among migrants. In the context of these phenomena of a marked socio-cultural nature, we consider the so-called “genetic myth,” according to which schizophrenia would have a genetic origin. On reviewing the current genetic emphasis in the light of epigenetics, it emerges that the environment and behavior recover their prominent role in the vicissitudes of development. The seventh reason, which closes the circle of the argument, concerns the role of interpersonal “chemistry” in recovery of the sense of self. [ABSTRACT FROM AUTHOR]

JESSICA BENJAMÍN. Sujetos iguales, objetos de amor. Ensayo sobre el reconocimiento y la diferencia sexual. Paidós. Argentina 1.997. L. López Mondéjar F. SANTANDER (COMP.). Ética y Práxis. Psiquiátrica. AEN. Madrid 2000. Fernando Santander Informe del Ararteko: Atención comunitaria de la enfermedad mental. Ander Retolaza FRANCISCO CARLES, ISABEL MUÑOZ, CARMEN LLOR, PEDRO MARSET. Psicoanálisis en España (1893-1968). Asociación Española de Neuropsiquiatría. 2000.341 págs. Fernando Mansilla P. D. MCGORRY, H. J. JACKSON ET AL. The Recognition and Management ofEarly Psychosis. A Preventive Approach Cambridge Univer~ity Press, 1999 (495 pág.) Oscar Jimenez Suarez. Mariano Hernández Monsalve Pliegos. Revista de la Sección de Madrid de la Escuela Europea de Psicoanálisis. Enero 2000. Alberto Gállego Cuevas

There are complex considerations when planning to disclose an attenuated psychosis syndrome ( APS) diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non- and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and bolsters communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non-disclosure advances nonmaleficence by limiting stigma and stress (which may inadvertently exacerbate the condition), and confusion (related to the rapidly evolving diagnosis) in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo-diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help-seeking cases that do not transition but remain clinically relevant. [ABSTRACT FROM AUTHOR]

Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed. [ABSTRACT FROM AUTHOR]

Near-infrared spectroscopy (NIRS) is generally accepted as a functional brain imaging technology for brain activation study. With multichannel highly sensitive NIRS instruments, it has become possible to assess functional connectivity of different brain regions by NIRS. However, the feasibility needs to be validated in complex cognitive activities. In this study, we recorded the hemodynamic activity of the bilateral prefrontal cortex (PFC) during a color-word matching Stroop task. Wavelet transform coherence (WTC) analysis was applied to assess the functional connectivity of all homologous channel pairs within the left/right PFC. Both the behavioral and brain activation results showed significant Stroop effects. The results of WTC analysis revealed that, bilateral functional connectivity was significantly stronger during both the incongruent stimuli and neutral stimuli compared to that of the rest period. It also showed significant Stroop effect. Our findings demonstrate that, NIRS becomes a valuable tool to elucidate the functional connectivity of brain cortex in complex cognitive activities. [ABSTRACT FROM AUTHOR]

Recent interest in the early course of schizophrenia accentuated altered cognition prior to the onset. Ultrahigh risk (UHR) individuals with attenuated positive symptoms and transient psychotic episodes demonstrate neurocognitive deficits across multiple domains such as memory, executive functioning, and processing speed which are consistent with similar disturbances identified in patients with a first episode of schizophrenia. Cognitive remediation (CR) approaches representing a broad set of activities are aimed to restore or improve cognitive functioning. CR proved to be effective in modulating the cognitive dysfunction in schizophrenia but is rarely used in ultrahigh risk individuals. From the clinical prospective, a better understanding of cognitive functioning in at-risk states is essential for the development of optimal early intervention models. In the review, we highlight the intervention targets, notably the specific cognitive deficits in at risk individuals which preceed the transition to psychosis and emphasize the need of the additional studies using CR approaches in UHR group aiming to enhance cognition and therefore mediate functional improvement. [ABSTRACT FROM AUTHOR]

Schizophrenia is a complex psychiatric disorder. Although a number of different hypotheses have been developed to explain its aetiopathogenesis, we are far from understanding it. There is clinical and experimental evidence indicating that neurodevelopmental factors play a major role. Disturbances in neurodevelopment might result in alterations of neuroanatomy and neurochemistry, leading to the typical symptoms observed in schizophrenia. The present paper will critically address the neurodevelopmental models underlying schizophrenia by discussing the effects of typical and atypical antipsychotics in animal models. We will specifically discuss the vitamin D deficiency model, the poly I:C model, the ketamine model, and the postnatal ventral hippocampal lesion model, all of which reflect core neurodevelopmental issues underlying schizophrenia onset. [ABSTRACT FROM AUTHOR]

Schizophrenias hold a special position among psychotic disorders. Schizophrenias often start in early adulthood and bear considerable psychosocial risks and consequences. Several years of nonpsychotic clinical signs and symptoms and growing distress for patient and significant others may pass by before definite diagnosis. Young males in particular often experience their first episode while still living in their primary families. Thus, the whole family system is involved. In worldwide initiatives on early detection and early intervention, near-psychotic prodromal symptoms as well as deficits of thought and perception, observable by the affected person himself, were found to be particularly predictive of psychosis. Various psychological and social barriers as well as ones inherent to the disease impede access to affected persons. Building trust and therapeutic alliance are extremely important for counseling, diagnostics, and therapy. The indication for strategies of intervention differs from the early to the late prodromal stage, depending on proximity to psychosis. For psychotherapy versus pharmacotherapy, the first evidence of effectiveness has been provided. A false-positive referral to treatment and other ethical concerns must be weighed against the risks of delayed treatment. [ABSTRACT FROM AUTHOR]

This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N=39) or to medication alone (control group: N=34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group. [ABSTRACT FROM AUTHOR]

Recent studies have begun to look at gender differences in schizophrenia and first-episode psychosis in an attempt to explain the heterogeneity of the illness. However, a number of uncertainties remain. This paper tries to summarize themost important findings in gender differences in schizophrenia and first-psychosis episodes. Several studies indicate that the incidence of schizophrenia is higher in men. Most of the studies found the age of onset to be earlier in men than in women. Findings on symptoms are less conclusive, with some authors suggesting that men suffer more negative symptoms while women have more affective symptoms. Premorbid functioning and social functioning seem to be better in females than males. However, cognitive functioning remains an issue, with lack of consensus on differences in neuropsychological profile between women and men. Substance abuse is more common in men than women with schizophrenia and first-episode psychosis. In terms of the disease course, women have better remission and lower relapse rates. Lastly, there is no evidence of specific gender differences in familial risk and obstetric complications. Overall, gender differences have been found in a number of variables, and further study in this area could help provide useful information with a view to improving our care of these patients. [ABSTRACT FROM AUTHOR]

Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment. [ABSTRACT FROM AUTHOR]

Persons with severe mental illness (SMI) have reduced workforce participation, which leads to significant economic and social disadvantage. This theoretical review introduces the strategies that have been implemented to address this issue. These include Individual Placement and Support (IPS) services, the most widely researched form of supported employment, to which cognitive remediation has more recently been recognised in the USA, as an intervention to improve employment outcomes by addressing the cognitive impairments often experienced by people with SMI. The authors review the international literature and discuss specifically the Australian context. They suggest that Australia is in a prime position to engage clients in such a dual intervention, having had recent success with increasing access to supported employment programs and workforce reentry, through implementation of the Health Optimisation Program for Employment (HOPE). Such programs assist with gaining and maintaining employment. However, they do not address the cognitive issues that often prevent persons with SMI from effectively participating in work. Thus, optimising current interventions, with work-focused cognitive skills development is critical to enhancing employment rates that remain low for persons with SMI. [ABSTRACT FROM AUTHOR]

Many genes have been implicated in schizophrenia as have viral prenatal or adult infections and toxoplasmosis or Lyme disease. Several autoantigens also target key pathology-related proteins. These factors are interrelated. Susceptibility genes encode for proteins homologous to those of the pathogens while the autoantigens are homologous to pathogens' proteins, suggesting that the risk-promoting effects of genes and risk factors are conditional upon each other, and dependent upon protein matching between pathogen and susceptibility gene products. Pathogens' proteins may act as dummy ligands, decoy receptors, or via interactome interference. Many such proteins are immunogenic suggesting that antibody mediated knockdown of multiple schizophrenia gene products could contribute to the disease, explaining the immune activation in the brain and lymphocytes in schizophrenia, and the preponderance of immune-related gene variants in the schizophrenia genome. Schizophrenia may thus be a "pathogenetic" autoimmune disorder, caused by pathogens, genes, and the immune system acting together, and perhaps preventable by pathogen elimination, or curable by the removal of culpable antibodies and antigens. [ABSTRACT FROM AUTHOR]

Schizophrenia is a severe mental disorder affecting about 1% of the population worldwide. Although the dopamine (DA) hypothesis is still keeping a dominant position in schizophrenia research, new advances have been emerging in recent years, which suggest the implication of white matter abnormalities in schizophrenia. In this paper, we will briefly review some of recent human studies showing white matter abnormalities in schizophrenic brains and altered oligodendrocyte-(OL-) and myelin-related genes in patients with schizophrenia and will consider abnormal behaviors reported in patients with white matter diseases. Following these, we will selectively introduce some animal models examining a putative role of white matter abnormalities in schizophrenia. The emphasis will be put on the cuprizone (CPZ) model. CPZ-fed mice show demyelination and OLs loss, display schizophreniarelated behaviors, and have higher DA levels in the prefrontal cortex. These features suggest that the CPZ model is a novel animal model of schizophrenia. [ABSTRACT FROM AUTHOR]

Patients experiencing a first psychotic episode have high rates of extrapyramidal symptoms (EPSs) when treated with the doses of neuroleptics used in multiepisode or chronic schizophrenia. There is some evidence that lower doses may be equally, if not more, effective but less toxic in this population. Here, we report the results of a biphasic open label trial designed to assess the efficacy, safety, and tolerability of low-dose (2-4mg/day) risperidone treatment in a group of 96 first-episode nonaffective psychosis patients. At the end of the trial, 62% of patients met the response criteria although approximately 80% had achieved a response at some time during the study. Reports of EPS remained low, and there were no dystonic reactions. We conclude that even at a dose of 2mg/day, risperidone was highly effective in reducing acute symptomatology in a real world sample of young first-episode psychosis patients. [ABSTRACT FROM AUTHOR]

Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria (n = 48) were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52%) of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time. [ABSTRACT FROM AUTHOR]

Objective. Despite observations that abnormal parietal lobe (PL) function is associated with psychotic-like experiences, our knowledge about the nature of PL involvement in schizophrenia is modest. The objective of this paper is to investigate the role of the PL in schizophrenia. Method. Medline databases were searched for English language publications using the following key words: parietal lobe, combined with schizophrenia, lesions, epilepsy, cognition, rare genetic disorders, MRI, fMRI, PET, and SPECT, respectively, followed by cross-checking of references. Results. Imaging studies in childhood onset schizophrenia suggest that grey matter abnormalities start in parietal and occipital lobes and proceed to frontal regions. Although, the findings are inconsistent, several studies with patients at risk to develop schizophrenia indicate early changes in the PL. Conclusions. We want to propose that in a proportion of individuals with emerging schizophrenia structural and functional alterations may start in the PL and progress to frontal regions. [ABSTRACT FROM AUTHOR]

Prenatal/obstetric complications are implicated in schizophrenia susceptibility. Some complications may arise from maternalfetal genotype incompatibility, a term used to describe maternal-fetal genotype combinations that produce an adverse prenatal environment. A review of maternal-fetal genotype incompatibility studies suggests that schizophrenia susceptibility is increased by maternal-fetal genotype combinations at the RHD and HLA-B loci. Maternal-fetal genotype combinations at these loci are hypothesized to have an effect on the maternal immune system during pregnancy which can affect fetal neurodevelopment and increase schizophrenia susceptibility. This article reviews maternal-fetal genotype incompatibility studies and schizophrenia and discusses the hypothesized biological role of these "incompatibility genes". It concludes that research is needed to further elucidate the role of RHD and HLA-B maternal-fetal genotype incompatibility in schizophrenia and to identify other genes that produce an adverse prenatal environment through a maternal-fetal genotype incompatibility mechanism. Efforts to develop more sophisticated study designs and data analysis techniques for modeling maternal-fetal genotype incompatibility effects are warranted. [ABSTRACT FROM AUTHOR]