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Attention to inclusivity and equity in health research and clinical practice has grown in recent years; however, coordinated specialty care (CSC) for early psychosis lags in efforts to improve equity despite evidence of ongoing disparities and inequities in CSC care. This Open Forum argues that marginalization and disparities in early psychosis research and clinical care are interrelated, and the authors provide suggestions for paths forward. Commitment to equity and justice demands recentering the perspectives of those most affected by early psychosis services and investing in the integration of historically excluded perspectives across all aspects of practice, policy, and research. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that both childhood trauma and perceived stress are risk factors for the development of psychosis, as well as negative symptoms such as anhedonia. Previous findings link increases in perceived stress to anhedonia in individuals at clinical high risk for psychosis (CHR) and depression; however, the role of childhood trauma in this relationship has not yet been explored, despite consistent evidence that it is associated with sensitisation to later stress. Aims: To examine whether perceived stress mediates the relationship between childhood trauma and anhedonia in a group of youth at CHR as well as in controls (groups with depression and with no diagnosed mental health concerns). Method: The study used multigroup mediation to examine the indirect effects of childhood trauma on anhedonia via perceived stress in CHR (n = 117) and depression groups (n = 284) and non-psychiatric controls (n = 124). Results: Perceived stress mediated the relationship between childhood trauma and consummatory anhedonia regardless of group status. Perceived stress mediated the relationship between childhood trauma and anticipatory anhedonia for the CHR and depression groups, but not for non-psychiatric controls. Further, groups differed in the magnitude of this relationship, with the effects trending towards stronger for those in the CHR group. Conclusions: Our findings suggest a potential transdiagnostic pathway through which childhood trauma contributes to anhedonia across severe mental illness. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances have frequently been associated with the full spectrum of psychosis, from psychotic‐like experiences (PLEs) to individuals who meet diagnostic criteria for schizophrenia. Similarly, dissociative experiences have been linked to both sleep disturbances and PLEs. Aim: The aim of this study was to examine the role of dissociation in the relationship between sleep quality and PLEs. Methods: PLEs, dissociative symptoms, and sleep quality were examined in 1677 young adults using self‐report measures. A mediation analysis was performed to examine whether dissociative experiences account for some of the relationship between sleep quality and PLEs. Results: Dissociative symptoms significantly mediated the relationship between sleep quality and PLEs, with both age and gender used as covariates. Conclusion: These findings suggest that dissociation may be a key contributor to the relationship between disrupted sleep and PLEs, which could have treatment and identification implications. [ABSTRACT FROM AUTHOR]

Aim: Elevated behavioural inhibition system sensitivity has been reported among schizophrenia patients. Yet, no study has investigated the relationship between behavioural inhibition system sensitivity and the occurrence of psychotic‐like experiences (subthreshold psychotic symptoms considered to be less severe or impairing), despite evidence that behavioural inhibition system sensitivity is related to other forms of psychopathology known to co‐occur with psychotic‐like experiences, such as depression and anxiety. Thus, the aim of this study was to assess the relationship between behavioural inhibition system levels and psychotic‐like experiences while controlling for depression and anxiety symptoms. We hypothesized that behavioural inhibition system sensitivity would be positively associated with the number of reported psychotic‐like experiences, and that this association would be nonsignificant after accounting for depression and anxiety symptoms. Methods: Psychotic‐like experiences, behavioural inhibition system sensitivity, depression symptoms, and anxiety symptoms were measured in 1162 young adults. Bivariate correlations were calculated and linear regressions performed to measure the relationship between variables of interest. Results: Psychotic‐like experiences, behavioural inhibition system sensitivity, and symptoms of depression, and anxiety were all significantly and positively correlated with one another. Behavioural inhibition system sensitivity was no longer related to the number of psychotic‐like experiences reported after controlling for anxiety symptoms, with and without controlling for depression symptoms. Discussion: These findings suggest that the hypersensitivity to threat observed among individuals reporting higher levels of psychotic‐like experiences is likely related to co‐occurring depression and anxiety symptoms. Thus, behavioural inhibition system sensitivity may be more reflective of a transdiagnostic phenotype of general psychopathology than specifically related to psychosis. [ABSTRACT FROM AUTHOR]

Aim: Pennsylvania (PA) first‐episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA‐OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6‐ and 12‐month outcomes. Methods: Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re‐administered at 6‐ and 12‐month follow‐up, and data were analysed for individuals (n = 230) who had completed 12‐months of treatment. Domains assessed via clinician report and/or self‐report included symptoms, role and social functioning, self‐perceived recovery and service utilization. Results: PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self‐perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school‐enrolment. Nearly all improvements were observed at 6‐month follow‐up, with earlier gains maintained at 12‐months. Conclusions: PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society. [ABSTRACT FROM AUTHOR]

Aim: Computer‐based virtual reality assessments of functional capacity have shown promise as a reliable and valid way to assess individuals with multi‐episode schizophrenia. However, there has been little research utilizing this innovative approach with young patients who are in the early phase of schizophrenia. Methods: Outpatients in the early course of schizophrenia (n = 42) were compared to controls (n = 13) at cross‐sectional study points. Patients were within 2 years of their first psychotic episode, were an average of 22.2 years old and had an average of 12.3 years of education. We used the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and the University of California, San Diego (UCSD) Performance‐Based Skills Assessment‐2 (UPSA‐2) to assess functional capacity. The MATRICS Consensus Cognitive Battery (MCCB) and the Cognitive Assessment Interview (CAI) were the measures of cognitive functioning. The Global Functioning Scale: Role (GFS‐R) and Social (GFS‐S), and the Role Functioning Scale (RFS) were the measures of daily functioning. Results: Early course patients vs controls were slower (patient M = 830.41 seconds vs control M = 716.84 seconds; t = 3.0, P <.01) and committed more errors (patient M = 3.2 vs control M = 1.7 seconds, t = 2.9, P <.01) on the VRFCAT. Total time was significantly correlated with the UPSA (r = −0.66, P <.01), MCCB (r = −0.70, P <.01), CAI (r = −0.51, P <.01), and GFS role (r = −0.52, P <. 01) and social functioning (r = −0.43, P =.03). Conclusions: We extend previous findings to patients with first‐episode schizophrenia. Virtual‐reality–based performance was correlated with a standard test of functional capacity, indicating VRFCAT validity. Furthermore, correlations with cognitive functioning and occupational/school and social functioning indicate promise as a co‐primary measure to track changes in response to treatment. [ABSTRACT FROM AUTHOR]

Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychoticspectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis. [ABSTRACT FROM AUTHOR]

Background: Childhood traumatic experiences have been consistently associated with psychosis risk; however, the specificity of childhood trauma type to interview-based attenuated positive psychotic symptoms has not been adequately explored. Further, previous studies examining specificity of trauma to specific positive symptoms have not accounted for co-occurring trauma types, despite evidence of multiple victimization. Methods: We examined the relationship between childhood trauma (Childhood Trauma Questionnaire) with type of attenuated positive symptom, as measured by the Structured Interview for Psychosis-risk Syndromes (SIPS) among a non-clinical, young adult sample (n = 130). Linear regressions were conducted to predict each attenuated positive symptom, with all trauma types entered into the model to control for co-occurring traumas. Results: Results indicated that childhood sexual abuse was significantly associated with disorganized communication and childhood emotional neglect was significantly associated with increased suspiciousness/persecutory ideas, above and beyond the effect of other co-occurring traumas. These relationships were significant even after removing individuals at clinical high-risk (CHR) for psychosis (n = 14). Conclusions: Our results suggest that there are differential influences of trauma type on specific positive symptom domains, even in a non-clinical sample. Our results also confirm the importance of controlling for co-occurring trauma types, as results differ when not controlling for multiple traumas. [ABSTRACT FROM AUTHOR]

Background Trauma has been consistently associated with psychosis risk; however, the specificity of childhood trauma to individual attenuated positive psychotic symptoms among non-help-seeking individuals has not yet been adequately explored, as only one study to date has examined this relationship among help-seeking individuals and focused only on violent vs. non-violent traumatic events, rather than specific types of traumas. Methods We examined the relationship between childhood trauma (Childhood Trauma Questionnaire) with type of positive symptom, as measured by the Structural Interview for Psychosis-risk Syndromes (SIPS) among a sample of non-help-seeking undergraduates at a large, ethnically and socioeconomically diverse urban university (n= 130). Results Simple linear regressions revealed that any childhood trauma was significantly associated with increased disorganized communication in young adulthood [β =.35, t(128) = 4.15, p <.001]. Childhood sexual abuse also predicted increased disorganized communication [β =.28, t(128) = 3.34, p =.001]. Additionally, childhood emotional neglect was significantly associated with increased suspiciousness/persecutory ideas [β =.32, t(128)= 3.76, p <.001]. Discussion This study is the first to identify specific attenuated positive psychotic symptoms linked to childhood traumas in a non-help-seeking sample. Specifically, our results suggest that there are differential influences of trauma type on specific positive symptom domains, which could be of potential use to future identification and prevention efforts. [ABSTRACT FROM AUTHOR]