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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.

Background. Working memory has been identified as a core cognitive deficit in schizophrenia that is associated with negative symptoms, but it is unclear whether it is impaired prior to onset of psychosis in symptomatic patients. Method. Thirty-eight young people at ultra high-risk (UHR) of developing psychosis (of whom nine later became psychotic) were compared with 49 healthy controls on tests of spatial working memory (SWM) and delayed matching-to-sample (DMTS). Results. Both SWM and DMTS performance was significantly poorer in the UHR groups. Those who later became psychotic generally performed more poorly than those who did not, although this did not reach significance for any measure. A significant association between SWM errors and negative symptoms was seen in the later-psychotic group only (P=0·02). Conclusions. Spatial working memory abilities are impaired in those at high-risk for psychosis. The relationship between working memory and negative symptoms may be useful as a predictive tool. [ABSTRACT FROM AUTHOR]

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]

Background. Recent research has focused upon the subdiagnostic level in an effort to derive more valid domains of psychotic disorder. This has led to the influential positive–negative dichotomy in schizophrenia being superseded by a three-syndrome model. The strategy of looking for syndromes within poorly validated diagnostic categories, such as schizophrenia, has limitations, particularly since it originated in, and has been largely restricted to, the more chronic subsamples. Method. A representative sample of first episode psychosis (N=509), which includes the full spectrum of functional psychosis, was utilized to re-examine the dimensional structure of functional psychosis from first principles. Patients were assessed with the Royal Park Multidiagnostic Instrument for Psychosis (MIP), a comprehensive procedure that documents the psychopathology of the first episode in a clinically valid manner. Results. Principal axis factor analysis was carried out on the tetrachoric correlation matrix of 92 core psychopathological items. A robust and clinically valid four-factor solution was obtained, comprising depression, mania and only two other factors. The first was a Bleulerian blend of negative symptoms, catatonic/motor symptoms and disorganization. The second was a combination of Schneiderian first rank symptoms, and other hallucinations and delusions. The data thus failed to support the three-syndrome model for non-affective symptoms in this population. A six-factor solution, although partially consistent with other studies, represented a more complex and confusing elaboration of the more clinically valid four-factor solution. Conclusions. The findings have implications for the conceptualization of early psychosis, which need to be explored further in validation studies. [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]

The current scoping review aimed to provide an overview of family empowerment strategies used in relapse prevention among individuals with schizophrenia. Three major topics were explored: (a) the family empowerment model used in relapse prevention among individuals with schizophrenia; (b) family intervention strategies; and (c) special considerations for integrating family empowerment in relapse prevention among individuals with schizophrenia. There is a need to identify and use family resources and strengths, such as acceptance of schizophrenia, development of spirituality, involvement in daily activities, and understanding of behaviors that exacerbate symptoms, to reduce relapse risk. The family empowerment paradigm incorporates new information and coping skills, family support, meaningmaking, life objectives, self-reflection, and good family experiences. Families as agents of care at home should be provided with stress management and family psychoeducation to improve family resilience. Further research is needed to understand family empowerment and develop comprehensive guidelines regarding relapse prevention management among individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

This study was aimed at developing methods to improve the effectiveness of psychological assistance to Ukrainians affected by the Russian-Ukrainian war. For this purpose, the current legislation of Ukraine was analysed, a survey among the affected civilian population was conducted, and international experience in providing psychological assistance in war and crisis situations was considered. The findings demonstrated significant gaps in the legislation presented in the reviewed regulatory documents. The identified weaknesses related to coordination between different services, funding of programmes and specific needs of different population groups (children, women, the elderly and internally displaced persons), which led to a lack of efficiency in the provision of psychological assistance and limited access to the necessary services in the context of the Russian-Ukrainian war. A survey of respondents on the availability and quality of psychological assistance showed that 28% of respondents in Group 1 (whose participants had experienced traumatic experiences, including the occupation) highly appreciated the availability of assistance, while in Group 2 this figure was 59%. The findings indicated significant differences in the perception of the availability of assistance between different categories of the population, which is likely related to the level of trauma and the effectiveness of existing support programmes. It was found that the need for psychological assistance far exceeds the available resources, and the need to expand assistance programmes and increase their effectiveness was substantiated. International experience of providing psychological assistance in war and crisis situations has shown that integrated interventions that combine medical and psychosocial support are effective in reducing the level of mental disorders among refugees and victims. Recommendations for improving legislation included the introduction of information campaigns to reduce the stigma of mental disorders and raise public awareness of available services. The findings pointed to the need to integrate psychological support into the general healthcare system and to increase funding for programmes. [ABSTRACT FROM AUTHOR]

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]

Early‐onset depression contributes significantly to the global health burden and has long‐term negative effects. This meta‐analysis collates and examines the effectiveness of family‐based interventions, where family members are involved in the treatment of depression in children and adolescents. A literature search was performed up to 8th March 2023. Randomised controlled trials of family‐based interventions were included for participants aged 3–18 years with a diagnosis of major depressive disorder or dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric Association, 2013) or with a score above a cut‐off on a standardised self‐report depression measure. The overall effect size for treatment versus active control was g = 0.22 (95% confidence interval [CI]: −0.05–0.50) (nine studies; 659 participants), and for treatment versus non‐active control it was g = 0.46 (95% CI: −0.09–1.01) (four studies; 385 participants). Effect sizes were not statistically significant, and heterogeneity was high, ranging between I2 = 64.3–81.1%. Subgroup analysis comparing attachment‐based family therapy with family therapy using other theoretical frameworks did not yield a significant difference between the two. The effects of family‐based therapies were larger than those in the comparison groups, but family‐based therapy did not demonstrate a significant treatment benefit compared to the controls. More randomised controlled trials are warranted, considering that evidence for other psychotherapies for depression in children and adolescents, indicates modest effects. Family‐based therapy may be an alternative for children and adolescents whose needs are not addressed by these treatments. [ABSTRACT FROM AUTHOR]

Rates of social, emotional, and behavioral difficulties are rising and significantly impact K-12 students' learning. Unfortunately, many teachers report being underprepared to identify, refer, or manage these symptoms. This study utilized a graduate course to address the mental health literacy needs of in-service teachers. Significant improvements in mental health literacy were achieved at course completion. Several participants also reported examples of how they demonstrated mental health literacy in their subsequent educational practices. These findings support the impact of in-service teacher education that focuses on mental health literacy. [ABSTRACT FROM AUTHOR]

Background: Studies that examined sex differences in first-episode patients consistently show that males compared to females have poor premorbid adjustment, earlier age of onset, worse clinical characteristics, and poorer outcomes. However, little is known about potential mediators that could explain these sex differences. Methods: Our sample consisted of 137 individuals with first episode schizophrenia (males, n = 105; 77%) with a mean age of 22.1(s.d. = 4.1) years and mean education of 12.5(s.d. = 1.7) years. At entry, patients were within 2 years of their first psychotic episode onset. Baseline assessments were conducted for premorbid adjustment, symptoms, cognitive functioning, insight, and at 6-months for role and social functioning. Results: Males as compared to females had poorer premorbid adjustment across several key developmental periods (p < 0.01), an earlier age of onset [M = 20.3(3.3) v. 22.8(5.6), p = 0.002], more negative symptoms (p = 0.044), poorer insight (p = 0.031), and poorer baseline and 6-month role (p = 0.002) and social functioning (p = 0.034). Several of these variables in which males showed impairment were significant predictors of 6-month role and social functioning. Premorbid adjustment and insight mediated the relationship between sex and role and social functioning at 6-months, but not negative symptoms. Discussion: Males compared to females were at lower levels across several key premorbid and clinical domains which are strongly associated with functional outcome supporting the hypothesis that males might have a more disabling form of schizophrenia. The relationship between sex with role and social functioning was mediated through premorbid adjustment and insight suggesting pathways for understanding why females might have a less disabling form of schizophrenia. [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]

Using data from the Pathways to Desistance Project, this study examined the bi-directional and longitudinal relationship between mental health symptoms and connectedness among 561 system involved Black youth. Higher mental health symptom scores at baseline increased connectedness scores one year later. Connectedness scores increased for two consecutive years until the transition to adulthood when participants were on average 19–20 years-old. During the transition to adulthood, mental health symptom scores worsened, highlighting the transition to adulthood as a key timepoint to administer supportive interventions addressing the mental health needs of Black youth who interact with the juvenile justice system. [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]

There is little research on personality disorder (PD) onset in older age. Many studies have shown that normative personality traits change across the life span, even into later life. This study aimed to investigate the onset of PDs in later adulthood (>age 55), and the possible influence of major life events on predicting this late onset. The current analysis was conducted with data from the St. Louis Personality and Aging Network (SPAN). Structured diagnostic interviews were administered three times over five years. Logistic regressions were conducted predicting late onset PD from baseline to FU5 and from FU5 to FU10 as a function of each major life event. 75 PD onsets occurred from baseline to FU5, and 39 PD onsets occurred from FU5 to FU10. Personal illness predicted the onset of PDs from FU5 to FU10. [ABSTRACT FROM AUTHOR]

Psychological distress is a significant and growing issue in society. In particular, depression and anxiety are leading causes of disability that often go undetected or late-diagnosed. Automatic detection, assessment, and analysis of behavioural markers of psychological distress can help improve identification and support prevention and early intervention efforts. Compared to modalities such as face, head, and vocal, research investigating the use of the body modality for these tasks is relatively sparse, which is partly due to the limited available datasets and difficulty in automatically extracting useful body features. To enable our research, we have collected and analyzed a new dataset containing full body videos for interviews and self-reported distress labels. We propose a novel approach to automatically detect self-adaptors and fidgeting, a subset of self-adaptors that has been shown to correlate with psychological distress. We perform analysis on statistical body gestures and fidgeting features to explore how distress levels affect behaviors. We then propose a multi-modal approach that combines different feature representations using Multi-modal Deep Denoising Auto-Encoders and Improved Fisher Vector Encoding. We demonstrate that our proposed model, combining audio-visual features with detected fidgeting behavioral cues, can successfully predict depression and anxiety in the dataset. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the co‐occurrence of nonsuicidal self‐injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. Methods: A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self‐Harm Inventory and a measure of ED pathology. Results: Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p <.001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self‐injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. Discussion: Adolescents—in particular, females— with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self‐injury than vice versa, underscoring the importance of carefully screening for the presence of self‐harm among males with ED pathology. Public Significance Statement: Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self‐harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self‐harm among males with ED pathology. Parents, schools, and health professionals should be aware that self‐harm and ED pathology commonly co‐occur and warrant assessment. [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]

Teachers can play a crucial role in identifying and responding to children's mental health difficulties. This study explored teachers' mental health literacy (MHL) and their help-giving responses, a topic which is relatively unexplored, particularly at primary school level. Primary teachers (N = 356) responded to a questionnaire that followed the presentation of each of three vignettes: a non-clinical, control, vignette and two clinical vignettes. One of the clinical vignettes described a child with generalised anxiety disorder and another described a child with depression. Mixed-methods questioning was used to assess teachers' ability to recognise internalising disorders and their help-giving responses. Most participants were able to recognise a child experiencing an internalising disorder, with 84% accurately identifying anxiety and 71% accurately identifying depression. Multiple regression analyses showed that being female and having more exposure to mental illness were significantly associated with greater concern for affected children. Greater concern and confidence in one's ability to help students in need were significantly associated with teachers' intention to offer support. More years of teaching experience was associated with less help-giving intentions. MHL training for teachers is recommended so as to improve their ability to identify and respond to children's mental health difficulties in a timely manner. [ABSTRACT FROM AUTHOR]

Experiencing a death by suicide is a devastating event in the lives of adolescents; however, little is known about what makes help helpful according to their experiences. Thematic analysis of individual and group interview data (N = 18) yielded four themes: feeling connected with, and understood by a helper, having a sense of control over, and access to the help as needed. Findings indicate that help should be based on supportive and educational approaches with respect to the adolescents' agency and the family context. Help must be accessible on a long-term basis while catering for flexible usage. [ABSTRACT FROM AUTHOR]

Sexual and relationship needs of people with psychosis are generally overlooked despite established psychosocial benefits and reduced risk of relapse. Despite mental health professionals' reluctance to initiate conversations about sexuality and intimacy with service-users, people with psychosis and their support networks have indicated their desire for professionals to address intimate topics. Clinical psychologists are specifically trained to address complex psychological issues; however, no research to date has explored their views around discussing sexuality and intimacy. Q-methodology was used to explore clinical psychologists' personal and professional views about discussing sexuality and intimacy with people with psychosis. 27 clinical psychologists completed Q-sorts. Varimax rotation revealed three factors with distinct views; a majority perspective that highlighted the normality of sexuality and intimacy for people with psychosis and the acceptability of such conversations in clinical work for practitioners, a view focused on concerns about the appropriateness of discussing sexuality and the possibility that conversations could lead to increased risk, and a view that related to concerns about competency in addressing intimate subjects. The practical and clinical implications are discussed in terms of training need and limited access to sexual health services. [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]

Aim: Research has shown that preventative intervention in individuals at ultra‐high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive‐behavioural case management and (3) antidepressant medication with an embedded fast‐fail option of (4) omega‐3 fatty acids or low‐dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. Methods: STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. Results: Of 1343, help‐seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty‐five percent of the enrolled sample had a non‐psychotic DSM‐5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. Discussion: The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate. [ABSTRACT FROM AUTHOR]

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

Background: Early‐onset (EO) major depressive disorder (MDD) patients experience more depressive episodes and an increased risk of relapse. Thus, on a neurobiological level, adult EO patients might display brain structure and function different from adult‐onset (AO) patients. Methods: A total of 103 patients (66 females) underwent magnetic resonance imaging. Structural measures of gray matter volume (GMV) and functional connectivity networks during resting state were compared between EO (≤19 years) and AO groups. Four residual major depression symptoms, mood, anxiety, insomnia, and somatic symptoms, were correlated with GMV between groups. Results: We found comparatively increased GMV in the EO group, namely the medial prefrontal and insular cortex, as well as the anterior hippocampus. Functional networks in EO patients showed a comparatively weaker synchronization of the left hippocampus with the adjacent amygdala, and a stronger integration with nodes in the contralateral prefrontal cortex and supramarginal gyrus. Volumetric analysis of depression symptoms associated the caudate nuclei with symptoms of insomnia, and persisting mood symptoms with the right amygdala, while finding no significant clusters for somatic and anxiety symptoms. Conclusions: The study highlights the important role of the hippocampus and the prefrontal cortex in EO patients as part of emotion‐regulation networks. Results in EO patients demonstrated subcortical volume changes irrespective of sleep and mood symptom recovery, which substantiates adolescence as a pivotal developmental phase for MDD. Longitudinal studies are needed to differentiate neural recovery trajectories while accounting for age of onset. [ABSTRACT FROM AUTHOR]

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

Background: The felt and emotional aspects of psychosis are poorly understood, however, their importance for the aetiology of, and recovery from, psychosis is increasingly accepted. Individuals experiencing psychosis often come into contact with mental health services during a crisis. Currently little is known about the emotional and felt aspects of this experience, yet this could support clinical intervention at this time. Aims: This research aims to gain an in-depth understanding of the lived, felt experiences of a first crisis in psychosis. Method: The study took a hermeneutic phenomenological perspective and utilised visual methods. Seven participants participated in idiographic, multi-modal interviews about their experiences. Results: Participants described their first crisis in psychosis as a shattering experience, entwined with their experiences of interpersonal trauma. In crisis, participants lost basic trust in the world; felt enveloped in a strange, threatening atmosphere, and lacked a sense of belonging. Conclusions: Attention to the felt aspects of a crisis indicate the existential, intersubjective and traumatic nature of the experience. Psychosocial, family and trauma-focused approaches that take into account the holistic, embodied and contextual nature of psychosis experiences seem best-placed to support treatment and research in this area. [ABSTRACT FROM AUTHOR]

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

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

There are well-documented situational factors which correspond to risks of exclusion and mental health difficulties. However, in education policy, factors relating to exclusion and mental health needs are often attributed to dispositional, within-person factors rather than situational factors, or even wider systemic factors which may contribute to the situations in which difficulties occur. There is also a great deal of evidence that the language of description has a significant impact on how issues are perceived and responded to. The following study aimed to explore the language used to describe concerns about children and young people's social, emotional and mental health needs on referral forms into a Local Authority SEND Support service. Thematic analysis identified a variation in how needs were described, including within themes of 'What?' the behaviour was, 'Why?' it was occurring and a 'So What?' factor in terms of implications. The following article concludes that the language used to describe behaviours causing concern can have an important impact on how the behaviours are framed, and therefore responded to, and argues for avoidance of language which predisposes within-person accounts of behaviours at the expense of the situational and systemic interpretations which need addressing in order to facilitate inclusive responses. [ABSTRACT FROM AUTHOR]

Background: headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. Methods: Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. Results: 1107 young people participated, aged 12–25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. Conclusions: Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare. [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]