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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Identifying early biomarkers of serious mental illness (SMI)—such as changes in brain structure and function—can aid in early diagnosis and treatment. Whole brain structural and functional connectomes were investigated in youth at risk for SMI. Methods: Participants were classified as healthy controls (HC; n = 33), familial risk for serious mental illness (stage 0; n = 31), mild symptoms (stage 1a; n = 37), attenuated syndromes (stage 1b; n = 61), or discrete disorder (transition; n = 9) based on clinical assessments. Imaging data was collected from two sites. Graph-theory based analysis was performed on the connectivity matrix constructed from whole-brain white matter fibers derived from constrained spherical deconvolution of the diffusion tensor imaging (DTI) scans, and from the correlations between brain regions measured with resting state functional magnetic resonance imaging (fMRI) data. Results: Linear mixed effects analysis and analysis of covariance revealed no significant differences between groups in global or nodal metrics after correction for multiple comparisons. A follow up machine learning analysis broadly supported the findings. Several non-overlapping frontal and temporal network differences were identified in the structural and functional connectomes before corrections. Conclusions: Results suggest significant brain connectome changes in youth at transdiagnostic risk may not be evident before illness onset. [ABSTRACT FROM AUTHOR]

Background: In their early stages, serious mental illnesses (SMIs) are often indistinguishable from one another, suggesting that studying alterations in brain activity in a transdiagnostic fashion could help to understand the neurophysiological origins of different SMI. The purpose of this study was to examine brain activity in youth at varying stages of risk for SMI using functional magnetic resonance imaging tasks (fMRI) that engage brain systems believed to be affected. Methods: Two hundred and forty three participants at different stages of risk for SMI were recruited to the Canadian Psychiatric Risk and Outcome (PROCAN) study, however only 179 were scanned. Stages included asymptomatic participants at no elevated risk, asymptomatic participants at elevated risk due to family history, participants with undifferentiated general symptoms of mental illness, and those experiencing attenuated versions of diagnosable psychiatric illnesses. The fMRI tasks included: (1) a monetary incentive delay task; (2) an emotional Go‐NoGo and (3) an n‐back working memory task. Results: Strong main effects with each of the tasks were found in brain regions previously described in the literature. However, there were no significant differences in brain activity between any of the stages of risk for SMI for any of the task contrasts, after accounting for site, sex and age. Furthermore, results indicated no significant differences even when participants were dichotomized as asymptomatic or symptomatic. Conclusions: These results suggest that univariate BOLD responses during typical fMRI tasks are not sensitive markers of SMI risk and that further study, particularly longitudinal designs, will be necessary to understand brain changes underlying the early stages of SMI. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to identify a sample of youth in distinct stages of risk for the development of a serious mental illness (SMI) according to a published clinical staging model and to follow this sample longitudinally to determine clinical changes over time. This article reports the 6‐ and 12‐month follow‐up of the cohort. Methods: This study recruited 243 youth, ages 12 to 25. The sample included (a) 42 healthy controls, (b) 41 nonhelpseeking individuals with no mental illness but some risk of SMI, for example, having a first‐degree relative with an SMI (stage 0), (c) 53 youth experiencing distress and mild symptoms of anxiety or depression (stage 1a), and (d) 107 youth with attenuated symptoms of SMIs such as bipolar disorder or psychosis (stage 1b). Participants completed a range of measures assessing depression, anxiety, mania, suicide ideation, attenuated psychotic symptoms, negative symptoms, anhedonia and beliefs about oneself at baseline, 6‐ and 12‐months. Results: There were few changes for healthy controls and stage 0 participants, although approximately 7% did move to a symptomatic stage within 12‐months. Of stage 1a participants, 50% remained symptomatic, with 7.5% moving to stage 1b or developing a SMI. Approximately 9% of stage 1byouth developed a SMI within 12‐months and approximately one‐third had remission of symptoms during the follow‐up. Conclusions: Results suggest that the implementation of a transdiagnostic staging model may be useful in youth mental health and support consideration of clinical stage‐based treatment for youth with early features of risk. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to describe the substance use of participants who are at‐risk for serious mental illness (SMI). Method: The Canadian Psychiatric Risk and Outcome study (PROCAN) is a two‐site study of 243 youth and young adults aged 13 to 25 years, categorized into four groups: healthy controls (n = 42), stage 0 (asymptomatic individuals with risk of SMI typically family high risk; n = 41), stage 1a (distress disorder or mild symptoms of anxiety or depression; n = 53) and stage 1b (attenuated syndromes, including bipolar disorder or psychosis; n = 107). Substance use measures were administered at baseline, 6‐ and 12‐months. Results: At baseline, the most commonly reported substance used in the past month was alcohol (43.6%), followed by cannabis (14.4%) and tobacco (12.4%). There were no significant group differences in use. 42.4% of all participants reported ever using cannabis in their lifetime, whereas 21.4% reported currently using cannabis. There were no group differences in ever having used cannabis. Regarding lifetime substance abuse disorders, cannabis use disorder (5.7%) and alcohol use disorder (4.5%) were the most common and more often reported in stage 1b participants relative to other groups. Furthermore, alcohol, cannabis and tobacco use remained relatively consistent at 6‐ and 12‐month follow‐ups when compared to baseline use. Conclusion: Alcohol was the most commonly used substance followed by cannabis and tobacco. Although substance use did not differ between those at different stages of risk, overall prevention strategies are still warranted for youth at‐risk for SMI, especially those who are more symptomatic and potentially at greater risk of developing an SMI. [ABSTRACT FROM AUTHOR]

Background: This study was conducted as a pilot exercise intervention in youth at‐risk for serious mental illness (SMI). The objectives were to examine the feasibility of an exercise intervention and to determine what improvement was observed, following participation in a moderate‐ to high‐intensity aerobic exercise programme. Methods: Forty‐four male and female youth at‐risk for SMI were recruited. Participants completed clinical, lifestyle and fitness assessments prior to and following a 16‐week moderate‐ to high‐intensity aerobic exercise intervention. Sixty‐minute exercise sessions were held three times per week. Results: Forty‐one participants completed the entire intervention and assessments; thus, the retention rate was 93.2%. Exercise participants achieved a mean of 98.3 (standard deviation (SD) 26.1) minutes/week of high‐intensity and a mean of 32.8 (SD 8.7) minutes/week of moderate‐intensity aerobic exercise over the course of 16 weeks. Improvements in aerobic fitness and body composition as well as reductions in anxiety and depression were observed after the exercise intervention. Conclusion: Aerobic exercise is a feasible and sound intervention strategy in youth at‐risk for SMI. Further research is required to expand upon these initial findings and develop knowledge of the mechanisms, optimum dose and factors that influence the efficacy of exercise. [ABSTRACT FROM AUTHOR]

Aim: Certain personality traits may be related to an increased risk of developing a severe mental illness (SMI). This study examined differences in personality characteristics in a sample of youth at‐risk of SMI across different clinical stages compared to healthy controls (HCs). Method: Personality characteristics were assessed with the NEO‐Five‐Factor Inventory‐3 for 41 non‐help seeking asymptomatic youth with risk factors for SMI (Stage 0), 52 youth with early mood and anxiety symptoms and distress (Stage 1a), 108 youth with an attenuated psychiatric syndrome (Stage 1b), and 42 HCs. Results: Symptomatic participants scored significantly higher in neuroticism, and lower in extraversion, and conscientiousness compared to non‐symptomatic participants. Compared to published norms, symptomatic participants had ratings of extraversion and conscientiousness in the low range and those with attenuated psychiatric syndromes scored high on neuroticism. Conclusion: The observed personality profiles of the symptomatic stages were similar to reported profiles for discrete disorders. Early identification of this profile could aid identification of those at risk of SMI. [ABSTRACT FROM AUTHOR]

Aim: Functional impairment is common in serious mental illness (SMI). This study assessed social and role functioning in a sample of youth at risk of SMI who met different stages of risk based on a transdiagnostic clinical staging model described by McGorry and colleagues. Method: The sample consisted of 243 male and female youths aged 12‐26 and included: non‐help‐seeking youth with risk factors (stage 0; n = 41); youth with mild symptoms (stage 1a; n = 52); youth with attenuated psychiatric syndromes (stage 1b; n = 108); and healthy controls (HCs; n = 42). Social and role functioning were assessed with the Global Functioning: Social and Role scales. Results: Participants in stage 1b (attenuated syndromes) had significantly poorer social and role functioning than stage 0 participants and HCs (P <.001) and poorer social functioning than stage 1a (P <.05). Stage 1a participants had significantly poorer social functioning than HCs (P <.01) and significantly poorer role functioning than stage 0 participants (P <.01). Participants in stages 1a and 1b did not significantly differ from each other in role functioning only. Conclusions: This study demonstrates that mild to moderate functional impairments are present in young people experiencing subthreshold psychiatric symptoms and distress in the absence of a diagnosable mental illness. Results partially validate the model in that social although not role functioning declines across the stages. [ABSTRACT FROM AUTHOR]

Aim: To investigate sleep behaviours of youth at‐risk for serious mental illness (SMI). Methods: This study included 243 youth, ages 12 to 25:42 healthy controls, 41 asymptomatic youth at‐risk for mental illness (stage 0); 53 help‐seeking youth experiencing distress (stage 1a) and 107 youth with attenuated syndromes (stage 1b). The Pittsburgh Sleep Quality Index was used to assess sleep dysfunction. Results: Stage 1b individuals indicated the greatest deficit in global sleep dysfunction (F = 26.18, P <.0001). Stages 1a and 1b reported significantly worse subjective sleep quality, a longer sleep latency, increased use of sleep medications as well as greater daytime dysfunction compared to the asymptomatic groups. Conclusion: Research investigating sleep behaviours of youth considered to be at‐risk for SMI is limited. This study provides early evidence that sleep disturbances are worse for individuals considered to be at higher risk of illness development. [ABSTRACT FROM AUTHOR]

Aim: Alterations in limbic structures may be present before the onset of serious mental illness, but whether subfield‐specific limbic brain changes parallel stages in clinical risk is unknown. To address this gap, we compared the hippocampus, amygdala, and thalamus subfield‐specific volumes in adolescents at various stages of risk for mental illness. Methods: MRI scans were obtained from 182 participants (aged 12–25 years) from the Canadian Psychiatric Risk and Outcome study. The sample comprised of four groups: asymptomatic youth at risk due to family history of mental illness (Stage 0, n = 32); youth with early symptoms of distress (Stage 1a, n = 41); youth with subthreshold psychotic symptoms (Stage 1b, n = 72); and healthy comparison participants with no family history of serious mental illness (n = 37). Analyses included between‐group comparisons of brain measurements and correlational analyses that aimed to identify significant associations between neuroimaging and clinical measurements. A machine‐learning technique examined the discriminative properties of the clinical staging model. Results: Subfield‐specific limbic volume deficits were detected at every stage of risk for mental illness. A machine‐learning classifier identified volume deficits within the body of the hippocampus, left amygdala nuclei, and medial‐lateral nuclei of the thalamus that were most informative in differentiating between risk stages. Conclusion: Aberrant subfield‐specific changes within the limbic system may serve as biological evidence to support transdiagnostic clinical staging in mental illness. Differential patterns of volume deficits characterize those at risk for mental illness and may be indicative of a risk‐stage progression. [ABSTRACT FROM AUTHOR]

Aim: The first aim of this project was to identify a sample of youth who met different stages of risk for the development of a serious mental illness (SMI) based on a published clinical staging model. The second aim was to determine whether participants allocated to the different stages were a good fit to the model by comparing these groups on a range of clinical measures. Methods: This two‐site longitudinal study recruited 243 youth, ages 12 to 25. The sample included (a) 42 healthy controls, (b) 43 non‐help seeking individuals with no mental illness but with some risk of SMI, such as having a first‐degree relative with a SMI (stage 0), (c) 52 help‐seeking youth experiencing distress and possibly mild symptoms of anxiety or depression (stage 1a) and (d) 108 youth with attenuated symptoms of SMI, such as bipolar disorder or psychosis (stage 1b). Participants completed a range of measures assessing depression, anxiety, mania, suicide ideation, attenuated psychotic symptoms, negative symptoms, anhedonia and beliefs about oneself. Results: There were no clinical differences between HCs and participants in stage 0. For most of the clinical measures, participants in stage 1b had more severe ratings than participants in stages 1a and 0 and HCs; those in stage 1a had more severe ratings than HCs and stage 0 participants. Conclusions: These results suggest that the staging process used to allocate participants to various stages is a good fit. That is, the clinical ratings followed an ordering effect consistent with that hypothesized in the staging model. [ABSTRACT FROM AUTHOR]

Objective: The aim was to describe treatment history including medications, psychosocial therapy and hospital visits of participants in the Canadian Psychiatric Risk and Outcomes Study (PROCAN).Methods: PROCAN is a 2-site study of 243 youth/young adults aged 12 to 25 y, categorized into 4 groups: healthy controls ( n = 42), stage 0 (non-help seeking, asymptomatic with risk mainly family history of serious mental illness (SMI); n = 41), stage 1a (distress disorders; n = 52) and stage 1b (attenuated syndromes; n = 108). Participants were interviewed regarding lifetime and current treatments, including medications, psychosocial therapies and hospital visits.Results: The number receiving baseline medications differed significantly across groups ( P < 0.001): 0% healthy controls, 14.6% stage 0, 32.7% stage 1a and 34.3% stage 1b. Further, 26.9% and 49.1% of stage 1a and stage 1b participants received psychosocial therapy at baseline, indicative of statistically significant differences among the groups ( P < 0.001). Similar results were observed for lifetime treatment history; stage 1b participants had the highest frequency of lifetime treatment. Medications started in adulthood (>18 y of age) were the most common for initiation of treatment compared to childhood (0 to 12 y) and adolescence (13 to 17 y) for stage 1a and 1b participants. Lifetime mental health hospital visits differed significantly across groups ( P < 0.001) and were most common in stage 1b participants (29.6%) followed by stage 1a (13.5%), stage 0 (4.9%) and healthy controls (2.4%).Conclusion: We found that treatment history for participants in the PROCAN study differed among the at-risk groups. Future initiatives focused on determining the effects of treatment history on SMI are warranted. [ABSTRACT FROM AUTHOR]

Aim: Major depressive disorder (MDD) onset generally occurs in adolescence/early adulthood. However, pharmacotherapy use in younger populations is restricted due to black box warnings. Aerobic exercise may be a viable treatment option for mild‐to‐moderate MDD, but little is known about its acceptability/effectiveness in young adults. Methods: Unmedicated and relatively inactive 18‐to‐24 olds with MDD completed fitness/clinical assessments at baseline and after 12 weeks of supervised aerobic exercise (3×/wk; 30‐minute sessions in target heart rate [HR] zone), with the aim of increasing cardiovascular fitness (VO2max‐indexed). Results: Post‐intervention, predicted VO2max increased, whereas depression scores decreased. A correlation existed between time spent in target HR zone and anxiety symptom decreases. Exercise adherence and satisfaction were high, and drop‐out was minimal. Conclusions: This pilot is among the first to assess the feasibility of aerobic exercise as an antidepressant treatment strategy in young adults, a group for which options have limited acceptability. [ABSTRACT FROM AUTHOR]

Highlights • Different stages of risk were associated with different neurocognitive functioning. • Youth with attenuated psychiatric syndromes showed some neurocognitive deficits. • These deficits spanned individual neurocognitive domains and a composite score. Abstract There is a growing literature which suggests that neurocognitive deficits may be markers of susceptibility for serious mental illness development. This study assessed neurocognitive functioning in a sample of youth at risk of serious mental illness across different clinical stages as described by McGorry and colleagues and compared them to healthy controls. The sample was 243 male and female youths aged 12–26 and included: asymptomatic participants with psychiatric risk factors (Stage 0; n = 41); youth with early mood or anxiety symptoms (Stage 1a; n = 52); youth with attenuated psychiatric syndromes (Stages 1b; n = 108); and healthy controls (n = 42). The neurocognitive battery included IQ measures and the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery. Participants in Stage 1b had lower scores than healthy controls on the composite score of neurocognitive performance, across all IQ measures, and in the domains of processing speed, working memory, attention and problem solving. They also had lower scores than subjects in Stage 0 across most IQ measures and in the domains of processing speed and working memory. This study increases what is known about neurocognitive performance associated with different stages of serious mental illness development. [ABSTRACT FROM AUTHOR]

The author discusses the relationship between gut microbiota and psychiatric illness. Topics covered include how depression, stress, anxiety and autism are at least partially sensitive to manipulation of the gut microbiome and the strength of the evidence on which decisions to take prebiotic or probiotic preparations are being made.

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background There exists very little evidence to guide clinical management for preventing recurrence of major depression. The objective of this study was to develop and validate a prediction algorithm for recurrence of major depression. Methods Wave 1 and wave 2 longitudinal data from the U.S. National Epidemiological Survey on Alcohol and Related Condition (2001/2002-2003/2004) were used. Participants with a major depressive episode at baseline and who had visited health professionals for depression were included in this analysis ( n = 2,711). Mental disorders were assessed based on the DSM-IV criteria. Results With the development data ( n = 1,518), a prediction model with 19 unique factors had a C statistics of 0.7504 and excellent calibration ( P = .23). The model had a C statistics of 0.7195 in external validation data ( n = 1,195) and 0.7365 in combined data. The algorithm calibrated very well in validation data. In the combined data, the 3-year observed and predicted risk of recurrence was 25.40% (95% CI: 23.76%, 27.04%) and 25.34% (95% CI: 24.73%, 25.95%), respectively. The predicted risk in the 1st and 10th decile risk group was 5.68% and 60.21%, respectively. Conclusions The developed prediction model for recurrence of major depression has acceptable discrimination and excellent calibration, and is feasible to be used by physicians. The prognostic model may assist physicians and patients in quantifying the probability of recurrence so that physicians can develop specific treatment plans for those who are at high risk of recurrence, leading to personalized treatment and better use of resources. [ABSTRACT FROM AUTHOR]

Increased, decreased, as well as unchanged pituitary volumes have been reported in bipolar disorders (BD). It is unclear, whether abnormal pituitary volumes increase vulnerability for BD (primary vulnerability marker), or are secondary to burden of illness. To address this question, we performed the first high-risk study of pituitary volumes in affected and unaffected relatives of bipolar subjects. High-risk participants (age range 15–30 years) were recruited from families multiply affected with BD and included 24 unaffected, 19 affected subjects with first or second degree bipolar I or II relative, matched by age and sex with 31 controls without a personal or family history of psychiatric disorders. Pituitary volumes were measured on 1.5 T 3D anatomical MRI images using standard methods. We found comparable pituitary volumes among unaffected, affected relatives of bipolar patients and controls. There were no differences in pituitary volumes between male and female subjects nor was there any sex by group interaction. Analyzing 26 participants with bipolar I parent or excluding 5 medicated subjects did not change the results. There were no differences between subjects from families containing bipolar I versus families containing only bipolar II subjects. The lack of abnormalities in unaffected and also affected subjects early in the course of illness in our study, as well as previous investigations of bipolar and familial unipolar children and adolescents, suggest that pituitary volume abnormalities are unlikely to be a primary risk factor for mood disorders. [ABSTRACT FROM AUTHOR]

Joffe RT, MacQueen GM, Marriott M, Young LT. A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorder. Bipolar Disord 2004: 6: 62–66. © Blackwell Munksgaard, 2004 There is a recent appreciation that patients with bipolar disorder spend a substantial period of time with minor or subsyndromal mood symptoms both manic and depressive. This study examined time spent in minor and subsyndromal mood states as well as with mania and depression in a cohort of well characterized bipolar I and II patients who were followed prospectively for an average of three years. Detailed life-charting data were obtained from 138 patients with bipolar disorder. Mood states were characterized as euthymic, subsyndromal, minor or major affective episodes based on rigorously defined criteria. The amount of time spent in these mood states during follow-up was examined. Patients in the total sample and within each bipolar subtype spent approximately half of their time euthymic. The remainder of the time was spent in varying severity of mood states. However, the majority of time was spent with minor and subsyndromal symptoms, both manic and depressive. Bipolar I patients differ from bipolar II in that significantly more time was spent with subsyndromal, minor and manic symptoms. There was no difference in time spent with depressive symptoms between the two groups. Patients with bipolar disorder spend a substantial proportion of time with depressive or manic symptoms with the preponderance being minor or subsyndromal. Awareness of subthreshold symptoms in bipolar disorders and treatment of such symptoms may be improved by establishing guidelines that specifically outline appropriate strategies for reducing the duration of subsyndromal symptoms in bipolar disorder. [ABSTRACT FROM AUTHOR]

The author suggests that while basic research on brain development during adolescence may seem to be thriving, the understanding of how to approach this development from a clinical and policy perspective is lagging. Topics discussed include adolescence as the period marking the transition from childhood to adulthood which typically spans from 12 to 18 years of age and adolescence as a distinct developmental period when the incidence of many psychiatric illnesses rises dramatically.

• No studies investigated longitudinal white matter changes in transdiagnostic risk • No significant differences in frontal white matter connectivity observed over time • Changes in right anterior thalamic radiations observed before corrections Longitudinal changes in white matter connectivity were assessed in a sample of youth at-risk for serious mental illness (n =183; age 12-25). Diffusion tensor imaging (DTI) was acquired at baseline and 12 months from youth recruited across two sites and classified as healthy controls (n =36), familial risk (n =30), mild-symptoms (n =41), attenuated syndromes (n =70), or transition (n =9) based on clinical assessments. Fractional anisotropy (FA) and mean diffusivity (MD) values were derived for the whole brain white matter, forceps minor, anterior cingulate, anterior thalamic radiations, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, and uncinate fasciculus. MANCOVA analysis controlling for site, sex, and age showed no significant group differences in FA and MD at baseline or at 12 months. Linear mixed effects analysis showed a significant effect for time for most white matter tracts, but no effect for group, or group by time interaction. Transdiagnostic risk groups have similar profiles of WM connectivity and similar rates of change over time. [ABSTRACT FROM AUTHOR]

Background: Most mental disorders begin in adolescence; however, there are gaps in our understanding of youth mental health. Clinical and policy gaps arise from our current inability to predict, from amongst all youth who experience mild behavioural disturbances, who will go on to develop a mental illness, what that illness will be, and what can be done to change its course and prevent its worsening to a serious mental illness (SMI). There are also gaps in our understanding of how known risk factors set off neurobiological changes that may play a role in determining who will develop a SMI. Project goals are (i) to identify youth at different stages of risk of SMI so that intervention can begin as soon as possible and (ii) to understand the triggers of these mental illnesses. Method: This 2-site longitudinal study will recruit 240 youth, ages 12–25, who are at different stages of risk for developing a SMI. The sample includes (a) healthy individuals, (b) symptom-free individuals who have a first-degree relative with a SMI, (c) youth who are experiencing distress and may have mild symptoms of anxiety or depression, and (d) youth who are already demonstrating attenuated symptoms of SMI such as bipolar disorder or psychosis. We will assess, every 6 months for one year, a wide range of clinical and psychosocial factors to determine which factors can be used to predict key outcomes. We will also assess neuroimaging and peripheral markers. We will develop and validate a prediction algorithm that includes demographic, clinical and psychosocial predictors. We will also determine if adding biological markers to our algorithm improves prediction. Discussion: Outcomes from this study include an improved clinical staging model for SMI and prediction algorithms that can be used by health care providers as decision-support tools in their practices. Secondly, we may have a greater understanding of clinical, social and cognitive factors associated with the clinical stages of development of a SMI, as well as new insights from neuroimaging and later neurochemical biomarker studies regarding predisposition to SMI development and progression through the clinical stages of illness. [ABSTRACT FROM AUTHOR]

Childhood trauma has been shown to have detrimental consequences on mental health. It is unknown what impact childhood trauma may have on the early trajectory of serious mental illness (SMI). The purpose of this article is to estimate the baseline prevalence, perceived impact, and duration of trauma that occurred before the age of 18 years in youth at risk for SMI using a transdiagnostic approach. This study included 243 youths, ages 12 to 25 years (42 healthy controls, 43 non-help-seeking individuals [stage 0], 52 help-seeking youth experiencing distress and possibly mild symptoms of anxiety or depression [stage1a], and 108 youth demonstrating attenuated symptoms of an SMI such as bipolar disorder or psychosis [stage 1b]). Participants completed an adapted version of the Childhood Trauma and Abuse scale. There were high frequencies of reported trauma across all stages. Symptomatic individuals experienced more trauma and bullying. Stage 1b individuals reported more physical abuse. Stage 1b also indicated psychological bullying to have a longer duration and impact on their lives. Future work should aim to clarify the complex interrelations between trauma and risk of SMI. [ABSTRACT FROM AUTHOR]

The article offers commentary on the paper "Absolute risk of suicide after first hospital contact in mental disorder," by M. Nordentoft, P. B. Mortensen and C. B. Pedersen which was published in volume 68 of "Archives of General Psychiatry." This study highlights the absolute risk of suicide among men who were diagnosed with bipolar disorder and the high incidence of suicide among women with schizophrenia. The article suggests that the key strength of this study is the long-term follow up.

• White matter changes in transdiagnostic risk was compared to discrete disorder. • Discrete disorder group had lower fractional anisotropy compared to other groups. • Attenuated syndromes group had higher fractional anisotropy compared to controls. • White matter changes in discrete disorder are most evident after illness onset. • Few changes in white matter were observed in the transdiagnostic risk phase. Identifying biomarkers of serious mental illness, such as altered white matter microstructure, can aid in early diagnosis and treatment. White matter microstructure was assessed using constrained spherical deconvolution of diffusion imaging data in a sample of 219 youth (age 12–25 years, 64.84% female) across 8 sites. Participants were classified as healthy controls (HC; n = 47), familial risk for serious mental illness (n = 31), mild-symptoms (n = 37), attenuated syndromes (n = 66), or discrete disorder (n = 38) based on clinical assessments. Fractional anisotropy (FA) and mean diffusivity (MD) values were derived for the whole brain white matter, forceps minor, anterior cingulate, anterior thalamic radiations (ATR), inferior fronto-occipital fasciculus, superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF). Linear mixed effects models showed a significant effect of age on MD of the left ATR, left SLF, and left UF, and a significant effect of group on FA for all tracts examined. For most tracts, the discrete disorder group had significantly lower FA than other groups, and the attenuated syndromes group had higher FA compared to HC, with few differences between the remaining groups. White matter differences in MDD are most evident in individuals following illness onset, as few significant differences were observed in the risk phase. [ABSTRACT FROM AUTHOR]