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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]

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 This has led to the influential positive–negative dichotomy in schizophrenia being superseded by a three-syndrome model.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]

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]

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]

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: 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]

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]

The lexical-semantic relatedness effect supposes different activation in the semantic memory of related versus unrelated word-pairs. Semantically related pairs are considered to result in a larger spread of activation as the activation of concept nodes is dependent on shared lexical-semantic features of concepts. The increased activation of concepts in the semantic memory in individuals with schizophrenia is found to be, faster spreading and lacking in inhibition in relation to healthy control subjects. The aim of this study was to examine whether the lexical-semantic relatedness effect influences processing in individuals with early course psychosis by utilizing an explicit semantic matching task with 0ms SOA (Stimulus Onset Asynchrony) to analyse the strategy-free automatic spreading activation process. Overall, the patient group had lower accuracy and longer reaction times compared with healthy subjects, as well as better accuracy for related word-pairs and longer reaction times are for unrelated word-pairs. In clinical practice, the determination of language classifiers for early course psychosis could potentially enable the creation of reliable diagnostic markers and instruments for identifying the population with an elevated risk ofdeveloping disorders within a spectrum of schizophrenia, and predicting the course of the disorder. [ABSTRACT FROM AUTHOR]

Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes. Aim: The primary aim of the study is, in a population of young people with first‐episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence‐based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24‐months follow‐up. Methods: Our single‐blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2‐year period in 180 remitted first‐episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow‐up. Results: This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017. Conclusion: This study will provide evidence as to whether an antipsychotic dose‐reduction recovery treatment leads to improved functioning and safer outcomes in first‐episode psychosis patients. In addition, it will be the first‐controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population. [ABSTRACT FROM AUTHOR]

Grey matter (GM) volume alterations have been repeatedly demonstrated in patients with first episode psychosis (FEP). Some of these neuroanatomical abnormalities are already evident in the at‐risk mental state (ARMS) for psychosis. Not only GM alterations but also neurocognitive impairments predate the onset of frank psychosis with verbal learning and memory (VLM) being among the most impaired domains. Yet, their interconnection with alterations in GM volumes remains ambiguous. Thus, we evaluated associations of different subcortical GM volumes in the medial temporal lobe with VLM performance in antipsychotic‐naïve ARMS and FEP patients. Data from 59 ARMS and 31 FEP patients, collected within the prospective Früherkennung von Psychosen study, were analysed. Structural T1‐weighted images were acquired using a 3 Tesla magnetic resonance imaging scanner. VLM was assessed using the California Verbal Learning Test and its factors Attention Span, Learning Efficiency, Delayed Memory and Inaccurate Memory. FEP patients showed significantly enlarged volumes of hippocampus, pallidum, putamen and thalamus compared to ARMS patients. A significant negative association between amygdala and pallidum volume and Attention Span was found in ARMS and FEP patients combined, which however did not withstand correction for multiple testing. Although we found significant between‐group differences in subcortical volumes and VLM is among the most impaired cognitive domains in emerging psychosis, we could not demonstrate an association between low performance and subcortical GM volumes alterations in antipsychotic‐naïve patients. Hence, deficits in this domain do not appear to stem from alterations in subcortical structures. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective. Methods: This study was conducted as part of a larger study that explored the perspectives of clients, caregivers and case managers on case management. All CMs except the CM researchers were recruited. Two CM focus group discussions (FGD) were conducted and facilitated by an experienced independent researcher from the research department. The FGDs were audio recorded and transcribed verbatim with all participants' identifiers omitted to protect confidentiality. Qualitative thematic analysis was conducted using NVivo V.10. (QSR International. NVivo V.10 (Computer software). 2012. ) Results: Eleven themes emerged from the CM FGDs which are based on the CMs' work with both clients and caregivers: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation, support and advocacy. Conclusions: The voices of CMs are important in planning service delivery models and improving the quality of care to clients and caregivers. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to describe the entry protocol of the Prevention and Early Intervention for Psychosis Program (PEPP)‐Montreal, an early intervention program for psychosis. The protocol is designed to fulfil a key objective of the early intervention movement—reducing delays to accessing high‐quality care. The paper also aims to describe how this rapid entry protocol can be deployed in other services interested in reducing delays in initiating treatment. Methods: PEPP provides rapid, easy access to quality care by placing a single, well‐trained professional, the intake clinician, at the point of entry. Anyone can refer a youth directly and without formalities to the intake clinician who responds promptly and sensitively to all help‐seeking, whether by a youth, a family member, a school counsellor or anyone acting on behalf of a youth in need. To promote accessibility, PEPP guarantees an initial assessment within 72 hours; maintains relationships with referral sources; and conducts awareness‐enhancing outreach activities. Results: Since 2003, PEPP has received 1750 referrals, which have all been responded to within 72 hours. Families have been involved in the intake process in 60% of the cases and hospitalization may have been averted in over half of the referrals originating from emergency‐room services. Another indicator of success is the very low turnover in the intake clinician's position. Overall, the PEPP model has succeeded in providing rapid, engaging, easy and youth‐friendly access to high‐quality care. Conclusion: The success of this protocol at PEPP has inspired the entry protocols at other first‐episode psychosis services. Its ability to provide rapid, engaging access to high‐quality services may allow this protocol to become a model for other early intervention services for psychosis and other mental illnesses. [ABSTRACT FROM AUTHOR]

Background: Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP). Method: MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses. Results: The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES −0.213, 95% confidence interval (CI) (−0.344 to −0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES −0.031, 95% CI (−0.048 to −0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ. Conclusion: There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking. [ABSTRACT FROM AUTHOR]

Aim: We aimed to systematically review the evidence of the effectiveness of family interventions for caregivers of people with recent‐onset psychosis compared with usual psychiatric care. A secondary objective was to directly compare the effects of different types of family interventions. Methods: MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete and EBSCOhost were searched to identify relevant randomized controlled trials. Trial data were extracted following the procedures described in the Cochrane Handbook of systematic reviews. Random‐effects models were used to pool the intervention effects. Results: Twelve studies including 1644 participants were included in this review. With the exception of a high risk of performance bias inherent to the nature of the psychosocial interventions, the studies had an overall low or unclear risk of bias, suggesting that sources of bias are unlikely to lower confidence in the estimate of intervention effects. Meta‐analyses were conducted for 4 different participant outcomes reported in 9 studies. Compared with usual psychiatric care, family intervention was more effective in reducing care burden over all follow‐up periods. Family intervention was also superior to usual care with regards to caregiving experience in the short term and improved utilization of formal support and family functioning over longer‐term follow up. Mutual support is more effective than psychoeducation in improving family functioning when measured 1 to 2 years after the intervention but had equivalent effects on utilization of formal support services. Conclusions: This review provides evidence that family intervention is effective for caregivers of recent‐onset psychosis, especially for care burden where the positive effects are enhanced over time. [ABSTRACT FROM AUTHOR]

Aim: Previous research indicates that preventive intervention is likely to benefit patients “at risk” of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive‐behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy. Methods: This is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline. Conclusion: This paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population. [ABSTRACT FROM AUTHOR]

Objective This study assessed lay people and clinicians' recognition of an at risk mental state (ARMS) for psychosis, their intentions to recommend help, and the equivalence of written and videotaped vignettes when detecting the problem. Methods In an Australian online survey, 52 lay people and 32 psychologists with provisional or full registration were randomly assigned to either a videotaped or written vignette of someone with an ARMS. Measures assessed detection and labelling of the mental health problem, and lay people's intentions to recommend help. Results Data were analysed with Chi-Square statistics, Fisher's Exact tests, and Multinomial Logistic Regression. Lay people frequently detected that a mental health problem existed but labelled it incorrectly. All clinicians detected that a mental health problem existed and most labelled it correctly. Lay people's detection that a mental health problem existed was not associated with vignette type but videotaped vignettes produced significantly more correct labelling. Clinicians had poorer labelling when the vignette was videotaped. Correct labelling was associated with intentions to recommend help to a doctor, psychiatrist, and psychologist/counsellor but not with other help sources or with 'no help.' Conclusions Results indicated that if lay people received further education about ARMS, they may be more likely to recommend help to certain mental health professionals. They further highlight the need to use multiple vignette methods in mental health literacy research and the importance of simulated learning about ARMS in professional training environments. Replication of these results in larger samples is required. [ABSTRACT FROM AUTHOR]

Cocaine continues to be a worldwide public health concern in Europe. To improve prognosis and intervention, it is necessary to understand the characteristics of the patients who depend on the services where they receive care. The objective is to analyze the differences among patients who use cocaine and between ambulatory and residential resources to better adapt treatment. This is a descriptive, observational study of two populations of cocaine users in treatment: the ambulatory therapeutic community (ATC) and the therapeutic community (TC). The PRISM diagnostic interview was used for both groups. An analysis of both populations indicates a high prevalence of cocaine, heroin, cannabis, sedative, psychostimulant, and hallucinogen use disorders in the TC population compared to the ATC. In alcohol use disorder, differences between both mental health services were not observed. The degree of severity of cocaine use disorders (CUD) is greater in the TC population. The prevalence of psychiatric comorbidity is not statistically significant between the two populations, except for primary psychotic disorders, which are more prevalent in the TC population. This difference in the prevalence of psychotic disorders may be related to the high prevalence of cannabis use disorders in TC patients. Differences in the prevalence of substance use disorders, severity of CUD, and psychiatric comorbidity may limit the efficiency of mental health services involved in substance use disorder therapeutics. These results suggest the need for careful and extensive phenotyping of patients to improve intervention and prognosis in a clinical resource-dependent manner. [ABSTRACT FROM PUBLISHER]

Objectives There is evidence that self-blame is an important predictor of distress and depression in relatives of people with long-term psychosis, but there is limited research investigating the nature and correlates of self-blame in relatives of people with recent-onset psychosis. Self-blame motivates a tendency to engage with others and to repair wrongdoings; it might be that such cognitions also impact on relatives' behaviours towards the patient. This study examined the association between self-blame and psychological distress, and tested the prediction that greater self-blame would be associated with more behavioural control attempts to patients in a sample of relatives of people with recent-onset psychosis. Methods Statements pertaining to self-blame and behavioural control were extracted and rated from 80 interviews with relatives, who also completed the General Health Questionnaire-28. Content analysis was used to examine the nature of self-blame attributions. Regression analyses were used to explore the links between self-blame attributions and distress, and between self-blame and behavioural control in this recent-onset population. Results Higher levels of self-blame were associated with more behavioural control attempts, and self-blame predicted relatives' behavioural responses when adjusting for the contribution of control attributions. Self-blame was also linked with distress, but did not emerge as an independent predictor in multivariate analysis. Most relatives who blamed themselves did so for not overseeing their family member's mental health problems properly or for perceiving themselves generally as poor carers. Conclusions This study extends findings related to self-blame to a population of relatives of people with recent-onset psychosis and highlights the possible role of blaming cognitions in promoting interpersonal engagement through behavioural control. Practitioner Points Self-blaming beliefs were linked with increased distress in relatives of people with recent-onset psychosis;, Increased self-blame was associated with more behavioural control attempts;, Most relatives blamed themselves for not overseeing their family member's mental health problems properly, and for perceiving themselves generally as poor carers., The cross-sectional study design limits inferences about causality. [ABSTRACT FROM AUTHOR]

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

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

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

Treatment guidelines for first episode psychosis (FEP) recommend at least 1 year of antipsychotic treatment following remission; however, in light of some recent research and the preference of some individuals to discontinue their medication sooner, this recommendation can be questioned. The aim of this article is to appraise the current discontinuation studies given our views on how this field should progress. We conducted a review of randomized controlled trials investigating dose-reduction/medication discontinuation compared with treatment maintenance in clinically remitted FEP patients. Seven trials were identified, and these reported a higher rate of relapse in the dose reduction or discontinuation groups. Relapse rates were higher when a lower threshold for relapse was utilized. However, only three studies specified that concurrent psychosocial interventions were also provided, despite an evidence base for these interventions in reducing symptom severity and relapse. Length of follow-up may also be important, as the study with the longest follow-up (7 years), albeit with some methodological shortcomings, found greater functional recovery in the dose-reduction group and that relapse rates between the two groups (dose-reduction vs. maintenance) were equal after 3 years. Finally, in addition to discontinuation or dose reduction, a diagnosis of schizophrenia, a longer duration of illness, and poor premorbid functioning were associated with a greater risk of relapse. Further trials are needed in this area to establish the long-term risk-benefit ratio of antipsychotic medication in FEP. Meanwhile, young people with FEP who do not fulfil criteria for a diagnosis of a schizophrenia disorder, achieve clinical remission for at least 3 months, attain early functional recovery, and have good social support may be possible candidates for discontinuation of antipsychotic medication bolstered by effective psychosocial interventions provided in the context of a specialized FEP service. [ABSTRACT FROM AUTHOR]

Aim: Prognosis following early psychosis is highly variable. Long‐term prognostic information from research studies is available in only a few areas. We sought to understand how well routine discharge information allows prediction of long‐term readmission prognosis. Methods: We reviewed the records of 239 people leaving Early Intervention services, after an average of 2.5 years, and counted the number of relapses. The distribution was modelled and extrapolated to a predicted 10 year outcome. Model predictions were compared with published data. Results: Numbers of relapses varied substantially, with 59% having no relapses before discharge, and 5% having 4 or more. Model predictions for 10‐year outcome were close to the observed data. Conclusions: A simple model can describe the distribution of numbers of relapses among people discharged from EI services, and predict long‐term outcomes matching those observed in formal research. This low‐cost approach could allow EI services to develop locale‐specific prognostic information. [ABSTRACT FROM AUTHOR]

Background: Specialised early intervention (SEI) programs have offered individuals with psychotic disorders and their families new hope for improving illness trajectories and outcomes. The Early Psychosis Prevention and Intervention Centre (EPPIC) was one of the first SEI programs developed in the world, providing services for young people experiencing their first episode of psychosis.Methods: We conducted a narrative synthesis of controlled and uncontrolled studies that have been conducted at EPPIC.Discussion: The history of the EPPIC model is first described. This is followed by a discussion of clinical research emerging from EPPIC, including psychopharmacological, psychotherapeutic trials and outcome studies. Neurobiological studies are also described. Issues pertaining to the conduct of clinical research and future research directions are then described. Finally, the impact of the EPPIC model on the Australian environment is discussed. [ABSTRACT FROM AUTHOR]

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

The association of substance abuse and psychotic disorders is of interest to clinicians, academics, and lawmakers. Commonly abused substances, such as cannabis, cocaine, amphetamines, and alcohol, have all been associated with substance-induced psychosis. Hallucinogens can induce desired psychedelic effects and undesirable psychomimetic reactions. These are usually transient and resolve once the duration of action is over. Sometimes, these effects persist, causing distress and requiring intervention. This article focuses on the hallucinogenic substance Salvia divinorum, the use of which has been observed, particularly among youth worldwide. We present background information based on a review of the literature and on our own clinical encounters, as highlighted by two original case reports. We hypothesize that consumption of Salvia divinorum could be associated with the development of psychotic disorders. We propose that clinicians routinely inquire about the use of Salvia in patients with substance use disorders or psychotic illnesses. More research is required to assess any relationship between Salvia divinorum and psychosis. Additionally, we advocate increased public and medical awareness of this substance and other emerging drugs of abuse. [ABSTRACT FROM AUTHOR]

Background: Recent research has highlighted the importance of psychological interventions such as cognitive behavioural therapy (CBT) in improving outcomes and promoting recovery for people with experience of psychosis, although a lack of trained therapists means that availability of face-to-face CBT is low. Alternative modes of delivering CBT are being explored, such as telephone and self-help methods, although research to date on whether they can be implemented effectively is limited. Aims: The aims of the present study were to describe and evaluate a new therapy fidelity scale (ROSTA; Recovery Oriented Self-help and Telephone therapy Adherence). This scale was developed to assess fidelity to cognitive behaviour therapy for psychosis (CBTp) focused on improving recovery, with optional subscales for delivery over the telephone and alongside a self-help guide. Method: Experienced CBT therapists rated recorded therapy sessions using the ROSTA scale. The scores were used to assess internal consistency and inter-rater reliability, before being compared to scores from an independent expert rater using an alternative fidelity scale for cognitive therapy in psychosis (the CTS-Psy), to investigate concurrent validity. Results: The ROSTA scale demonstrated excellent internal consistency, inter-rater reliability and validity when evaluated as a whole, although findings were mixed in terms of the individual subscales and items. Conclusions: The ROSTA scale is, on the whole, a reliable and valid tool, which may be useful in training and supervision, a utility that would be further emphasized if the therapeutic intervention it assesses is deemed to be efficacious based on future work. [ABSTRACT FROM AUTHOR]

Families play an important role in relapse-prevention following a person's first psychotic episode. To evaluate an open-ended family group intervention within a public adult mental health service, semi-structured interviews were conducted with: (1) carers who continually attended; (2) carers who attended once only; (3) carers who never attended; (4) case managers and (5) early psychosis clinicians. Benefits to group participation included: reduced isolation, sense of collective experience, opportunity to feel heard, reduced stigma and shame, increased knowledge about mental illness, and enhanced skills in supporting the care recipient. Barriers included: competing family and work commitments, applicability to own experiences of caring, discomfort with social situations and revealing and hearing emotions, and a belief that experiences are private. While attending the group increased knowledge, the benefits most emphasized were in the social connection with other carers and sharing one's story in a safe and reassuring environment. [ABSTRACT FROM AUTHOR]

The objective of this study is to explore patients' and family members' experiences of the different elements of a psychoeducational family intervention. A qualitative, explorative study was performed based on digitally recorded in-depth interviews with 12 patients and 14 family members. The interview data were transcribed in a slightly modified verbatim mode and analysed using systematic text condensation. Six themes that both patients and family members experienced as important in the family intervention were identified: alliance, support, anxiety and tension, knowledge and learning, time, and structure. A good relationship between the group leaders and participants was essential in preventing dropout. Meeting with other people in the same situation reduced feelings of shame and increased hope for the future. Hearing real life stories was experienced as being more important for gaining new knowledge about psychosis than lectures and workshops. However, many patients experienced anxiety and tension during the meetings. The group format could be demanding for patients immediately after a psychotic episode and for those still struggling with distressing psychotic symptoms. Group leaders need to recognise patients' levels of anxiety before, and during, the intervention, and consider the different needs of patients and family members in regards to when the intervention starts, the group format, and the patients' level of psychotic symptoms. The findings in the present study may help to tailor family work to better meet the needs of both patients and family members. [ABSTRACT FROM AUTHOR]

Purpose: Vocational recovery is a primary treatment goal of young people with first-episode psychosis (FEP), yet treatment in this domain is often delayed due to concerns that it might be too stressful. This study aimed to examine whether a relationship exists between vocational status and level of perceived stress and daily hassles in FEP. Methods: Forty-seven FEP participants were recruited upon admission to the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne. Demographics, psychopathology, perceived stress (Perceived Stress Scale; PSS) and daily hassles (Hassles Scale; HS) were measured. Results: Regarding vocational status, 19 participants were unemployed, 13 were employed, 14 were students, and 1 reported 'home duties'. ANOVAs and post hoc tests comparing the first three groups on perceived stress and daily hassles revealed that the mean PSS Total and mean PSS Distress scores of the employed group were significantly lower than those of the unemployed and student groups. Regarding hassles scores, the employed group had a significantly lower mean Hassles Intensity score than the unemployed group. Results were largely unchanged when covariates were included. There were no significant differences between the three groups in levels of anxiety, negative or positive symptoms. The employed group reported lower depression than the student group, but this finding disappeared after controlling for gender. Conclusions: These results provide preliminary evidence supporting the notion that working or studying is not associated with increased perceived stress or daily hassles in FEP. The findings require replication in larger samples and in different phases of psychosis. [ABSTRACT FROM AUTHOR]

An abstract of the article "Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual," by Eóin Killackey, H. J. Jackson and P. D. McGorry is presented.

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

The main mental disorders which develop and persist through adult life typically emerge during the critical developmental phase of adolescence and early adulthood, and are frequently associated with considerable associated distress and functional decline. Our current diagnostic system lacks validity and therapeutic utility, particularly for the early stages of these mental disorders, when symptoms are still evolving and may have not yet stabilised sufficiently to fit familiar or traditional syndromal criteria. Furthermore, there is often difficulty in distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness. These factors point to the need for reform of our current diagnostic systems. The clinical staging model seeks to define the extent of progression of a disorder at a particular point in time and aims to differentiate early, milder clinical phenomena from those that accompany illness progression and chronicity. The staging framework allows clinicians to select treatments relevant to earlier stages of an illness, and to evaluate their effectiveness in preventing progression and producing remission or return to milder or earlier stages of disorder. For staging to be a valid approach, interventions in the early stages need to shown to be not only more effective but also safer than treatments delivered later in the course of illness. Staging may also allow a more efficient integration of our rapidly expanding knowledge of the biological, social and psychological vulnerability factors involved in development of mental illness into what may ultimately resemble a clinicopathological staging model. [ABSTRACT FROM AUTHOR]

Bechdolf A, Thompson A, Nelson B, Cotton S, Simmons MB, Amminger GP, Leicester S, Francey SM, McNab C, Krstev H, Sidis A, McGorry PD, Yung AR. Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Objective: We aimed to replicate a recent finding of high prevalence of trauma history in patients at ‘ultra-high risk’ (UHR) of psychotic disorder and to investigate whether trauma predicts conversion to psychosis in this population. Method: A consecutive sample of UHR patients was assessed. History of trauma was accessed with the General Trauma Questionnaire. Cox regression models were used to explore relationship between conversion to psychosis and trauma. Results: Of 92 UHR patients nearly 70% had experienced a traumatic event and 21.7% developed psychosis during follow-up (mean 615 days). Patients who had experienced a sexual trauma (36%) were significantly more likely to convert to first-episode psychosis (OR 2.96) after controlling for meeting multiple UHR intake groups. Conclusion: UHR patients have a high prevalence of history of trauma. Previous sexual trauma may be a predictor of onset of psychotic disorder in this population. [ABSTRACT FROM AUTHOR]

Background. Little research has focused on delineating the specific predictors of emotional over-involvement (EOI) and critical comments (CC) in the early course of psychosis. The purpose of this study was to investigate the differential relationships of EOI and CC with relevant predictors in relatives of first-episode psychosis (FEP) patients. Method. Baseline patient-related factors including psychotic symptoms, depression and duration of untreated psychosis (DUP) and carer attributes comprising CC, EOI, burden of care and carers' stress and depression were assessed in a cohort of 63 remitted FEP patients and their relatives. Carers were reassessed at 7 months follow-up. Results. Baseline analysis showed that EOI was more strongly correlated with family stress compared with CC, whereas CC yielded a stronger association with DUP than EOI. Carers' CC at follow-up was not significantly predicted by either baseline family stress, burden of care or patient-related variables. Conversely, baseline EOI predicted both family stress and burden of care at 7 months follow-up. Finally, family burden of care at follow-up was a function of baseline EOI and patients' depressive symptoms. Conclusions. This study provides preliminary support to the postulate that EOI and CC may be influenced by separate factors early in the course of psychosis and warrant future research and therapeutic interventions as separate constructs. Implications for family interventions in the early phase of psychosis and the prevention of CC and EOI are discussed. [ABSTRACT FROM AUTHOR]

In this review, we describe neuropsychological and brain imaging findings in the early stages of psychosis and schizophrenia. We focus on recent clinical high-risk studies and consider whether the evidence supports these as ‘endophenotypes’ of a vulnerability to the illness or as ‘biomarkers’ of illness onset and transition. The findings suggest that there are a number of processes at psychosis onset that may represent biomarkers of incipient illness. These neurobiological indices particularly implicate the integrity of frontal and temporal cortices, which may or may not be related to the genetics of psychosis (i.e. potential ‘endophenotypes’). However, these brain regions are dynamically changing during normal maturation, meaning that any putative neurobiological markers identified at the earliest stages of illness may be relatively unstable. We suggest that, while such measures may be readily identified as potential neurobiological markers of established illness, they are inconsistent at (or around) the time of illness onset when assessed cross-sectionally. Instead, identification of more valid risk markers may require longitudinal assessment to ascertain normal or abnormal trajectories of neurodevelopment. Accordingly, we assert that the current conceptualisations of potential biomarkers and/or ‘endophenotypes’ for schizophrenia may need to be reconsidered in the context of normal and abnormal brain maturational processes at the time of onset of psychotic disorders. [ABSTRACT FROM AUTHOR]

The article presents abstracts on psychiatry which include early recognition and early intervention of psychosis, current evidence and future perspectives on psychological treatments in schizophrenia and research and perspectives on pharmacogenetics of schizophrenia.

The Graduated Recovery Intervention Program (GRIP) is a novel cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. In this paper, the treatment development process of GRIP is described and data from an open feasibility trial are presented. Findings suggest clinical and psychosocial benefits associated with GRIP, and the treatment was well-received by clients and therapists. The retention rate of 67%, however, suggests the need for protocol modifications to improve engagement. Initial data on the efficacy of GRIP are encouraging, although the study design precludes more robust conclusions at this time. [ABSTRACT FROM AUTHOR]

Background: The stigma of mental illness has been shown to be a barrier to recovery in schizophrenia. Aims: The present study aimed to examine the influence of perceived stigma on self-efficacy and the coping styles of secrecy and withdrawal over and above selected sociodemographic and clinical variables and psychopathology. Method: Outpatients diagnosed with schizophrenia (N = 127) filled in measures of perceived stigma, secrecy and withdrawal as coping modi, positive and negative symptom severity, self-efficacy, depression and insight into psychosis. Results: Perceived stigma accounted for a significant amount of variance in secrecy and withdrawal, as well as low self-efficacy, over and above the amount of variance explained by positive and negative symptomatology, depression, insight, age and gender. Conclusion: Our findings demonstrate the negative influence of stigma perceived by persons with schizophrenia on self-efficacy and coping. Clinicians should offer guidance in functional coping with perceived stigma in order to reduce the effect of stigma on patients' lives. [ABSTRACT FROM AUTHOR]

BackgroundThe ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up.MethodTwo therapists treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed by independent raters on four primary outcome measures of symptoms and functioning: at pretreatment, the middle of treatment, the end of treatment and at 1-year follow-up. An independent pair of raters assessed treatment integrity.ResultsBoth groups improved significantly over time. ACE significantly outperformed Befriending by improving functioning at mid-treatment, but it did not improve positive or negative symptoms. Past the mid-treatment assessment, Befriending caught up with the ACE group and there were no significant differences in any outcome measure and in hospital admissions at follow-up.ConclusionsThere is some preliminary evidence that ACE promotes better early recovery in functioning and this finding needs to be replicated in other independent research centres with larger samples. [ABSTRACT FROM AUTHOR]

Background: There is at present scant data published on actual early psychosis intervention programmes and their development. Most studies have focused on duration of untreated psychosis and outcomes. Aims: We present the development of a programme based on a business model which would provide a reference for other locations planning to set up similar services, especially in situations of limited resources. Method: This is a descriptive paper of a programme which operates on the "Balanced Scorecard" model. The various interventions, assessments and outcomes of the programme were compared with a historical group of the precursor service. Results: A total of 747 patients were accepted. The key outcomes included an increase in those diagnosed with and treated for psychosis, and a fall in the duration of untreated psychosis. There was a change in the referral pattern: a higher proportion sought help on their own and a fall in police referrals. Compared to the historical group, the rates of antipsychotic polypharmacy and benzodiazepines prescriptions were significantly lower, and the treatment default rate was significantly lower. Conclusions: A public mental health programme based on a business model could attain good clinical outcomes as well as facilitate better accountability to the various stakeholders. [ABSTRACT FROM AUTHOR]

Background: High rates of remission are associated with effective treatments for first-episode psychosis (FEP). However, the goal of relapse prevention remains elusive for many remitted FEP patients. Aims: This paper describes the clinical and functional status of remitted FEP patients at a specialist service, and outlines the rationale and methodology of a randomized controlled trial of a multimodal relapse prevention therapy for these patients. Method: Eighty one remitted FEP patients and 63 of their family members attending the Early Psychosis Prevention and Intervention Centre (EPPIC) were randomized to treatment as usual (TAU) or to a relapse prevention therapy (RPT). Baseline data included demographics, Axis I and II diagnoses, psychiatric symptoms, functional status, and family distress, burden, and communication styles. Results: The findings indicated high rates of depressive and negative symptoms and substance abuse problems. Less than half of the patients had returned to employment. A high rate of depressive and anxiety symptoms was evident amongst family members, and burden was comparable to results from other FEP studies. Conclusions: FEP patients who reach remission have wide-ranging clinical and psychosocial needs. Relapse risk remains high, and relapse prevention is a critical priority. Family members also need specific interventions. Declaration of interest: This study described in this paper has been funded by an independent research grant from Eli Lilly via the Lilly Melbourne Academic Psychiatry Consortium. [ABSTRACT FROM AUTHOR]

Preventive strategies can be divided into universal, selective and indicated prevention and early intervention. Universal interventions are directed to the general population. Selective approaches are targeted at people who have risk factors for an illness, but who do not show any current signs. Indicated approaches target high risk individuals with minimal signs or symptoms foreshadowing mental disorder, but who do not meet diagnostic levels at the current time. Early intervention involves treating those with already diagnosable disorder in a timely and optimal manner aiming to decrease the severity of the illness, and reduce secondary morbidity. Although universal and selective interventions are not yet viable strategies, indicated prevention and early intervention are now realistic possibilities in schizophrenia. Development of methods to identify those at risk of psychosis continues to evolve. Promising results in the prevention and delay of transition to psychotic disorder from high risk state have been found. Early intervention in schizophrenia, including promotion of early help-seeking, has been shown to reduce the duration of untreated psychosis, which is known to be associated with poor outcome in schizophrenia. Early intervention programmes which optimise the care of the first episode have been shown to produce better outcomes than routine management. [ABSTRACT FROM AUTHOR]

Although the underlying neurobiology of emerging psychotic disorders is not well understood, evidence from structural imaging and other studies support the notion that schizophrenia arises as a consequence of both an 'early neurodevelopmental' disturbance, as well as 'late neurodevelopmental' changes occurring during the initial stages of a psychotic illness, including around the time of transition to illness. In line with this, our longitudinal MRI findings in individuals at ultra-high risk for developing a psychotic illness show that there are excessive neuroanatomical changes in those who convert to psychosis. These aberrant changes are observed most prominently in medial temporal and prefrontal lobe regions. In a further series of longitudinal studies in first-episode psychosis, we have identified changes in prefrontal regions that indicate an accelerated loss of grey matter in patients compared to healthy control subjects. We suggest that the available evidence is consistent with the presence of subtle regionally and temporally specific neurobiological changes through the course of psychosis (Pantelis et al., 2005), including: (1) evidence for early (pre- and peri-natal) neurodevelopmental anomalies, (2) evidence for progressive grey matter loss involving medial temporal and orbital prefrontal regions around the time of transition to illness, and (3) evidence of late (post-pubertal) neurodevelopmental changes soon after the onset of psychosis, involving an acceleration of normal brain maturational processes, associated with significant loss of grey matter in dorsal prefrontal regions. The pathological processes underlying such changes remain unclear and may reflect anomalies in genetic and/or other endogenous mechanisms responsible for brain maturation, the adverse effects of intense or prolonged stress, or other environmental factors. These findings suggest that early markers of impending illness may prove difficult to define, and that brain changes in psychosis may better be conceptualized as anomalous trajectories of brain development. Further, active changes during transition to illness may present the potential to intervene and ameliorate these changes with potential benefit clinically. [ABSTRACT FROM AUTHOR]

Objective: While rates and correlates of comorbidity have been investigated in the early course of psychosis, little is known about comorbidity in the medium-to-longer term or its relationship with outcome. Method: A total of 182 first-episode psychosis (FEP) patients who met DSM-IV criteria for a current psychotic disorder 8 years after index presentation were grouped according to concurrent comorbidity [no concurrent axis I disorder; concurrent substance use disorder (SUD); other concurrent axis I disorder; concurrent SUD and other axis I disorder]. Outcomes were compared between groups controlling for relevant covariates. Results: As much as 39% met criteria for one or more concurrent axis 1 diagnoses. Comorbidity was associated with greater severity of general psychopathology, but not with measures of functioning, treatment or negative symptoms. Conclusion: Specific combinations of comorbid disorders may influence patterns of psychotic symptomatology. Routine examination of axis I disorders is warranted in the ongoing management of psychosis. [ABSTRACT FROM AUTHOR]

Objective: Anterior cingulate (ACC) hypo-activity is commonly observed in chronically ill schizophrenia patients. However, it is unclear whether this is secondary to persistent illness and/or medication. Method: We examined eight antipsychotic-naïve first-episode patients and matched healthy controls undergoing PET scanning while performing the Stroop task. Results: Group-averaged and single-subject analyses showed ACC activation in both controls and patients, albeit in different sub-regions (paracingulate and cingulate respectively). A direct comparison revealed relative under-activity of the left paracingulate cortex in patients. Conclusion: These findings suggest that the more pervasive hypo-activation observed in chronic patients may be secondary to persistent illness and/or medication. [ABSTRACT FROM AUTHOR]

Individuals in random community samples not diagnosed as mentally ill report a variety of mental states along a continuum from 'normalcy' to psychosis. The existence of this continuum suggests that in addition to hallucinations and delusions, other more subtle reflections of psychotic thought processes might occur in ordinary mental life. Five transient disruptions of ordinary mental life which may mirror the cognitive processes underlying psychosis are identified. Thought experiments designed to heighten awareness of each of these states are described. The thought experiments aim at helping clinicians 'normalize' psychotic symptoms by locating analogies to psychosis in their own mental life. In addition, a questionnaire was administered to subjects in a random community sample to assess the frequency of the transient disruptions explored in the exercises in the general population. These disruptions appear to be quite common. This would suggest that at least some psychotic symptoms are a pathological expression of psychological processes latent in and widely distributed throughout the general population. [ABSTRACT FROM AUTHOR]

Objective: To identify the treated incidence of psychosis in catchment of the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. Method: Cases were aged 15-29 years with a first episode of a psychotic disorder accepted into EPPIC between 1997 and 2000. Age- and sex-specific incidence rates per 10 000 person-years were calculated in 5 year age bands. Rate ratios were used for age group comparisons. Results: The age-specific treated incidence of first-episode psychosis in 15-29-year old individuals was 16.7 per 10 000 person-years in males, and 8.1 per 10 000 person-years in females. The incidence was highest in 20-24-year-old males and in 15-19-year-old females. For both sexes, incidence rates were significantly lower in the 25-29-year age group. Conclusions: The incidence of psychosis in the catchment of EPPIC was higher than previously reported, especially in female teenagers. Peak rates in 15-24 year olds suggest a youth model approach to early psychosis may be indicated. [ABSTRACT FROM AUTHOR]