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This study examined the impact of Patient-Centered Communication (PCC), Open Dialogue-inspired changes to rounding practices and culture, on patient perceptions of care on an inpatient psychotic disorders unit. A retrospective cohort analysis was conducted based on medical records, restraint and seclusion records, and hospital Perceptions of Care (PoC) surveys. The analysis compared data from 6-month periods before and after implementation of PCC to quantify whether the implementation of PCC was associated with more positive care ratings. There were trends toward improvement suggestive of an effect on patients' perception that their care was adequately explained, that they felt involved in care, that they felt respected, and that they were supported during hospitalization, although improvements did not achieve statistical significance. Greater improvement was observed for teams that incorporated a greater number of interventions. Dialogic practice-inspired changes on an acute inpatient unit may improve patient perceptions of inclusion and respect in their care. [ABSTRACT FROM AUTHOR]

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Introduction The evolving global landscape has led to increased involvement of the French armed forces, exposing military personnel to operational challenges that can affect their mental well-being. As a result, psychiatry has become the second most common reason for Medical Evacuation (MEDEVAC). In war zones where specialized medico-psychological consultations may not be readily available, medical officers play a vital role in providing initial care. Therefore, there is a growing emphasis on the precise evaluation of these practices. Materials and Methods In this retrospective observational study, we analyzed MEDEVAC request files from the Operational Health Headquarters (Patient Medical Request sheets), Aeromedical Evacuation Mission Order sheets, and hospital records from the entire military hospital complex in the Île-de-France region for French military personnel who underwent low-priority MEDEVAC (P3) for medico-psychological reasons from a non-metropolitan area to metropolitan France. The study spanned from January 1, 2013, to December 31, 2016. The primary objective is to evaluate the concordance of diagnoses between general practitioners and psychiatrists. The secondary objective is a detailed description of the introduction of psychotropic drugs, especially benzodiazepines, by the medical officer in the field. Results In total, our study included 610 patients. Significant differences were observed between diagnoses made by military general practitioners and military psychiatrists, except for "psychotic disorders" and "other diagnoses" categories. During hospitalization, benzodiazepines were prescribed to 26.5% of repatriated patients, antidepressants to 12.7%, hypnotics to 17.6%, neuroleptics to 24.23%, and hydroxyzine to 18.8%. Upon discharge, benzodiazepines were prescribed to 23.5% of patients, antidepressants to 17.8%, hypnotics to 9.9%, neuroleptics to 28.9%, and hydroxyzine to 19.7%. The chi-squared test revealed significant differences in prescription between military operations and hospitalization for all molecules except hydroxyzine. Among patients diagnosed with Psychological Disorder Related to a Traumatic Event (TPRET) (<1 and >1 month) by psychiatrists during hospitalization, 66.2% were prescribed benzodiazepines during operational theaters, 24.3% continued during hospitalization, and 16.8% received a prescription upon discharge. The duration of missions often hinders precise psychiatric diagnoses, leading medical officers to transmit clinical data for optimized specialized care at military training hospitals. Furthermore, significant differences in therapeutic administration between medical officers and psychiatrists, particularly in benzodiazepine prescriptions for patients with TPRET, highlight the importance of prioritizing psychotropic prescription modalities in the training of medical officers on mental disorders. Strengthening operational preparations in recent years could enable more practitioners to benefit from these measures. Conclusions We suggest several measures to enhance the transmission of medical information between medical officers and military psychiatrists. First, optimizing the drafting of Patient Movement Requests could involve implementing pre-filled drop-down menus or providing an adapted bilingual lexicon, facilitating the optimal transmission of clinical information for repatriated patients. Second, strengthening the training of medical officers before deployment and sharing the "Emergency Psy Kit," a comprehensive support tool developed by French military psychiatrists, would further enhance the tool kit available to field practitioners for judiciously prescribing psychiatric drugs. [ABSTRACT FROM AUTHOR]

The aim of this scoping review was to map intervention programmes for first-episode psychosis by identifying their characteristics, participants, and specific contexts of implementation. It seems reasonable to suggest that early intervention may be beneficial in improving recovery outcomes and reducing the duration of untreated psychosis (DUP). Despite the expansion of these programmes, there are still some significant variations and barriers to access that need to be addressed. In line with the Joanna Briggs Institute (JBI) methodology and the Participants, Concept, and Context (PCC) framework, this review encompasses studies focusing on individuals grappling with early-stage psychosis and their caregivers across a range of settings, including hospital and community environments. The review identified 47 studies from 2002 to 2023, which revealed a great deal of diversity in programme characteristics and implementation contexts. This reflects a global perspective. The results showed that there is a great deal of variety in the characteristics of the programmes, with interventions ranging from single-component strategies, such as cognitive–behavioural therapy (CBT) and cognitive remediation therapy (CRT), to multicomponent programmes that integrate a number of different approaches, including psychosocial, pharmacological, and family-focused strategies. The objectives included attempts to improve cognitive functioning; enhance coping skills; reduce caregiver burden; and address symptoms such as anxiety, depression, and hallucinations. It is notable that there was considerable variation in the frequency, duration, and follow-up periods of the interventions, with some lasting just three sessions over one month and others spanning five years and 48 sessions. The majority of the programmes were delivered in community or outpatient settings, although there were also examples of hospital- and home-based interventions. These findings highlight the value of early interventions and provide a useful resource for adapting programmes to different social and cultural contexts. It would be beneficial for future research to explore how these interventions can be tailored to diverse settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Methods Results and Discussion Conclusion Self‐transcendence is a personality feature and psychological resource that involves feelings of connectedness with the universe, all of humanity, and the individual self. Self‐transcendence has been positively associated with both positive psychotic symptoms and clinical high risk for developing psychosis status, but studies reporting these findings focus solely on the connectedness‐with‐universe aspect of self‐transcendence. The broader self‐transcendence literature, which also includes connection with humanity and oneself, robustly supports self‐transcendence as an indicator of well‐being. Given this discrepancy, we sought to understand whether self‐transcendence should be considered a risk or resilience factor for youth at clinical high risk.We operationalised self‐transcendence using two more holistic measures novel to the clinical high risk population. Clinical high risk participants (n = 42) and healthy controls (n = 44) completed the Adult Self‐Transcendence Inventory and participated in narrative life story interviews which were coded for self‐transcendence themes.Clinical high risk individuals scored lower than healthy controls on measures of self‐transcendence, functioning, and life satisfaction. However, there were no group differences in the relationships between self‐transcendence and measures of well‐being.Our findings suggest self‐transcendence is a part of healthy personality development that may be impacted in clinical high risk individuals yet may still function as a psychological resource for this population, pointing toward new avenues for intervention in clinical high risk and other mental health populations. [ABSTRACT FROM AUTHOR]

Background: Cannabinoids have been of increasing interest mainly due to their putative efficacy in a wide array of psychiatric, psychosomatic, and neurological conditions. Aims: This systematic review aims to synthesize results from randomized placebo-controlled trials regarding the efficacy and the dosage of cannabinoids as therapeutics in psychiatric disorders in children, adolescents, and young adults. Methods: All publications up to June 30th, 2024, were included from PubMed and Embase. Eligibility criteria in accordance with the PRISMA-guidelines was applied. RCTs providing pre- and post-treatment parameters on cannabinoid therapies for mental disorders in comparison to controls in an age range from 0 to 25 years were included. Effect sizes were calculated as Hedges' g for primary outcomes, and a multilevel random-effects meta-analysis was conducted to account for dependent outcomes from same study populations. Results: We identified 7603 records, of which 8 independent clinical trials (reported in 9 publications) met the pre-established eligibility criteria, comprising 474 unique participants (245 treatment, 229 control). Analysis of 13 primary outcomes (of 7 clinical trials) revealed a modest positive overall effect for symptom improvement or normalization of brain physiology (Hedges' g = 0.308, 95% CI: 0.167, 0.448). Autism spectrum disorder studies showed the most consistent evidence (g = 0.264, 95% CI: 0.107, 0.421), while other conditions showed wider confidence intervals. Age-stratified analysis showed that adult populations (mean age 23.3 years, n = 5 outcomes) demonstrated higher effect sizes (g = 0.463, SD = 0.402) compared to pediatric populations (mean age 11.8 years, n = 8 outcomes; g = 0.318, SD = 0.212). Whole plant preparations (g = 0.328, 95% CI: 0.083, 0.573) and pharmaceutical cannabinoids (g = 0.292, 95% CI: 0.069, 0.515) showed comparable effects. CBD dosages ranged from 17.5 mg to 600 mg per day, with no significant correlation between dosage and effect size (ρ = -0.014, p = 0.963). Mild to moderate side effects were reported, but no serious adverse events. Risk of bias assessment ranged from low (n = 3) to high (n = 5). Conclusion: While meta-analysis of effect sizes for primary outcomes revealed modest positive effects, particularly for autism spectrum disorders, the current evidence remains insufficient to broadly recommend cannabinoids for treating mental disorders in youth populations. Larger, controlled studies with standardized outcomes are needed to establish definitive clinical recommendations. [ABSTRACT FROM AUTHOR]

Background: There is considerable research on the ramifications of medication non-adherence for adults with psychotic illnesses. Much of which has tightly controlled designs and strict inclusion/exclusion procedures (i.e., it is less "ecologically valid," or consistent with real-world challenges in care). The authors sought to determine predictive relationships between psychiatrists' clinical assessments of non-adherence and treatment outcomes, via a design that would be more applicable to practice. Method: Multiple regression analyses were conducted on non-adherence, symptom severity upon admission, number of recent hospitalizations, and length of hospital stay. The sample consisted of 182 inpatients with psychotic spectrum disorders and significant risk and vulnerability factors. Non-adherence was measured via the psychiatrists' diagnosis of V15.81. Symptom severity was measured via the 24-item Brief Psychiatric Rating Scale (BPRS-E). Results: There were null findings on non-adherence and BPRS-E pretest score (χ 2= 2, p = 0.16), recent hospitalizations (χ 2= 1.2, p = 0.27), and length of stay (β = 0.003, p = 0.97). Higher symptom severity predicted a modestly longer length of stay (χ 2=.20, p = 0.007), though Bonferroni correction nullified this finding. White/Caucasian participants were far more likely to be non-adherent than black/African-American participants (t = -8.66; p >.00001). Conclusions: Null findings suggest the psychiatrist's initial, quick-form assessment of non-adherence may not necessarily presume a poor prognosis. Perhaps, because individuals with severe and chronic psychotic disorders may have greater coping, adaptive, and survival skills than is often assumed. In severely under-resourced hospitals, such second thoughts and more reliable information about adherence and contributing factors may improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Cumulative research finds that exposure to childhood trauma, sleep dysfunction, and high stress levels are prevalent in youth diagnosed with and at-risk for psychotic disorders. However, few studies have investigated the association between nightly sleep and moment-to-moment stress in youth who are at familial high-risk (FHR) for psychotic disorders with varying levels of exposure to childhood trauma. The current study examined the day-to-day associations between trauma severity, nightly sleep duration, and next-day momentary stress in 19 FHR and 19 non-psychiatric youth (ages 13–19 years, 66 % girls). Ecological Momentary Assessment was used to assess these variables across three longitudinal timepoints (baseline, 6-months, and 12-months). The FHR group reported greater trauma severity and shorter sleep duration than the non-psychiatric group. In the whole sample, trauma severity and reduced sleep duration were associated with next-day momentary stress. While group status did not moderate the association between sleep duration and next-day momentary stress, group status did moderate the positive association between trauma severity and next-day momentary stress, showing that the association was specific to the non-psychiatric group. Lastly, the effect of nightly sleep duration on next-day momentary stress was significant and negative, but only at low levels of trauma severity for the whole sample. Findings offer preliminary insights into the associations between trauma severity, sleep duration, and momentary stress. Furthermore, this design can provide a foundation for future research examining environmental and psychosocial risk factors that contribute to symptom progression and prognosis of youth who are genetically vulnerable to psychosis. [ABSTRACT FROM AUTHOR]

Prior studies have found that individuals with schizophrenia often have an enlarged "personal space". However, the neurocognitive mechanisms underlying this consistent finding remain unknown. The well-validated Stop Distance Procedure was used to measure the personal space preferences of individuals with psychotic disorders (PD, N = 22) and demographically-matched healthy controls (HC, N = 20) in response to human and virtual (avatar) intruders. Physiological arousal and subjective discomfort were measured during intrusions into personal space and modeled across different interpersonal distances. Additionally, participants were interviewed to assess their subjective awareness of their personal space preferences. Personal space measurements with humans and avatars were highly correlated and reliable over repeated trials, and influenced by the displayed emotion and gender of the intruders, in both groups. The PD group exhibited a larger personal space than the HC group (all p < 0.028), and the size of personal space with avatar intruders was significantly correlated with positive symptom severity in the PD subjects. Moreover, the magnitude of arousal responses to personal space intrusions was proportional to a power (exponent) of the distance between subjects and intruders, with a significantly smaller exponent in the PD (compared to the HC) for both human (p = 0.026) and avatar (p = 0.011) intruders, indicating a less steep function. Lastly, much of the participants' qualitative impressions of their personal space behaviors were consistent or correlated with the quantitative findings, reflecting some awareness of the determinants of personal space. These findings reveal both intact and altered aspects of personal space regulation in psychotic disorders, and the potential utility of personal space measurements, given their high reliability, to serve as objective targets of interventions. [ABSTRACT FROM AUTHOR]

Objective: To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow‐up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants. Study design: Retrospective cohort study; analysis of de‐identified linked NBCSP, Pharmaceutical Benefits Scheme (PBS), and Medicare Benefits Schedule (MBS) data. Setting: Australia, 2006–2019. Participants: People aged 50–74 years (NBCSP‐eligible) with severe mental illness, defined as those dispensed two or more prescriptions for second generation antipsychotics or for lithium (PBS data), and a random sample of people aged 50–74 years eligible for Medicare‐subsidised services but never prescribed psychotropic medications (antipsychotics, lithium, antidepressants). Main outcome measures: NBCSP participation (returned faecal occult blood test sample), valid test result, positive test result, and follow‐up colonoscopy rates. Results: A total of 119 475 people with severe mental illness and 1 090 574 control group people were included in our analyses. The proportion of women was larger in the severe mental illness group (51.3%) than the control group (48.7%), as were the proportions who lived in inner regional areas (23.5% v 19.1%) or in areas in the lowest socio‐economic quintile (21.8% v 14.7%). The NBCSP participation rate was lower among people with severe mental illness (adjusted incidence rate ratio [IRR], 0.70; 95% confidence interval [CI], 0.69–0.84). The proportion of valid test results was smaller for people with severe mental illness (95.9% v 98.7%; adjusted IRR, 0.97; 95% CI, 0.96–0.99), and the positive test result proportion larger (12.3% v 6.6%; adjusted IRR, 2.01; 95% CI, 1.94–2.09). The proportion of positive test results followed by colonoscopy was smaller for people with severe mental illness (71.7% v 82.6%; adjusted IRR, 0.88; 95% CI, 0.85–0.92). Conclusions: People with severe mental illness were less likely to participate in the NBCSP or to undergo colonoscopy after a positive test result than other Australians. These differences may contribute to higher colorectal cancer mortality among people with severe mental illness. The contributions of differences in cancer stage at diagnosis and subsequent treatment to higher colorectal cancer mortality require further study. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairments in individuals with psychotic disorders impact day-to-day activities and social and occupational functioning (Bowie CR, 2006). Most of the cognitive interventions were developed in the west focusing mainly on clinical research and were not available in routine care. Adaptability and accessibility of these techniques in low-resource settings like India had major challenges. Keeping this in mind, Compensatory Cognitive Training (CCT), being an economical and noncomputerized intervention, was adapted to be used for an urban English-speaking population in India. Aim: The study aimed to determine the acceptability and feasibility of delivering CCT to persons with schizophrenia through virtual one-on-one sessions. Materials and Methods: Patients with a diagnosis of schizophrenia were assessed for their subjective and objective cognitive deficits. CCT was delivered for 13 participants as a virtual one – one session. Three participants dropped out midway. Semistructured interview was conducted with all ten participants who completed the intervention to understand their acceptability of Virtual CCT. Feasibility was assessed using a visual analog scale on their attendance, involvement, and comprehending ability. The mean percentile scores on cognitive domains at baseline and end of intervention were analyzed. Results: Significant change was observed in specific domains of cognition. Participant involvement, lesser dropout rates, and their feedback indicated that Virtual CCT is a feasible and acceptable intervention. Conclusion: Virtually delivered CCT appears to be an acceptable and feasible intervention to increase access to cognitive interventions for persons with schizophrenia in LAMI countries. This needs to be tested in larger populations.

BACKGROUND: The 22q11.2 deletion syndrome (22qDel) is a genetic copy number variant that strongly increases risk for schizophrenia and other neurodevelopmental disorders. Disrupted functional connectivity between the thalamus and the somatomotor/frontoparietal cortex has been implicated in cross-sectional studies of 22qDel, idiopathic schizophrenia, and youths at clinical high risk for psychosis. Here, we used a novel functional atlas approach to investigate longitudinal age-related changes in network-specific thalamocortical functional connectivity (TCC) in participants with 22qDel and typically developing (TD) control participants. METHODS: TCC was calculated for 9 functional networks derived from resting-state functional magnetic resonance imaging scans collected from 65 participants with 22qDel (63.1% female) and 69 demographically matched TD control participants (49.3% female) ages 6 to 23 years. Analyses included 86 longitudinal follow-up scans. Nonlinear age trajectories were characterized with generalized additive mixed models. RESULTS: In participants with 22qDel, TCC in the frontoparietal network increased until approximately age 13, while somatomotor TCC and cingulo-opercular TCC decreased from age 6 to 23. In contrast, no significant relationships between TCC and age were found in TD control participants. Somatomotor connectivity was significantly higher in participants with 22qDel than in TD control participants in childhood, but lower in late adolescence. Frontoparietal TCC showed the opposite pattern. CONCLUSIONS: 22qDel is associated with aberrant development of functional network connectivity between the thalamus and cortex. Younger individuals with 22qDel have lower frontoparietal connectivity and higher somatomotor connectivity than control individuals, but this phenotype may normalize or partially reverse by early adulthood. Altered maturation of this circuitry may underlie elevated neuropsychiatric disease risk in this syndrome.