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The use of standardized screening tools to identify trauma exposure and associated symptoms is commonly recommended as a key component in the development of trauma informed services and is seen as integral to facilitating access to evidence‐based therapies. However, there is limited evidence in the UK about the factors influencing the adoption of such tools into routine practice in children's social care. This paper presents the findings from a process evaluation of how practitioners implemented a screening tool for post‐traumatic stress disorder, anxiety and depression into their day‐to‐say practice and what worked or did not work during the process. The findings from this study highlight the potential benefits for both young people and practitioners, alongside some of the challenges involved. In particular, practitioners need to see the direct benefit for young people of being assessed. Additionally, practitioners value regular mentoring as they become more proficient in using standardized screening tools.

Objective: This paper presents the key findings from the Northern Ireland Youth Wellbeing Prevalence Survey (NIYWS), specifically the prevalence of common mental health disorders and their association with personal, familial and socio-economic risk factors. Methods: The Northern Ireland Youth Wellbeing Survey (NIYWS) is a large nationally representative household survey of young people aged 2–19 years (N = 3074) and their parents (N = 2816). Data collection was by means of a stratified random probability household survey. Children and young people were eligible to take part if they were aged 2 to 19 and lived in Northern Ireland. Mood and anxiety disorders were measured using the Revised Children’s Anxiety and Depression Scale (RCADS: Chorpita et al., 2000). Results: Based on the cut-off scores for the RCADS 11.5% of the sample met the criteria for any mental health disorder. The most prevalent disorder was panic disorder (6.76%) and the least common was generalised anxiety disorder (2.69%). Poor child health, special educational needs, parental separation, living in a household in receipt of benefits, living in an area of deprivation and living in an urban area were all significant predictors of any mood or anxiety disorder. Conclusions: The results indicate somewhat elevated prevalence rates of mood and anxiety disorders in children and young people in Northern Ireland compared to England and other international countries. These findings can be used to help inform mental health policy and practice.

Objective: Mental health promotion and primary prevention have been evident in government policies in recent decades and this focus may also be visible in response to the COVID-19 pandemic. However, there has yet to be a review of promotion and prevention in current mental health plans in relatively high-income countries with small populations. The objective of this review was to analyse recent government mental health plans in relatively high-income countries with small populations in order to compare and contrast their plans on promotion and prevention. Method: The review focussed on mental health policies, strategies or action plans published in English between 2017 and 2020 in Finland, New Zealand, the Republic of Ireland, Scotland and Wales. The research team developed an analytical framework for the review based on online interviews with policy and mental health experts and WHO guidance. Individual plans were then reviewed against the policy framework to produce an analysis in table form which provided the basis for a narrative discussion of developments. Results: There is evidence of attention in current mental health plans to ‘whole of population’ mental health and prevention which suggests a consensus on the need for action at this end of the spectrum. The extent of commitments to prevention and to reducing inequalities in mental health varies and is evidenced by commitments to cross-departmental structures for action on mental health and dedicated actions to reduce inequalities. Discussion: The results of this review can help to inform the development of national mental health policies.

Traumatic experiences during childhood are common and often lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). The primary aim of this study was to determine whether a well-validated screening tool for PTSD administered in frontline services effectively identifies diagnosable PTSD in young people with a history of maltreatment. In total, 141 young people in community care settings were screened using three screening instruments (Child Revised Impact of Events Scale-8; Generalised Anxiety Disorder-2; Patient Health Questionnaire-2). Participants described a range of adverse life events: 110 of the 141 participants reported at least one adverse life experience (mean number for the total sample was 2.8), with 44.2 per cent (n = 46) experiencing at least one form of interpersonal trauma; and 102 participants (72.3 per cent) screened positively for probable PTSD and subsequent mental health assessments confirmed this condition in 64.7 per cent of these participants. Further, 36.9 per cent (n = 52) and 46.8 per cent (n = 66) met the threshold for probable depression and anxiety, respectively. Three items were associated with positive PTSD screens: a history of being on the child protection register, previous mental health contact and interpersonal index trauma. Interpersonal traumas were also associated with higher risks of offending. It seems feasible to use screening measures effectively within frontline social care services if staff are provided with appropriate training and support to identify young people with PTSD who may benefit from evidence-based mental health therapies.

Backgrounds and Aims: The Northern Ireland Youth Wellbeing Survey (NIYWS) was commissioned by the Health and Social Care Board (NI) with the aim of providing reliable prevalence estimates of the mental health problems of children and young people aged 2–19 years. Method: The NIYWS used a random probability design, stratified by deprivation decile and county, to ensure even geographical distribution and representation. The survey used a broad range of validated measures to identify children and young people who met established clinical criteria for common mood, anxiety and behaviour disorders, trauma related disorders, as well as those at risk of autism spectrum disorder, eating disorders, future psychotic illness, self-injury or suicide. Results: Data were collected on 3074 children and young people aged 2–19 years, as well as over 2800 parents. The survey achieved a high response rate (67%) and initial findings indicated that 11% of the sample were at risk of emotional or behavioural problems. Conclusions: The NIYWS was the first large scale nationally representative survey of the mental health of children and young people in NI. Despite the legacy of political violence the initial findings show comparable levels of emotional and behavioural problems to England.

New-born heel prick blood spots are routinely used to screen for inborn errors of metabolism and life-limiting inherited disorders1. The Danish Newborn Screening Biobank (DNSB) has shown that nucleic acid, metabolic and protein assays are feasible on archived new-born dried blood spots2. Denmark is currently the only country in the world where nation-level linkage of such secondary data to health records is approved2. In the new era of health data science and predictive medicine, the potential value of secondary data from new-born blood spot archives merits wider ethical consideration and assessment of feasibility for public benefit. Early life exposures and behaviours set health trajectories in childhood and later life. The new-born blood spot is potentially well placed to create an unbiased and cost-effective population-level retrospective birth cohort study. Scotland has retained new-born blood spots, commonly known as Guthrie cards, for all children born since 1965, around 3 million in total. However, a moratorium on research access is currently in place, pending public consultation. We conducted a Citizens’ Jury, with Jurors delivering an agreed verdict that conditional research access to the Guthrie Cards was in the public interest. The Chief Medical Officer for Scotland authorised restricted lifting of the current research moratorium to allow a feasibility study. In support of a wider public consultation, Guthrie cards from consented Generation Scotland volunteers3,4 were retrieved and their potential for both epidemiological and biological research demonstrated.

Objectives: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11–19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors.Designs and Methods: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed.Results: A total of 16.2% (n =211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46).Conclusions: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.

SummaryThere are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.

Perinatal mental health is a vital component of public mental health. The perinatal period represents the time in a woman’s life when she is at the highest risk of developing new-onset psychiatric disorders or relapse of an existing mental illness. Optimisation of maternal mental health in the perinatal period is associated with both short- and long-term benefits not only for the mother, but also for her infant and family. However, perinatal mental health service provision remains variable across the world. At present in Northern Ireland, 80% of women do not have access to specialist community perinatal mental health services, and without access to a mother and baby unit, mothers who require a psychiatric admission in the postnatal period are separated from their baby. However, following successful campaigns, funding for development of specialist perinatal mental health community teams has recently been approved. In this article, we discuss the importance of perinatal mental health from a public health perspective and explore challenges and opportunities in the ongoing journey of specialist service development in Northern Ireland.

Background Throughout the coronavirus disease 2019 (COVID-19) pandemic, health and social care workers have faced unprecedented professional demands, all of which are likely to have placed considerable strain on their psychological well-being. Aims To measure the national prevalence of mental health symptoms within healthcare staff, and identify individual and organisational predictors of well-being. Method The COVID-19 Staff Wellbeing Survey is a longitudinal online survey of psychological well-being among health and social care staff in Northern Ireland. The survey included four time points separated by 3-month intervals; time 1 (November 2020; n = 3834) and time 2 (February 2021; n = 2898) results are presented here. At time 2, 84% of respondents had received at least one dose of a COVID-19 vaccine. The survey included four validated psychological well-being questionnaires (depression, anxiety, post-traumatic stress and insomnia), as well as demographic and organisational measures. Results At time 1 and 2, a high proportion of staff reported moderate-to-severe symptoms of depression (30–36%), anxiety (26–27%), post-traumatic stress (30–32%) and insomnia (27–28%); overall, significance tests and effect size data suggested psychological well-being was generally stable between November 2020 and February 2021 for health and social care staff. Multiple linear regression models indicated that perceptions of less effective communication within their organisation predicted greater levels of anxiety, depression, post-traumatic stress and insomnia. Conclusions This study highlights the need to offer psychological support to all health and social care staff, and to communicate with staff regularly, frequently and clearly regarding COVID-19 to help protect staff psychological well-being.

Objective: To conduct a systematic review of controlled studies to determine the effect of digital health technologies on psychotic symptoms.Method: Electronic databases were searched up to...

Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking.This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads.Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074).Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables.In the final model, young person ACE scores were associated with older child age (β = 0.082, p = .016), younger parental age (β = -0.083, p = .022), fewer children in the household (β = -0.120, p .001), poor child health (β = 0.160, p .001), low family support (β = 0.118, p = .001) and the household being in receipt of benefits (β = 0.223, p .001).This study found a small association between parent and young person ACE exposure which was attenuated through other variables.

The COVID-19 pandemic has affected people’s physical and mental health. Quarantine and other lockdown measures have altered people’s daily lives; levels of anxiety, depression, substance use, self-harm and suicide ideation have increased. This commentary assesses how international governments, agencies and organisations are responding to the challenge of the mental health impact of COVID-19 with the aim of informing the ongoing policy and service responses needed in the immediate and longer term. It identifies some of the key themes emerging from the literature, recognises at-risk populations and highlights opportunities for innovation within mental health services, focusing on the published academic literature, international health ministry websites and other relevant international organisations beyond the United Kingdom and Ireland. COVID-19 has challenged, and may have permanently changed, mental health services. It has highlighted and exacerbated pre-existing pressures and inequities. Many decision-makers consider this an opportunity to transform mental health care, and tackling the social determinants of mental health and engaging in prevention will be a necessary part of such transformation. Better data collection, modelling and sharing will enhance policy and service development. The crisis provides opportunities to build on positive innovations: the adaptability and flexibility of community-based care; drawing on lived experience in the design, development and monitoring of services; interagency collaboration; accelerating digital healthcare; and connecting physical and mental health.

Background: The incidence of psychotic disorders is higher in ethnic minorities groups. The ‘ethnic density effect’, in which living in a neighbourhood with a low own-group proportion increases the risk of psychosis, is one explanatory factor. The density effect in the ethno-religious and sectarian context of Northern Ireland has been found to be reversed, particularly for Catholics, in which there is harmful effect of high own-group density areas. This is partly explained by high urbanicity, deprivation and unemployment, but is otherwise not well understood. Aims: This study aimed to examine the density effect at the level of symptomology (positive and negative psychosis symptoms and depressive symptoms) in a representative sample of people with a first episode of psychosis in Northern Ireland. Method: Data linkage methodology was used drawing on data from the Northern Ireland First Episode Psychosis Study (NIFEPS) and the 2001 Census of Northern Ireland. Results: In total, 223 people between the ages of 18 to 64 were included in the study. A significant density effect was found for Catholics for total psychosis scores, but not for positive, negative and depressive symptoms, nor for general psychopathology, after adjusting for individual and area characteristics. The model accounted for just over 12% of the variance. No effect was found for Protestants. Conclusion: The findings suggest that the density effect for Catholics is unrelated to the core features of psychosis (hallucinations, delusions and anhedonia) but rather to broader cognitive and emotional disturbances and area deprivation. Explanations of exposure to social adversity and inequality are proposed, with implications for public mental health and social policy.

Aim: The at-risk mental state allows clinicians to identify individuals who have an increased risk of developing psychosis. At present, most screening for psychosis-risk is carried out within help-seeking populations, however screening within educational settings may allow clinicians to identify individuals at-risk earlier and to increase the rate of detection. This review aimed to examine screening for the at-risk mental state in educational settings, with the key questions: what screening tools have been used in educational settings, can screening in educational settings detect individuals with ARMS, what threshold scores in screening tools indicate a positive screen in educational settings, are there comorbid mental health conditions associated with the ARMS in educational settings?Methods: Searches were carried out in PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science and reference lists of included articles searched. Results were summarised using narrative synthesis. Results: Nine papers were included for narrative synthesis. A variety of screening tools have been used when screening for the at-risk mental state in educational settings. The majority of studies have been conducted in schools. The prevalence of the at-risk mental state reported in ranges from 1-8%. Conclusions: The at-risk mental state indicates the presence of distressing symptoms for which intervention may be beneficial. Screening programs within educational settings may allow outreach for prodromal symptoms at an earlier stage than clinical settings currently provide for.

Aim: To determine if poor sleep makes a unique contribution in predicting the likelihood of experiencing six or more attenuated psychotic symptoms and associated distress, after examining and controlling for sociodemographic factors, depression and drug/alcohol use. Method: An online survey was conducted using Amazon's online crowdsourcing service Mechanical Turk (MTurk). The sample was 1013 adults (18 to 36 years) from the general population in the United States. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9, the Drug Abuse Screening Test 10 and the Alcohol Use Disorders Identification Test. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, holding constant sociodemographic variables, depression, and alcohol/drug abuse. Results: 37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 < .001) of endorsing six or more PQ-16 items. After controlling for sociodemographic variables, depression and drug/alcohol abuse, poor sleep quality made a unique contribution of 5.8% of the variance accounted for in level of distress experienced by attenuated psychotic symptoms. Conclusion: Effective treatment of sleep disturbance may reduce the likelihood of experiencing attenuated psychotic symptoms and associated distress.

Background Mental disorders in pregnancy are common causes of morbidity and mortality with associated risks of adverse neonatal outcomes. Our aims were to evaluate the prevalence of self-reported mental disorders in women presenting to maternity services and to determine the association between history of self-reported maternal mental disorder and adverse neonatal outcomes. Methods Data on all singleton pregnancies known to maternity services in Northern Ireland over the period 2010 to 2015 were extracted from the Northern Ireland Maternity System (NIMATS), including frequency data for number of pregnancies where the mother reported a history of mental disorder. Odds ratios were derived from logistic regression analyses to determine the associations between self-reported maternal mental disorder and preterm birth, low infant birth weight and APGAR scores. Results In total, 140,569 singleton pregnancies were registered using NIMATS over this period. In 18.9% of these pregnancies, the mother reported a history of at least one mental disorder. After adjustment for potential confounding factors, significant associations were demonstrated between self-reported maternal mental disorder and preterm birth (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.25–1.37), low infant birth weight (OR 1.29, 95% CI 1.21–1.38) and APGAR score Conclusions These findings emphasise the critical importance of routine enquiry regarding psychiatric history when women present to maternity services and the impact of maternal mental illnesses upon outcomes for their infants.

Aim This study aimed to examine the relationship between types of childhood adversity and attenuated psychotic symptoms in a general population sample, and to determine the predictive role of other psychosocial factors such as resilience, coping style and social support. Methods An online survey was conducted with a US-based general population sample of 748 participants (aged 18 to 35 years) using Amazon's Mechanical Turk (an online crowd-sourcing service). Participants completed the Adverse Childhood Experiences Questionnaire (ACE-Q), the Prodromal Questionnaire (PQ-16), the Brief COPE Scale, the Brief Resilience Scale (BRS), the Multidimensional Scale of Perceived Social Support and the Neighbourhood Cohesion Scale. A series of backwards stepwise hierarchical regression analyses was employed to determine the predictors of PQ-16 score. Results Participants reported an average of 2.99 attenuated psychotic symptoms (from a total of 16), and an average of 2.77 childhood adversities (from a total of 10). In the final model, the specific types of childhood adversity which significantly predicted PQ-16 score were verbal abuse, sexual abuse and physical neglect. Resilience, as well as the coping styles of self-distraction, denial, substance use, emotional support, venting, religion and self-blame, were significant predictors; perceived social support and neighbourhood cohesion were not. This model predicted 33% of the variance in PQ-16 score. Conclusions The results of this study support the association between childhood adversity and attenuated psychotic symptoms in the general population. Resilience and coping styles were also important predictive factors. These data suggest potential strategies on which to focus for early intervention and prevention.

There is increasing evidence to suggest both a symptomatic overlap and a clinically significant degree of co-occurrence between Autism Spectrum Disorders (ASD) and psychotic disorders such as schizophrenia but the nature of such relationships remain unclear. We reviewed the literature reporting prevalence rates of Autistic-like Traits (ALTs) and ASD in populations with a diagnosis of schizophrenia or other psychotic disorder. A search of three large databases was conducted and from this seven studies met the criteria for inclusion. The point prevalence rates for ALTs ranged from 9.6% to 61%, whilst the prevalence rates for diagnosed ASD ranged from

ObjectivesThis study explores rates of a history of childhood trauma in adult patients with bipolar disorder and depression and the impact of such trauma and parental bonding patterns on depressive mood and interpersonal functioning at the time of assessment.MethodsA cross-sectional design was used and a sample of 49 participants was recruited from a mental health outpatient service in Northern Ireland. Data were subject to correlations, one-way analysis of variance and hierarchal regression analyses. A cut-off point of r=±0.25 was used to select variables for inclusion in the hierarchal regression analyses.ResultsHigh rates of childhood trauma were present in both samples: 74% in bipolar disorder and 82% in depression. Childhood trauma and poor parental bonding (with mother) were significant predictors of higher rates of current inter-episode depressive mood and interpersonal difficulties.ConclusionsThis finding adds to the evidence that routine assessment of early childhood experience is likely to prove helpful in clinical care.

Background Background: One factor known to be associated with attenuated psychotic symptoms is poor sleep but it is not known if poor sleep increases the likelihood of experiencing multiple attenuated psychotic symptoms, which research suggests may be suggestive of an At-Risk Mental State (ARMS). The study aimed to determine if poor sleep quality makes a unique contribution to predicting the number of attenuated psychotic symptoms endorsed in a prodromal questionnaire and the level of distress associated with the symptoms, when accounting for demographics, depression and drug/alcohol use variables. Methods Method: An online survey was conducted using Amazon’s online crowdsourcing service Mechanical Turk (MTurk). The sample was 1,013 adults (18 to 36 years) from the general population in the USA. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9 (PHQ-9), the DAST-10 and the AUDIT. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, while controlling for sociodemographic variables, depression, and alcohol/drug abuse. Results Results: 37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 Discussion Conclusion: A significant proportion of young adults in the general population may have an at-risk mental state. The results add to the evidence that sleep disturbance is a contributory factor in attenuated psychotic symptoms. Further research is required to investigate the possible mechanisms (e.g. impaired cognitive processes) through which poor sleep influences attenuated psychotic symptoms and if effective treatment of sleep disturbance can influence the likelihood of developing an at-risk mental state.

BACKGROUND: The Prodromal Questionnaire-16 (PQ-16; Ising et al., 2012) is a measure used to screen for attenuated psychotic symptoms that may indicate the presence of the at-risk mental state. The PQ-16 has been validated for use in help-seeking populations and the structure of the measure in this population is categorized by three subscales. These are perceptual abnormalities/hallucinations subscale, the unusual thought content/paranoia subscale, and negative symptoms subscale. The present study aimed to examine the structure of the PQ-16 in a non-help-seeking population through exploratory factor analysis and a confirmatory factor analysis. METHODS: Participants (n=722) were recruited through Amazon’s Mechanical Turk (MTurk) and completed the PQ-16 as part of a battery of questionnaires. For the exploratory factor analysis, the mean age of the sample was 27.93 years (SD=4.8), 55% of the sample were male, and 49% were single. The exploratory factor analysis, using principal axis factoring and oblique rotation, indicated a two-factor model was suitable for the PQ-16 in this population. Based on the current study and previous studies, three separate confirmatory factor models will be analyzed using SPSS Amos Version 25. RESULTS: The exploratory factor analysis indicated that there was a two-factor model suitable for this sample. Factor 1 appeared to represent perceptual abnormalities/hallucinations, while factor 2 was interpreted as general symptoms. Factor loadings indicated that items 2 & 14 of the PQ-16 did not fit into either factor and were excluded from the two-factor confirmatory factor model. Exploratory factor analysis has been completed, and confirmatory factor analysis of the PQ-16 in a similar non-help-seeking population is underway. DISCUSSION: The exploratory factor analysis indicated that a two-factor model is suitable for this sample (Factor 1 representing perceptual abnormalities/hallucinations; factor 2 representing general symptoms). The confirmatory factor analysis will allow us to explore what model is the best fit for the PQ-16 in this population.

Researchers have consistently demonstrated associations between trauma and psychosis (e.g. Rossiter et al., 2015) and there remains an important question as to whether enquiring about traumatic exp...

This study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of bipolar disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time, and it was postulated that a similar high reliability would be demonstrated in this population. A total of 39 patients with a confirmed diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria) were followed up and readministered the Childhood Trauma Questionnaire after 18 months. Cohen's kappa scores and intraclass correlations suggested reasonable test-retest reliability over the 18-month time period of the study for all types of childhood abuse, namely, emotional, physical, and sexual abuse and physical and emotional neglect. Intraclass correlations ranged from r = .50 (sexual abuse) to r = .96 (physical abuse). Cohen's kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.

Purpose: Studies have found an association between a history of trauma and the presence of psychotic symptoms. Despite the research evidence it appears to be the case that many clinicians are not routinely asking about traumatic experiences. This study aims to ascertain the level of agreement between rates of self-reported trauma and that which is recorded in case notes.Methods: The study population was drawn from all individuals with a confirmed diagnosis of psychosis, residing within a defined catchment area. Rates of childhood trauma, lifetime trauma and trauma related to the Troubles in Northern Ireland recorded in participants’ case notes were compared to their responses on self-report questionnaires: THQ, CTQ and TREQ.Results: Relatively high levels of trauma were reported by participants on the self-report measures that were administered. The rates of trauma recorded in case note records were similar to that found in other studies. Also in line with other research were poor levels of agreement betw...

Background The relationship between psychotic symptoms and bullying has received limited attention to date. A systematic review by Cunningham, Hoy, & Shannon (2016) identified only ten studies that met their inclusion criteria for examining the relationship between childhood bullying and psychosis via a prospective research design. A meta-analysis of these studies suggested that being bullied does predict the later development of psychotic symptoms. The authors went on to say that a better understanding of the factors that mediate the bullying/psychosis relationship is needed. It is possible that prolonged exposure to social adversity and exclusion can lead to a state of “social defeat” which has also been found to increase the risk of psychosis (Johnston et al., 2011; Selten et al., 2013; Selten and Cantor-Graae, 2005). Being bullied in childhood has also been linked to depression in adulthood (Bowes et al. 2014), and social support from family and friends may also mediate the bullying victimisation-depression relationship. Methods The present study is a secondary data analysis of a prospective cohort study; namely, the Belfast Youth Development Study (BYDS). The BYDS followed a group of children longitudinally from ages 12–21 years. The participants are 2,087 individuals who took part in the Belfast Youth Development Study (BYDS) in 2011 (Wave 7). This longitudinal survey started in 2001 (Wave 1) when the sample members were aged 11 years. The sample were then surveyed again annually up until age 15 years (Waves 2–5), and post-compulsory schooling follow ups were carried out at 17 and 21 years (Waves 6 & 7). The secondary analysis will involve conducting path models. The first of which will be a bullying victimisation-psychosis mediation model; this will include a predictor (bullied, age 12 years), outcome (Psychosis, age 21 years), mediators (e.g. peer attachment, age 13 years; parental attachment. age 14 years), and covariates (gender, free school meals, depression, and frequency of cannabis use in the past year; cannabis abuse screening test). A bullying victimisation-depression mediation model will also be examined; this will include the same mediator and covariate variables. Results The results will be reported in the poster submission (analysis in progress). These will include measures of direct and indirect effect, as well as model fit statistics. Discussion Clinical implications in terms of prevention, assessment, and intervention for young people at risk of psychotic disorders will be discussed.

Over recent years there has been a growing interest in identifying the early stages of psychosis. The At Risk Mental State (ARMS) is characteristic of the prodromal stages of psychosis and its identification gives rise to a number of clinical and research opportunities including early intervention and prevention of psychosis. This study employs interpretative phenomenological analysis to gain insights into the subjective experience and individuals understanding of the development of their ARMS. Five participants took part and provided information on the experience of symptoms, life prior to onset of their ARMS and their understanding of symptoms and their development through a semi structured interview. From the analysis of transcripts eight themes emerged which were common across participants accounts. Three themes of experience (disturbed world/disturbed self, disconnection with the world, thunderstruck) and five themes of understanding (absence of understanding, use of others, identity, forming links, fragmented understanding) were identified. Themes are explored in detail and discussed in relation to existing literature and theory. Clinical implications, directions for future research, and limitations are discussed within.

BACKGROUND: The at-risk mental state provides a model which can allow clinicians to identify individuals at-risk of developing psychosis and intervene to prevent or delay onset. Early intervention is linked with better prognosis and recovery. At present, most screening is carried out within help-seeking populations, however screening within educational settings may allow clinicians to identify individuals at-risk earlier. This is a systematic narrative review examining the screening tools that have been used in educational settings, with three key questions. Can screening in this setting detect individuals at-risk? What screening tools have been used in educational settings? Are there differences in threshold scores in screening tools in this context? METHODS: Searches were carried out on PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science. The searches aimed to find any articles that detailed screening procedures for the at-risk mental state carried out within educational settings. Inclusion criteria were studies that were carried out in educational settings using a screening measure for attenuated psychotic symptoms with a follow-up assessment to assess for the at-risk mental state. All study types were included. Studies that did not include these three criteria were excluded. RESULTS: 2097 references were identified for title and abstract screening. 104 articles were identified for screening by full-text. 11 articles are included in the review. Data extraction was completed using an adapted version of the template from the Cochrane Collaboration Data Collection Form for Intervention Reviews: RCTs and non-RCTs. DISCUSSION: The PQ-16 is the most commonly used screening measure in educational settings such as colleges and university settings and secondary schools. A full review will be presented and the potential benefits of identifying young people at risk of psychosis in educational settings will be discussed.

Identification of individuals with an at-risk mental state (ARMS) who are at a heightened risk of developing psychosis allows researchers and clinicians to identify what factors are associated with poorer outcomes and transitions to psychosis. A number of socioenvironmental factors are linked to an increase risk of developing psychosis, of which childhood trauma is widely acknowledged. The current review aims to examine what impact trauma has on the ARMS by reviewing reported relationships between trauma variables and transition to psychosis, ARMS severity, adaptive functioning and comorbid symptomology from both cross sectional and prospective design studies. A literature search was conducted for all relevant original research articles published in the English language up to December 2015 using 3 electronic databases: PsycINFO, Web of Science and PubMed. A total of 6 papers met the inclusion criteria and were included in the current review. Trauma was found to have a significant impact on the ARMS observed through reported relationships between trauma variables and transition to psychosis, ARMS severity, adaptive functioning and comorbid symptomology. Sexual trauma demonstrated the most consistent trauma variable to impact the ARMS. Individuals with an ARMS who have experienced sexual trauma are at a heightened risk of poorer outcomes and transitions to psychosis. Further prospective design studies are required to examine this observation further.

ObjectiveTo report new prescriptions of psychotropic medications among adolescents presenting with new onset psychotic symptoms during a 5-year period.MethodsThe Northern Ireland Early Onset Psychosis Study is a naturalistic longitudinal observational study of patients with an early onset first psychotic episode. All patients aged n=113). Clinical case notes were analysed retrospectively for details of subsequent treatment with psychotropic medications.ResultsA total of 100 patients (88.5%) were prescribed some form of psychotropic medication. Over three-quarters of patients received an antipsychotic as their first medication. Risperidone (45.8%), olanzapine (24.0%) and chlorpromazine (12.5%) were the most commonly prescribed first-line antipsychotic medications. Of a total of 160 antipsychotic prescriptions, 81 (50.6%) were off-label. Prescriptions were most likely to have been deemed off-label owing to medications not being licensed in under-18s (71.6% of off-label prescriptions) but other reasons were medications being used outside licensed age ranges (23.5%) and outside licensed indications (4.9%).ConclusionsThis is the first study examining psychotropic prescribing patterns in a complete sample of all children and adolescents presenting with early onset psychotic episodes in a single geographical area. The observation of risperidone as the most commonly prescribed antipsychotic was in keeping with previous studies in child and adolescent populations. Rates of off-label prescribing were lower than previously observed although our study was the first to investigate off-label prescribing solely in children and adolescents presenting with psychotic symptoms.