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Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.

Objectives:Hallucinations and delusions that occur in the absence of a psychotic disorder are common in children and adolescents. Longitudinal phenomenological studies exploring these experiences are notably lacking. The objective of the current paper was to explore the phenomenology and characteristics of hallucinations and delusions from early adolescence to early adulthood.Methods:Participants were 17 young people aged 18–21 years from the general population, all of whom had a history of childhood hallucinations and/or delusions. Longitudinal data on the phenomenological characteristics and attributions of reported hallucinatory and delusional phenomena spanning nine years were explored using content analysis.Results:Hallucinatory and delusional phenomena were transient for two-thirds of the sample. The remaining one-third reported reoccurring hallucinatory and delusional phenomena into early adulthood. In those, two typologies were identified: (1) Paranormal typology and (2) Pathological typology. The former was characterised by hallucinatory and delusional phenomena that were exclusively grounded in subcultural paranormal or spiritual belief systems and not a source of distress. The latter was characterised by delusion-like beliefs that were enmeshed with individuals’ mood states and a source of distress. The perceived source, the subcultural context and how young people appraised and integrated their experiences differentiated the Paranormal and Pathological typologies.Conclusions:Not all hallucinatory and delusion-like experiences are psychotic-like in nature. To reliably differentiate between pathological and non-pathological hallucinations and delusions, assessments need to explore factors including the phenomenology of individuals’ experiences, how people make sense and appraise them, and the subcultural contexts within which they are experienced.

Objective To systematically review evidence for the association between trauma experienced in childhood or adolescence, and the subsequent experience of affective or psychotic mental disorders in adulthood. Methods Electronic databases (Scopus, Medline (for Ovid), EMBASE and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies in the English language examining child or adolescent exposure to trauma, and adult-diagnosed depression, anxiety, psychotic disorder or bipolar disorder. A total of 23 manuscripts were retained. Results Results revealed a significant association between the following childhood exposures and adult mental disorder: bullying (victimhood, perpetration and frequency); emotional abuse; physical neglect; parental loss; and general maltreatment (unspecified and/or multiple trauma exposure). There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more than three times the odds of developing a mental disorder (Odds ratio = 3.11, 95% CI = 1.36-7.14). There was no significant association found between physical or sexual abuse and adult mental disorder; however, this is likely an artefact of how these adversities were assessed. Conclusion There is strong evidence of an association between childhood trauma and later mental illness. This association is particularly evident for exposure to bullying, emotional abuse, maltreatment and parental loss. The evidence suggests that childhood and adolescence are an important time for risk for later mental illness, and an important period in which to focus intervention strategies.

Objectives:Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how young people made sense of those experiences.Methods:Participants were 53 young people aged 11–13 years from a population-based study of mental health. All met criteria for UPTBs following clinical interviews as part of the study. Documentary data on UPTBs in the form of transcribed notes, recorded during clinical interviews, were analysed using content analysis. Data on UPTBs were coded, organised into categorical themes and quantified using descriptive statistics. Qualitative themes on how participants made sense of their experiences were identified.Results:Participants reported UPTBs across four domains: auditory verbal, auditory non-verbal, non-auditory perceptual experiences and unusual thoughts and beliefs. UPTBs were phenomenologically rich and diverse. Young people sought to make sense of their experiences in multiple ways: normalising them, externalising them by attributing them to paranormal entities and distancing them from psychiatric explanations. Uncertainty about the source of UPTBs was identified as a superordinate theme.Conclusion:Findings from this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in young people.

Objective To identify neuropsychological and motor changes from adolescence to early adulthood in young people with psychotic experiences (PE). Methods A community-based sample of 56 young people attended the study over a 9 year follow-up period. Participants were assessed over 3 time-points at T1, T2 and T3 aged x ¯ = 11.69, x ¯ = 15.80 and x ¯ = 18.80 years respectively. PE were assessed using the Kiddie Schedule for Affective and Depressive Symptoms (K-SADS). Neuropsychological assessments, including subtests of the MATRICS battery, and motor assessments were examined at T2 and T3. Two groups were compared: those who ever reported PE during their adolescence or early adulthood (n = 21) and a healthy control group (n = 35). Further group analysis was conducted within the PE group subdividing into those with transient PE (n = 10) and those with persistent PE (n = 11). Results At T3, a significant group difference was found between the PE and control groups in the fine motor skill task, the Pegboard task (F = 4.8, p = .03) and the processing speed task, the Digit-Symbol Coding task (F = 5.36, p = .03). Furthermore, a significant group difference was found between the transient PE and control groups on the Digit-Symbol Coding task (F = 5.61, p = .02), while a significant group difference was found between the persistent PE and control groups on the Pegboard task (F = 7.84, p = .01). Conclusion This study shows that fine motor skill and processing speed deficits persist in young people who report PE, even in those with transient PE. The current research advances the knowledge about the trajectory and precursors of sub-clinical symptoms of psychosis in young people.

Background Psychotic experiences (PEs) are not uncommon in young people and are associated with both psychopathology and compromised global functioning. Although psychotic experiences are transient (short-lived, self-resolving and non-recurring) for most people who report them, few studies have examined the association between early transient PEs and later functioning in population samples. Additionally, studies using self-report measures of interpersonal and educational/ vocational difficulties are lacking. The aim of this study was to examine the relationship between transient psychotic experiences and self-reported interpersonal and educational/vocational difficulties in adolescence and young adulthood. Methods Participants were 103 young people from a longitudinal population-based study cohort of mental health in Ireland. They attended for baseline clinical interviews in childhood (age 11–13) and were followed up in young adulthood (age 19–25). Participants who reported psychotic experiences at baseline but not at follow-up were classified as having transient psychotic experiences. Data from both time-points were used to examine the association between transient psychotic experiences and self-reported interpersonal and educational/ vocational difficulties in young adulthood using poisson regression modelling. Results Young people with a history of transient psychotic experiences reported significantly higher interpersonal (adj IRR: 1.83, 95%ileCI: 1.10–3.02, p = .02) and educational/vocational (adj IRR: 2.28, 95%ileCI: 1.43–3.64, p = .001) difficulties during adolescence. However, no significant differences in interpersonal (adj IRR: 0.49, 95%ileCI: 0.10–2.30, p = .37) or educational/vocational (adj IRR: 0.88, 95%ileCI: 0.37–2.08, p = .77) difficulties were found in young adulthood. Self-reported interpersonal and educational/vocational difficulties in young people both with and without a history of transient psychotic experiences decreased between adolescence and young adulthood. Conclusions Young people with transient psychotic experiences have increased interpersonal and educational/vocational difficulties in adolescence but these may not persist into the young adult years. This finding indicates that early psychotic experiences may not confer high risk for long-term interpersonal or educational/vocational deficits among young people who experience these phenomena transiently.

BACKGROUND Mental ill-health is one of the most significant health and social issues affecting young people globally. To address the mental health crisis, a number of cross-sectoral research and action priorities have been identified. These include improving mental health literacy, translating research findings into accessible public health outputs, and the use of digital technologies. There are, however, few examples of public health–oriented knowledge transfer activities involving collaborations between researchers, the Arts, and online platforms in the field of youth mental health. OBJECTIVE The primary aim of this project was to translate qualitative research findings into a series of online public mental health animations targeting young people between the ages of 16 and 25 years. A further aim was to track online social media engagement and viewing data for the animations for a period of 12 months. METHODS Qualitative data were collected from a sample of 17 youth in Ireland, aged 18-21 years, as part of the longitudinal population-based Adolescent Brain Development study. Interviews explored the life histories and the emotional and mental health of participants. The narrative analysis revealed 5 thematic findings relating to young people’s emotional and mental health. Through a collaboration between research, the Arts, and the online sector, the empirical thematic findings were translated into 5 public health animations. The animations were hosted and promoted on 3 social media platforms of the Irish youth health website called SpunOut. Viewing data, collected over a 12-month period, were analyzed to determine the reach of the animations. RESULTS Narrative thematic analysis identified anxiety, depression, feeling different, loneliness, and being bullied as common experiences for young people. These thematic findings formed the basis of the animations. During the 12 months following the launch of the animations, they were viewed 15,848 times. A majority of views occurred during the period of the social media ad campaign at a cost of €0.035 (approximately US $0.042) per view. Animations on feeling different and being bullied accounted for the majority of views. CONCLUSIONS This project demonstrates that online animations provide an accessible means of translating empirical research findings into meaningful public health outputs. They offer a cost-effective way to provide targeted online information about mental health, coping, and help-seeking to young people. Cross-sectoral collaboration is required to leverage the knowledge and expertise required to maximize the quality and potential reach of any knowledge transfer activities. A high level of engagement is possible by targeting non–help-seeking young people on their native social media platforms. Paid promotion is, therefore, an important consideration when budgeting for online knowledge translation and dissemination activities in health research.

Background: Psychotic experiences in young people have known associations with childhood adversity and functional deficits. However, few studies have focused only on childhood psychotic experiences that remit during adolescence (transient psychotic experiences). Additionally, studies using self-report measures of interpersonal and educational/vocational difficulties are lacking. The aim of this study was to examine the relationship between childhood adversity and transient psychotic experiences and transient psychotic experiences and self-reported interpersonal and educational/vocational difficulties in adolescence and young adulthood. Methods: Participants were 103 young people from a longitudinal population-based study cohort of mental health in Ireland. They attended for clinical interview in childhood (age 11-13) and young adulthood (age 19-25). Data on childhood adversity were collected at baseline. Data on self-reported interpersonal and educational/vocational difficulties were collected at follow-up. Data on psychotic experiences were collected at both times. Associations between childhood adversity, transient psychotic experiences and self-reported interpersonal and educational/vocational difficulties were examined. Results: Young people with a history of transient psychotic experiences reported an almost 3.5-fold increase in odds of childhood victimization (OR 3.43 CI 1.21-9.71). They also reported significantly higher interpersonal ( p = 0.03) and educational/vocational ( p = 0.001) difficulties during adolescence. However, no significant differences in interpersonal ( p = 0.91) or educational/vocational ( p = 0.35) difficulties were found in young adulthood. The higher rates of childhood victimization found did not account for any observed differences. Self-reported interpersonal and educational/vocational difficulties in young people both with and without a history of transient psychotic experiences decreased between adolescence and young adulthood. Conclusions: Young people with transient psychotic experiences have increased interpersonal and educational/vocational difficulties in adolescence but these may not persist into the young adult years. These findings may indicate that early transient psychotic experiences do not confer high risk for persistent interpersonal and/or educational/vocational deficits and young people who experience these phenomena transiently. Thus, psychotic experiences in childhood that remit by young adulthood may not be a strong risk indicator for future functioning deficits, as experienced and/or perceived by individuals themselves.

BackgroundPsychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of psychiatric disorders. The aims of this study were to examine associations between PEs and a range of factors including psychopathology, adversity and lifestyle, and to investigate mediating effects of coping style and parental support on associations between adversity and PEs in a general population adolescent sample.MethodCross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe study. Students completed a self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. PEs were assessed using the 7-item Adolescent Psychotic Symptom Screener.ResultsOf the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. In multivariate analysis, associations were found between PEs and number of adverse events reported (OR 4.48, CI 1.41–14.25; p < 0.011), maladaptive/pathological internet use (OR 2.70, CI 1.30–5.58; p = 0.007), alcohol intoxication (OR 2.12, CI 1.10–4.12; p = 0.025) and anxiety symptoms (OR 4.03, CI 1.57–10.33; p = 0.004). There were small mediating effects of parental supervision, parental support and maladaptive coping on associations between adversity and PEs.ConclusionWe have identified potential risk factors for PEs from multiple domains including adversity, mental health and lifestyle factors. The mediating effect of parental support on associations between adversity and PEs suggests that poor family relationships may account for some of this mechanism. These findings can inform the development of interventions for adolescents at risk.

Background Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of schizophrenia and other psychiatric disorders in adulthood. Few modifiable protective factors have been identified to date. The aims of this study were to examine associations between a range of psychopathological, adverse life event, coping and social support factors and PEs in a general population sample of Irish adolescents. Methods Cross-sectional data were drawn from the Irish centre of the Saving and Empowering Young Lives in Europe (SEYLE) study (German Clinical Trials Registry, DRKS00000214). Students were administered a classroom-based self-report questionnaire and 973 adolescents, of whom 522 (53.6%) were boys, participated. Psychotic experiences were assessed using the 7-item Adolescent Psychotic Symptom Screener. Results Of the total sample, 81 (8.7%) of the sample were found to be at risk of PEs. A wide range of factors from adverse life event, lifestyle and mental health domains had crude associations with PEs, while parental support was associated with lower prevalence of PEs. In multivariate analysis, independent associations were found between PEs and the number of adverse life events experienced (OR: 1.61; CI: 1.29–2.02; p Conclusion These findings can inform the development of optimal interventions for adolescents at risk of psychopathology and their families.

Aims: Smaller hippocampal volumes are among the most consistently reported neuroimaging findings in schizophrenia. However, little is known about hippocampal volumes in people who report psychotic experiences. This study investigated differences in hippocampal volume between young people without formal diagnoses who report psychotic experiences (PEs) and those who do not report such experiences. This study also investigated if any differences persisted over two years. Methods: A nested case-control study of 25 adolescents (mean age 13.5 years) with reported PEs and 25 matched controls (mean age 13.36 years) without PEs were drawn from a sample of 100 local schoolchildren. High-resolution T1-weighted anatomical imaging and subsequent automated cortical segmentation (Freesurfer 6.0) was undertaken to determine total hippocampal volumes. Comprehensive semi-structured clinical interviews were also performed including information on PEs, mental diagnoses and early life stress (bullying). Participants were invited for a second scan at two years. Results: 19 adolescents with PEs and 19 controls completed both scans. Hippocampal volumes were bilaterally lower in the PE group compared to the controls with moderate effects sizes both at baseline [left hippocampus p = 0.024 d = 0.736, right hippocampus p = 0.018, d = 0.738] and at 2 year follow up [left hippocampus p = 0.027 d = 0.702, right = 0.048 d = 0.659] throughout. These differences survived adjustment for co-morbid mental disorders and early life stress. Conclusions: Psychotic experiences are associated with total hippocampal volume loss in young people and this volume loss appears to be independent of possible confounders such as co-morbid disorders and early life stress.

AimsTo estimate the prevalence of DSM-V mental disorders in a population of Irish emerging adultsBackgroundMental disorders are the leading cause of years lived with disability in youth worldwide. Few studies use gold standard of face to face semi-structured standardized interview tools, and this is a limitation in the estimates of prevalence rates of mental disorder in the extant literature.MethodBriefly, we recruited a representative sample of 212 adolescents and followed them up over ten years. In this wave of the adolescent brain development study, 103 of the initial 212 participants took part, 50 males and 53 females, with a mean age of 20.87 years (SD = 1.3). Psychopathology was assessed in all participants by trained research psychologists and mental health professionals using the Structured Clinical Interview for DSM-V (SCID).Result52.4% of participants had one lifetime mental disorder, the prevalence rates were highest for Major Depressive Episode (25.3%), Social Anxiety (12.6%) and Generalized Anxiety (8.7%). 50.5% had a history of a mental disorder. 27.2% had 1 lifetime diagnosis, 15.5% had 2 and 7.8% had >2.ConclusionRates of mental disorder rapidly increase during emerging adulthood. In a similar Irish study, 55% of young adults met the criteria for lifetime mental disorder. Whilst the rates of mental disorder are high in young people, previous longitudinal research has suggested that many common mental disorders remit by the late twenties. We suggest a need for further research investigating the comparative later functional and economic outcomes of these young people. Research to date is supportive of a need to expand capacity of youth friendly services for prevention and treatment.Ethical ApprovalEthical approval for the study protocols, including interviews and assessments, along with informed consent documents, was granted by the Beaumont Hospital Medical Ethics Committee in 2016.Acknowledgements:1. European Research Council Consolidator Award and Health Research Board Ireland Award to Mary Cannon2. Health Professionals Fellowship from the Health Research Board Ireland to Helen Coughlan.

The brain is our most important organ and perhaps the least well understood. Our brain is the “command station” for our body. It controls what we think, what we feel and what we do. It is the home of our emotions and personality. It makes sense of our experiences. But how does the brain work? The truth is that, after decades of research, scientists and doctors are only now beginning to figure out that question. We know that different types of cells in the brain work together to form certain areas which have specialist roles in memory, vision and logical thinking. We also know that hormones and chemicals influence our brain and our emotions and that we are very sensitive to changes in their levels. We know that the different brain areas mature at different stages and are connected by tracts, rather like railway lines, which can sometimes go astray and lead to illnesses. And finally we know that by looking in the blood we can find clues, called biomarkers, which may ultimately help us to understand and predict brain disorders. Through this book we want to help everyone to understand the workings of the brain through pictures and cartoons. If you would like to learn more about these pictures go to our website rcsi.ie/brainjourney

Background Psychotic experiences (PEs) are commonly reported in adolescence and are associated with a range of negative outcomes. Few targets for intervention for PEs have been identified. One potential target is self-concept: an individual's beliefs about his/her personal attributes. Improvements in self-concept have been shown to reduce psychotic symptoms in patients with schizophrenia but no study has investigated the relationship between changes in self-concept and risk of PEs in the general population. We aimed to investigate: (a) the relationship between child and adolescent self-concept and adolescent PEs; and (b) whether changes in self-concept between childhood and adolescence were associated with risk of adolescent PEs. Method Using data from age 9 and age 13 (n = 7,423) of the child cohort (Cohort'98) from the Growing Up in Ireland study we investigated the relationship between self-concept at age 9 and age 13 and PEs at age 13. PEs were measured using the Adolescent Psychotic Symptoms Screener and self-concept was measured using the Piers Harris-II. Using a stratified analysis, we investigated the relationship between change in self-concept between age 9 and age 13 and the risk of PEs at age 13. Additionally we investigated changes across the six self-concept subscales. Results Psychotic experiences were reported by 13% of participants at age 13. 'Very low' self-concept at age 9 was associated with an increased risk of PEs at age 13 (Adjusted-OR: 2.74, CI: 1.80-4.19), and 'High' self-concept at age 9 was associated with a decreased risk of PEs at age 13 (Adjusted-OR: 0.77, CI: 0.60-0.97). The stratified analysis indicated that improvements in self-concept reduced the odds of adolescent PEs and decline in self-concept increased the odds of adolescent PEs. This effect was noted across the majority of the self-concept subscales. Conclusions There is a strong relationship between self-concept and PEs. The antecedents of low self-concept may be a useful target for preventative psychiatry. Broad-spectrum interventions targeting self-concept in childhood may help to reduce the incidence of PEs in adolescence.

ObjectivesIncreasing rates of young people not in education, employment or training (NEETs) are a cause of concern both in Ireland and internationally, but little longitudinal research has examined the link between psychiatric disorder in young people and NEET status.MethodsThe Challenging Times (CT) Study is a longitudinal, population-based study of psychopathology among 212 young Irish people. Clinical interviews were performed at two time points: 12–15 years and 19–24 years.ResultsNEET status in young adulthood was associated with a sevenfold increased risk of current suicidal ideation. This result was independent of prior adolescent mental disorder. NEET young people had a fourfold increased odds of being diagnosed with a mental disorder in childhood or early adolescence compared with their economically active peers. NEET young people were at an almost threefold increased risk of any mental health disorder a twofold increased risk of anxiety disorder and threefold increased odds of suicide attempts over their lifetime compared with economically active peers.ConclusionsNEET young people are at increased risk for mental disorder and suicidal ideation. The association is bidirectional, as prior mental disorder in adolescence appeared to account for much of the association between NEET status and current mental health problems. However, economic inactivity conveys an increased risk for suicidal ideation over and above that due to prior disorder. Our findings provide a compelling economic and societal argument for early intervention and treatment of mental disorder and the importance of vocational interventions for reducing suicide risk in young adults.

BackgroundThere is a lack of epidemiological research on the mental health of young adults in Ireland.ObjectivesTo determine prevalence of psychiatric disorders in a cohort of young Irish adults.MethodsThe Challenging Times study was a landmark study of the prevalence of psychiatric disorders in adolescents in North Dublin, Ireland: 212 school children aged 12-15 years were recruited through schools and interviewed using the K-SADS semi-structured diagnostic instrument. This cohort was traced again at age 19-24 years (mean age 20.8 years) and interviewed using SCID I & II. Main outcome measures were current and lifetime Axis I and Axis II psychiatric disorders.ResultsFollow-up rate was 80%. Using a weighted population prevalence analysis 19.8% of the cohort had a current mental disorder, 56.0% had a lifetime mental disorder of whom 28.4% had mood disorders, 27.1% had anxiety disorders, 22.7% had substance use disorders; 25.4% had lifetime multi-morbidity. Cluster A personality disorders were found in 2.3%. Lifetime prevalence of binge-drinking was 75.0%, cannabis use 65% and 17% of young adults had fulfilled criteria for an alcohol use disorder at sometime in their life. Lifetime prevalence of suicidal thoughts/behaviour was 21.1%.ConclusionsLifetime prevalence of psychiatric disorder and substance use were high in this sample of young Irish adults. Mental Health service provision for this age group is a priority. Larger studies of nationally representative samples are needed to inform service development.

BACKGROUND Psychotic experiences (PEs) are common in childhood and have been associated with concurrent mental disorder and poorer global functioning. Little is known about the effects of childhood PEs on future functioning. We investigated the effects of childhood PEs on global functioning from childhood into early adulthood. METHOD Fifty-six participants from a community sample completed all three waves of the Adolescent Brain Development study (T1x¯ Age: 11.69, T2x¯ Age: 15.80 T3x¯Age: 18.80). At each phase, participants completed a clinical interview assessing for PEs, mental disorder and global function. Repeated measures models, adjusted for mental disorder and gender, were used to compare current (C-GAF) and most severe past (MSP-GAF) functioning in participants who had reported PEs in childhood and controls. RESULTS Participants with a history of PEs had significantly poorer C-GAF (P

AIM: This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years. METHODS: Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19-24 years. RESULTS: Sexual minority youth had 6.6-fold (95% CI 1.7-24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3-18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8-32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6-27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers. CONCLUSIONS: This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth. Language: en

The emergence of a new youth mental health paradigm has challenged how we think about the provision of mental health care for adolescents and young adults. This editorial tracks the origins of this new paradigm within the field of mental health both internationally and in Ireland.

Background This study investigated the prevalence of DSM-IV Axis 1 mental disorders, deliberate self-harm and suicidal ideation in a sample of Irish adolescents aged 11–13 years. Methods A total of 1131 students was surveyed for general psychopathology using the Strengths and Difficulties Questionnaire. Following this, a representative sample of 212 adolescents was assessed for mental disorders, deliberate self-harm and suicidal ideation using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Results 14.6% of the sample met criteria for a borderline score and 6.9% for an abnormal score on the Strengths and Difficulties Questionnaire. Following clinical diagnostic interviews, 27.4% of participants received a current diagnosis of an Axis 1 disorder and 36.8% received a lifetime diagnosis, those rates falling to 15.4% and 31.2% respectively when specific phobias were excluded. Conclusions Findings from this study reveal that Irish adolescents aged 11–13 years are experiencing high levels of mental ill-health.

A recent and growing body of evidence on youngpeople’s mental health has pointed to the need foran international response to the increasing and con-cerning rates of mental ill-health among youngpeople.1,2The periods of adolescence and emergingadulthood3are considered the peak periods for theonset of mental ill-health4with 75% of all adult diag-noses of mental ill-health having had an onsetbefore the age of 25 years.5In an era when the physi-cal health of young people has never been better,6their psychological and mental health has neverbeen worse.7This leaves young people vulnerable todeveloping potentially intractable and enduringmental health difficulties with the inevitable per-sonal, familial, social and vocational consequencesthat accompany the experience of mentalill-health

Background: Previous magnetic resonance imaging (MRI) research suggests that, prior to the onset of psychosis, high risk youths already exhibit brain abnormalities similar to those present in patients with schizophrenia. Objectives: The goal of the present study was to describe the functional organization of endogenous activation in young adolescents who report auditory verbal hallucinations (AVH) in view of the “distributed network” hypothesis of psychosis. We recruited 20 young people aged 13–16 years who reported AVHs and 20 healthy controls matched for age, gender and handedness from local schools. Methods: Each participant underwent a semi-structured clinical interview and a resting state (RS) neuroimaging protocol. We explored functional connectivity (FC) involving three different networks: 1) default mode network (DMN) 2) salience network (SN) and 3) central executive network (CEN). In line with previous findings on the role of the auditory cortex in AVHs as reported by young adolescents, we also investigated FC anomalies involving both the primary and secondary auditory cortices (A1 and A2, respectively). Further, we explored between-group inter-hemispheric FC differences (laterality) for both A1 and A2. Compared to the healthy control group, the AVH group exhibited FC differences in all three networks investigated. Moreover, FC anomalies were found in a neural network including both A1 and A2. The laterality analysis revealed no between-group, inter-hemispheric differences. Conclusions: The present study suggests that young adolescents with subclinical psychotic symptoms exhibit functional connectivity anomalies directly and indirectly involving the DMN, SN, CEN and also a neural network including both primary and secondary auditory cortical regions.

Purpose: \ud The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. \ud \ud Methods: \ud The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the U.K. and Canada) currently active in the youth mental health field. \ud \ud Results: \ud Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front line services (Jigsaw) which are being implemented across different jurisdictions; in the UK a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. \ud \ud Conclusions: \ud There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.

Background Neurocognitive impairments are a prevalent aspect of psychosis which, on average, begin in early adolescents, with particular impairment apparent in speed of processing and nonverbal working memory in early stages (Kelleher et al., 2012). It is important to understand the impact of cognitive impairment on functional ability, particularly in early stages of illness which may assist in the development of targeted therapeutic strategies. Methods A population sample of 212 school going adolescents aged 11–13 years partook in the study, which included community-based adolescents who report experiencing psychotic symptoms but who were not clinically diagnosed. Psychotic symptoms were assessed using the psychosis section of the Schedule for Affective Disorders and Schizophrenia. Six cognitive domains were assessed using the MATRICS consensus cognitive battery. Functioning was assessed using the Children’s Global Assessment Scale. Six separate linear regression analyses were performed to test if each cognitive domain of the MATRICS battery predicted functioning. Results In the entire sample (including those who experienced psychotic experiences and those who did not) (n=211), speed of processing significantly explained 8% of the variance in functioning (F(1, 76) = 6.61, p = .0012, R-squared = 0.08.), (Beta = 0.39, p = 0.012). When the sample was subdivided into those who ever experienced auditory hallucinations (AH) (n=62) versus those that did not (n=149), speed of processing significantly predicted 18% of the variance in functioning in the group experiencing AHs (F(2, 33) = 3.82, p =0.032, R-squared = 0.18), (Beta = 0.43, p = 0.06). However, no effect was found in the group without AVs (F(1,40) = 1.19, p =0.28). No other cognitive domain predicted functioning. Discussion Speed of processing appears to be a core cognitive deficit in psychosis which impacts on functioning in young adolescents particularly in those experiencing psychotic symptoms such as auditory hallucinations, however the variance predicted by processing speed is relatively low. This research highlights the potential of speed of processing as a possible viable target for early intervention in psychotic disorders.

Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Children's Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR = 0.25, 95% CI = 0.14-0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR = 0.28, 95% CI = 0.12-0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR = 0.48, 95% CI = 0.22-1.05, P

Suicide is one of the leading causes of death worldwide among young people. One of the strongest predictors of completed suicide is a previous suicide attempt (1). Suicide attempts are more frequent among young people, and a suicide attempt may be a marker of a lasting trajectory of adverse mental and physical problems into middle adulthood (1,2).There is limited evidence for factors during the adolescent period and the period of transition to young adulthood that increase the risk of attempted suicide. We used a prospective cohort study design incorporating clinical interviews to determine what factors measured at ages 12-15 years are associated with attempted suicide reported at ages 19-24 years. The methods for the baseline adolescent study have previously been described (3). Using a stratified random sampling technique, 743 students in eight mainstream schools were screened for psychopathology. Adolescents who scored above threshold on the screening instruments or who indicated the presence of significant suicidal ideation (N=140) were invited to attend for interview, along with a group of 174 controls matched for gender, school and school year. 84.3% adolescents from the “at risk” category and 54% of the control group attended for a semi-structured clinical interview, along with a parent or guardian. All 212 young people who were interviewed as young adolescents were invited to take part in a follow-up interview eight years later. Follow-up information was obtained on 168 participants (79% follow-up rate). There were no differences between responders and non-responders in age, gender, parental socio-economic status, “at-risk” status at baseline, or diagnosis of psychiatric disorder at baseline. We collected exposure information at interview on: family and childhood risk factors (family history of psychiatric illness and experience of childhood trauma, i.e. physical/sexual abuse or witnessing domestic violence); adolescent risk factors (psychopathology, cannabis use and alcohol use); young adult risk factors (psychopathology, cannabis use, self-harm, education level and employment status). The outcome measure was lifetime suicide attempts at 19-24 years old. Ten percent of participants had made a suicide attempt at some point in their lives up to age 19-24 years. The mean age of those attempting suicide was 20.6 years. Fifty-three percent of those who reported a suicide attempt were female. Hierarchical logistic regression models showed that adolescent mood disorder and adolescent cannabis use, young adult mood and anxiety disorders, and a low level of education were the most strongly predictive factors for making a suicide attempt when the effects of family psychiatric history, childhood trauma, alcohol use and other psychopathology were taken into account. Adolescent mood disorder and adolescent cannabis use both independently increased the odds of a suicide attempt 7-fold (OR=7.0, 95% CI: 1.4-34.3; OR=7.5, 95% CI: 1.2-43.8), while young adult mood and anxiety disorders both independently increased the odds of an attempt 11-fold (OR=11.7, 95% CI 1.8-73.9; OR=11.1, 95% CI: 21.0-57.9). Young adults with only secondary-level education had an 8-fold increase in the odds of a suicide attempt compared to those with third-level education (OR=8.0, 95% CI: 1.1-54.4). There is evidence that substance use disorders in adulthood increase the risk of suicidal behaviours. Here we show that any use of cannabis in the early adolescent period is a strong independent predictor of attempted suicide in young adulthood. We know that significant brain maturation continues to occur during adolescence, particularly in limbic structures such as the hippocampus; and within the prefrontal cortex important processes such as synaptic pruning, myelination and programming of neurotrophic levels are occurring at this time (4). Regular cannabis use can lead to grey matter volume reduction in a range of brain areas, including the medial temporal cortex, the parahippocampal gyrus, the insula and orbitofrontal regions (5). There is evidence of a linear association between the age at onset of cannabis use and both white matter integrity and grey matter volume, suggesting that the earlier the onset of use, the greater the toxic effects on the brain (5,6). Neuroimaging studies of people who have attempted suicide show structural and functional brain changes that are in keeping with those found in cannabis users (7). It is possible that cannabis use in early adolescence, at a vulnerable time for neurodevelopment, leads to or exacerbates ongoing dysfunctional brain changes that prime young people for a maladaptive trajectory towards young adulthood. Those most at risk for attempted suicide may have experienced accumulating risk exposures throughout childhood and adolescence and in young adulthood may lack adequate problem solving skills, as possibly indexed here by low levels of education. The increasing awareness among the mental health community that we need to focus on early clinical intervention to protect against the worst effects of emotional distress among our young people, both on a personal and an economic level (8), can only be acted on when we can reliably identify which young people are most at risk. The available evidence suggests that the specialist treatment of psychiatric disorder in adolescence alone is insufficient for the prevention of future suicide attempts (9). We need a more tailored approach to youth mental health and a greater awareness of the different contingencies involved in the pathway to suicidal behaviours such as accumulating risk from adolescent cannabis use, adolescent mood disorders and a lack of education.

Importance Abnormal brain connectivity is thought to have a key role in the pathophysiology of schizophrenia and other psychotic disorders. White matter (WM) abnormalities have been reported in patients with schizophrenia and patients with prodromal syndromes. To our knowledge, no studies have yet reported on WM differences among adolescents who report psychotic experiences, a known vulnerability group for later severe psychopathology, including psychotic illness. Objective To study WM differences using diffusion-weighted imaging (whole-brain and tractography analyses) in adolescents who report psychotic experiences. Design, Setting, and Participants A population-based case-control study of 28 adolescents 13 to 16 years old who reported psychotic experiences and a matched sample of 28 adolescents who did not report psychotic experiences drawn from a sample of 212 young people recruited from primary schools in North Dublin and Kildare, Ireland. The study dates were 2008 to 2011. Interventions High-angular resolution diffusion-weighted imaging data were used to conduct whole-brain WM analysis using tract-based spatial statistics. Based on this exploratory analysis, a tractography-based approach with constrained spherical deconvolution was performed. Results Compared with control group participants, adolescents who reported psychotic experiences showed WM differences bilaterally in striatal regions in proximity to the putamen (increased fractional anisotropy, P = .01, false discovery rate corrected), and tractography identified significant WM differences bilaterally in the uncinate fasciculus (increased fractional anisotropy in the right [ P = .001] and axial diffusivity in the left [ P = .01] uncinate fasciculus, respectively). Similar patterns of WM differences between groups survived adjustment for other psychopathology, indicating some specificity for psychotic experiences. Exploratory along-tract analyses showed WM differences between groups in the frontal projections of the right inferior fronto-occipital fasciculus (reduced radial diffusivity in approximately 32% of the tract segment [ P ≤ .0001] and increased fractional anisotropy in approximately 16% of the tract segment [ P ≤ .0009]). Conclusions and Relevance In a population-based study of adolescents reporting psychotic experiences, we found a number of WM differences in the region of the putamen located between the inferior fronto-occipital fasciculus and the uncinate fasciculus and in the left parietal regions that include the fiber bundle of the superior longitudinal fasciculus. These findings suggest that subtle structural changes to WM microstructure are not merely a consequence of disorder but may index vulnerability to psychosis even at a very early age.

The idea that the content of delusions and hallucinations may have meaning or be symbolically significant is not new. From a psychodynamic perspective, the experience of psychosis has long been conceptualised as a defence against unbearable or unmanageable emotions (Martindaleetal2013)andthecontentofpsychoticexperiencesistherefore considered to have meaning and relevance for clinical practice (Martindale 2007). In adult samples, the content of delusions and hallucinations has been found to be associated with the experience of trauma and abuse (Raune et al. 2006, Reiff et al. 2012). To the best of our knowledge, no study to date has examined the content of sub-clinical psychotic-like experiences (PLEs) using non-clinical child or adolescent samples. This study aims to identify the presence of themes in the content of PLEs among children and adolescents from the general population and to examine associations between the content of the psychotic experience and adverse or abusive life events.

Abnormal functional connectivity (FC, the temporal synchronization of activation across distinct brain regions) of the default mode (DMN), salience (SN), central executive (CEN), and motor (MN) networks is well established in psychosis. However, little is known about FC in individuals, particularly adolescents, reporting subthreshold psychotic experiences (PE) and their trajectory over time. Thus, the aim of this study was to investigate the FC of these networks in adolescents with PE. In this population-based case-control study, 24 adolescents (mean age = 13.58) meeting the criteria for PE were drawn from a sample of 211 young people recruited and scanned for a neuroimaging study, with a follow-up scan 2 years later (n = 18, mean age = 15.78) and compared to matched controls drawn from the same sample. We compared FC of DMN, SN, CEN, and MN regions between PE and controls using whole-brain FC analyses. At both timepoints, the PE group displayed significant hypoconnectivity compared to controls. At baseline, FC in the PE group was decreased between MN and DMN regions. At follow-up, dysconnectivity in the PE group was more widespread. Over time, controls displayed greater FC changes than the PE group, with FC generally increasing between MN, DMN, and SN regions. Adolescents with PE exhibit hypoconnectivity across several functional networks also found to be hypoconnected in established psychosis. Our findings highlight the potential for studies of adolescents reporting PE to reveal early neural correlates of psychosis and support further investigation of the role of the MN in PE and psychotic disorders.

SummaryThere has been a resurgence of interest in the role of childhood trauma in the aetiology of psychosis. In this review, recent findings on the association between childhood trauma and a continuum of psychotic symptoms are presented. Evidence of the association between specific childhood trauma subtypes and psychotic symptoms is examined, with a brief discussion of some current hypotheses about the potential mechanisms underlying the associations that have been found. Some practice implications of these findings are also highlighted.Learning Objectives• Identify findings from recent meta-analyses on the association between childhood trauma and a range of psychotic outcomes, from non-clinical psychotic experiences to psychotic disorders• Consider which childhood traumas are the most potent in the context of psychotic outcomes• Recognise that the relationships between childhood trauma, psychotic symptoms and other psychopathology are complex, dynamic and multidimensional

AIM:Psychotic-like experiences (PEs) have been associated with childhood adversity and psychopathology. However, few studies have examined the dynamic interplay between risk and protective factors and later life outcomes in people with PEs. This study aimed to explore and compare patterns of early adverse and protective experiences and young adult outcomes in a sample of young people with a history of PEs.METHOD:Longitudinal qualitative data spanning nine years were collected from a general population sample of seventeen young adults who had reported PEs in early adolescence. A qualitative comparative case study design was used to explore patterns of early life experiences and young adult outcomes.RESULTS:Four archetypal profiles of early life experiences and later outcomes were identified. Qualitative differences between types of early adverse experiences and the quality of attachment relationships were dominant discriminating factors between low-risk and at-risk archetypes for poor young adult outcomes. Experiences of multiple adversities, which included childhood trauma and occurred in the absence of secure attachment relationships was associated with the poorest young adult outcomes. The presence of secure attachment relationships was protective, even among individuals who had experienced adversity.CONCLUSIONS:Not all young people who report PEs have high levels of adversity. Those who experience multiple early adversities, childhood trauma and insecure attachment relationships are at highest risk for reoccurring PEs and poor young adult outcomes. Developing trusted attachment relationships and engaging in corrective experiences may be protective and could promote positive outcomes in youth with PEs.

BackgroundPsychotic experiences (PE) are highly prevalent in childhood and are known to be associated with co-morbid mental health disorders and functional difficulties in adolescence. However, little is known about the long-term outcomes of young people who report PE.MethodsAs part of the Adolescent Brain Development Study, 211 young people were recruited in childhood (mean age 11.7 years) and underwent detailed clinical interviews, with 25% reporting PE. A 10 year follow-up study was completed and 103 participants returned (mean age 20.9 years). Structured clinical interviews for DSM-5 (SCID-5) and interviewer-rated assessments of functioning were conducted. A detailed neuropsychological battery was also administered. Analyses investigated group differences between those who had ever reported PE and controls in early adulthood.ResultsThe PE group was at a significantly higher risk of meeting DSM-5 criteria for a current (OR 4.08, CI 1.16–14.29, p = 0.03) and lifetime psychiatric disorder (OR 3.27, CI 1.43–7.47, p = 0.005). They were also at a significantly higher risk of multi-morbid lifetime psychiatric disorders. Significantly lower scores on current social and global functioning measures were observed for the PE group. Overall, there were no differences in neuropsychological performance between groups apart from significantly lower scores on the Stroop Word task and the Purdue Pegboard task for the PE group.ConclusionsOur findings suggest that reports of PE are associated with poorer mental health and functional outcomes in early adulthood, with some persisting cognitive and motor deficits. Young people who report such symptoms could be considered a target group for interventions to aid functional outcomes.

AIMS (a) To investigate the utility of childhood PE as a predictor of adolescent psychopathology while accounting for three known risk factors: childhood mental disorder; traumatic experiences and poor childhood functioning, and (b) to investigate the additive effects of including childhood PE in predictive clinical model of adolescent psychopathology. METHOD The study sample comprised of 86 Irish youths who completed two waves of the "Adolescent Brain Development" study (baseline age: 11.7 and follow-up age: 15.7). At baseline, participants completed a clinical interview assessing for PE, mental disorders, traumatic experiences and global functioning in childhood. The internalizing and externalizing problems sub-scales from the Youth Self Report questionnaire were used as follow-up outcomes variables in adolescence. RESULTS Logistic regression analyses revealed that childhood PE was the only predictor significantly associated with both internalizing (univariate OR: 7.58, CI: 2.59-22.15; multivariate OR: 5.43, CI: 1.53-19.29) and externalizing (univariate OR: 11.76, CI: 3.70-37.41; multivariate OR: 30.39, CI: 5.28-174.80) problems in adolescence. All predictive models with PE significantly predicted adolescent outcomes (area under the curve range: 0.70-0.81; all P

Psychotic experiences (PEs) are common in early adolescence and are associated with nonpsychotic psychopathology. However, not all adolescents with PEs have subsequent psychopathology, and vice versa. To date, factors mediating the relationship between PEs and psychopathology have been understudied. The aims of this study were to investigate the bidirectional relationship between PEs and psychopathology in adolescence and to investigate potentially malleable mediators of these relationships. Data from 2 waves (age 13 and 17 years) of Cohort '98 of the Growing Up in Ireland study were examined (n = 6,206). Using KHB pathway decomposition, we investigated the following as potential mediators of the relationship between psychopathology and PEs: parent-child relationship (conflict and positive), self-concept, and child-peer relationship (alienation and trust). Supplementary counterfactual mediation and sensitivity analyses were conducted. Early adolescents with psychopathology had twofold increased odds of late adolescent PEs (internalizing problems: odds ratio [OR] = 2.03, 95% confidence interval [CI; 1.56, 2.62]; externalizing problems: OR = 1.99, CI [1.51, 2.60]). Parent-child conflict explained between 23% and 34% of the associations between internalizing and externalizing problems and subsequent PEs. Early adolescents with PEs had increased odds of late adolescent psychopathology (internalizing problems: OR = 2.01, CI [1.61, 2.50]; externalizing problems: OR = 1.70, CI [1.25, 2.31]). Self-concept alone accounted for 52% of the relationship between PEs and subsequent internalizing problems. There is a bidirectional heterotypic relationship between psychopathology and PEs. Parent-child conflict and self-concept are important characteristics that mediate a proportion of the relationship between PEs and psychopathology. Interventions targeting parent-child conflict in the context of psychopathology and self-concept in the context of PEs may assist in reducing the incidence of poorer outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Little is known about the prevalence of inconsistent trauma reporting in community samples and about its associations with psychopathology. This study aimed to assess for the first time the prevalence of inconsistent trauma reporting in a community sample of children/adolescents and to explore associations with both psychotic experiences and with psychopathology more generally. Method A community-based sample of 86 children/adolescents (baseline mean age 11.5) were interviewed at two time points with data collected in relation to potentially traumatic events through the K-SADS. Emotional and behavioural problems were assessed at follow-up (mean age 15.7) through the Youth Self Report questionnaire while the presence of psychotic experiences was based on expert consensus post interview. Logistic regression models were used to test associations between inconsistent reporting and psychotic experiences at baseline and follow-up, with associations with emotional and behavioral problems at follow-up also assessed. Results Overall, 16.3% of adolescents failed to report previously reported potentially traumatic events at follow-up and were therefore defined as inconsistent trauma reporters. Inconsistent reporting was associated with emotional and behavioural problems as assessed by the Youth Self Report with the exception of rule breaking behaviour and with psychotic experiences as assessed on interview. Conclusions Inconsistent trauma reporting is associated with psychotic experiences and emotional and behavioural problems in young people and may represent an important marker for psychopathology in youth.

Background Individuals with schizophrenia show significant brain morphological abnormalities. The ENIGMA consortium identified that patients with schizophrenia had smaller hippocampus, amygdala, thalamus, accumbens and intracranial volumes.1 Reduced hippocampal volume is one of the most consistent findings in schizophrenia research.2–4 Also, Previous research has reported differences in hippocampal volume and white matter integrity in young adolescents who report psychotic experiences.5,6 However there has been little longitudinal research to investigate the developmental trajectory of these regions in adolescence with an increased susceptibility to psychotic disorders. Aims to investigate two-year longitudinal changes in hippocampal volume in a sample of adolescents who reported psychotic experiences relative to their peers. To investigate the role of presence of co-morbid DSM IV mental disorders and stressful life events in influencing hippocampal volume and study the differences in hippocampus volume between adolescents who were having persistent symptoms versus adolescents with remitting symptoms. Methods A longitudinal case-control study of 50 community-based adolescents aged 13–16 years (25 with psychotic experiences and a matched sample of 25 without psychotic experiences), compared hippocampal volume. All participants were assessed at baseline and two years follow up. T1 weighted anatomical high-resolution imaging and high angular resolution diffusion imaging data were used to conduct quantitative anatomical volumetric evaluations of global hippocampal volume. Clinical interviews also provided information on psychotic experiences, co-morbid disorders and adverse life events. Results There were significant differences in the Right and Left Whole hippocampus between PE and Control group at baseline and 2-year follow up (p≤ 0.05). There were significant differences between PE persist and Control group in the left and right whole hippocampus (p≤ 0.05). Discussion The differences identified in our study suggest that early hippocampal reductions, may play a role in increasing vulnerability to psychosis. References 1. van Erp TG, Hibar DP, Rasmussen JM, et al. Subcortical brain volume abnormalities in 2028 individuals with schizophrenia and 2540 healthy controls via the ENIGMA consortium. Mol Psychiatry. 2016;21(4):585. 2. Wright IC, Rabe-Hesketh S, Woodruff PW, David AS, Murray RM, Bullmore ET. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry. 2000;157(1):16–25. 3. Nelson MD, Saykin AJ, Flashman LA, Riordan HJ. Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging: a meta-analytic study. Arch Gen Psychiatry. 1998;55(5):433–440. 4. Stein JL, Medland SE, Vasquez AA, et al. Identification of common variants associated with human hippocampal and intracranial volumes. Nat Genet. 2012;44(5):552–561. 5. Drakesmith M, Caeyenberghs K, Dutt A, et al. Schizophrenia-like topological changes in the structural connectome of individuals with subclinical psychotic experiences. Hum Brain Mapp. 2015;36(7):2629–2643. 6. Satterthwaite TD, Wolf DH, Calkins ME, et al. Structural Brain Abnormalities in Youth With Psychosis Spectrum Symptoms. JAMA psychiatry. 2016;73(5):515–524.