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It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.

Deficits in cognition and motivation predict functioning in depressive and psychotic disorders. However, experimental tasks of cognitive motivation are inconsistently correlated with functioning, time-intensive, and not intuitive in clinical practice. We aimed to develop and validate a self-report instrument to assess motivation processes pertinent to engagement with cognitive activities in daily life. Following item generation, scale dimensionality, reliability, and validity were evaluated iteratively over Studies 1–3 with online general adult participants (n 1 = 205; n 2 = 235; n 3 = 181). The 20-item Cognitive Motivation scale was also validated in a Study 3 sub-sample reporting high levels of depressive symptoms (n = 74) and Study 4 early psychosis outpatients (n = 25). Two-factor model of cognitive approach and cognitive withdrawal, each with good internal consistency, convergent validity, discriminant validity was supported. Cognitive withdrawal showed stronger associations with cognitive difficulties, depressive symptoms, and functional impairments than traditional motivation scale. Participants reporting high depression levels showed more severe difficulties with cognitive motivation than participants reporting low depression levels. In early psychosis outpatients, correlations with functioning and cognitive effort expenditure provided support for scale validity. Cross-sectional data collection restricted evaluation of repeated administration psychometric properties. Scale validation was mostly established in online community samples and a small patient sample during the COVID-19 pandemic, thereby limiting generalizability of clinical applications. Cognitive Motivation scale is a promising tool for future intervention trials seeking to target motivational processes associated with functioning in the general population and potentially across patient groups with amotivation symptoms. • Novel scale validly measures cognitive motivation in general and psychiatric adults • Two factors of cognitive motivation confirmed: cognitive approach and withdrawal • New scale demonstrated superior clinical utility over traditional scale • Scale sensitive to impaired cognitive motivation in depressed and psychotic samples • Robust subscale relationships with depression, negative symptoms, and functioning [ABSTRACT FROM AUTHOR]

Objective: Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists' stance towards persons with psychosis with the aim of better understanding its characteristic—hindering and helpful—aspects. Method: 6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing. Results: 4 core categories were generated and interrelated in a theoretical model. Therapists' stance was initially characterized by uncertainty. Different ways of dealing with uncertainty yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or „dosing") of you and I was conceived as its core aspect. Conclusion: These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists. [ABSTRACT FROM AUTHOR]

L'hôpital public est nécessaire aux patients présentant les souffrances psychiques les plus graves. Au sein d'une institution, les symptômes des uns impactent le fonctionnement collectif, entre contre-attitudes, projections scissionnelles, etc. Nous savons depuis Jean-Étienne Esquirol que l'hôpital peut être soignant en lui-même, s'il est investi par des soignants « habiles ». À l'heure d'une restructuration de l'hôpital public, les outils issus du champ de la psychothérapie institutionnelle peuvent-ils participer à « soigner l'hôpital pour qu'il devienne soignant », selon l'aphorisme d'Hermann Simon ? Nous proposons d'articuler des savoirs psychopathologiques aux concepts institutionnels, afin de questionner un possible soin des singularités via le travail collectif. Nous présentons une élaboration théorico-clinique à partir de vignettes cliniques qui tentent de rendre compte de la pratique quotidienne d'un service de psychiatrie publique orienté par la psychothérapie institutionnelle et du soin psychothérapique possible, en institution, de sujets psychotiques. Les concepts issus de la psychothérapie institutionnelle s'appuient sur des psychopathologies psychanalytiques et phénoménologiques qui font l'épreuve de la clinique : notamment les questions d'espace, d'ambiance et de transfert, au cœur de la psychopathologie des psychoses. Ces concepts peuvent être discutés et affinés au regard de l'actualité de la recherche et des pratiques et soutiennent des prises en soins créatives adossées à la logique de secteur. Les outils institutionnels semblent soutenir les équipes soignantes dans leurs accueils de la souffrance psychique. S'ils ne font pas l'objet de positionnements dogmatiques, ils favorisent une alliance thérapeutique au plus près de la subjectivité des acteurs, et permettent une théorisation performative de la pratique quotidienne. Une attention conjointe portée à la psychopathologie et à la clinique institutionnelle contribue à proposer des prises en soin individualisées et à soutenir la singularité et de la subjectivité des patients les plus fragiles et des équipes qui les accompagnent. Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by "skilled" caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to "heal the hospital so that it can heal", in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work. We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects. Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors. Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice. Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them. [ABSTRACT FROM AUTHOR]

Background: We have previously analysed outcomes for all community treatment orders commenced during a 10-year period in New Zealand. Given Te Tiriti O Waitangi obligations to scrutinise health and consider equity for Māori, we completed this analysis to consider community treatment-order outcomes according to ethnicity. Methods: Ministry of Health databases provided demographic, service use and medication dispensing data for community treatment-order recipients between 2009 and 2018. As non-Māori on community treatment orders are older, less deprived and less likely to be diagnosed with a Psychotic Disorder, data were categorised according to age (<35/⩾35 years), level of deprivation (New Zealand Dep levels ⩽3, 4–6 and ⩾7) and diagnosis (Psychotic Disorder/non-Psychotic Disorder). The incidences of key outcome measures (admissions, community care, medication dispensing) were calculated for periods on/off community treatment orders for Māori and non-Māori to consider the differential impact of community treatment orders according to ethnicity. Results: Māori have high rates of community treatment order utilisation and are younger, more likely to be diagnosed with a Psychotic Disorder and spend longer receiving compulsory treatment than non-Māori. Non-Māori are more likely to receive more additional depot antipsychotic medication on–community treatment orders compared with periods off-community treatment order than Māori but other clear patterns of response distinguishing between Māori and non-Māori were not present. Conclusion: The differences between Māori and non-Māori for community treatment-order utilisation suggest the presence of structural inequity in underlying mental illness distribution and treatment provision. Māori cultural expertise at all levels of healthcare including healthcare planning and delivery is required to make advances and reduce disparity. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of treatment-resistant schizophrenia (TRS) among people with first-episode schizophrenia (FES) has been sub-optimally researched in Australia and internationally. We evaluated the prevalence of TRS among a cohort of FES patients and compared their sociodemographic and clinical characteristics to those with FES who were treatment responsive. Methods: Over 2 years, we collated demographic, clinical and treatment-related data of all patients with ICD-10 (International Classification of Diseases, Tenth revision) diagnosis of schizophrenia who were active in October 2020 at four early psychosis intervention services (EPIS) in Western Australia. We used a modified version of Suzuki et al. criteria to diagnose TRS. The data were analysed utilising descriptive statistics, the Mann–Whitney U test, Student's t -test and the False-Discovery Rate method. Results: The prevalence of TRS among the 167 patients diagnosed with FES was 41.3%, and the rates did not differ significantly between the services (p = 0.955). Those in the TRS group were less independent (p = 0.011), had more prolonged unemployment (p = 0.014) and were more likely to be on disability pension (p = 0.011) compared to the treatment responsive group. Furthermore, they had greater severity of symptoms (p = 0.002), longer duration of psychiatric symptoms (p = 0.019), more hospitalisations (p = 0.002) and longer cumulative admission durations (p = 0.002). Conclusions: Our study revealed that treatment resistance to antipsychotics is prevalent among people with FES managed at EPIS. Notably, it establishes an association between TRS and heightened clinical severity and psychosocial and treatment burden. These findings highlight the imperative for early detection of treatment resistance and timely and specialised interventions for this condition in mental health services. [ABSTRACT FROM AUTHOR]

Background: The higher rate of mental illness, including severe psychotic disorders, among people in prisons compared to the general community is well-established. However, there have been no reviews or attempts to pool data on the reported prevalence of mental illness across prisons in Australia and New Zealand. Methods: A systematic search of electronic databases from 1966 to the end of 2020 was conducted to identify studies reporting rates of 'any' mental illness, and separately rates of psychotic illness, among adult men and women in Australian and New Zealand prisons. A meta-analysis was performed according to PRISMA guidelines (PROSPERO ID: CRD42021241946), with separate analyses conducted for lifetime and current prevalence rates. Results: Seventeen studies, with a total of 10,209 people in prison, met inclusion criteria. The pooled lifetime prevalence of 'any' mental illness was 69.0% (95% confidence interval = [0.56, 0.79]), and the pooled lifetime prevalence for psychosis was 9.1% (95% confidence interval = [0.07, 0.12]). Meanwhile, the pooled prevalence for 'any' current mental illness was 54.0% (95% confidence interval = [0.39, 0.68]) and for any current psychosis was 6.4% (95% confidence interval = [0.04, 0.10]). There was substantial heterogeneity between studies, with evidence that lifetime rates of psychosis have increased over time, with true prevalence estimates in 95% of all comparable populations falling between 2.7% and 26.4%. Conclusion: The prevalence of mental illness, including severe psychotic illness, is high in Australian and New Zealand prisons. Furthermore, there is evidence that the prevalence of psychosis may be increasing over time, indicating more effort is needed to ensure diversion of people with mental illness away from the criminal justice system and into healthcare pathways. [ABSTRACT FROM AUTHOR]

Mental illnesses are the leading causes of disability worldwide. Psychotic disorders occur in about 3% of people in the general population during their lifetimes. Patients experiencing acute psychosis need a medical provider who is capable of differentiating among medical, drug-induced, and psychiatric causes of the presentation to initiate the most appropriate management plan. This article focuses on the role of the acute care NP in medical clearance evaluations and initial management of adult patients experiencing acute psychosis in acute care settings. [ABSTRACT FROM AUTHOR]

If we want to take the great importance of psychic reality seriously, as did Freud and Jean Laplanche, then technical considerations follow. The psychoanalytic method would then have the task of enabling the patient to explore that psychic reality where this inner "foreign body" is. This is so that the patient can visualize and assess this with respect to both the coherence of the speech and also with respect to the intersubjective and personal historical (infantile) reality in general. When the patient becomes aware of a possible "illogicality" of this psychic reality, the path opens up to a critical exploration in order to arrive at a new, more appropriate, more bearable translation. Such a translation is a dynamic process in the life of the individual, as Freud already emphasized in the early days of psychoanalysis: we do not have memories from the past but form memories about the past. A new formation, i.e., a new translation, in different stages of life then becomes conceivable, especially as the human being is a "self-deprecating, self-theorizing subject" (Laplanche). We need to move from a logic of states to a logic of change, and if transformation is not possible, the insight into that which cannot be cured can make it possible to live with what will always remain a foreign body (especially in cases of psychoses and after sexual abuse). [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of acceptance and commitment therapy (ACT) compared to treatment as usual in managing psychotic symptoms, emotional dysregulation, recovery and psychological flexibility in inpatients with primary psychoses. The Primary outcome assessed the positive and negative syndrome scale, while the secondary outcomes were to assess difficulties in the emotion regulation scale, recovery assessment scale and acceptance and action questionnaire. An open‐label, two‐arm parallel randomized controlled trial was conducted. Participants diagnosed with primary psychoses were randomly assigned to either the ACT (n = 33) or treatment‐as‐usual (n = 32) group. The intervention included six structured sessions of ACT. ACT significantly reduced psychotic symptoms from 128 to 104 (Z = 5.01) compared to treatment as usual from 130 to 117 (Z = 4.88). Emotional regulation improved significantly in the ACT group from 73 to 55 (Z = 4.835) compared to treatment as usual from 73 to 70 (Z = 2.406). Recovery increased in the ACT group from 50 to 88 (Z = 5.01) compared to treatment as usual from 51 to 61 (Z = 4.93). Psychological flexibility improved in the ACT group from 33 to 25 (Z = 4.98) compared to treatment as usual from 33 to 31 (Z = 4.75). Between‐group differences after intervention were significant for psychotic symptoms, emotional regulation, recovery and psychological flexibility (Z = 2.356, 4.652, 3.881 and 4.453, respectively). Accordingly, the current study demonstrates the effectiveness of ACT in reducing psychotic symptoms and improving emotional regulation, recovery and psychological flexibility in patients with primary psychoses. Integrating ACT into standard care protocols can enhance treatment outcomes, offering a comprehensive approach to managing complex mental health conditions. Trial Registration: ClinicalTrials.gov identifier: NCT06160869 [ABSTRACT FROM AUTHOR]

Objectives: Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice‐hearers to distinguish impairments in emotion processes from non‐clinical populations. The present study hypothesised voice‐hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia. Method: T‐tests tested these hypotheses, comparing self‐report measures of emotional reactivity, emotion regulation and alexithymia in voice‐hearers (n = 50) to controls (n = 53). Results: There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice‐hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic. Conclusions: These findings may help researchers and clinicians identify difficulties in voice‐hearers' emotion processing, providing better direction for case formulation and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Many people with psychosis do not seek help which delays access to recommended treatments. Duration of untreated psychosis is associated with poor healthcare outcomes and increased risk of relapse. The reasons why people delay accessing treatment remain unclear. This is the first systematic review to synthesise the literature examining professional and non‐professional help‐seeking in psychosis across clinical and subclinical populations. Methods: We searched four databases (APA PsycINFO, APA PsycArticles, Medline and British Library EThOS) to generate a comprehensive account of the quantitative literature. Heterogeneity of measures precluded a meta‐analysis. Results: We identified 19 articles (including 9686 participants) that met criteria for the review. Help‐seeking in psychosis is associated with being female, having a higher level of education, and experiencing more than one symptom. People with psychosis report stigma, poor mental health literacy and lack of family support as key barriers. Clinicians report childhood physical abuse, insecure attachment and severity of psychosis as additional barriers. We also found differences in preferred sources of help across cultures. There is currently no consensus on reliable help‐seeking measures. Conclusions: This is the first systematic review to examine help‐seeking behaviour in psychosis. Assertive and culturally sensitive engagement efforts should be targeted towards people with a history of early adversity, poor mental health literacy, limited social support and more severe psychosis. [ABSTRACT FROM AUTHOR]

Background and Objective: Psychosis represents one of the most challenging clinical presentations in psychiatry. Schizophrenia and bipolar disorder may both present psychotic features, and cariprazine may offer improvement in the treatment and care of these conditions. Therefore, the objective of the current work was to synthesise results of efficacy for cariprazine in these disorders. Methods: In total, five electronic databases were searched for randomized controlled trials enrolling patients across the psychosis spectrum, using the search term 'Cariprazine' (PubMed, Embase, clinicaltrials.gov, EUDRACT, Cochrane—last search January 2024). No filter or limits were employed. Effect sizes were extracted, by the mean difference in psychometric variables before and after the intervention (Clinical Global Impression Scale, Positive and Negative Symptom Scale, Montgomery–Asberg Depression Rating Scale, Young Mania Rating Scale, Hamilton Anxiety Rating Scale). Results: In total, 12 studies enrolling either patients with schizophrenia or bipolar disorder were included (total n = 6477; n = 4814 patients treated with cariprazine, n = 1663 controls treated with placebo). Cariprazine was effective in reducing global clinical severity, and higher improvements were observed at increasing dosages (− 0.25 at ≤ 1.5 mg/day, − 0.45 at ≥ 3 mg/day). Cariprazine also effectively reduced psychotic total scores: − 6.74, [95% confidence interval (CI) − 8.31; − 5.17], depression: − 1.78, [95% CI − 2.54; − 1.02], mania: − 5.72, [95% CI – 6.95; – 4.49], and anxiety symptoms: – 1.24, [95% CI – 1.92; – 0.56]. Conclusions: Cariprazine was observed as efficacious across retrieved studies, offering a potential for tailored treatments across the psychosis spectrum. Registration Number: https://osf.io/pmyhq. [ABSTRACT FROM AUTHOR]

Background: Pharmacogenetics is considered a promising avenue for improving treatment outcomes, yet evidence arguing for the use of pharmacogenetics in the treatment of psychotic disorders is mixed and clinical usefulness is under debate. Many patients with psychosis use multiple medications, which can alter the metabolic capacity of CYP enzymes, a process called phenoconversion. In clinical studies, treatment outcomes of drugs for psychosis management may have been influenced by phenoconversion. Aim: Here we evaluate the impact and predictive value of CYP2D6 phenoconversion in patients with psychotic disorders under pharmacological treatment. Method: Phenoconversion-corrected phenotype was determined by accounting for inhibitor strength. Phenoconversion-corrected and genotype-predicted phenotypes were compared in association with side effects, subjective well-being and symptom severity. Results: Phenoconversion led to a large increase in poor metabolizers (PMs; 17–82, 16% of sample), due to concomitant use of the serotonin reuptake inhibitors fluoxetine and paroxetine. Neither CYP2D6-predicted nor phenoconversion-corrected phenotype was robustly associated with outcome measures. Risperidone, however, was most affected by the CYP2D6 genotype. Conclusion: Polypharmacy and phenoconversion were prevalent and accounted for a significant increase in PMs. CYP2D6 may play a limited role in side effects, symptoms and well-being measures. However, due to the high frequency of occurrence, phenoconversion should be considered in future clinical trials. [ABSTRACT FROM AUTHOR]

Background: The need to increase exercise and decrease sedentary behaviour in people diagnosed with psychosis is well-recognised. Aims: We set out to explore caregivers' perspectives on what supports and prevents physical activity, and how to use carers' support most effectively. Method: Fourteen caregivers of people diagnosed with psychosis were interviewed. Data were analysed using reflexive thematic analysis, in collaboration with caregivers. Results: Four themes were developed, the first flagging the importance of physical activity, then the others calling for action: (a) Physical inactivity matters: carers are keen to support efforts to increase physical activity in their family or friends because of the enormous impact physical inactivity has on patients, and consequently on carers themselves, such as social isolation and reduction in their own activity. (b) Tell us: without being well-informed about how to help, carers can feel like they are powerless to stop a 'slow suicide' or 'decline' in patients. (c) Listen to us: through knowing their family and friends well, carers are able to identify important changes in patients and identify successful motivators for them, but these insights can feel uninvited. (d) Ask us: being invited to support activity as a partner in a patients' care is desirable but having offers of help rejected can "demotivate the motivator." Conclusions: Caregivers described strong motivation to help patients to be more physically active but can feel that their support is overlooked and under-used by services. Clinical recommendations for carer involvement in physical activity interventions are offered. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: In inpatient wards, there is a risk that conflicts occur when nursing staff interact with psychotic patients.The Interactive Approach (IA) model is an action‐based model, used in psychiatric settings, to manage conflict situations. What this paper adds to existing knowledge?: The IA model can be used to improve communication between nursing staff and patients in numerous critical situations.Using a structured risk scale to evaluate a conflict can be an effective way to guide action and sort out the different aspects of communication between nursing staff and psychotic patients. What are the implications for practice?: The clarity of an action‐based model will help sort out which interventions are most likely to succeed in each conflict situation.The IA model highlights the importance of understanding and strengthening the patient's perspective, being flexible for each individual patient, and providing the patient with clear information about the situation. Introduction: The Interactive Approach (IA) model is a structured management tool used to improve communication between caregivers and patients in psychiatric care settings. Aim/Question: To examine the nursing staff's experiences of the IA model. How do they use the interventions in conflict situations with psychotic patients? Method: A sample of nursing staff (n = 11) was recruited from three psychosis inpatient care units. Semi‐structured questions covered staff experiences of working with the problem‐solving interventions in the IA model. Transcribed data were analysed by qualitative content analysis. Results: Three categories were defined: (1) 'To apply a flexible approach' describes how staff tried to adapt to each patient and situation; (2) 'Try to understand the person's inner world' describes the importance of active listening and exploring the patient's concerns; and (3) 'To communicate clearly' relates to experiences of clear communication and the setting up of boundaries. Discussion: The risk scale and training in communication skills helped the interaction between staff and patients in conflict situations. Different interventions were used with a focus on maintaining patient alliance. Implications for Practice: The findings highlight the importance of educational efforts and practical training, to prevent violence and the use of coercive measures. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: New parents who have previously experienced psychosis outside and/or following childbirth have an increased likelihood of experiencing an episode during the postpartum period.The decision to try to conceive can be agonising.Receiving care from a specialist perinatal community mental health team can improve outcomes. What does this paper add to existing knowledge?: This article offers a first‐person insight into the steps the author took to minimise the impact of an episode of postpartum psychosis and/or postnatal depression whilst navigating new motherhood. What are the implications for practice?: This lived experience narrative aligns with the evidence base that demonstrates specialist perinatal community mental health services improve outcomes.It highlights the importance of maternity care providers asking about mental health history to identify any previous episodes or family history and offering referral to a specialist perinatal mental health service if available. Introduction: Postpartum psychosis is a life‐changing but treatable condition that usually occurs in the first few days to weeks after childbirth affecting 1–2 in 1000 pregnancies. Those who have experienced psychosis before, either as a single episode, related or unrelated to childbirth or as part of a long‐term mental health condition have a higher likelihood of experiencing an episode in the postnatal period. Aim: In this lived experience narrative the author shares personal experience of planning and navigating pregnancy with a higher likelihood of experiencing postpartum psychosis and postnatal depression around this major life transition due to previous episodes. Methods: The author utilises a first‐person approach to share and reflect on her lived experience. Findings: The author shares her experience of receiving care and some of the steps she took to try to manage the impact of pregnancy and birth on her mental health during this major life transition. She describes how care from a specialist perinatal community mental health team and peer support contributed significantly to her family's well‐being. Discussion: Specialist perinatal community mental health services can improve outcomes for those with a higher likelihood of experiencing postpartum psychosis and postnatal depression by facilitating planning and mitigating some of the risks that could lead to relapse in the perinatal period. [ABSTRACT FROM AUTHOR]

Objective: Previous qualitative studies have investigated the experiences of undergoing an evidence‐based psychotherapy for psychosis among individuals affected by such condition. However, the literature investigating the perspectives, experiences and needs of psychological practitioners providing the treatment remains considerably underrepresented. In the context of Asian cultures, where pervasive stigma towards psychosis and mental health services exists and interferes with proactive help‐seeking, such research appears even more pertinent. To address the gap in the existing literature, this study utilised qualitative methodology to investigate the experiences of practitioner psychologists working with clients with psychosis in a South‐East Asian city‐state. Method: Six fully qualified participants were recruited from the local mental health services via convenience sampling. Semi‐structured qualitative interviews were conducted. Transcribed verbatim data were then subjected to inductive thematic analysis. Results: Four superordinate themes emerged, as follows: therapeutic alliance, cognitive behavioural therapy for psychosis (CBTp) as primary approach, cultural influences and needs of practitioners. Conclusions: Results indicated that both practitioner psychologists and their clients contributed collaboratively to the establishment of therapeutic alliance. Although CBTp was utilised as a principal psychotherapeutic approach, acceptance and commitment therapy (ACT) was also valued. Necessary adaptations in the treatment were reflected on to address the specificity of local cultures, including the use of language and addressing pervasive public stigma. The necessity of multidisciplinary collaboration, localised training and supervision was also expressed. [ABSTRACT FROM AUTHOR]

Personality dysfunction operationalized as impairment in self- and interpersonal functioning is a characteristic of personality disorders. The metacognitive model suggests that dysfunctional metacognitive beliefs are a common cause of psychological disorders, but the relevance and importance of metacognitions for personality dysfunction is less explored and was the objective for the current study. In a sample of 1278 individuals, we conducted a multiple hierarchical regression analysis to test the predictive role of metacognitive beliefs for personality dysfunction. We found a unique and independent contribution from negative beliefs about the uncontrollability and danger of worry and lower cognitive confidence to personality dysfunction whilst controlling age, gender, maladaptive personality traits, big-5 personality traits, emotional distress symptoms, and general psychosocial functioning. The results bring further support for the metacognitive model of psychological disorders which may be relevant for formulation and treatment of personality dysfunction and disorder. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairments are prevalent across mood disorders and psychosis spectrum disorders, but there is a lack of real-life-like cognitive training programmes. Fully immersive virtual reality has the potential to ensure motivating and engaging cognitive training directly relevant to patients' daily lives. We will examine the effect of a 4-week, intensive virtual reality-based cognitive remediation programme involving daily life challenges on cognition and daily life functioning in patients with mood disorders or psychosis spectrum disorders and explore the neuronal underpinnings of potential treatment efficacy. Methods: The trial has a randomized, controlled, double-blinded, parallel-group design. We will include 66 symptomatically stable outpatients with mood disorders or psychosis spectrum disorders aged 18–55 years with objective and subjective cognitive impairment. Assessments encompassing a virtual reality test of daily life cognitive skills, neuropsychological testing, measures of daily life functioning, symptom ratings, questionnaires on subjective cognitive complaints, and quality of life are carried out at baseline, after the end of 4 weeks of treatment and at a 3-month follow-up after treatment completion. Functional magnetic resonance imaging scans are performed at baseline and at the end of treatment. The primary outcome is a broad cognitive composite score comprising five subtasks on a novel ecologically valid virtual reality test of daily life cognitive functions. Two complete data sets for 54 patients will provide a power of 80% to detect a clinically relevant between-group difference in the primary outcome. Behavioural data will be analysed using linear mixed models in SPSS, while MRI data will be analysed with the FMRIB Expert Analysis Tool (FEAT). Treatment-related changes in neural activity from baseline to end of treatment will be investigated for the dorsal prefrontal cortex and hippocampus as the regions of interest. Discussion: The results will provide insight into whether virtual reality-based cognitive remediation has beneficial effects on cognition and functioning in symptomatically stable patients with mood disorders or psychosis spectrum disorders, which can aid future treatment development. Trial registration: ClinicalTrials.gov NCT06038955. Registered on September 15, 2023. [ABSTRACT FROM AUTHOR]

Henri Grivois has posited that psychosis involves the subjective experience of oneself as the center or focal point of the world. In this experience, the world that is typically unrelated to oneself becomes incomprehensible, and in its place is the sense that all life events are directly related to oneself or that one is perpetually at the center of all noteworthy activity. We suggest that this experience of centrality can be understood through the lens of the integrated model of metacognition. Specifically, we explore the idea that the metacognitive domain of decentration, or the ability to form ideas about the larger community one is a part of, can be used to operationalize and measure centrality. We propose a three-phase approach to addressing centrality within an integrative psychotherapy focused on subjective and experiential aspects of recovery. These phases focus on the patient's experience of centrality and include (1) inviting the therapist to join one's centrality, (2) acknowledging others as different from oneself, and (3) recognizing alternative perspectives in the world. We provide case examples and explore the metacognitive tasks and potential barriers associated with each phase. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aims of the Study Methodology Results Conclusion Early‐onset psychotic disorders include the prodromal phase and the first‐episode psychosis (FEP). They constitute a high‐risk period for suicidal behavior. Early intervention for psychosis (EIP) consists of intervening as early as possible. The effectiveness of early intervention on overall prognosis has been reported in numerous studies, and EIP services are emerging worldwide. Several authors report an improvement in suicidal behavior, but no study has looked at all the data.The aim of work is to study whether early intervention for psychosis has an impact on deaths by suicide and suicide attempts, and study which intervention methods have an impact on suicidal behavior.By respecting the PRISMA criteria, previously declared on PROSPERO, by exploring 5 medical databases (PubMed, Cochrane, PsycINFO, Scopus, Embase), from their creation dates, published until 20/02/2023, in English, we carried out a meta‐analysis. The articles selected had to deal with the EIP and deaths by suicide or suicide attempts. Our primary outcome is the deaths by suicide and the secondary outcome the suicide attempt.The exhaustive search identified a total of 2310 references. Nine articles were included. Their intervention modalities were pharmacotherapy, psychotherapy, case‐management, or related services, and psycho‐social therapies. Our meta‐analysis shows that early intervention for early‐onset psychotic disorders is associated with a statistically significant reduction by a third in deaths by suicide (ORa = 0.66 (0.49–0.88), p = 0.005) and by a third in suicide attempts (ORa = 0.66 (0.50–0.86), p = 0.002), with non‐significant heterogeneity. Sensitivity analyses excluding the study with statistical difficulties due to the absence of an event and studies with a high risk of bias point in the same direction, that is a statistically significant reduction and non‐significant heterogeneity.The literature shows that early intervention programs are associated with positive impact on deaths by suicide and suicide attempt. This is the first meta‐analysis of early intervention in early psychotic disorders and its impact on suicidal risk. The deployment of EIP should be supported worldwide in order to intervene as early as possible and prevent the risk of suicide.Trial Registration: PROSPERO CRD42022366976 [ABSTRACT FROM AUTHOR]

The role of inflammation in the etiology of psychotic disorders (PD) is well-established. This study aimed to identify inflammation parameters in patients diagnosed with PD, assess their potential as biomarkers, and examine their relationship with criminal behavior. This retrospective study comprised three groups: 530 patients diagnosed with PD who had committed crimes (offenders with PD), 530 patients with PD who had not committed crimes (non-offenders with PD), and 530 healthy controls, totaling 1,590 participants. Routine hematological tests were used to measure neutrophil, lymphocyte, monocyte, and platelet counts, high-density lipoprotein (HDL), systemic inflammatory response index (SIRI), systemic immune-inflammatory index (SII), and neutrophil/HDL (NHR), lymphocyte/HDL, platelet/HDL (PHR), and monocyte/HDL (MHR) ratios. Offenders with PD exhibited significantly higher levels of SII, SIRI, PHR, NHR, LHR, neutrophils, and monocytes compared to non-offenders with PD and healthy controls (p < 0.001). The criminal group had lower HDL and lymphocyte levels than the remaining two groups (p < 0.001). Among those treated in forensic psychiatry units, patients with two or more treatments showed significantly higher SIRI values compared to those with only one treatment (p = 0.045). Non-offenders with PD had higher platelet values than the remaining two groups (p < 0.001). This study underscores the role of systemic inflammation in the pathophysiology of psychotic disorders through a comparison of patients who have and have not committed crimes, highlighting the relationship between inflammation and lipid metabolism. Further research is required to clarify these findings. [ABSTRACT FROM AUTHOR]

Evidence suggests that individuals who use methamphetamine are at a significantly higher risk of developing psychosis compared to non-users. This study aims to examine the rate of psychosis among methamphetamine users and to investigate factors related to methamphetamine-associated psychosis (MAP). Two thousand ninety-eight (2,098) individuals with methamphetamine use were admitted to outpatient care. Available admissions data included clinical interviews, the Addiction Profile Index (API), and API-clinical forms. MAP was identified in 267 (12.7%) participants. Our data analysis found significant sociodemographic, clinical, and personality differences between MAP and non-MAP cohorts on admission. Multivariate regression analysis revealed that older age (OR = 1.049), younger age of substance use onset (OR = 0.960), more frequent MA use (OR = 1.622), being single (OR = 1.974), lower education (OR = 0.46), increased number of withdrawal symptoms (OR = 1.100), higher lack of anger control scores (OR = 1.422), higher lack of assertiveness scores (OR = 1.396), and higher anxiety scores (OR = 1.715) were significantly associated with MAP. Although factors identified in this study represent state (on admission) rather than stable characterological traits, these results may nonetheless help us better characterize contextual factors associated with MAP in an outpatient population. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease psychosis (PDPsy) is associated with increased nursing home placement and mortality and is closely linked with cognitive dysfunction. Objective: Assess the clinical and cognitive features associated with PDPsy in patients without dementia. Methods: We prospectively recruited people with Parkinson's disease (PwP) without dementia for a 3-year, longitudinal study at an outpatient movement disorders clinic. Participants completed annual visits involving assessment of motor and non-motor symptoms including neuropsychological testing. PDPsy was defined as the recurring presence of visual illusions, sense of presence, hallucinations, or delusions for at least 1 month. Using generalized estimating equations, we conducted two sets of analyses to separately assess the clinical and the cognitive predictors of PDPsy. Results: We enrolled 105 participants. At baseline, mean age was 67.8 (SD = 8.0), median disease duration was 4.9 years (IQR: 3.4–7.7), and mean MoCA was 24.8 (SD = 2.3). Prevalence of PDPsy increased over 3 years from 31% (n = 32) to 39% (n = 26). Forty-five participants (43%) experienced PDPsy. Visual illusions were most common (70%, n = 84), followed by hallucinations (58.3%, n = 70). In multivariate analysis, of the clinical variables, only depressive symptoms [OR 1.09, 95% CI: (1.03, 1.16), p = 0.004] increased the odds of PDPsy; of the cognitive variables, only Trail Making Test B-A scores [OR 1.43, 95% CI: (1.06, 1.93), p = 0.018] significantly increased the odds of PDPsy. Conclusions: In PwP without dementia, depressive symptoms were associated with increased risk of PDPsy. Executive/attentional dysfunction was also associated with PDPsy and may mark the transition from isolated minor hallucinations to more complex psychotic symptoms. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Compared to usual care, specialty services for first‐episode psychosis (FES) have superior patient outcomes. The Early Psychosis Intervention Network (EPINET), comprised of eight U.S. regional clinical networks, aims to advance the quality of FES care within the ethos of learning healthcare systems (LHS). Among these, the Academic Community (AC) EPINET was established to provide FES care, collect common data elements, leverage informatics, foster a culture of continuous learning and quality improvement, and engage in practice‐based research.We designed and implemented a novel LHS of university‐affiliated FES programs within a hub (academic leadership team) and spoke (FES clinics) model. A series of site implementation meetings engaged stakeholders, setting the stage for a culture that values data collection and shared learning. We built clinical workflows to collect common data elements at enrollment and at consecutive 6‐month intervals in parallel to an informatics workflow to deliver outcome visualizations and drive quality improvement efforts.All six clinical sites successfully implemented data capture workflows and engaged in the process of designing the informatics platform. Upon developing the structure, processes, and initial culture of the LHS, a total of 614 patients enrolled in AC‐EPINET, with the most common primary diagnoses of schizophrenia (32.1%) and unspecified psychotic disorders (23.6%). Visualized outcomes were delivered to clinical teams who began to consider locally relevant quality improvement projects.AC‐EPINET is a novel LHS, with a simultaneous focus on science, informatics, incentives, and culture. The work of developing AC‐EPINET thus far has highlighted the need for future LHS’ to be mindful of the complexities of data security issues, develop more automated informatic workflows, resource quality assurance efforts, and attend to building the cultural infrastructure with the input of all stakeholders. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion One in three people with psychosis experience visions. However, little is known about what people see, and current treatments have limited benefits.To improve the understanding and treatment of visions, this study explored the phenomenology of visions in people with psychosis.Twelve people with psychosis participated in semi‐structured interviews. Reflective thematic analysis was used.Three main themes were generated covering important aspects of phenomenology: ‘Content’, ‘Coherence’ and ‘Quality’. The first theme ‘Content: People see people’, demonstrated that the most distressing visions were of people. The second theme ‘Coherence: Visions of people who behave like people’, captured how visions were coherent with real human behaviour, often by being multimodal experiences that spoke to and touched the observer. The third theme, ‘Quality: They look too real’ highlighted the compelling sense of authenticity of the visions, making them indistinguishable from reality.Visions represent what we expect to see in everyday life: people, who act and look real. This powerful combination provides insight into the absorbing and all‐encompassing nature of visions and their impact on participant's lives. The framework of ‘Content’, ‘Coherence’ and ‘Quality’ provides guidance to support clinicians and researchers to better explore the phenomenology of visions in psychosis. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Results Conclusions The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans‐diagnostically assessed the prevalence and co‐occurrence of at‐risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr.This cross‐sectional and observational‐prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16–35 who were referred for various kinds of non‐psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities.Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED‐consistent and ED‐inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference.From a trans‐diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co‐morbid ED in other kinds of psychopathology is being overlooked. [ABSTRACT FROM AUTHOR]

Persons with schizophrenia spectrum disorders (SSDs) are at higher risk of becoming violent compared to the general population. Hence, obtaining a detailed account of characteristics of individuals with SSDs at high risk for committing violent acts is of high interest. A closer look on the phenomenological perspective by exploring basic self-disorders (BSDs) may help to better understand the complex interplay between schizophrenia and violence. To explore if persons with SSDs and a history of severe violence show distinct BSDs, clinical symptoms, sociodemographic data and BSDs were obtained in a sample of 33 male patients with SSDs, including 17 with a history of severe violence. Degree of BSDs were examined with the Examination of Anomalous Self-Experience (EASE). EASE-scores were compared between the two groups. The EASE composite score (degree of BSDs) was lower in SSD patients with a history of severe violence compared to non-violent SSD patients. When controlling for confounders, insight turned out to be the key factor in the relationship. The results are inconclusive regarding an association between proneness to violent behaviour and level of basic self-disorders but suggest that such associations may exist and call for further investigations. [ABSTRACT FROM AUTHOR]

Evidence supports associations between polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and psychosis. However, polyunsaturated fatty acid trajectories in the general population have not been characterized, and associations with psychosis spectrum outcomes in early adulthood are unknown. Plasma omega-6 to omega-3 ratio and DHA (expressed as percentage of total fatty acids) were measured by nuclear magnetic spectroscopy at 7, 15, 17, and 24 years of age in participants of ALSPAC (Avon Longitudinal Study of Parents and Children). Curvilinear growth mixture modeling evaluated body mass index–adjusted trajectories of both measures. Outcomes were assessed at 24 years. Psychotic experiences (PEs), at-risk mental state status, psychotic disorder, and number of PEs were assessed using the Psychosis-Like Symptoms interview (n = 3635; 2247 [61.8%] female). Negative symptoms score was measured using the Community Assessment of Psychic Experiences (n = 3484; 2161 [62.0%] female). Associations were adjusted for sex, ethnicity, parental social class, and cumulative smoking and alcohol use. Relative to stable average, the persistently high omega-6 to omega-3 ratio trajectory was associated with increased odds of PEs and psychotic disorder, but attenuated on adjustment for covariates (PEs adjusted odds ratio [aOR] = 1.63, 95% CI = 0.92-2.89; psychotic disorder aOR = 1.69, 95% CI = 0.71-4.07). This was also the case for persistently low DHA (PEs aOR = 1.42, 95% CI = 0.84-2.37; psychotic disorder aOR = 1.14, 95% CI = 0.49-2.67). Following adjustment, persistently high omega-6 to omega-3 ratio was associated with increased number of PEs (β = 0.41, 95% CI = 0.05-0.78) and negative symptoms score (β = 0.43, 95% CI = 0.14-0.72), as was persistently low DHA (number of PEs β = 0.45, 95% CI = 0.14-0.76; negative symptoms β = 0.35, 95% CI = 0.12-0.58). Optimization of polyunsaturated fatty acid status during development warrants further investigation in relation to psychotic symptoms in early adulthood. [ABSTRACT FROM AUTHOR]

In an online, survey-based experiment, musculoskeletal surgeon members of the science of variation group (n = 243) and a group of consult-liaison psychiatrists (n = 18) read 5 hypothetical scenarios of patients recovering from musculoskeletal trauma, each containing 5 randomized patient variables, and indicated their recommendation for psychiatry consultation or not. Factors associated with recommendation for psychiatry consultation included younger age, history of a psychiatric disorder, and pre-injury use of antipsychotic medications, and scenarios involving psychosis, suicidality, hallucinations in the setting of substance withdrawal, and questionable capacity for informed consent, but not with sadness alone. Musculoskeletal surgeons can collaborate with psychiatrists to develop comprehensive care for inpatients with musculoskeletal trauma starting with relatively pressing mental health needs and perhaps expanding into treatment of sadness or worry that can manifest as greater symptom intensity and a delayed recovery trajectory. [ABSTRACT FROM AUTHOR]

Background: Early intervention services (EIS) for psychosis have proven highly effective in treating first episode psychosis. Yet, retention or "engagement" in EIS remains highly variable. Dis/engagement as a contested concept and fluid process involving relationships between service providers and service users remains poorly understood. This study aimed to critically evaluate and explain the dynamic interplay of service provider-user relationships in effecting dis/engagement from an early intervention program for psychosis. Methods: Forty study participants, 16 service providers and 24 service users (19 current and 5 disengaged) from a Canadian EIS program, were administered semi-structured interviews. Qualitative analysis was conducted using grounded theory methods, with findings captured and reconceptualized in a novel explanatory model. Findings: A model of engagement with eight major domains of engagement in EIS positioned along a control-autonomy spectrum was developed from the findings, with Clinical engagement (attendance) and Life engagement (life activities) at opposite ends of the spectrum, interspersed by six intermediate domains: Medication/treatment, Symptoms/illness, Mental health, Physical health/wellness, Communication, and Relationships, each domain bearing uniquely on engagement. Conclusions: An examination of service user and service provider perspectives on the various domains identified in the spectrum model, and their dynamic interplay, reveals the complexity of choices faced by service users in engaging and not engaging with services. [ABSTRACT FROM AUTHOR]

The human need to find meaning in life and the human need for connection may be two sides of the same coin, a coin forged in the developmental crucible of attachment. Our need for meaningfulness can be traced to our developmental need for connection in the attachment relationship. The free energy principle dictates that in order to resist a natural tendency towards disorder self-organizing systems must generate models that predict the hidden causes of phenomenal experience. In other words, they must make sense of things. In both an evolutionary and ontogenetic sense, the narrative self develops as a model that makes sense of experience. However, the self-model skews the interpretation of experience towards that which is predictable, or already "known." One may say it causes us to "take things personally." Meaning is felt more acutely when defenses are compromised, when the narrative self is offline. This enables meaning-making that is less egocentrically motivated. Dreams, psychosis, and psychedelic states offer glimpses of how we make sense of things absent a coherent narrative self. This has implications for the way we understand such states, and lays bare the powerful reach of attachment in shaping what we experience as meaningful. [ABSTRACT FROM AUTHOR]

Schizophrenia is a psychotic disorder affecting approximately 0.32% of the global population. Despite advancements in pharmacological treatments, many patients with schizophrenia continue to experience significant impairments, and approximately one-third of these patients do not respond to antipsychotic drugs. However, various studies have demonstrated the potential benefits of herbs in managing schizophrenia due to the diverse biological activities of phytochemicals, including neuroprotective activity, anti-oxidant potential, modulation of neurotransmission, and anti-inflammatory activity. Bacopa monnieri (Brahmi) is a widely studied herb used in the treatment of the central nervous system. This study conducted a systematic review to determine the effectiveness of Brahmi in managing schizophrenia. PubMed, Scopus, Web of Science, and Cochrane databases were searched between February and March, 2024. A total of 103 articles were found, with only 9 studies meeting the eligibility criteria. Data analysis was done by using themes. The review found that Brahmi could reverse positive, negative, and cognitive symptoms of schizophrenia. It does this by changing the glutamatergic pathway and GABAergic transmission, lowering MDA levels, raising GSH levels, slowing down the activity of acetylcholinesterase (AchE), and maintaining the density of neurones. It is recommended that additional research elucidating the effects of Brahmi in other models of schizophrenia and the possible mechanisms of action be conducted. [ABSTRACT FROM AUTHOR]

ObjectivesDesignMethodsResultsConclusionsTrauma and post‐traumatic stress are involved in the aetiology and maintenance of voice‐hearing. It has been proposed that trauma‐focused therapy (TFT) might affect voice‐hearing, but previous studies are limited and remain undecided.We aimed to investigate the effect of TFT on voice‐hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice‐hearing are related to changes in PTSD.This is an adjunct longitudinal ESM study of a sub‐group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting‐list control group.Voice‐hearing participants filled in 10 daily voice‐hearing‐related questionnaires for six consecutive days at baseline and post‐treatment at pseudo‐random times during the day. PTSD symptom severity was assessed at baseline and post‐treatment. Multilevel linear regression was used to test the effect of TFT on voice‐hearing and to analyse the relationship between changes in voice‐hearing and changes in PTSD.The intention‐to‐treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice‐hearing in the TFT group than in the waiting‐list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice‐hearing (p < .00001).Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices. [ABSTRACT FROM AUTHOR]

Problem: The association of pediatric‐onset multiple sclerosis (POMS) and psychosis remains rare and unclear in the literature. We aim to elucidate the association between POMS and psychosis across case reports. Methods: We report a case of schizophrenia (SCZ) revealing POMS. We conducted a systematic review of case reports adhered to PRISMA 2020. We searched PubMed, Google Scholar, Web of Science, and Cochrane for case reports describing psychoses in POMS cases. Findings: We presented a 21‐year‐old male who developed psychotic symptoms at 16 and was diagnosed with SCZ at 18. Regarding the treatment‐resistant SCZ, neurological assessment led to POMS. The patient had a favorable outcome after POMS management. Moreover, our systematic review of nine cases revealed that most psychoses began before or concomitant to the POMS diagnosis, highlighting a delay in identifying POMS. SCZ and BP were the most common types of psychosis observed. We observed a predominance of males with a median age at psychosis onset was 15 years (12.5–16.5 years). Treatment‐resistant SCZ was noted in one study along aside with our case. All cases had a good evolution after POMS management. Conclusion: Our study suggested a critical link between POMS and psychosis emphasizing the need for thorough evaluation, early diagnosis, and prompt management. This association highlights the importance of recognizing psychotic symptoms as potential indicators of POMS, particularly in males. [ABSTRACT FROM AUTHOR]

Background: The neurodevelopmental hypothesis of schizophrenia represents the disorder as an expression of an alteration during the brain development process early in life. Neurodevelopmental variables could become a trait marker, and the study of these variables in children and adolescents at clinical high risk for psychosis (CHR) could identify a specific cluster of patients who later developed psychosis. The aim of this study is to describe clinical and neurodevelopment predictors of transition to psychosis in child and adolescent participants at CHR. Naturalistic longitudinal two-center study of 101 CHR and 110 healthy controls (HC) aged 10–17. CHR participants were children and adolescents aged 10–17, meeting one or more of the CHR criteria assessed at baseline and at 18 months' follow-up. Neurodevelopmental variables assessed were obstetric complications, delay in principal development milestones, and presence of a neurodevelopment diagnosis. Pairwise comparisons, linear regressions, and binary logistic regression were performed.A transition rate of 23.3% at 1.5 years was observed. Participants who developed psychosis (CHR-P) showed higher rates of grandiosity and higher proportions of antipsychotic medication intake at baseline compared to participants who did not develop a psychotic disorder (CHR-NP). In terms of neurodevelopment alterations, CHR-P group showed a higher proportion of participants reporting delay in language development than the CHR-NP and HC groups. The odds of psychosis increased by 6.238 CI 95% [1.276–30.492] for a one-unit increase in having a positive score in grandiosity; they increased by 4.257 95% CI [1.293–14.023] for a one-unit increase in taking antipsychotic medication, and by 4.522 95% [1.185–64.180] for showing language development delay. However, the p-values did not reach significance after adjusting for multiple comparisons.A combination of clinical and neurodevelopmental alterations could help predict the transition to psychotic disorder in a CHR child and adolescent sample. Our results suggest the potential utility of collecting information about neurodevelopment and using these variable multifactorial models to predict psychosis disorders. [ABSTRACT FROM AUTHOR]

First-episode psychosis is a significant mental health condition that can have a profound and lasting effect on an individual's functional abilities and overall quality of life. While music therapy has shown promise in improving these areas, there is a lack of research exploring the impact of music groups led by mental health professionals without formal music therapy training in the context of early intervention in psychosis. This study aimed to conduct a qualitative evaluation of a once-weekly, 12-week, nurse-led music group, offered as an adjunct to early intervention in young people with first-episode psychosis. The specific objectives were to explore social interaction and experiences of participants and instructors in relation to the music group and provide focus points for implementation in clinical practice. The study utilized Interpretive Description, collecting data through participant observation (6 sessions × 1.5 hrs; 9 hrs in total), key informant interviews (n = 1), and group (n = 4) and email-based (n = 2) interviews. The data was transcribed, thematized, and analyzed using NVivo12 and Interpretive Description inductive analysis resulting in three main themes: Practicalities of the music group, Restored identity, and Music as medicine reflecting the potential of the music group to contribute to a sense of non-patient identity, decreasing symptoms related to mental illness, foster social relationships and a feeling of belonging to a musical community. This study highligts how participation in music groups can be a possible promoter of recovery. However, sustainability appears contingent on the skills and resources of the facilitator (i.e., nurse). Suggestions for a program theory and clinical implications are presented and discussed. [ABSTRACT FROM AUTHOR]

Objective: The incidence of neuroleptic malignant syndrome (NMS), a rare, potentially fatal adverse effect of antipsychotics, among children and youth is unknown. This cohort study estimated NMS incidence in antipsychotic users age 5–24 years and described its variation according to patient and antipsychotic characteristics. Methods: We used national Medicaid data (2004–2013) to identify patients beginning antipsychotic treatment and calculated the incidence of NMS during antipsychotic current use. Adjusted hazard ratios (HRs) assessed the independent contribution of patient and antipsychotic characteristics to NMS risk. Results: The 1,032,084 patients had 131 NMS cases during 1,472,558 person-years of antipsychotic current use, or 8.9 per 100,000 person-years. The following five factors independently predicted increased incidence: age 18–24 years (HR [95% CI] = 2.45 [1.65–3.63]), schizophrenia spectrum and other psychotic disorders (HR = 5.86 [3.16–10.88]), neurodevelopmental disorders (HR = 7.11 [4.02–12.56]), antipsychotic dose >200mg chlorpromazine-equivalents (HR = 1.71 [1.15–2.54]), and first-generation antipsychotics (HR = 4.32 [2.74–6.82]). NMS incidence per 100,000 person-years increased from 1.8 (1.1–3.0) for those with none of these factors to 198.1 (132.8–295.6) for those with 4 or 5 factors. Findings were essentially unchanged in sensitivity analyses that restricted the study data to second-generation antipsychotics, children age 5–17 years, and the 5 most recent calendar years. Conclusion: In children and youth treated with antipsychotics, five factors independently identified patients with increased NMS incidence: age 18–24 years, schizophrenia spectrum and other psychotic disorders, neurodevelopmental disorders, first-generation drugs, and antipsychotic doses greater than 200 mg chlorpromazine-equivalents. Patients with 4 or 5 of these factors had more than 100 times the incidence of those with none. These findings could improve early identification of children and youth with elevated NMS risk, potentially leading to earlier detection and improved outcomes. [ABSTRACT FROM AUTHOR]

Aim: We aim to give an insight into the current situation in Switzerland concerning the pathways to care of young people with clinical high risk of psychosis. In a second step we propose a procedure of optimizing pathways to care developed within the project PsyYoung. Methods: A qualitative survey derived and adapted from Kotlicka‐Antczak et al. (2020) was conducted in large early detection services of three Swiss cantons (Geneva, Basel‐Stadt, Vaud) focusing on pathways to care. More specifically, using questionnaires delivered to the heads of participating services, information was collected on referral sources, on activities to implement outreach campaigns and on the use of a pre‐screening tool. Results: Main results on referral source indicated that sources were variable but seemed to come primarily from the medical sector and more so from the psychiatric sector. Very few referrals came from non‐medical sectors. Outreach activities included the contact to other clinics as well as through brochures and posters. All services but one used the Prodromal Questionnaire – 16 as pre‐screening tool. Conclusions: All in all, the results indicate a referral and care pathway system implemented mostly within the medical and particularly mental health sector. Accordingly, the PsyYoung project proposes a procedure for pathways to care which could help overcome the obstacle of referrals being restrained to a narrow field of mental health and to harmonize the referral process within services dedicated to the same aim of helping young people at high risk of developing a psychosis. [ABSTRACT FROM AUTHOR]

Introduction: Supported accommodations (SAs) are key components of community mental health care, but little is known about residents' care pathways. This study analysed the care pathways of residents of SAs, and factors associated with their age of entry and length of stay. Methods: A random sample of SAs' residents in Portugal was interviewed and a questionnaire was specifically developed to assess their care pathways. Associations between sociodemographic and clinical characteristics, age of entry and length of stay, were analysed using hierarchical regression. Results: Overall, 213 residents of 43 different SAs participated. Their mean age was 55 years. Most were male, single, pensioners and had early-onset psychotic disorders. On average, they integrated the current SA at around 50 years old and had a 4.5 year length of stay. Most participants had been in another SA before (35.0% in more supported, 33.8% in less supported and 6.3% in similarly supported SAs). Conclusions: Findings suggest that residents spend several years in the residential pathway, with a significant proportion moving to more supported SAs. This calls for increasing the number of SAs with different typologies and developing coordinated community supports. [ABSTRACT FROM AUTHOR]

Schizophrenia is a severe psychiatric disorder associated with brain alterations at rest. Amplitude of low-frequency fluctuations (ALFF) and its fractional version (fALFF) have been widely used to investigate alterations in spontaneous brain activity in schizophrenia. However, results are still inconsistent. Furthermore, while these measurements are similar, they showed some differences, and no meta-analysis has been yet performed to compare them in schizophrenia. Thus, we conducted systematic research in five databases and in the grey literature to find articles investigating fALFF and/or ALFF alterations in schizophrenia. Two separate meta-analyses were performed using the SDM-PSI software to identify fALFF and ALFF alterations separately. Then, a conjunction analysis was conducted to determine congruent results between the two approaches. We found that patients with schizophrenia showed altered fALFF activity in the left insula/putamen, the right paracentral lobule and the left middle occipital gyrus compared to healthy individuals. Patients with schizophrenia exhibited ALFF alterations in the bilateral putamen, the bilateral caudate nucleus, the bilateral inferior frontal gyrus, the right precuneus, the right precentral gyrus, the left postcentral gyrus, the right posterior cingulate gyrus, compared to healthy controls. ALFF increased activity in the left putamen was higher in drug-naïve patients and was correlated with positive symptoms. The conjunction analysis revealed a spatial convergence between fALFF and ALFF studies in the left putamen. This left putamen cluster is part of the associative striatum. Its alteration in schizophrenia provides additional support to the influential aberrant salience hypothesis of psychosis. [ABSTRACT FROM AUTHOR]

Social deficits are common in psychosis. The Social Skills Performance Assessment (SSPA) is a performance-based measure used to approximate an individual's social skills. Those with psychosis perform worse than do unaffected controls. Prior work has examined two social skills domains derived from the SSPA: social competence and social appropriateness. Social competence and appropriateness are associated with neurocognition and functioning outcomes. However, no study to date has examined the relationship of social cognition to social competence and appropriateness. We aimed to examine the relationships among different aspects of social cognition and performance-based social functioning and hypothesized that social cognitive performance would be related to social competence and appropriateness. We also hypothesized that after controlling for neurocognition, social cognition would account for unique variance in social competence and appropriateness in separate regression models. Forty-one participants who had experienced psychosis and 42 unaffected controls completed a comprehensive battery of neurocognitive, social cognitive, and social functioning measures. Social competence was associated with neurocognition and some aspects of social cognition, while social appropriateness was only marginally associated with neurocognition. Regression models revealed that social cognition did not account for additional and unique variance in social competence or appropriateness, after adjusting for demographic covariates and neurocognition. Findings suggest that aspects of social functioning performance are differentially related to neurocognitive and social cognitive skills. Social skill interventions may be most effective when targeting both neurocognitive and social cognitive skills in treatment. [ABSTRACT FROM AUTHOR]

Background: Offspring of parents with affective disorders (OAD) are at risk of developing a wide range of mental disorders. Deficits in the rearing environment and high levels of stress are well‐known risk factors for negative outcomes in OAD. Building on prior research, we aim to examine the longitudinal relationships between family dysfunction, stressful life events, and mental health in OAD and control offspring of parents with no affective disorder. In the present study, we hypothesized that high levels of family dysfunction would be associated with more internalizing and externalizing problems across time in OAD than in controls, and that family dysfunction would mediate the relationship between stressful life events in adolescence and poor mental health in adulthood, particularly in OAD. Methods: As part of the TRacking Adolescents' Lives Survey (TRAILS), 2230 participants (51% female, Mage = 11.1 years, SD = 0.6, at baseline) and their parents completed measures across six time points, spanning 15 years. Mental health, family dysfunction, and stressful life events were assessed with the Youth and Adult Self‐Report, Family Assessment Device, and an in‐house measure, respectively. Results: Multi‐group structured equation modeling revealed that family dysfunction was linked to internalizing and externalizing problems in OAD, but not controls, across time. Risk status did not moderate family dysfunction's mediation of the relationship between stressful life events and negative outcomes in adulthood. Conclusions: OAD show high sensitivity to dysfunction in the rearing environment across childhood and adolescence, which supports the use of family based interventions to prevent the development of mental disorders in high‐risk youth. [ABSTRACT FROM AUTHOR]

Background: People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. Objective: Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. Methods: A cohort (N = 14,122) of young people (16–24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan–Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. Results: In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan–Meier plots show hospitalisation and mortality inequities emerging approximately 4–7 years following first-episode psychosis diagnosis. Conclusions: Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. Methods: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015–2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. Results: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. Conclusion: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations. [ABSTRACT FROM AUTHOR]

Objective: Studies using proton magnetic resonance spectroscopy reveal substantial inconsistencies in the levels of brain glutamate, glutamine and glutamate + glutamine across schizophrenia spectrum disorders. This systematic review employs qualitative and quantitative methods to analyse the patterns and relationships between glutamatergic metabolites, schizophrenia spectrum disorders and brain regions. Methods: A literature search was conducted using various databases with keywords including glutamate, glutamine, schizophrenia, psychosis and proton magnetic resonance spectroscopy. Inclusion criteria were limited to case-control studies that reported glutamatergic metabolite levels in adult patients with a schizophrenia spectrum disorder diagnosis – i.e. first-episode psychosis, schizophrenia, treatment-resistant schizophrenia and/or ultra-treatment-resistant schizophrenia – using proton magnetic resonance spectroscopy at 3 T or above. Pooled study data were synthesized and analysed. Results: A total of 92 studies met the inclusion criteria, including 2721 healthy controls and 2822 schizophrenia spectrum disorder participants. Glu levels were higher in the basal ganglia, frontal cortex and medial prefrontal of first-episode psychosis participants, contrasting overall lower levels in schizophrenia participants. For Gln, strong differences in metabolite levels were evident in the basal ganglia, dorsolateral prefrontal cortex and frontal cortex, with first-episode psychosis showing significantly higher levels in the basal ganglia. In glutamate + glutamine, higher metabolite levels were found across schizophrenia spectrum disorder groups, particularly in the basal ganglia and dorsolateral prefrontal cortex of treatment-resistant schizophrenia participants. Significant relationships were found between metabolite levels and medication status, clinical measures and methodological variables. Conclusion: The review highlights abnormal glutamatergic metabolite levels throughout schizophrenia spectrum disorders and in specific brain regions. The review underscores the importance of standardized future research assessing glutamatergic metabolites using proton magnetic resonance spectroscopy due to considerable literature heterogeneity. [ABSTRACT FROM AUTHOR]

Aims: To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD) during early pregnancy. Design: Observational study. Setting: Kaiser Permanente Northern California, USA. Participants: 299 496 pregnancies from 227 555 individuals screened for cannabis use by self‐report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011–December 2021 (excepting year 2020). The sample was 62.5% non‐White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD. Measurements: Exposure variables included electronic health record‐based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self‐reported cannabis use and CUD during early pregnancy. Findings Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53–3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52–15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82–4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53–29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use. Conclusions: Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders. [ABSTRACT FROM AUTHOR]

Objectives: Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems – depression and anxiety – via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies. Methods: We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio‐demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis. Results: A 2‐item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long‐term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk. Conclusions: Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully. [ABSTRACT FROM AUTHOR]

Purpose: Isoniazid, a first-line antitubercular drug, is associated with nervous system adverse drug reactions such as seizures, peripheral neuropathy, and psychosis. This systematic review of case reports and case series aimed to characterize the demographic, social, and clinical factors associated with isoniazid-induced psychosis in patients with active tuberculosis (TB) and those who received isoniazid for latent TB infection (LTBI). Methods: We comprehensively searched the Embase, PubMed, and Scopus databases to identify relevant studies published between the date of inception of the database and June 2024. Results: A total of 28 studies, including 21 case reports and 7 case series involved 37 patients who developed isoniazid-induced psychosis. A higher frequency of isoniazid-induced psychosis was observed during the first 2 months of treatment, with a relatively early onset observed among patients aged 18 years or less. Delusions and/or hallucinations are the common symptoms of isoniazid-induced psychosis. Psychomotor disturbances, disorganized speech or formal thought disorder, disorganized or abnormal behaviour, and neuropsychiatric symptoms (sleep disturbances, hostility or aggression, confusion, affective symptoms, anxiety symptoms, and cognitive difficulties) were the other symptoms observed in the included studies. More than 80% of cases rechallenged with isoniazid resulted in the recurrence of psychotic symptoms. Conclusion: Patients with TB and LTBI should be assessed for psychotic and neuropsychiatric symptoms during isoniazid therapy, mainly in the first 2 months. Further research is required to understand the impact of underlying risk factors, such as genetic predisposition and isoniazid pharmacokinetics, as well as the clinical utility and dosage recommendations of pyridoxine for managing isoniazid-induced psychosis. [ABSTRACT FROM AUTHOR]