Background: With the digital cultures that youth are exposed to and participating in come potential risk and protective factors for their mental health. However, despite clear need there is a lack of guidance to help mental health professionals evaluate the role of social media, artificial intelligence, and other technologies in young people’s mental health. Aims: To co-design with young people the Digital Culture Interview, an interview tool to support the clinical assessment of digital cultural factors in mental health care. Method: We recruited a diverse group of 12 participants aged 16 to 35 years old (mean age 22 years) from outpatient mental health clinics in Montreal, Canada. Using the nominal group technique, they identified topics they found most relevant for exploring in a clinical assessment the experiences and practices involving digital technologies. Based on the topics that received the most votes from participants, we co-developed a list of interview questions and written guidance for their administration. Results: Participants identified and ranked 48 themes. Drawing from these, 14 questions were developed for inclusion in the Digital Culture Interview, covering four topics: identity and worldview, negative experiences online, coping, and understanding of mental health. Participants emphasized that exploring digital culture in mental health care requires patients’ trust and a baseline of knowledge. If done sensitively, this may enhance the patient-clinician alliance and improve mutual understanding. Conclusions: The Digital Culture Interview has the potential to enhance rapport and reveal risk and protective factors that are salient to and actionable in mental health care.

Background: Despite growing evidence that clinical gains are lost when clients transition back to care as usual, typical coordinated specialty care programs (CSCs) continue to be limited to 2-3 years. This qualitative paper aims to explore the experiences of first episode psychosis clients within a CSC clinic that retains clients beyond the standard 2-3 years. Methods: The authors conducted qualitative interviews with ten clients who engaged with the clinic for three or more years. The guiding research question was; what motivates clients to remain engaged with CSC beyond the typical 2–3-year treatment period? Results: Five main themes emerged from qualitative thematic analysis: symptom improvement, recovery as a process, supportive staff, trusting relationships, and individualized care. Results demonstrate preliminary evidence on the benefits of prolonged engagement in first episode psychosis care. Discission: The emergent themes from the qualitative analysis provide insight into clients’ experiences of team based first episode psychosis care beyond 2-3 years. Given the value placed on continuity of care and meaningful therapeutic alliances, we must consider how established timeframes for first episode psychosis programs may negatively impact the overarching goal of sustaining gains long term. Perspectives from those living the experience of first episode psychosis treatment are important to inform standards of care.

Background In high-income countries, early intervention in psychosis (EIP) services provide treatment for first episode psychosis (FEP) as early as possible, proving to effectively improve health outcomes. These services rarely exist in low- and lower-middle-income countries (LMICs). The TRANSLATE programme aims to evaluate the effectiveness of EIP services in terms of implementation outcomes in two LMIC countries, and to develop a clinical tool to predict the risk of Treatment Resistant Schizophrenia (TRS) in patients with FEP. Methods This is an observational implementation research study, conducted across five sites in Pakistan and one in Sri Lanka, with recruitment of 670 FEP patients. The key clinical such as status of functioning, quality of life, psychopathology, family burden, stigma and physical health, will be assessed at baseline and periodically over 1 year period. A descriptive analysis of baseline data and service utilisation data will be conducted, stratified by site. For implementation outcomes, the probabilities of disengagement and remission will be modelled using logistic regression models adjusting for duration of untreated psychosis, baseline symptom severity, and geographical location. For secondary implementation outcomes, selected key clinical outcomes and a process evaluation will be conducted. To develop a clinical model prediction model for TRS, a penalised multivariable logistic regression model will be fitted to estimate the one-year risk of TRS following an FEP diagnosis, incorporating up to 15 predictor variables identified within the study cohort. Model performance will be assessed using calibration plots and the C-statistics for discrimination. Internal validation will be carried out by bootstrapping, and the optimism-adjusted calibration slope will be used as a global shrinkage factor to account for overfitting, with the model intercept re-estimated to ensure calibration-in-the-large. Discussion This will be the first large study that will implement and evaluate the EIP service in a LMIC country setting. The findings of this study and the process evaluation will inform the adoption and scaling-up of EIP services in routine clinical practice. The clinical prediction model for the early detection of TRS will help initiate effective treatments for TRS at the earliest possible stage and potentially reduce the significant burden of disease associated with TRS.

Introduction: Attention-Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental condition in childhood. Although pharmacological treatments are effective for many patients, a substantial proportion show partial response or experience adverse effects. Nutritional strategies such as omega-3 supplementation and the Mediterranean diet have been proposed as complementary approaches to modulate symptoms and improve tolerability. Objectives: To evaluate the efficacy of omega-3 fatty acid supplementation and adherence to the Mediterranean diet on ADHD symptoms in children and adolescents. Methods: A systematic review was conducted in PubMed, Scopus, and Web of Science using the terms “Diet, Mediterranean”, “Fatty Acids, Omega-3”, and “Attention Deficit Disorder with Hyperactivity”. Studies published up to 2026 were included if they examined these interventions in participants under 18 with ADHD. Results: Twenty-three studies involving 1,838 participants met inclusion criteria. Most evaluated omega-3 supplementation, reporting mixed but generally favorable effects on attention, impulsivity, and hyperactivity. In several trials, combining omega-3 with pharmacotherapy reduced stimulant doses and adverse events. Only one randomized trial examined the Mediterranean diet, showing modest improvements limited by low adherence. Conclusion: Omega-3 supplementation may provide modest but meaningful benefits for core ADHD symptoms, particularly when combined with standard treatment. Evidence for the Mediterranean diet remains preliminary and requires further high-quality research.

The escalating crisis in pediatric mental health has rendered traditional, episodic care models insufficient. Reliance on infrequent clinical interviews often fails to capture the rapid, non-linear fluctuations of adolescent psychiatric disorders, leaving clinicians blind to prodromal signs of relapse. This narrative review synthesizes emerging evidence from 2020 to 2026 regarding digital phenotyping—the continuous, passive collection of behavioral data via smartphone sensors—as a paradigm shift toward precision psychiatry. We examine how raw sensor inputs, including accelerometry, GPS mobility patterns, and human-computer interaction (HCI) logs, are transformed by machine learning algorithms into objective ”digital biomarkers.” The reviewed literature demonstrates that these biomarkers—specifically sleep-wake cycle fragmentation, life-space contraction, and semantic shifts in typing—can successfully predict depressive relapse, differentiate bipolar mania from ADHD, and quantify suicide risk with high sensitivity. Crucially, these digital signals often precede subjective symptom reporting by 7–10 days, offering a vital window for Just-in-Time Adaptive Interventions (JITAIs). However, the translation of these computational insights into routine clinical practice faces significant ”last mile” challenges, including the integration of high-velocity data into Electronic Health Records (EHRs), the risk of clinician alarm fatigue, and ethical concerns regarding patient privacy and the socioeconomic ”digital divide.” We conclude that while digital phenotyping offers a revolutionary stethoscope for the mind, its successful adoption requires a hybrid framework where Artificial Intelligence augments, rather than replaces, the therapeutic alliance. This review provides a strategic roadmap for moving the field from passive sensing to proactive, preventative clinical care.

INTRODUCTION. Preventive actions for individuals with Clinical High Risk for psychosis (CHR) are highly effective in reducing the risk of transition to psychosis. Improving the identification of at-risk individuals could enable earlier access to care and reduce both the personal and societal burden of psychotic disorders. In this context, screening questionnaires are essential tools for identifying early signs of psychosis in the general population and referring individuals with a CHR to specialized centers. The Self-Screen Prodrome questionnaire (S-PRO) is a screening questionnaire designed for this purpose. The first aim of this study is to validate the French version of this instrument. Secondly, we will explore the reduction of its items to improve precision and reduce administration time. METHODS. Following international guidelines, items were translated and pre-tested for clarity and relevance. Seventy-two CHR patients or patients experiencing a first psychotic episode according to the Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria were included. RESULTS. Cronbach’s alpha score of the French version of the S-PRO was 0.893, and specificity/sensitivity were respectively 0.86 and 0.61 with an optimal cut-off point at 15 positive items. Using logistic regression, we reduced the S-PRO to a 12-items version. Cronbach’s alpha score of the S-PRO12 was 0.71, and specificity/sensitivity remain the same, respectively 0.86 and 0.61. DISCUSSION. These results suggest that the 12-item version of the S-PRO could be an effective screening instrument for its use by general health practitioners in primary care.

Background: First-episode psychosis (FEP) is a critical period where treatment engagement influences long-term outcomes. While early intervention models are informed by high-income country data, evidence from low- and middle-income countries (LMICs) such as India remains limited. Objectives: To assess sociodemographic and clinical predictors of medication adherence and follow-up among adolescents and young adults with FEP in India. Methods: A retrospective cohort study of 150 patients aged ≤24 years with FEP was conducted at the Institute of Psychiatry and Human Behaviour, Goa (2019-2023). Sociodemographic and clinical variables were extracted from records. Patients were categorized as 6-month completers (n=82), 12-month completers (n=30), and those lost to follow-up (n=38). Descriptive statistics, chi-square, and analysis of variance were applied. Results: Mean age was 20.9 years; 59.3% were male. Attrition was 25.3% at 6 months and 80% at 12 months. Female gender (p<0.001), rural residence (p<0.001), lower education (p=0.004), and lower socioeconomic status (p<0.001) predicted dropout. Substance use (23.3%), poor insight (38.7%), and prior faith healer contact (29.3%) were also linked to disengagement. Risperidone (52.7%) and olanzapine (34.7%) were the most prescribed. Side effects, chiefly extrapyramidal symptoms and sedation, commonly led to discontinuation. Antipsychotic polypharmacy occurred in 27.3%, and 8% received electroconvulsive therapy. Conclusions: Sociodemographic vulnerabilities, substance use, poor insight, and cultural beliefs predicted early disengagement. Culturally sensitive, youth-focused interventions addressing structural barriers, dual diagnosis, and medication tolerability are essential for improving early psychosis outcomes in LMICs.

Background and Aims Communication about the at-risk mental state may shape not only clinical understanding but also peer-directed social evaluations. Prior work from our group has shown that positively reframing psychosis-risk feedback reduces perceived emotional harm and clinician stigma. The present study examined whether positive reframing influences adolescents’ peer-directed social stigma and desire for social distance toward an at-risk youth, and whether these effects are moderated by adolescents’ own distressing prodromal experiences, sex, and cultural background. Methods 108 community-dwelling adolescents were randomly assigned to view either positively or negatively framed simulated clinical feedback about an at-risk youth. Participants then completed measures of social stigma and desired social distance. Prodromal experiences were assessed prior to the experimental manipulation. Results Across stigma and social distance indices, framing effects were directionally consistent with a priori hypotheses, with positive reframing associated with lower stigma-related responses. However, effects were selective in magnitude. Statistically significant or marginal effects emerged primarily for perceptions of dangerousness and willingness for limited social proximity, whereas effects on other stigma dimensions were more modest and non-significant. Framing effects varied by adolescents’ own prodromal experiences, and exploratory analyses suggested additional moderation by sex and cultural background. Conclusions Positive reframing can shape adolescents’ peer-directed social evaluations of the at-risk state in systematic but selective ways, particularly by weakening perceptions of dangerousness that drive social avoidance. These findings underscore the importance of developmentally and culturally sensitive risk communication and highlight positive framing as a context-dependent strategy with socially consequential implications beyond the clinical encounter.

The objective was to analyze the reliability, internal structure, invariance, and sex-based network of the scores of Mexican university students on the Depression, Anxiety, and Stress Scale (DASS-21). The sample consisted of 773 participants from a public university in Mexico. We analyzed factorial, convergent, discriminant, and predictive validity using Confirmatory Factor Analysis, Average Variance Extracted (AVE), the Fornell–Larcker discriminant analysis, Heterotrait–Monotrait Correlation Relationships (HTMT), and Linear Regression Analysis, respectively. The reliability of the scale was analyzed using McDonald’s Omega coefficient. Using Multigroup Confirmatory Factor Analysis, Mean Analysis, and Network Analysis, we compared the scale scores of participants grouped by gender. Evidence of reliability and validity was found for the scores of Mexican university students on the Depression, Anxiety, and Stress Scale (DASS-21). Likewise, significant differences were found between men and women in symptoms of Depression, Anxiety, and Stress, and an internal structure was identified that assumes a higher-order factor called General Psychological Distress, which explains the factors of Depression, Anxiety, and Stress. Thus, a reliable and valid instrument to evaluate and address the mental health of university students in Mexico from a preventive approach.

Background: Poor engagement with Early Intervention Services (EIS) for first-episode psychosis threatens program effectiveness, yet research often reduces engagement to a binary measure (engaged/disengaged), limiting understanding of those who disengage and re-engage. This study examined demographics, clinical characteristics, and health service utilization patterns among engaged, intermittently engaged, and disengaged patients of the Nova Scotia Early Psychosis Program (NSEPP). Methods: A retrospective cohort comprised of 331 individuals enrolled in NSEPP between July 22, 2005, and October 9, 2015, was constructed by linking clinical and administrative datasets. Engagement types (engaged, intermittently engaged, disengaged) were characterized in terms of baseline demographics and clinical factors, along with patterns of health service utilization before, during, and after program enrollment. Crude and adjusted associations between program engagement and post-program health service utilization (emergency department (ED) use and mental health-related hospital admissions) were assessed using negative binomial regression models. Results: During program enrollment, the intermittently engaged group had the greatest illness severity (35% spent 30+ days in hospital), and highest proportion of individuals with at least one ED visit (85%) and one hospital admission (55%). These during-program health service use factors were the strongest predictors of post-program health service use outcomes. Conclusions: The three engagement types show distinct health service utilization patterns, which may reflect differences in need or program effectiveness. These results provide evidence that dichotomization of engagement may mask important heterogeneity. Further characterization of the engagement continuum to include intermittent engagement may provide insights to reducing barriers and improving access to and uptake of EIS.

Objective: Timely intervention for emerging mental health disorders in young people remains challenging despite high prevalence rates. This study evaluates the Comprehensive Assessment Service for Psychosis and At Risk (CASPAR) over a 6-year period, identifying predictors of service access, treatment engagement, and clinical outcomes. Methods: We analyzed service utilization, demographic and clinical data for all clients accessing CASPAR between 2017-2023, including social and occupational functioning (SOFAS), and psychosis transition rates. Results: From 1062 referrals, 799 young people completed assessment and 592 were registered for ongoing care. Of these, 496 (83.8%) engaged with treatment while 96 disengaged (16.2 %) early. Among those accepted, 7.1% transitioned to first-episode psychosis, with predictors including male gender, lower baseline functioning, and ultra-high risk status. Of those completing care, 75.2% functioned without significant impairment at discharge, with 45.7% showing reliable SOFAS improvement. Ultra-high risk status predicted treatment engagement, while emotional dysregulation and personality disorder diagnoses predicted poorer social and functional outcomes. Conclusions: CASPAR effectively bridges the gap between primary and tertiary mental health services for young people. High engagement rates demonstrate the success of this integrated care model, particularly for priority populations. Findings regarding predictors of treatment engagement, transition to psychosis, and functional improvement can inform future service development to better support vulnerable youth with emerging mental health issues.

Background Development of new evidence-based interventions for youth who are at clinical high risk for psychosis (CHR-P) is needed. Health behaviors and lifestyle habits such as physical activity, sleep and substance abuse are modifiable risk factors for a variety of health outcomes. We assessed the feasibility and acceptability of a novel health behavior-focused psychosocial intervention for CHR-P youth. Methods In a non-randomized feasibility trial, youth aged 13-17 who met CHR-P criteria participated in a 9-week health behavior promotion group that provided psychoeducation and skills training regarding stress management, sleep, physical activity, nutrition, mitigating substance use, and health behavior goal setting. Primary outcomes included feasibility and social validity. Secondary outcomes were pre-to post-intervention change in health behaviors. Results Seven participants enrolled and five completed at least two thirds of the intervention, indicating good retention. There were no significant pre-post changes across measures of health behaviors or symptoms. Participants endorsed the goals of the intervention as meaningful and congruent with their treatment goals. The group format was described as acceptable, while the didactic style was less preferred. Discussion Findings support the intervention as acceptable and feasible. Changes in health behaviors and symptoms were not significant but trended in the expected direction. Future trials are needed to refine the intervention and assess effectiveness.

Early identification and support for individuals with psychotic-like experiences (PLEs) are essential for timely intervention and improved outcomes. Emotional mimicry, which refers to the automatic imitation of another person’s emotional expression, such as a smile, is a fundamental social process that supports smooth interpersonal interaction and is known to be impaired in schizophrenia. However, its role across the broader psychosis-risk continuum remains unclear. This study examined smiling mimicry (the emotional mimicry of smiling) in individuals with PLEs and explored its relationship with key negative symptoms. Secondary analyses explored whether such patterns were particularly characteristic of a clinical high-risk (CHR) subgroup. A total of 102 participants were categorized into a PLE group (n = 75) or a healthy control group (HCs; n = 27) using structured clinical interviews. Within the PLE group, a subset met CHR criteria (n = 41). Negative symptoms were assessed using the Negative Symptom Inventory – Psychosis Risk (NSI-PR). Zoom recordings from clinical assessments were analyzed using FaceReader, an automated facial expression analysis tool. Primary analyses showed no overall group differences between PLE and HC participants in smiling mimicry. However, within the PLE group, mimicry was significantly negatively associated with blunted affect (r = –.36, p = .002). In secondary analyses, CHR participants did not differ from HCs in smiling mimicry. These findings highlight the value of automated facial analysis for detecting subtle interpersonal deficits and suggest that reduced smiling mimicry is specifically linked to blunted affect across the psychosis-risk spectrum, with implications for early identification and intervention.

Introduction Early Intervention in Psychosis (EIP) services in England are commissioned to provide up to three years’ support to people experiencing first episode psychosis, but the optimal duration remains debated. This qualitative study aimed to explore how decisions about EIP duration are made and experienced by multiple stakeholders. Methods Qualitative longitudinal study comprising semi-structured interviews with EIP Service Users (SUs), carers, EIP practitioners, GPs, and mental health service commissioners; follow-up interviews with SUs 6-11 months later. Data were collected between September 2022 - September 2024 and informed by information power. Data were thematically analysed by a multidisciplinary team. Patient and carer involvement and engagement was integral to the study. Results The three-year time limit of contact with EIP teams was thought to work well when SUs felt supported and ready for discharge, but constrained shared decision making when they did not. Some participants described early discharge before three years, either as a negotiated decision based on wellness and readiness to move on or as a consequence of poor engagement. Others reported extended care beyond three years in response to individual needs or delays in transfer to Community Mental Health Teams (CMHTs). This flexibility in duration varied across teams and trusts. Well managed, relational care was viewed as key to effective discharge. Conclusion Flexible, person-centred episodes of care and collaborative discharge planning, supported by effective coordination between EIP, primary care, and CMHTs, are essential to sustaining relational practice and ensuring smoother transitions.

Introduction: Early intervention services (EIS) are crucial for improving outcomes in psychotic spectrum disorders but are less accessible for females. The disparity has been attributed to a sex and gender-specific presentations of psychosis as well as social factors. The aim of this study was to conduct an exploratory qualitative analysis of female-specific barriers to accessing EIS for psychosis. Methods: Semi-structured interviews were conducted with 14 cisgender female participants enrolled in the Nova Scotia Early Psychosis Program (NSEPP) in Halifax, Nova Scotia. Retrospective chart reviews were also conducted for each participant to gather information about their referral pathways and clinical history. The interview data was analyzed using reflexive inductive thematic analysis methodology. Results: The analysis revealed four superordinate themes and ten subordinate themes of female experiences accessing EIS. (1) Clinician preconceptions or dismissal: descriptions of multiple interactions with the healthcare system, clinician preconceptions of presentation and feeling dismissed. (2) Interpersonal relationships: male romantic partners delayed access to care and support of family and friends accelerated access to care. (3) Masking symptoms: participants hid symptoms out of fear of external perceptions and apparent high functioning at onset affected care (4) Trust and communication with the medical team: reports of a lack of understanding, distrust and unclear communication from clinicians. Conclusions: These themes underscore the importance of improving clinical awareness of sex and gender-specific characteristics of the presentation of early psychosis.

Background: Translating cognitive remediation gains into everyday functioning remains limited in schizophrenia. We evaluated a peer-mediated Feuerstein Instrumental Enrichment (FIE) approach, grounded in mediated learning principles, in individuals in the early phase of illness. The FIE approach utilizes small-group sessions, mediator oversight, and explicitly guided transfer strategies to promote metacognitive reflection and strengthen real-world generalization. Objective: This pilot study aimed to assess the feasibility and acceptability of a peer-mediated FIE program in first-episode psychosis (FEP) and to generate preliminary signals of its effect on patient-centered functional outcomes. Methods: In this open-label, single-arm pilot study, 16 individuals with FEP participated in a 10-week, group-based FIE program. Outcomes were assessed at baseline (T0), post-intervention (T1), and 6-month follow-up (T2). The primary outcome was patient-centered functioning, measured by the Goal Attainment Scale (GAS). Secondary outcomes included cognitive domains (MCCB) and symptom severity (PANSS). Change over time were analyzed using the non-parametric Friedman test. Results: The intervention demonstrated excellent feasibility, with 100% participant retention. Significant and sustained improvements were observed in patient-defined functional goals (GAS; χ2(2)=24.43, p<.001). Additionally, preliminary cognitive gains emerged in Processing Speed, as measured by the Coding subtest (χ2(2)=10.47, p<.005), and in Verbal Working Memory, assessed by the Letter–Number Span (χ2(2)=10.34, p<.006), suggesting domain-specific enhancement of cognitive efficiency and working memory manipulation. Furthermore, significant reductions were noted in positive, general, and total PANSS scores, while negative symptoms remained stable. Conclusions: Peer-mediated FIE is a highly feasible and acceptable intervention for individuals with FEP. The promising preliminary signals on patient-centered functioning and specific cognitive domains strongly support the need for a large-scale randomized controlled trial with an active control group to definitively establish efficacy.

Introduction: The present study was conducted with objective of investigating long-term outcomes in individuals diagnosed with autism spectrum disorder (ASD) during childhood. Investigation focused on current symptom severity and social functioning, and it examined role of parental psychological well-being, empathy, and parent-child relationship. Methods: A total of 64 subjects who had previously been diagnosed with ASD were subject of a re-evaluation seven years after their initial diagnosis. Participants were divided into two groups: those who retained their ASD diagnosis (n=53) and those who no longer met diagnostic criteria (n=11). The clinical assessments comprised CARS, ABC, SRS, and ASSP for participants, and BSI, FAST, EQ, and PCRS for their parents. Multiple linear regression and correlation analyses were used to examine associations between autism symptom severity, social skills, and parental variables. Results: Greater autism severity was associated with lower social skills, reduced parental empathy, and higher parental psychopathology. Parental empathy (EQ) and positive dimension of parent-child relationship (PCRS) were significantly higher in loss of ASD group. Parental empathy (EQ) and child social functioning (ASSP) positively predicted quality of parent-child relationship (PCRS). Higher parental psychiatric symptoms (BSI) and lower child social functioning significantly predicted greater autism severity (CARS). Conclusions: The severity of autism and an individual’s social functioning are closely interlinked, with child characteristics having strong predictive power. Parental mental health and empathy have been shown to have a significant impact on the developmental outcomes and relational dynamics of their children.

Aim: Sleep problems and impaired socio-occupational functioning (SOF) are highly prevalent in early psychosis. Although research in this area is growing, the relationship between these domains remains unclear. This systematic review synthesises evidence on the association between sleep disturbance and SOF in at-risk mental states and first-episode psychosis, focusing on two questions: (1) what is the relationship between sleep disturbance and SOF in early psychosis, and (2) do psychological sleep interventions improve SOF in this population? Methods: A comprehensive search across PsycINFO, CINAHL, MEDLINE, EMBASE and Scopus databases was conducted in February 2025. Eligible studies reported on the association between sleep and SOF in early psychosis populations. Additionally, intervention studies targeting sleep were included if they met the above criteria. Study characteristics and findings were extracted for synthesis and analysis. Results: Out of 8,682 studies, 13 met the inclusion criteria. Most studies reported that poorer sleep (e.g. insomnia, reduced quality, circadian disruption) was associated with lower SOF across commonly used measures (e.g. GAF, WSAS, SOFAS). Intervention studies, primarily CBT-based, showed improvements in sleep with indications of benefit for SOF, though mediation analyses were limited. Heterogeneity in design, sample size and measures precluded meta-analysis. Conclusions: Sleep disturbance is consistently linked with poorer socio-occupational functioning in early psychosis, and sleep-focused psychological interventions show promise for functional improvement. Routine assessment and treatment of sleep problems should be considered within early intervention pathways. Robust trials with larger, diverse samples and standardised sleep and functioning measures are recommended. Keywords: at-risk mental state, first episode psychosis, sleep disturbance, socio-occupational functioning