Short title of the paper … Introduction: Peer support has increasingly been integrated into youth mental health programs globally. Peer support workers are an important ally in an individual’s recovery journey, providing both emotional and instrumental support and advocacy through their lived experiences. Objectives: To conduct a scoping review examining peer support services for youth with mental health concerns. Methods: This scoping review was prospectively registered with The Open Science Framework and followed the PRISMA scoping review extension checklist. In consultation with a health services librarian, seven electronic databases (i.e., MEDLINE, PsycINFO, Embase, SocINDEX, ERIC, CINHAL, and Education Research Complete) were searched from inception to May 2023. Two blinded reviewers chose peer-reviewed studies for inclusion in this scoping review if the research examined youth with mental health concerns that were involved in a peer support intervention or program. Results: After duplicate references were removed, 4,001 titles and abstracts were screened. In total, 70 studies met the inclusion criteria for this scoping review. A total 11147 youth (mean age 19.5 years) were identified as receiving peer support. About half the studies examined peer support service or program only (34/70; 49%). In others, peer support was examined alongside elements such as group therapy (29/70; 41%), goal setting (5/70; 7%), and cognitive-behavioural therapy (CBT) (5/70; 7%). Peer support services were identified as being significantly effective in treating mental health concerns in 81% (57/70) of studies. Conclusion: This scoping review demonstrated the ability of peer support services in aiding young people with mental health needs. Offering peer support may help mitigate future mental health problems in adulthood and increase quality of life.

Background: Biomarkers of immune dysfunction, such as serum inflammatory cytokines, may provide clues to pathophysiology in persons presenting with first-episode psychosis (FEP). Aim: Investigate the expression of serum inflammatory cytokines in FEP. Methods: In this sub-study of an ongoing longitudinal HIV in FEP study, blood samples were collected from February 2021 to January 2023 in participants meeting DSM-5 criteria for FEP who were aged 18 to 45 years and had less than six weeks of antipsychotic treatment. A multiplex ELISA assay measured interleukin (IL) 6, 8 and 10 levels, correlating them with socio-demographic factors, body mass index (BMI), psychosis severity (PANSS), depression (PHQ-9), cognitive screening (International HIV Dementia Scale), substance use (WHO ASSIST) and HIV status. Results: 70 participants were included (male =74%), with substance use being present in 79-83%, and 63% reported exposure to trauma during childhood. Current alcohol use was associated with elevated IL-8 levels (p=0.01), and high IL-10 levels correlated with lifetime and current alcohol use (p=0.02, p=0.04, respectively). Sensitivity analysis of 58 HIV-negative patients found associations between elevated IL-6 and IL-8 levels and current alcohol use (p=0.04, p=0.01), and elevated IL-10 levels with lifetime tobacco use (p=0.01) and lifetime and current alcohol use (p=0.00, p=0.03). Cytokines were not significantly associated with psychosis and neurocognitive performance. Conclusion: While there is evidence of immune dysfunction in FEP, there is no clear clinical significance of this dysfunction. Better methodologically designed studies could assist in understanding the significance of immune dysfunction.

Aim To investigate treatment retention rates, dropout predictors and dropout chronology across patients with substance use disorders at a Women-Specific Outpatient Service in Brazil, across different age strata: Emerging Adults (18-25), Middle Aged Adults (26-59), and Older Adults ( 60+). Methods An observational cohort study, across 27 years. Sociodemographic and other exposures information were collected at enrollment. Survival curves with dropout as event were estimated for each age stratum and log rank tests were performed. Survival probabilities and Cox proportional hazards models were used to gauge dropout risk and determine dropout risk factors. Hazard functions of dropout were estimated to understand chronology of dropout across age strata. Results 714 women were included. Emerging adults exhibited significantly lower treatment retention with 10.2% survival at 104 weeks p<0.0001), and increased rate of early dropout, compared to the other age stratas. Higher education was a protective factor, associated with lower dropout risk (HR= 0.73, p=0.02). Cocaine/crack as the main substance of abuse was a risk factor (HR=1.36 , p=0.003). Hazard function curves showed a first peak of dropout in emerging adults at 12 weeks of treatment. Conclusions Emerging adulthood is a critical period for health interventions. The gender gap is narrowing and even inverting among Emerging Adults, and women are still underrepresented in studies. We found very high and early dropout rates among Emerging Adults in our sample. These findings underscore the necessity for early-stage risk stratification and intervention protocols for this subpopulation.

Introduction Early detection and intervention in psychotic disorders are public health issues that have led to the creation of specific care systems in France, the visibility of which is still debated. Moreover, these services are often concentrated in adult rather than child psychiatry, which may increase the duration of untreated psychosis. Methods The main objective of this study was to take stock of the care provided in the adolescent unit of the Candélie hospital (Lot-et-Garonne, France) in 2023 and the proportion of adolescents aged over 15 diagnosed with a mental health condition at risk who were followed up. The second objective was to propose an experimental approach to improving care for this group of patients by introducing an advanced practice nurse. Results The results of the retrospective study carried out in 2022 show that staffing levels and care units in adolescent medicine are saturated. Depending on the system, between 19% and 39% of patients are classified as mentally vulnerable. The construction of an Ishikawa diagram highlights three major issues on which the advanced nurse practitioner could intervene: support for one of the systems under particular pressure (RESEDA), the resumption of part of the medical activities given the shortage of doctors, and the child psychiatry-adult psychiatry relay. Conclusion Restructuring existing systems to include initial consultation and monitoring of these adolescents and their families by advanced practice nurses would reduce the duration of untreated psychosis and allow earlier intervention with these adolescents.

Introduction: Bipolar Disorder (BD) is a severe, persistent disorder that causes functional impairment. Besides heritability, environmental factors, such as traumatic experience, impact the development of BD. Little is known about the early developmental signs of this disorder; therefore, this study aims to look at the impact of interpersonal trauma on the early developmental signs of BD. Specifically, differences in psychopathological behaviors were investigated between (1) at-risk children to controls and (2) at-risk children who experienced an interpersonal traumatic event to those who did not. Methods: Using the Adolescent Brain Cognitive Development (ABCD) dataset, participants with a first-degree relative with BD were identified (N at-risk=625) and matched on sex and age to a control group (N control=625). The Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) was used to assess interpersonal trauma and psychopathological symptoms. The trauma (N trauma=198) and no trauma subgroups (N no trauma=428) were built from the at-risk population. Group comparison was conducted on depressive, manic, and anxiety symptoms. Results: Compared to controls, at-risk children exhibited a significantly greater number of manic symptoms at baseline, and depression and anxiety symptoms at two-year follow-up. No significant differences were found between the trauma and no-trauma groups at either baseline or follow-up. Discussion: These results confirm the presence of early symptoms in at-risk children, in line with the staging model of BD. Extended longitudinal research is needed to further investigate the potential specific role of trauma on its early behavioral patterns.

Aim: Research has shown that people from ethnic minority backgrounds living with psychosis are less likely to seek support from healthcare professionals (e.g. GP), but more likely to seek support from non-healthcare professionals (e.g. faith leaders). This systematic review assessed the impact of community-level interventions aimed at improving help seeking and access to support for psychosis in non-secondary care settings among ethnic minority populations. Methods: The EMBASE, PsychINFO, Medline Ultimate, CINAHL Ultimate and Scopus databases were searched in December 2023. Studies were included if published in English, conducted in high-income countries, reported on psychosis and minority ethnic groups aged 18-65 years, and interventions targeted at people from minority ethnic groups with or at risk of psychosis, caregivers, or the general public. Outcomes of interest were changes in help-seeking behaviours, pathways to care characteristics and barriers and facilitators of intervention implementation. Results: Five studies reporting two interventions met the inclusion criteria. All studies were conducted in the United States. Narrative synthesis revealed mixed results about the effectiveness of interventions on help seeking and duration of untreated psychosis. However, the results show promise for professional help-seeking recommendations post-intervention across the studies. Barriers and facilitators were identified for intervention implementation. Conclusions: Community-level interventions have some success in promoting help-seeking for psychosis in ethnic minority populations. However, research in this area was limited. Future research could include studies across different countries, ethnicities, genders and socioeconomic status to ensure generalisable results.

Objectives: To identify the differences in the clinical characteristics of frailty syndrome between patients with schizophrenia and healthy controls and to explore the correlation between frailty severity and immune-inflammatory markers in patients with schizophrenia. Methods: Twenty-seven community-dwelling patients (male, 51.9%; mean age, 39.9 ± 7.8 years; age range, 20–55 years) with schizophrenia and 14 healthy controls (male, 35.7%; mean age, 37.1 ± 8.4 years) were recruited; laboratory data were collected for assessing frailty using the index-laboratory and immune-inflammatory markers. Results: The Frailty Index-laboratory scores of participants with schizophrenia were higher than those of healthy controls significantly. Relative to the healthy controls, the participants with schizophrenia exhibited significantly higher levels of memory (CD45RO+) γ/δ T− Th17, naïve (CD45RA+) γ/δ T+, regulatory γ/δ T− Th, memory (CD45RO+) regulatory γ/δ T− Th, and memory (CD45RO−) Tc. By contrast, the two groups did not differ significantly for hs-CRP and homocysteine. The level of memory (CD45RO+) γ/δ T− Tc was positively correlated with FI-Lab results. Conclusions: The participants with schizophrenia exhibited a higher level of frailty and various immune-inflammatory markers relative to the healthy controls. Memory (CD45RO+) γ/δ T− Tc may serve as proxies reflecting prefrailty changes in patients with schizophrenia before old age.

Introduction: Quality of Life (QoL) is an important outcome measure for people with a first episode psychosis (FEP). Despite high numbers of patients being admitted to psychiatric hospitals following an FEP, the impact of hospital admission on outcome measures such as QoL is under-investigated. This study aimed to systematically review evidence of the impact of hospital admission on QoL in patients with an FEP. Methods: A systematic review was conducted in line with the PRISMA Guidelines. PsychINFO, Medline, CINAHL and EMBASE were searched from 2000 to 2022, examining the impact of QoL for people with an FEP following a hospital admission. Quantitative, qualitative and mixed methods studies were included in the search. Study quality was assessed using the Mixed Methods Assessment Tool. Data was analysed using narrative synthesis. Results: Seven hundred and eight two abstracts were found. Fifty-three full texts were reviewed. Data was extracted for eight articles. Across the eight studies, four discrete QoL measures were employed. Results showed that QoL scores were consistent over time, with little statistical change from baseline to follow-up. Across studies, participants reported low average QoL scores. Across studies, information on the treatment components and duration of hospital admission were scarce. Conclusion: There is a relative paucity of studies that have examined QoL in relation to hospital admission. QoL scores remained consistent over time, suggesting that QoL is relatively well preserved at the first episode. Further research is needed on the impact of inpatient-based interventions in FEP.

Treatment for youth at clinical high risk for psychosis (CHR-P) presents an opportunity for early intervention with the capacity to decrease the burden associated with a potential psychotic illness later in life. However, significant barriers prevent youth at CHR-P from accessing specialty mental health services. Few studies have examined the pathways to care for youth at CHR-P within the U.S. health system. The present study reports the results of a codebook thematic analysis of qualitative interviews conducted with 15 families of youth at CHR-P. We inquired about their experiences navigating the health system to eventually arrive at the CHR-P specialty program, including help-seeking events and referrals, attributions for CHR-P symptoms, and barriers and facilitators to care using a semi-structured interview guide. Caregivers reported confusion and uncertainty regarding symptom attributions. They also disclosed the significant challenges to obtaining mental health care including mental health literacy, illness stigma, provider availability and appropriateness, and adequacy of referrals. Notably, most youth at CHR-P had encounters with emergency services during their help-seeking journey. Our results help define targets for future policy, research, and clinical efforts to improve access to specialty care for youth at CHR-P in the U.S.

Objective: Individuals with schizotypal traits can be considered at high-risk for schizophrenia. Studies have shown that individuals with schizotypal traits exhibited neurophysiological abnormalities. However, whether and to what extent could electroencephalogram (EEG) data discriminate individuals with high and low schizotypal traits remained unknown. The present study aimed to examine this issue using a deep learning approach. Method: The resting-state EEG data were collected in 48 individuals with high schizotypal traits and 50 individuals with low schizotypal traits during both eyes-open and eyes-closed conditions. Three EEG datasets were constructed: the eyes-open dataset, the eyes-closed dataset, and the combined dataset. Subsequently, the EEG data of the two groups were classified using the Long and Short-Term Memory Network combined with a one-dimensional Convolutional Neural Network (LSTM-1DCNN) model. Results: The LSTM-1DCNN model demonstrated high accuracy in identifying individuals with schizotypal traits across the eyes-open, eyes-closed and combined datasets, with an accuracy of 94.86%, 94.26%, and 95.30%, respectively. The state of participants’ eyes (open or closed) did not affect the identification accuracy. Conclusion: Individuals with high schizotypal traits exhibited distinct EEG patterns compared to those with low schizotypal traits. EEG data and deep learning algorithm can be employed to identify individuals at risk for schizophrenia.

Aim: Cannabis use disorder (CUD) typically onsets before age 22 and accounts for the majority of substance use treatment presentations by Australian youth. There are no established pharmacotherapies for CUD. Guanfacine extended-release (XR) is an alpha 2a adrenergic receptor agonist that is approved for attention deficit hyperactivity disorder in children and adolescents. Immediate-release guanfacine alleviates some cannabis withdrawal symptoms in adults. The XR formulation can be taken once daily, is well-characterised in children and adolescents, and reduces impulsivity in those with ADHD. The GRACE study – embedded within youth substance use treatment services in Victoria, Australia – will assess whether guanfacine XR added to treatment as usual (TAU) reduces the frequency of cannabis use following monitored abstinence in youth with CUD. Methods: GRACE is a pragmatic Phase 2b, double-blind, parallel-group superiority randomised controlled trial of guanfacine XR for youth aged 12-25 years seeking treatment for CUD (mild-severe). Participants (N=100) are randomly assigned in a 1:1 ratio to receive guanfacine XR (target dose 4 mg/day) or placebo plus TAU, including residential admission for supervised withdrawal for up to 14 days. The primary endpoint is efficacy, indexed by change from baseline in frequency of cannabis use (days/week) during 4-weeks in the community following discharge from residential withdrawal, measured weekly with the Timeline Follow Back. Results. GRACE commenced recruitment in August 2023; data collection is ongoing. Conclusions. The GRACE trial will investigate the efficacy of guanfacine XR – a promising candidate for CUD – in young people presenting for CUD treatment.

Background: A majority of patients with psychosis have experienced trauma, but trauma-focused (TF) treatment is not routinely offered. As new studies are published continuously, updated reviews are necessary to guide clinical practice, including a broader focus on several outcome variables. The current systematic review set out to examine the effect of TF treatments in patients with a psychotic disorder and comorbid trauma symptoms on symptoms of (1) trauma, (2) psychosis and (3) anxiety, depression, and psychosocial functioning. Methods: A systematic search following the PRISMA guideline yielded 17 studies reported in 19 records, which were evaluated and presented. Results: Overall, results indicated positive effects on trauma symptoms following TF Cognitive Behavioural Therapy, Eye Movement Desensitisation Reprocessing, Prolonged Exposure, Written Emotional Disclosure, and Imagery Rescripting. Results were inconclusive but suggestive of positive effects for other outcomes. Discussion: The present findings gives preliminary support for the effect of TF treatment on trauma symptoms, but are more inconclusive for outcomes related to symptoms of psychosis, anxiety, depression, and psychosocial functioning. In addition, support was found for treatments delivered both individually and by group. The current evidence base on TF treatment in psychosis is, however, still at an early stage and challenged by methodological issues.

Background: Posttraumatic stress disorder (PTSD) is a common comorbid diagnosis in psychotic disorders. However, little is known about the effect of comorbid PTSD in youth at clinical high risk (CHR) for psychosis. Purpose: The purpose of this study was to investigate group differences in symptom severity, risk for psychotic conversion, and functioning among youth at CHR for psychosis with and without PTSD. Methods: This longitudinal study utilized data from N = 693 individuals who met criteria for CHR as part of the North American Prodrome Longitudinal Study 3 (NAPLS-3). Individuals who met criteria for PTSD were compared to those who did not meet criteria for PTSD on demographic, symptom and functional variables. Results: Individuals diagnosed with PTSD (N=54) reported more severe overall positive symptoms (p<0.001), negative symptoms (p<0.01), and general symptoms (p<0.001) compared to those without the diagnosis (N=639). These symptom differences were primarily accounted for by more grandiose (p<0.01) and perceptual symptoms (p<0.04), decreased experience of emotions (p<0.01) and occupational functioning (p<0.03), sleep disturbance (p<0.01), dysphoric mood (p<0.002) and impaired tolerance to stress (p<0.001) in those with PTSD. A diagnosis of PTSD was not associated with a greater rate of psychotic conversion or greater functional deficits. Conclusions: Our findings suggest that a diagnosis of PTSD is associated with more severe overlapping symptoms in individuals meeting the criteria for CHR but not psychotic conversion. Our findings underscore the importance of recognizing and treating comorbid psychiatric conditions including PTSD in CHR populations as a means of reducing symptoms and improving outcome.

Youth suicide is a concern world-wide and suicidality, the presence of suicidal ideation or intent, is a critical risk for youth mental health services. This study aimed to determine the prevalence of suicidality in primary care, youth mental health services, along with its correlates and the course of treatment offered to clients. Routinely collected data from Australia’s headspace national youth mental health foundation, which has over 160 centres across Australia providing mental health care to young people aged 12-25 years, were analysed for new clients who started and completed their first episode of care between 1 July 2022 and 30 June 2023. This included 30,437 young people/episodes of care and 74,393 occasions of service. Results showed that suicidality was evident in almost one-quarter of young people, although it was rarely reported as a primary presenting issue. When evident, it was usually identified at first visit. Those most at risk were young people in unstable accommodation, who identified as LGBTIQA+ or who were Indigenous. The findings show that suicidality should be anticipated in young people presenting to primary care mental health settings, and youth services need to be able to competently deal with suicide risk rather than using this as exclusion criteria.

Introduction: The problem of detecting people at ultra-high risk for psychosis (UHR) remains an issue. Thus, screening tools have received increased attention. We assessed the performance of the Prodromal Questionaire-16 (PQ-16) and the Perceptual and Cognitive Aberrations scale (PCA) to screen for UHR in the general population of Sao Paulo. Methods: Individuals aged 18-35 years (n=6500) were interviewed with the PQ-16 and the PCA. Those with a combined score>10 on the PQ-16+BS were called for assessment with the Structured Interview for Psychosis-Risk Syndromes (SIPS). 75 individuals were deemed as UHR and 99 as healthy comparison; 44 randomly selected individuals (PQ-16+PCA scores<10) joined as further controls. All participants had no DSM-5 diagnosis. Scores of the PCA, PQ-16 (total score and distress index), and their combinations were analyzed. Results: All the proposed scorings significantly distinguished between UHR and control subjects. PQ-16 scoring showed the best performance (AUC=0.711), followed by the PQ-16+PCA combination (AUC=0.700). PQ-16 distress index had the worst performance. Conclusions: Data provides further evidence for the use of the PQ-16 as an effective screening instrument to search for UHR states in the general population. This can help UHR identification, reduce delays in care, while minimizing the risk of false positives.

Background. Bipolar disorder (BD) is a chronic affective mental disorder characterized by cycling affective episodes. Its prognosis depends on several factors such as age, sex or comorbidities. In this review, we will focus on the so-called ”duration of untreated bipolar disorder” (DUB), defined as the period between the onset of the patient’s symptoms and the start of an appropriate treatment, since it may have an influence on the recovery of BD patients. Objectives. The main objective is to assess the association between the DUB and the clinical outcomes of patients with BD and to highlight the importance of reducing the DUB to improve the prognosis of this disease. Methods. The search strategy is based on using Mesh descriptors in different databases: PubMed, Scopus, and Cochrane Library. Then, 15 articles were finally selected. The results obtained have been reflected for subsequent systematic evaluation. Results. A prolonged DUB is associated with the presence of BD subtype II, a longer duration of the illness, an early age of onset, a first episode of depressive polarity, a higher number of affective episodes of depressive type, and a higher number of suicide attempts. Limitations: The concept of DUB lacks consensus leading to varied terminology and limited research. Unlike psychotic disorders, there’s no standardized tool to measure DUB. Conclusions. DUB appears to be a modifiable factor linked to poorer outcomes in BD patients. Minimizing DUB is crucial for enhancing the long-term management of BD. Tailored early treatment strategies might be implemented to address this.

Accurate and appropriate cognitive screening has the potential to significantly enhance early psychosis care, yet no screening tools have been validated for the early psychosis population and little is known about current screening practices, experiences, or factors that may influence implementation. Using a hybrid type 1 design, the CogScreen study aims to validate two promising screening tools with young people with first episode psychosis (primary aim) and to understand the context for the implementation of cognitive screening in early psychosis settings (secondary aim). The present protocol outlines the implementation study, which aims to explore the experiences and practices, acceptability, feasibility, and determinants of cognitive screening in early psychosis settings from the perspective of key stakeholders. Young people with first episode psychosis (n=350), caregivers (minimum n=10), and service providers (minimum n=12) will be recruited from primary and specialist early psychosis services in Melbourne, Adelaide, and Sydney, Australia. Grounded in implementation science, two theoretical frameworks inform data collection and analysis: the Theoretical Framework of Acceptability and the Consolidated Framework for Implementation Research. A mixed methods design will be employed to collect and analyse data from questionnaires with young people with first episode psychosis, interviews with all stakeholder groups, and administrative processes. Quantitative data will be analysed using descriptive statistics. Qualitative data will be analysed through content analysis using deductive and inductive coding. Together with accuracy findings, results from the present implementation study will provide new insights about the practices, experiences, enablers and barriers to cognitive screening in early psychosis services.

Background: Individuals with psychosis have reduced life expectancy and this is largely driven by cardiometabolic disease. Cardiometabolic risk increases with age and duration of psychotic illness. Anthropometric and physiologic abnormalities have been identified among individuals with at-risk mental state (ARMS) for psychosis. The prevalence of cardiometabolic disease is disproportionately higher in lower middle-income countries (LMIC); however, literature on cardiometabolic disease in individuals with psychosis spectrum disorders in LMIC is scarce. Method: This is a cross-sectional secondary analysis of data from two large randomised controlled trials that recruited individuals with ARMS (n=326) and schizophrenia (SCZ; n=303) from inpatient and outpatient settings in Pakistan. All participants completed anthropometric and physiological assessments. Results: There was a statistically significant difference in BMI between groups, 21.42 (SD=4.11) in ARMS and 23.31 (SD=5.41) in the SCZ group (p=0.001). Although mean values were within the normal range, 17.8% (n=58) of ARMS individuals and 33.1% (n= 100) SCZ individuals were overweight or obese. Waist circumference was 32.75in (SD=3.13) in the ARMS group and 32.16in (SD=5.18) in SCZ. Although waist circumference was higher in ARMS, this was not statistically or clinically significant. The pulse rate and blood pressure in both groups were within normal range. Conclusion: We found evidence of abnormal anthropometric and physiological parameters that would indicate that individuals with psychotic-spectrum disorders in Pakistan are at an elevated cardiometabolic risk.