Introduction. Young people’s participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future, and feeling that things are improving in their lives. This study reports on young people’s session experiences over time and by key demographics for headspace youth mental health services. Methods. The sample comprised 16,484 young people aged 12 to 25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. Results. Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. Conclusion. Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

Background: The study was designed to assess the role of coping style and self-esteem in the context of different phases of schizophrenia. Methods: Recurrent Schizophrenia (ReSch) , first-episode schizophrenia patients (FEP), ultra-high risk for psychosis (UHR) patients, and healthy controls (HC) (40 per group) were subjected to in-person clinical interviews. The results of these interviews were then used to gauge coping style and self-esteem using the Coping Styles Questionnaire (CSQ) and the Rosenberg’s Self-Esteem Scale (RSES). Data were analyzed through ANCOVAs and logistic regression analyses. Results: The result s found that positive coping style (CSQ problem-solving and CSQ seeking for help) generally decline with progression through the HC, UHR, and FEP groups,while negative coping style(CSQ fantasy,CSQ repression and CSQ self-blame) generally increase with progression through the HC, UHR,and FEP groups (except that UHR group was slightly lower than HC group in CSQ self-blame).Results for members of ReSch group were in line with those of members of the FEP group in coping style. At the level of self-esteem, the UHR group was similar to the HC group and significantly higher than the FEP group and the ReSch group. Logistic regression analyses indicated that UHR group patients exhibited increased negative coping styles (CSQ fantasy) relative to members of the HC group, but had greater Positive coping style (CSQ problem-solving) than did members of the FEP group. Conclusion: These findings suggest that both UHR individuals experience impaired negative coping styles which expands the understanding of the psychological characteristics of the prodromal group. Further explorations are warranted to develop optimal psychosocial interventions.

Intro: psychotic disorders (PD) and eating disorders (ED) both are highly invalidating, costly and associated with premature death. Researchers call for early detection and intervention. Little is known about co-occurrence and associations between the at risk mental state for psychosis (ARMS) and ED. Objectives: to explore the prevalence of and associations between ARMS and ED-risk. To gain a first explorative insight into the similarities and differences of ARMS profiles in individuals with and without an ED risk score (EDr versus EDnr). Method: a cross sectional observational prevalence study (N=736) in secondary mental health care with a qualitative examination of ARMS profiles (N=47), using an ED screener (SCOFF), psychosis prodromal screener (PQ16) and CAARMS interview (detection of ARMS). We analyzed prevalences, associations (using Fisher’s exact test), and conditional probabilities of frequencies for CAARMS and SCOFF outcomes. We explored differences in ARMS profiles between EDr and EDnr by inspection of CAARMS reports. Results: ARMS and EDr are common across all psychiatric conditions. ED appear to remain largely undetected. Findings demonstrated no significant or conditional association of frequencies between CAARMS and EDr/nr outcome. ARMS items ‘guilt/punishment’ and ‘ideas of reference’ stood out in the EDr group. Conclusions: Be aware of ARMS and psychosis in ED. Pay more attention to possible ED. ARMS and psychosis are equally prevalent in EDr and EDnr, and vice versa. Researchers are encouraged to conduct studies on severity associations and profiles of psychosis spectrum symptoms in the various manifestations of ED.

Introduction. Psychotic disorders are associated with academic difficulties. Supported Employment Program (SEP) guidelines have become the gold standard to improve occupational functioning in psychotic disorders. More recently, these guidelines have been adapted to education. In Canada, several community organizations and hospital programs offer supported education to young people with psychotic disorders. However, SEP guidelines are not systematically used. The objective of this study was to assess the fidelity of 6 Canadian (Quebec) organizations offering supported education services to young people with psychotic disorders to the SEP guidelines adapted to education. Methods. Six sites offering educational services to young people with psychotic disorders were recruited. Semi-structured interviews were conducted with one supported education professional and one manager of each site, using the Quality of Supported Education Implementation Scale (QSEDIS). This new scale has been developed from the Quality of Supported Employment Implementation Scale. The QSEDIS assesses the fidelity of the quality of the implementation of supported education programs, using three subscales (Employees, Organization and Services). Results. Acceptable fidelity scores were observed in the three QSEDIS subscales for all six sites combined. The Services subscale received the highest score of fidelity (4.4./5), followed by the Supported Education Employee (4.1/5) and the Organization (3.7/5). Conclusion. The results suggest that supported education services offered to young people with psychotic disorders in the six sites are generally consistent with SEP guidelines adapted to education. Further research is warranted to validate whether acceptable SEP guidelines fidelity according to the QSEDIS translates into educational outcomes.

Objective: This case series explored the integration of smartwatches in a community mental health service to support severe mental illness (SMI) management and intervention. We examined whether biometric data provided by smartwatches could help to predict relapse and inform treatment decisions. Method: Four SMI patients were selected from a prior study. Clinicians accessed patients’ biometric data (activity, sleep, heart rate, and electrodermal activity) through smartwatches. Results: Changes in circadian rhythm and electrodermal activity preceded hospitalization in two cases. Additionally, smartwatch data was effectively used to guide targeted interventions, improving patient treatment outcomes. Conclusion: Integrating smartwatches in community mental health services offers promise as adjunct tools for severe mental illness management. However, ethical considerations on data privacy and technology reliance require further evaluation.

Background Children, adolescents and young adults are experiencing an increase in the prevalence of depressive and anxiety symptoms. Aerobic training (AT) has been shown to be effective at reducing symptoms, but the efficacy of resistance training (RT) in reducing anxiety and depression levels in young individuals is unclear. Aim To quantify the change in depressive or anxiety symptoms following RT in young individuals. Methods We searched MEDLINE, PsychINFO, and PubMed for articles published in English from January 1980 to February 2022 for randomised controlled trials (RCT) that included at least 4 weeks of RT, with participants aged 26 years or younger. A random-effects meta-analysis was used to calculate a pooled effect size of RT pre-and post-intervention compared to control groups and the quality of evidence was assessed using a Cochrane risk-of-bias 2 (RoB 2) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. Results Ten RCTs were eligible for inclusion in the analysis. RT was associated with a significant reduction with a large-sized mean effect in depressive (Hedge’s g= -1.06, 95% CI -1.61 to -0.51, p<.001) and anxiety symptoms (Hedge’s g = -1.02, 95% CI -1.50 to -0.54, p <.001). Sensitivity analyses on the training variables were not conducted due to the small sample and large heterogeneity, however, a summary of the trials with a large effect size (≥-1.0) was conducted. Conclusion RT significantly reduces depression and anxiety symptoms in young people. Future studies exploring the effect RT training intervention with adequate detail and in various mental health treatment treating settings are warranted.

Objectives: The present study aimed to evaluate data from patients admitted to the first-episode psychotic (FEP) outpatient clinic at the Hospital of Clinics of the Federal University of Pernambuco from July 2018 to July 2021, seeking to identify factors related to better clinical outcomes. Methods: This study was conducted using a convenience sample, including all patients between 15 and 65 years of age who were admitted to the FEP outpatient clinic from July 2018 to July 2021. Descriptive statistical analysis was performed using mean and standard deviation or median and interquartile range for continuous quantitative variables, and absolute number/percentage for qualitative variables. Paired T-test, a parametric test, was used to compare PANSS scores upon admission and after 6 months. Spearman’s correlation test was employed to assess the correlation between duration of untreated psychosis (DUP) and treatment response with other variables. Results: The sample consisted of 85.3% male individuals, with 50% of patients aged between 19-30 years, and 82% residing in the metropolitan area of Recife. Seventy percent of patients responded to the treatment implemented by the outpatient clinic, and only 30% required psychiatric hospitalization within 6 months of follow-up. The majority of patients had a history of psychoactive substance use (82.4%); however, the use of these substances did not impact the prognosis within the analyzed sample. The median DUP was 4 weeks, and a shorter DUP was associated with a lower probability of psychiatric hospitalization and a greater treatment response (reduction >50% in PANSS). Conclusion: A shorter DUP was associated with a lower likelihood of psychiatric hospitalization and a greater treatment response. Furthermore, the specialized early psychosis outpatient clinic itself appears to yield positive outcomes, as 70% of the treated patients exhibited a positive treatment response.

Aim: Psychotic disorders and obsessive-compulsive disorder (OCD) commonly co-occur. Likewise, subthreshold psychosis symptoms (clinical high risk for psychosis; CHR-p) and obsessive-compulsive symptoms (OCS) commonly overlap and may be difficult to differentiate. Previous work suggests some notable differences between OCS and psychosis include insight and the content of thoughts and experiences. Methods: The current study explored the overlap between OCS and psychosis symptoms in a CHR-p sample. Results: Results demonstrated 13.5% of the sample experienced co-morbid OCD and CHR-p. Individuals with comorbid OCD and CHR-p experienced no other significant differences in presenting concerns, including psychosis symptoms, social or role functioning, anxiety, or depression. Exploratory factor analyses conducted on the CFOCI-A revealed two subtype factors: 1) checking and counting, and 2) intrusive thoughts and images of harm/guilt. The checking and counting factor was significantly correlated with depression and social anxiety. The intrusive thoughts and images of harm/guilt factor was significantly correlated with unusual thought content, suspiciousness and persecutory ideas, attenuated positive symptoms, and social anxiety. Conclusions: These findings suggest individuals who experience intrusive thoughts and images may be more likely to rate on positive symptoms, while individuals with checking and counting symptoms may not rate on positive symptoms, though may experience greater levels of depression.

Introduction Emergent mental illness during adolescence affects daily functioning, causing disruption to daily activities, routines, and patterns. Multiple inter-related personal, social and environmental determinants influence the onset, nature and subsequent course of those difficulties. Research suggests a bi-directional relationship exists between mental health and activity choices. Activity-focused interventions such as occupational therapy may improve adolescent mental health related outcomes. In this study, we identify and select which activity-related determinants should be prioritised in the development of an occupation therapy-based intervention for adolescents with emerging mental health difficulties using expert consensus. Method A modified two-round Delphi survey method was conducted with occupational therapists and researchers to ascertain a consensus opinion on the prioritisation of specific activity-related determinants that influence 16-to 17-year-olds’ Results Eighty-nine determinants were identified and prioritised. Fourteen of these were personal activity-related determinants including ‘types of activity’ in which young people engage, the ‘balance of activities’ in which they engage, their ‘over and under consumptions of activities’, and their ‘underdeveloped occupation-based coping skills’. The expert panel prioritised ‘personal self-confidence’, ‘values’, and ‘perception of confidence’ in relation to the activities adolescents do. Conclusions This study generated a detailed picture of the activity-related determinants that are important in adolescence, and aligns with the adolescent model of occupational choice. Our findings have potential to inform activity-related intervention development and policy. Further research is needed, particularly to understand young people’s perspectives on these determinants and to investigate the determinants that would benefit from further empirical research.

Aim. Timely help-seeking and pathways to care (PtC) have been linked to positive outcomes in suicidal adolescents. While the importance of formal contacts is recognised, caregivers also play a significant role in these pathways. Caregiver’s familiarity with mental health issues may influence an adolescent’s PtC. This study explores the relationship between a caregiver’s prior suicidality and mental health treatment on their children’s pathways to entering a specialist suicide prevention treatment program. Method. Caregivers ( n = 118, 35 males and 83 females) of young individuals (12-25 years) who were admitted into an outpatient suicide prevention service, completed a self-report questionnaire describing their child’s onset of symptoms, help-seeking, PtC and the caregiver’s prior suicidality and mental health treatment. Results. Parents were the source most likely to recognise the onset of suicidality, with general practitioners and psychologists the most common first contacts. Significant delays were identified for onset duration averaging 48.0 weeks, and it was observed that shorter delays in treatment were related to fewer number of contacts. Caregiver prior suicidality was associated with longer delays in treatment but had no relationship with onset duration. Conclusion. Caregivers and professional contacts are vital agents in improving the PtC of suicidal adolescents. Results highlight the significant delays in treatment and the added complexity of a caregiver’s prior experience of suicidality to these pathways. These complexities warrant further exploration to minimise obstacles that hinder help-seeking and lengthen PtC, as this may improve interventions and outcomes for suicidal adolescents and their caregivers. Keywords. Pathways to care; delay in treatment; caregiver familiarity; suicide; adolescent.

Background: Most young adults experiencing psychosis enter early intervention services for psychosis (EIS) via inpatient services and emergency departments. Referral in this manner is believed to increase young adults’ risk for adverse outcomes while in EIS such as diminished trust and engagement in services. However, little research has empirically examined the impact of young adults’ referral and help-seeking experiences on their subsequent views towards EIS and engagement to services. Methods: This qualitative study involved semi-structured interviews with 12 young adults (mean age = 24.83) within 3-12 months following acceptance to an EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. Data were analyzed using the Interpretative Phenomenological Analysis approach. Results: 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Events. Participants with referral pathways involving urgent care services, particularly through involuntary hospitalization, described more adversity during their referral pathway and were more likely to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. Conclusions: The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants’ accounts. Sense making was further contextualized by participants’ illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users’ dignity and for EIS to provide opportunities for patients to process past negative healthcare experiences to strengthen engagement.

Aims: The objective of this study is to underline the impact of Gaming Disorder on the clinical evolution of patients with First Episode Psychosis. The specific aims of the study are to determine the prevalence of gaming disorder among those patients and assess the consequences of gaming on their clinical trajectory. Methods: This is a prospective multicenter cohort study that will enroll 800 patients diagnosed with a first episode psychosis, with a follow-up period of up to 3 years. Using a systematic screening procedure for gaming disorder, the clinical staff will assess patients gaming habits at admission and every 6 months thereafter. Information from patients’ medical records will also be extracted using the same timeframe. Results: The patients’ characteristics at admission and during follow-up will be presented in the form of descriptive statistics and compared between different subgroups of patients using uni- and multivariate logistic regression models. Repeated measures ANCOVA will also be performed to analyze the impact of gaming disorders on patients’ clinical path as assessed by the Positive and Negative Syndrome Scale and the Clinical Global Impression scale, considering covariates such as psychiatric diagnosis, pharmacological treatment, age, sex/gender, and duration of untreated psychosis. Conclusion: These findings will guide the development of prevention, detection, and treatment strategies for the comorbidity between gaming disorder and first episode psychosis, ultimately improving the patients’ recovery.

Objectives: Early trauma exposure is common among young adults receiving public mental health services, posing increased risk for PTSD. While d supports the feasibility of PTSD screening, clinicians often fail to screen for PTSD in this population. This study aimed to examine the demographic factors, psychiatric comorbidity, and predictors of charted PTSD diagnosis among treatment-seeking young adults with positive PTSD screens in a community mental health care system. Methods: Screening for trauma history and PTSD symptoms was implemented among clients receiving community mental health services. There were 266 treatment seeking young adults (aged 18-35) endorsed at least one traumatic event and had a score of at least 45 on the DSM-IV PTSD Checklist (PCL), indicating probable PTSD. Results: Treatment-seeking young adults with positive PTSD screens were predominantly female (68%), minority (69%), and diagnosed with mood disorders (66%), with nearly 25% diagnosed with major depressive disorder. Of the young adults with positive PTSD screens (PCL >=45), only 15% had a chart diagnosis of PTSD. Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. Conclusion: Routine PTSD screening and early trauma intervention for treatment-seeking young adults with mental health conditions should be prioritized to address the long-term impact of trauma. Keywords: schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder (PTSD), trauma screening, community mental health care

Aim: Patient-reported outcome measures (PROMs) provide valuable information and promote shared decision-making but are infrequently used in psychosis. Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH) are single-item PROMs in which respondents rate their health and mental health from ‘poor’ to ‘excellent’. We examined the psychometric properties of the SRH and SRMH in early intervention for psychosis contexts in Chennai, India and Montreal, Canada. Methods: Assessments were completed in Tamil/English in Chennai and French/English in Montreal. Test-retest reliability included data from 59 patients in Chennai and Montreal. Criterion validity was examined against clinician-rated measures of depression, anxiety, positive and negative symptoms, and a quality-of-life PROM for 261 patients in Chennai and Montreal. Results: SRH and SRMH had good to excellent test-retest reliability (ICC>0.63) at both sites and in English and Tamil (but not French). Results for criterion validity were mixed. Whereas in Montreal, low SRH was associated with not being in positive symptom remission, and poorer functioning and quality of life, SRH was associated only with functioning in Chennai. No associations were found for SRMH in Montreal. In Chennai, however, low SRMH was associated with not being in positive symptom remission and poorer functioning. Conclusions: Our work advances knowledge of more feasibly integrating single-item PROMs into clinical settings. Importantly, it highlights how PROMs may perform differently across languages and contexts. More critical work is needed to understand if discrepancies between PROMs and CROMs are indicative of poor validity of PROMs or “valid” differences between patient and clinician perceptions.

Introduction- Cannabis use disorders are global emerging problem nowadays, with high prevalence and morbidity. Though cognitive impairments are one of the most replicated findings in individuals with cannabis dependence, but there are very few studies assessed cognitive functioning as a risk factor for cannabis use disorder. In this study, we assessed cognitive functioning as an endophenotype in cannabis use disorders. Methodology- In this study comparison of cognitive functioning was done among three groups- patients with cannabis dependence syndrome, their first degree relative (FDR) and normal healthy controls (HC). Each group included 30 participants. Individuals of all three groups were assessed in domains of complex attention, executive functions, language, learning and memory and perceptual-motor. Results- Performance of patients with cannabis dependence was impaired in attention, verbal memory, executive functions compared to both other groups. Attention, semantic verbal fluency and memory were found to be an endophenotype as both patient and FDR group performed poorly than HC group. Verbal memory was impaired in patients’ group compared to group of first-degree relatives, whose performance in-turn impaired than normal healthy controls. Performances of verbal and visual memory were correlated positively with age of onset and negatively with frequency of cannabis intake. Age of first-degree relatives was inversely correlated with verbal memory. Conclusion- Performance of individuals with cannabis dependence was impaired than normal healthy controls in all domains of cognitive functioning. As per definition, verbal memory could be considered as an endophenotype marker in cannabis use disorders.

Background: Family peer workers form connections with family/carers and can offer emotional support, psychoeducation and referrals based on their own lived experience. Although an increasing number of family peer support programs exist in the youth mental health sector, they are rarely described or reported on. There is a need for greater documentation of the experiences of family peer workers operating in the healthcare sector, in order to raise awareness of issues currently facing the workforce and support organisations to make positive changes. Methods: We present a detailed description of the family peer support program at Orygen in Victoria, Australia. In doing so, we highlight factors that impact effective program implementation and delivery from the perspectives of four family peer workers and two supervisors. Findings/Conclusions: Organisations should encourage self-care and social connections between family peer workers to reduce impacts of ongoing mental-ill health and workplace burnout and isolation. Staff should be educated about the field of family peer support to improve role clarity and foster a positive team environment. It is vital to develop a comprehensive position description, training program, and onboarding procedures to ensure new employees are adequately equipped. To improve staff retention and compensate those with further education, experience and skills, organisations may consider offering increased remuneration, negotiate longer-term contracts with a potential for a greater number of workdays, and should promote/hire senior lived experience positions. Further research is needed to formally investigate barriers and facilitating factors of program implementation in mental health settings.

Introduction: Aberrant salience and psychotic-like experiences have been proven to be linked. Moreover, anxiety is a key symptom in psychosis prone subjects and in most psychotic patients. We propose a mediation model that attempts to interpret the role of psychotic-like experiences in the association between aberrant salience and anxiety among healthy controls and psychotic patients. Materials and Methods: Demographic and psychometric data (Aberrant Salience Inventory, Community Assessment of Psychic Experiences, Symptom Check List-90-revised) from 163 controls and 27 psychotic patients was collected. Descriptive statistics, correlations and a mediation analysis with covariates were subsequently performed. Results: Aberrant salience correlated with more frequent positive psychotic-like experiences and higher anxiety levels in both patients and controls. However, positive psychotic-like experiences’ frequency mediated the relationship between aberrant salience and anxiety only among controls. Conclusions: The preservation of insight onto their psychotic-like experiences among controls with high aberrant salience, and its partial or complete loss in psychotic patients seems to be the most probable hypothesis to explain why psychotic-like experiences linked to aberrant salience appear to induce anxiety among the former group but not the latter.

Aim: Early intervention services are the established and evidence-based treatment option for individuals with first-episode psychosis. They are time-limited, and care pathways following discharge from these services have had little investigation. We aimed to map care pathways at the end of early intervention treatment to determine common trajectories of care. Methods: We collected health record data for all individuals treated by early intervention teams in two NHS mental health trusts in England. We collected data on individuals’ primary mental health care provider for 52 weeks after the end of their treatment and calculated common trajectories of care using sequence analysis. Results: We identified 2224 eligible individuals. For those discharged to primary care we identified four common trajectories: Stable Primary Care, Relapse and return to CMHT, Relapse and return to EIP, and Discontinuity of Care. We also identified four trajectories for those transferred to alternative secondary mental health care: Stable Secondary Care, Relapsing Secondary Care, Long-term Inpatient, and Discharged Early. The Long-term Inpatient trajectory (1% of sample) accounted for 29% of all inpatient days in the year follow-up, with Relapsing Secondary Care (2% of sample and 21% of inpatient days), and Relapse and return to CMHT (5% of sample, 15% of inpatient days) the second and third most frequent. Conclusions: Individuals have common care pathways at the end of early intervention in psychosis treatment. Understanding common individual and service features that lead to poor care pathways could improve care and reduce hospital use.