BACKGROUND:Although extensive research interest has been paid to the pathways between early experiences of school-age bullying and psychosis onset, knowledge about the effects of bullying victimization in adulthood and the workplace context remains surprisingly scarce. This study aimed to uncover how shame can serve as a mediator between workplace bullying and psychotic experiences (PEs) in a non-clinical population of Arabic-speaking workers from Tunisia. METHODS:A cross-sectional study using a web-based approach was conducted during the period from August to December 2024 among Tunisian workers. RESULTS:Internal shame acted as a partial mediator between the two dimensions of workplace bullying and PEs. External shame fully explained the relationship between person-related bullying and PEs, whereas it only partially mediated the relationship between work-related bullying and PEs. Specifically, higher work- and person-related bullying was significantly associated with higher internal/external shame, and internal/external shame was significantly associated with greater PEs. Finally, higher work- and person-related bullying was directly associated with greater PEs. CONCLUSION:Our results shed light on the urgent need for the development of policy actions and organizational support systems to help create safe working environments and minimize the occurrence and negative consequences of bullying behaviours on workers.
AIM:Childhood-onset Obsessive-Compulsive Disorder (OCD) has been associated with an increased vulnerability to psychosis, yet no prospective studies have examined this risk in paediatric populations. METHODS:In this pilot prospective study, 59 adolescents with a primary diagnosis of OCD were assessed at baseline for psychotic vulnerability, measured through Cognitive-Perceptual basic symptoms (COPER) and the high-risk criterion Cognitive Disturbances (COGDIS), as well as for OCD severity and psychosocial functioning. The number of subjects who developed a first episode of psychosis (FEP) during the 18-month follow-up period was evaluated. Logistic regression and moderation analyses were performed. RESULTS:During the follow-up period, 18.6% of participants presented with a FEP. These patients were older and displayed poorer psychosocial functioning compared with those who did not develop a FEP. Logistic regression identified higher COPER symptoms and lower psychosocial functioning as the only significant predictors of FEP. Although moderation effects were not statistically significant, exploratory simple slopes suggested that both COPER and COGDIS symptoms were more strongly associated with psychosis onset in adolescents with lower psychosocial functioning. CONCLUSIONS:This study highlights a notable rate of progression to psychosis among adolescents with OCD over an 18-month period. Despite methodological limitations, our findings offer preliminary evidence that COPER symptoms and impaired psychosocial functioning are key risk factors in adolescents with OCD for progression to psychosis.
BACKGROUND:Prolonged delay between the onset of the first episode of psychosis (FEP) and initiation of treatment is common in lower- and middle-income countries (LMICs), including Pakistan. This qualitative study explored perspectives of young persons with FEP, carers, healthcare professionals, and traditional and spiritual healers (TSHs) on drivers of delayed diagnosis and treatment of FEP, to suggest interventions aimed at addressing factors contributing to prolonged duration of untreated psychosis (DUP) in Pakistan and similar contexts. METHODS:We conducted a qualitative study in Peshawar, Pakistan using focused ethnography as a research design. We first conducted focused ethnography using participant observation with 15 TSHs. Subsequently, data was collected through semi-structured interviews (n = 26) and focus group discussions (n = 6) with FEP individuals (age 14-25), their carers, and healthcare professionals. We used framework analysis, combining inductive and deductive thematic approaches to analyse the data. RESULTS:Three themes emerged from the analysis in relation to care pathways in psychosis: (1) moral-spiritual explanations legitimise spiritual healings; (2) stigma renders psychiatric disclosure socially risky; and (3) structural exclusion of inaccessibility of mental health from primary care. CONCLUSION:Psychosis remains untreated for a prolonged time as families navigate a moral-spiritual landscape that makes TSHs the only legitimate healers, stigma makes psychiatric disclosure a threat to family honour, and absent or dismissive services make biomedical care unreachable. Engagement with TSHs represents an underutilised opportunity to develop collaborative care models that reduce the duration of untreated psychosis.
INTRODUCTION:Despite a solid evidence base, mental health services often struggle to implement family interventions as part of routine psychosis care. Barriers to implementation include staff lacking training, supervision and confidence, as well as organisations lacking resources and prioritising crisis-focused interventions. Specific barriers in the early psychosis context include family readiness and interest, access limitations, and lack of perceived alignment with their needs and preferences. This paper describes and evaluates a pragmatic family education and support program in an Australian public mental health Early Psychosis service. METHODS:This uncontrolled pre-post study used routinely collected data. Data were retrospectively sourced from clinical and administrative records for the 2022-2023 period, during which a low-intensity (four-session) multi-family group program was run on four occasions. A routine voluntary pre- and post-participation survey was completed, which included consideration of the extent to which the program met participants' needs. Data were primarily considered using repeated measures t-tests and Cohen's d as a measure of effect size. RESULTS:Less than half of the families invited to the program participated (38.8%). Despite the program's low intensity, it was reported to meet the needs of most participating families and caregivers. Participants reported significantly increased knowledge of psychosis and reported higher levels of coping with symptoms at post compared with pre-intervention measures. An increased number of sessions attended predicted improvements in knowledge (limited to 'relapse') but not coping. CONCLUSION:A low-intensity family education program in the early psychosis project may meet the needs of most families and caregivers who are willing to engage. However, improvements in coping were modest and variable across participants, and the clinical significance of this change should be interpreted cautiously. Such a program may be inadequate to consistently meet the needs of all families engaged with an early psychosis service. Public mental health services need to continue to find better ways to engage and support the families of people experiencing early psychosis.
BACKGROUND:While religious beliefs are known to affect help-seeking pathways, little is known about how they shape engagement in first-episode psychosis (FEP) care. The purpose of the present study is to explore how religious belief, religious identity and cultural norms shape engagement with FEP care. METHODS:Semi-structured interviews were conducted with 23 NAVIGATE participants in Israel. The sample comprised 11 Ultra-Orthodox (UO) and 12 non-observant (Non-Obs) Jewish FEP participants. Thematic analysis was used to identify themes related to religious factors in FEP care engagement and the therapeutic alliance. RESULTS:Two main themes emerged. The first focused on how faith contributed to participation in NAVIGATE by framing FEP care as God's will and viewing therapy as a spiritual experience. The second focused on trust issues, emphasising autonomy and collaborative decision-making. Across both themes, the therapeutic relationship emerged as a critical independent source of NAVIGATE engagement. CONCLUSIONS:Findings indicate that religiosity shapes day-to-day engagement throughout FEP care, extending beyond initial help-seeking. Implications are discussed with a focus on dialogue, psychoeducation and communication and on combining religious responsiveness with a strong therapeutic alliance.
INTRODUCTION:Adverse childhood experiences have been consistently linked to a range of mental health related difficulties in adulthood. One such experience is bullying, which has been shown to predict psychotic symptoms. This study aimed to explore whether bullying victimisation in early adolescence is associated with certain mental health outcomes (psychosis, depression and cannabis abuse) and whether this is mediated by the individuals' perception of social support from peers and family. METHODS:This study performed secondary data analysis of a prospective cohort study, the Belfast Youth Development Study (BYDS). It used longitudinal data from 2087 participants from ages 12-21 years and performed path analysis (using Mplus V8) between bullying and the above mental health outcomes and mediators. RESULTS:The results showed a direct path from bullying to psychotic symptoms (estimate = 0.10; SE = 0.0; p = 0.030) as well as an indirect path mediated by peer attachment, parental attachment and depression symptoms (estimate = 0.01; bootstrapped 95% CIs 0.01, 0.02). CONCLUSION:Being bullied in childhood is directly associated with a greater risk of having psychotic symptoms as an adult. There is also an indirect path from bullying in childhood to psychosis symptoms as an adult mediated by peer attachment, parental attachment, and depression. Interventions should be aimed at addressing bullying and strengthening social support from peers and family.
AIM:To develop and describe the implementation and early outcomes of a stepped, transdiagnostic early intervention service (FIPP) for individuals aged 17-30, and to evaluate changes in access, age profile, length of stay, diagnostic mix and community engagement between 2016 and 2024. METHODS:The Jean Wier outpatient centre is part of the public mental health hospital Érasme, which is part of the GHT PsySudParis group in the metropolis of greater Paris (France). Data and surveys showed a treatment gap in service delivery for young people with emerging psychiatric disorders. A comprehensive reorganisation of mental health services was initiated. Developmental aims were training professionals, service establishment and introducing standardised assessment. Evaluation aims were shifts in access, length of stay and diagnostic distribution. RESULTS:The results show an improved healthcare provision by better trained teams, increased community engagement, a diminished average age of service users, a decreased average length of stay and a diagnostic shift in the day-care program (CARE). Duration of untreated psychosis and disengagement have not yet been objectified. CONCLUSIONS:A proactive, structured and collaborative approach in public mental health care can enhance access to early psychiatric care for young adults in France.
INTRODUCTION:Family members play an important role in supporting their loved ones with first episode psychosis (FEP), but few have access to interventions demonstrated to support them in this endeavour. Psychosis REACH (Recovery by Enabling Adult Carers at Home; p-REACH) is a family intervention for psychosis (FIp), delivered directly to families by clinicians and peers, that provides both psychoeducation and Cognitive Behavioural Therapy for psychosis (CBT-p) informed skills to family carers. This study aimed to qualitatively explore family participants' experiences of receiving the p-REACH intervention and assess its feasibility and acceptability within an early psychosis service. METHODS:Following the p-REACH intervention, all participants were invited to partake in qualitative interviews and analysed using a Reflexive Thematic Analysis approach. RESULTS:Family carers reported positive experiences with the intervention. Key themes indicated that it helped build (1) internal resources, as participants valued increasing their knowledge and understanding of psychosis and learning skills to support themselves and their loved ones-leading to greater confidence and (2) external resources, as the group-based, peer-supported format enhanced their sense of connection with their loved ones and with other families. CONCLUSIONS:This study demonstrates that the intervention was both feasible and acceptable to participants in an early psychosis setting. It contributes to the growing body of evidence supporting the positive impact of family interventions in psychosis, specifically the teaching of CBTp skills to caregivers of those with early psychosis.
AIM:Current estimates suggest that about 1.7% of the general population meets criteria for clinical high-risk for psychosis (CHR), but Latinx individuals are more likely to be at higher risk due to factors that could inflate rates of symptomatology. Disparities in screening, access to services, and intervention for Latinx individuals at CHR persist despite calls to action. METHODS:Through the lens of service utilisation models, the present narrative review builds on prior calls to action by summarising the literature and providing culturally sensitive recommendations for clinicians and researchers. RESULTS:Disparities include challenges in the identification of need for services by individuals and their social networks, the lack of culturally appropriate tools and interventions across community and specialty settings, and barriers to service retention and engagement. DISCUSSION:In response, recommendations include disseminating psychoeducational materials and programs to Latinx communities, creating norms for Latinx individuals for standard screeners and clinical interviews, increasing specialised trainings for providers in different settings, and making psychosis-related research in Latinx populations more accessible through open science practices.
AIMS:Negative symptoms are a core component of schizophrenia, affecting up to 60% of individuals with the disorder. They are categorised into primary negative symptoms (PNS), which are intrinsic to the illness, and secondary negative symptoms, which arise from external factors such as depression or medication side effects. They can also be divided into diminished expression and amotivation/anhedonia subtypes. While inflammation has been implicated in schizophrenia and linked to negative symptoms, little is known about whether inflammatory profiles differ between negative symptom subtypes in individuals at Ultra-High Risk (UHR) for psychosis. METHODS:We conducted a secondary analysis of 147 UHR participants from the Staged Treatment in Early Psychosis (STEP) study to examine whether inflammatory markers (Alpha-2-Macroglobulin, IL-6, CRP, sICAM-1, sVCAM-1, and suPAR) differed across negative symptom subgroups, using multinomial and binomial logistic regression models adjusted for age, sex, smoking, and BMI. RESULTS:Overall, most inflammatory markers were not significantly associated with negative symptom subgroups. However, higher sICAM-1 levels were asscoiated with lower odds of primary negative symptoms compared with no negative symptoms. Additionally, younger age was associated with increased odds of PNS and amotivation, while smoking was associated with higher odds of secondary negative symptoms compared with no negative symptoms. DISCUSSION:These findings suggest that inflammation may not broadly distinguish negative symptom subtypes at the UHR stage, although sICAM-1 may play a role in early illness processes. Limitations include sample ascertainment, potential misclassification of negative symptoms, and the relatively small number of participants with PNS. Future studies with larger samples and longitudinal designs are needed to clarify whether inflammatory changes contribute to the emergence of specific negative symptom subtypes.
INTRODUCTION:CBT for psychosis (CBTp) is an evidence-based care standard and a core element of Canadian and United States (US) early intervention for psychosis (EIP) programs. Outside of early intervention programs, fewer than 1% of Canadian and US individuals experiencing psychosis have access to this intervention. However, no empirical investigations of CBTp availability in EIP programs exist in the peer-reviewed literature. METHODS:We investigated CBTp availability and quality among Canadian and US EIP programs using a structured questionnaire distributed to team leaders via listservs. RESULTS:Across program respondents (Canada N = 28; US N = 48), all endorsed offering CBTp in some form (low-intensity, group-based and/or high intensity), yet few endorsed quality monitoring or ongoing supervision specific to CBTp. We report EIP program characteristics and determinants of clients being offered CBTp. CONCLUSION:Efforts and resources to enhance CBTp delivery, including quality assurance, are a vital part of enhancing access to CBTp in EIP programs.
AIM:To evaluate the effectiveness of digital interventions in supporting young caregivers' mental health, well-being, and caregiving experiences, and to assess implementation factors including adherence and acceptability. METHOD:We systematically searched six databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central, and Scopus) and grey literature sources from inception to March 2025, identifying studies evaluating digital interventions for caregivers aged 25 years or younger. Study selection, data extraction, and risk of bias assessment were conducted independently by two reviewers. Due to substantial heterogeneity, narrative synthesis was performed following the Synthesis Without Meta-analysis (SWiM) reporting guidelines. RESULTS:From 752 records, six studies met inclusion criteria, comprising three randomized controlled trials, one feasibility study, and two development/adaptation studies. Interventions included web-based platforms, mobile applications, audio-conferencing systems, and e-learning platforms. Digital tools showed limited effectiveness for mental health outcomes but demonstrated promise for quality-of-life improvements, with one trial showing statistically significant results (Wilks' λ = 0.95, F(4, 418) = 2.74, p = 0.03). Adherence varied dramatically between self-guided platforms (26%) and structured programs (93%). All RCTs demonstrated a high risk of bias. DISCUSSION:These findings reveal a 'digital paradox' whereby the theoretical advantages of accessibility failed to translate into engagement without human facilitation. Digital interventions for young caregivers require hybrid models combining technological convenience with relational support, structured flexibility, and continuous co-design with young caregivers to optimize engagement and effectiveness. The limited number of included studies and uniformly high risk of bias across RCTs underscore the need for pragmatic trials with robust implementation evaluations. PROSPERO REGISTRATION:CRD42024604175.
BACKGROUND:Development of new evidence-based interventions for youth who are at clinical high risk for psychosis (CHR-P) is needed. Health behaviours 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 behaviour-focused psychosocial intervention for youth at CHR-P. METHODS:In a non-randomized feasibility trial, youth aged 13-17 who met CHR-P criteria participated in a 9-week health behaviour promotion group that provided psychoeducation and skills training regarding stress management, sleep, physical activity, nutrition, mitigating substance use, and health behaviour goal setting. Primary outcomes included feasibility and pre-to post-intervention change in health behaviours and symptoms. The secondary outcome explored the social validity of the intervention. RESULTS:Out of 18 invited participants, seven enrolled, and five completed at least two-thirds of the intervention, indicating modest feasibility and good retention in those who enrolled. There were no significant pre-post changes across measures of health behaviours or symptoms. Participants endorsed the goals of the intervention as meaningful and congruent with their treatment goals. Among those who enrolled, the group format was described as acceptable, while the didactic style was less preferred. DISCUSSION:Findings of this study showed the intervention to be modestly acceptable and feasible. Changes in health behaviours and symptoms were not significant but trended in the expected direction. Future trials are needed to refine the intervention and assess effectiveness. TRIAL REGISTRATION:Clinicaltrials.gov Identifier: NCT05532683.
INTRODUCTION:Discrimination is a risk factor for psychotic symptoms among minoritised individuals. Social support has been shown to be a broad protective factor for stressors like discrimination and for psychosis outcomes. However, it is unclear whether social support equally benefits all groups. METHODS:In this study, 134 young adults identifying as Asian American, Latine, or non-Hispanic White reported on recent experiences of discrimination, perceived social support, and subclinical psychotic and depressive symptoms. RESULTS:Distinct moderation effects of social support on the association between discrimination and psychosis and depression were found in the NHW and Asian American groups. Above average social support mitigated the effects of discrimination in the NHW group. For Asian American young adults, social support was not sufficient to mitigate the effects of discrimination on psychosis or depression outcomes. CONCLUSIONS:Prevention of psychotic disorders among Asian and Asian American groups may require targeting distinct coping strategies to address disparities in illness outcomes.
BACKGROUND:Over the last two decades, integrated mental health services for youth aged 12-25 have expanded globally to enable young people to access comprehensive age-appropriate care. This study examined the barriers and facilitators of integrated care from the perspective of health practitioners and service providers. METHOD:In total, 45 service managers and practitioners who work with young people aged 12-25 years participated in interviews investigating the barriers and enablers of integrated youth mental health care. Themes were identified through inductive analysis and organised by overarching themes. RESULTS:Five overarching themes were identified: (i) continuity of care, referring to challenges associated with service fragmentation, navigation, and timely access to care; (ii) workforce, referring to challenges impacting staff ability to provide integrated care; (iii) information exchange, referring to areas to improve communication of patient information; (iv) financing, referring to supporting integrated care through core funding; and (v) leadership, referring to system- and service-level priorities impacting service delivery. CONCLUSION:Improving integrated youth mental health care entails a multi-level health system transformation. Strategies to achieve this are discussed in the context of the current results and emerging youth-specific frameworks for strengthening service integration and integrated 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 specialised centres. 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 remains 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 use by general health practitioners in primary care.
BACKGROUND:Early detection of psychosis is associated with improved outcomes for patients with serious mental illness. METHODS:Psychosis screening items were added to an electronic medical record template used for same-day consultations by behavioural health clinicians in an adolescent/young adult medical clinic. We conducted a retrospective chart review to characterise psychosis prevalence and documentation of psychosis screening. RESULTS:Documentation of any responses to psychosis screening items was present in 28% of consultations (n = 116). Among consultations where providers directly inquired about psychosis (14%; n = 59), 20% (n = 12) documented ≥ 1 psychosis risk item, representing 10 unique patients. For three of these patients, this was an initial identification of psychosis concern. CONCLUSIONS:Despite inclusion of psychosis screening items on a consultation template, most behavioural health consultations did not include documentation of psychosis risk assessment. Documented direct clinician inquiry into psychosis risk was associated with the discovery of previously unidentified psychosis risk factors and symptoms.
AIM:This scoping review aimed to systematically provide an overview of existing findings on the use of ecological momentary assessment (EMA) and related mobile sensing to assess positive and negative symptoms, as well as stress, in individuals at clinical high risk for psychosis (CHR-P) and those with first-episode psychosis (FEP). METHODS:Following the PRISMA-ScR guidelines, PubMed, PsycINFO, and Web of Science were searched for empirical studies published up to October 2025. Eligible studies assessed positive and negative symptoms and stress in daily life using EMA or related mobile sensing implemented on contemporary devices. Data were extracted on study characteristics, EMA design (sampling schedule, prompting logic, duration, completion rates), and domains assessed and were summarised descriptively. RESULTS:Ten studies (14 records) met the inclusion criteria. Most used smartphone-based EMA with semi-random prompts 4-10 times daily over 6-28 days. Six assessed positive symptoms, three negative symptoms and two stress. Symptoms were all assessed through self-report EMA, while stress was assessed through self-report EMA in one study and objectively through skin conductance in one. The reporting of completion, item validity, and incentive structure was inconsistent, limiting comparability across studies. CONCLUSIONS:Self-report EMA offers a feasible method for real-world assessment of symptoms and stress; however, mobile sensing remains underutilised. IMPLICATIONS:Future research should integrate EMA and related mobile sensing, employ validated indicators and standardise reporting practises to enhance methodological transparency and clinical utility.
AIM:Insomnia is common in the clinical course of schizophrenia, including in individuals at clinical high risk for psychosis (CHR-P). We previously found associations between insomnia and psychosis-risk symptoms in CHR-P. We attempted to replicate findings in an independent cohort. METHOD:We explored associations between insomnia and psychosis-risk symptoms in CHR-P individuals in the Accelerating Medicines Partnership Schizophrenia (AMP SCZ) program (n = 269). We investigated relationships between insomnia and psychosis-risk symptoms (Brief Psychiatric Rating Scale [BPRS]). RESULTS:The prevalence of any terminal and initial insomnia at AMP SCZ baseline was 28% and 38%, respectively. After controlling for potential confounders, insomnia was a significant indicator of higher BPRS total (β = 0.33) and positive (β = 0.22), affect (β = 0.34), and activation (β = 0.13) subscale scores. DISCUSSION:Insomnia is prevalent and associated with psychosis-risk symptoms in CHR-P individuals. Findings are clinically relevant and highlight the need for more rigorous assessment and treatment of insomnia in this population.
