BACKGROUND AND HYPOTHESIS:Digital remote monitoring (DRM) captures service users' health-related data remotely using devices such as smartphones and wearables. Data can be analyzed using advanced statistical methods (eg, machine learning) and shared with clinicians to aid assessment of people with psychosis' mental health, enabling timely intervention. Such methods show promise in detecting early signs of psychosis relapse. However, little is known about clinicians' views on the use of DRM for psychosis. This study explores multi-disciplinary staff perspectives on using DRM in practice. STUDY DESIGN:Fifty-nine mental health professionals were interviewed about their views on DRM in psychosis care. Interviews were analyzed using reflexive thematic analysis. Study Results: Five overarching themes were developed, each with subthemes: (1) the perceived value of digital remote monitoring; (2) clinicians' trust in digital remote monitoring (3 subthemes); (3) service user factors (2 subthemes); (4) the technology-service user-clinician interface (2 subthemes); and (5) organizational context (2 subthemes). CONCLUSIONS:Participants saw the value of using DRM to detect early signs of relapse and to encourage service user self-reflection on symptoms. However, the accuracy of data collected, the impact of remote monitoring on therapeutic relationships, data privacy, and workload, responsibility and resource implications were key concerns. Policies and guidelines outlining clinicians' roles in relation to DRM and comprehensive training on its use are essential to support its implementation in practice. Further evaluation regarding the impact of digital remote monitoring on service user outcomes, therapeutic relationships, clinical workflows, and service costs is needed.

Dissociation has increasingly been acknowledged as a key factor in post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). However, there is evidence that it is not being recognized by clinicians and often trauma treatments do not target dissociation experiences. The purpose of this review was to investigate the effect of any psychological intervention compared to any control on dissociation in adults with PTSD and/or CPTSD. Systematic database searches (PsychINFO, COCHRANE, EMBASE and Medline) were conducted using a predetermined search strategy and inclusion criteria to identify controlled trials reporting psychological therapies for trauma, had a control group and measured dissociation as an outcome. To assess the risk of bias in studies, the Risk of Bias 2 (ROB-2) tool and the Mixed methods appraisal tool (MMAT) were used. Thirteen studies were included in the review. Using a random effect model to perform the meta-analysis, a small effect of current treatments on dissociation experiences was found (g =  -0.28, 95% CI [-0.41, -0.15]; Z =  -4.12, p < .001), with a small level of heterogeneity across studies (I2 = 7.8%). Subgroup analyses showed some important effects across control conditions, therapy modalities and type of measures, albeit overall moderation was not significant in any of the models. While the overall treatment effect was observed when dissociation was a secondary outcome in most studies, for PTSD treatments to be effective on dissociation interventions they need to focus on dissociation more explicitly.

Abstract Introduction In many Low- and Middle-Income countries (LMIC), access to psychological therapies for psychosis remains extremely limited, contributing to significant treatment gaps and persistent inequalities in care. Novel interventions that are effective, scalable, and culturally acceptable across diverse settings are urgently needed. AVATAR therapy is an innovative digital intervention for distressing voices in psychosis, developed in the UK. The therapy enables voice-hearers to engage in a series of facilitated dialogues with a customized computer-based representation of their main distressing voice. AVATAR3 represents the first initiative to contextually adapt AVATAR therapy and evaluate its acceptability in two LMIC settings (Ethiopia and India). Methods and analysis We will establish Innovation and Implementation Hubs in Addis Ababa, Ethiopia (Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa) at Addis Ababa University (AAU) and Mental Health Service Users Association (MHSUA), Ethiopia) and New Delhi, India (All India Institute of Medical Sciences). Phase 1 employs formative work and diverse stakeholder engagement to inform context-specific adaptations. Reflexive thematic analysis will be used, with data synthesis informed by the Cultural Adaptation of Scalable Psychological Interventions (CASPI) framework and Ecological Validity Model (EVM). Phase 2 tests adapted AVATAR therapy through a parallel case series (n=15 per site, targeting 70% completion rate) measuring feasibility, acceptability, and safety indicators at baseline, 12-weeks, and 24-weeks. Qualitative research will explore the experiences of participants (n=10) and therapists (n=8) at each site. Ethics and dissemination Ethical approval has been obtained from Addis Ababa University College of Health Science Institutional Review Board, All India Institute of Medical Sciences (AIIMS) Institutional Review Board and the King’s College London (study sponsor) Research Ethics Committee. Findings will be disseminated to inform the implementation of AVATAR therapy across diverse international settings. Strengths and limitations of this study Interdisciplinary and participatory approach Contextual adaptation of a digital innovation Expert by experience leadership and involvement from the conception of the study The study will develop tools and share learning to support future digital mental health innovation across diverse international settings The case-series at each site will not have a control group

BACKGROUND:Relapses result in negative consequences for individuals with psychosis and considerable health service costs. Digital remote monitoring (DRM) systems incorporating "passive sensing" (sensor data gathered via smartphones/wearables) may be a low-burden method for identifying relapses early, enabling prompt intervention and potentially averting the consequences of full relapse. OBJECTIVE:This study examined detailed views from people with psychosis about using passive sensing in this context. STUDY DESIGN:Qualitative interviews, analyzed using reflexive thematic analysis. Setting: Secondary care mental health services across the United Kingdom. An advisory group with relevant lived experience was involved throughout, from developing the topic guide to analysis. Participants: Clinician confirmed diagnosis of schizophrenia-spectrum psychosis (n = 58). STUDY RESULTS:Four overarching themes were developed. Theme 1 outlined participants' polarized feelings about passive sensing, highlighting specific challenges relating to privacy, especially regarding location data. Theme 2 examined participants' fears that clinicians might judge their movements or routines, creating a sense of pressure to modify their actions and undermining their autonomy. Theme 3 described potential solutions: offering users choice about what data are shared, when, and with whom. Theme 4 outlined specific benefits that participants valued, including intended functions of passive sensing within DRM (ease of use, early identification of relapse, and relevance of sleep monitoring) and novel uses. CONCLUSIONS:Our findings underline the importance of fully informed consent, choice, and autonomy. Given the potential privacy impacts, individuals are unlikely to engage with passive sensing unless they perceive clear personal benefits. Prospective DRM users need clear, accessible information about passive data collection and its relevant costs and benefits.

Background: Anhedonia, the loss of pleasure or interest in previously enjoyed activities, is a core symptom in conditions such as psychosis and depression. Carers’ perspectives on this experience are crucial but currently missing in the field, offering a unique vantage point for understanding how anhedonia manifests in everyday life and how it reshapes the caring relationship itself. This study aimed to explore informal carers’ experiences of caring for a loved one experiencing anhedonia and the challenges they face. Methods: We conducted a qualitative study using online focus groups and reflexive thematic analysis with unpaid carers of adults experiencing anhedonia in the context of a mental health condition. Participants (n = 29) were recruited in the United Kingdom through purposive sampling. Four focus groups, each with 6–8 participants, were facilitated using a topic guide developed with lived experience contributors. Discussions were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Results: Carers described anhedonia as profoundly disruptive to their loved ones’ emotional expression, relationships, and participation in daily life. Accounts consistently emphasised social withdrawal, emotional blunting, and pervasive hopelessness. Carers reported significant personal burden, both practical and emotional. Carers expressed uncertainty about the causes of anhedonia, they also highlighted a lack of recognition and tailored support from healthcare staff. Conclusions: This study provides the first qualitative account of caring for individuals with anhedonia. Findings underscore the impact of anhedonia on both service users and carers, highlighting a largely unmet need for recognition, psychoeducation, and support. Interventions should address anhedonia explicitly and integrate carers’ perspectives to reduce caregiver burden and improve outcomes.

Background Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions. Aims The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective. Method Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes. Results Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia. Conclusions The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.

BackgroundPreventing relapses of psychosis is difficult and important. Digital remote monitoring (DRM) systems are being developed and tested to support this. Increasingly, these systems use algorithm-based relapse prediction. Hence, understanding stakeholder views about algorithmic prediction is crucial. Existing qualitative work has explored health professionals’ views, but very few studies have examined the perspectives of people with psychosis on this topic. ObjectiveThis paper aimed to provide an in-depth examination of the views of people with psychosis regarding algorithmic relapse prediction within a DRM system that incorporates active symptom monitoring and passive sensing data. MethodsPeople with psychosis (n=58) were recruited from 6 geographically distinct areas of the United Kingdom. They participated in semistructured qualitative interviews exploring their views about using a DRM system that predicts psychosis relapse based on a machine learning algorithm. Transcripts were analyzed using reflexive thematic analysis. People with lived experience of psychosis were involved extensively in study design, analysis, and reporting. ResultsFindings were described across 4 themes. First, accuracy was a prominent theme. Participants emphasized that transparency about algorithm sensitivity and specificity is crucial and discussed the risks of the relapse prediction algorithm producing false positives (flagging that someone was relapsing when they were not) and false negatives (missing actual relapses). In both cases, participants said that errors may be partially mitigated through a human-in-the-loop approach (theme 2), with DRM blended with human oversight, from clinicians or a dedicated digital monitoring team, and calibrated based on service user, carer, and clinician feedback. The third theme, trust, fears, and choice, noted the interplay between users’ trust in the DRM system and their relationship with the clinical team. This theme described participants’ fears about potential overreactions (hospitalization or excessive medication) or underreactions (no additional support) from the clinical team in response to algorithm-generated relapse predictions. It emphasized the importance of retaining choice around the use of relapse detection algorithms and the sharing of personal data. The final theme described participants’ views about the benefits of using a relapse prediction algorithm, including facilitating early intervention, triaging care according to need, minimizing human bias in assessment, and efficiency in saving staff time. ConclusionsPeople with psychosis acknowledged potential benefits of algorithm-assisted relapse prediction for receiving timely or efficient care, but with several caveats. Algorithm-generated relapse alerts need to be sufficiently accurate and must be interpreted, with understanding of their limitations, by a trustworthy human who is aware of the relevant context. Algorithm-based relapse predictions should only be used with valid consent, in a way that promotes and respects the autonomy and voice of service users and avoids increasing the use of excessive restriction.

BackgroundAVATAR therapy is a novel psychological therapy that aims to reduce distress associated with hearing voices. The approach involves a series of therapist-facilitated dialogues between a voice-hearer and a digital embodiment of their main distressing voice (the avatar), which aim to increase coping and self-empowerment. ObjectiveThis study explored therapeutic processes that are distinctive to AVATAR therapy, including direct early work with voice content and the role of the therapist in dialogue enactment. MethodsPeople with lived experience relating to psychosis (peer researchers) contributed to each stage of the study. Peer researchers led semistructured interviews, which were conducted with 19 participants who received AVATAR therapy as part of the AVATAR2 trial, including 3 participants who dropped out of therapy. Data were analyzed using interpretative phenomenological analysis (n=5) and template analysis (n=14). ResultsParticipants described the initial challenges of experiential work with distressing voice content; however, most reported a meaningful increase in power and control over the course of dialogues and improvements with voices in daily life. A strong therapeutic alliance was experienced by all participants, including those who chose to discontinue therapy, often mitigating the discomfort associated with initial challenges by enhancing their sense of safety. Several important themes relating to individual engagement were highlighted, such as the emotional intensity of the experience and the importance of participants’ determination and open-minded attitudes despite initial doubts. Those who decided not to continue with therapy described challenges with the realism of working dialogically with a digital representation of their distressing voice. ConclusionsThis study has provided a deeper understanding of the experience of engaging in AVATAR therapy, in particular the challenges and opportunities of direct work with voice content. The importance of therapeutic alliance and establishing a sense of voice presence has been emphasized. Implications for the planned optimization and wider implementation of AVATAR therapy in routine care settings are discussed. Trial RegistrationISRCTN Registry ISRCTN55682735; https://www.isrctn.com/ISRCTN55682735

Mental health research often seeks to witness, understand and empower marginalised communities through use of methods such as qualitative research. Although, qualitative research has the tendency to favour rich and meaningful segments of data to represent peoples’ lived experiences.The neurodiversity movement has identified and challenged the ableism which can arise with the application of these research methods that have normative assumptions about human minds and language production. However, schizophrenia and psychosis qualitative research has so far been under considered in efforts to reduce these forms of ableism in research. This paper highlights how mental health researchers can resist and reject the ableism that comes from adopting ‘rich data’ as representative of the lived experiences of those with schizophrenia. Qualitative research may occlude the real experiences of indidivuals with schizophrenia if they are not heard or represented in the multitude of ways they themselves communicate or articulate themselves, the language they use and the stories they tell. This article provides solutions to meaningfully represent those with schizophrenia and their voices in all stages of the research process so that the available research in the field accurately reflects the needs and experiences of those with schizophrenia.

BackgroundDigital remote monitoring technologies, including smartphones and wearables, offer promising avenues for early detection of psychosis relapse. However, selecting devices that are acceptable to participants and produce high-quality data remains challenging. ObjectiveThe aim of this nested pilot study was to assess the acceptability and data quality of 3 commercially available wearable devices in people with psychosis recruited to the CONNECT cohort study. MethodsParticipants recruited to the CONNECT study before July 31, 2024, were included in the pilot study and selected 1 of 3 wearable devices: a Fitbit Charge 5, Samsung Galaxy Watch 5, or Apple Watch SE. Baseline demographics were compared between device groups. Acceptability of devices to participants was assessed through a Wearable Device Satisfaction Questionnaire after 3 months of use, with the proportion of positive responses to each question calculated and compared. Data completeness was also assessed by calculating the number (and percentage) of valid days of step count, heart rate, and sleep data, and comparing between groups. Data quality was assessed through summarizing the amount of troubleshooting required, additional metrics available from the wearables, and continuity of data completeness by calculating the proportion of participants with at least 3 days of heart rate data per week for the first 20 weeks of follow-up. Predefined criteria were used to determine the next steps for the wider CONNECT study: if one device was superior, this would be selected; if none were found to be superior and the Fitbit was found to be noninferior, then Fitbit would be retained. ResultsOf the first 107 participants recruited to CONNECT, 105 were included in the pilot study evaluation. The Samsung Galaxy Watch was selected most frequently by participants (46/105, 43.8%), followed by the Apple Watch (27/105, 25.7%), and Fitbit Charge (23/105, 21.9%). Differences in participant demographics were observed across device groups. Self-reported acceptability after use did not differ substantially between devices. However, in terms of data completeness, the median proportion of valid heart rate data days was significantly lower for Samsung Galaxy (median 31.2%, IQR 8.5%-46.0%) compared to Fitbit (median 80.1%, IQR 26.7%-95.0%; P=.003) and Apple Watch (median 49.3%, IQR 21.5%-86.0%; P=.02). There was no significant difference between Fitbit and Apple Watch. Similar patterns were observed for step count and sleep data. The Samsung Galaxy Watch required more frequent troubleshooting for data flow issues and lacked additional physiological metrics, available from the other devices. ConclusionsDue to comparatively lower data quality and technical performance, the Samsung Galaxy Watch was discontinued for use in the subsequent phase of the CONNECT study. The study highlights the importance of incorporating nested evaluations of devices in long-term research.

PurposeStaff-patient interactions in mental health wards may involve multiple, sometimes contradictory, stressful interpersonal sequences. National guidelines stress the importance for clinicians to have appropriate training to develop: a good understanding of staff-patient interactions; a capacity to step back and reflect. Mentalizing skills training has been proposed to support staff in these two areas. This approach teaches general clinicians core concepts and skills derived from specialist mentalization-based treatment. Earlier mentalizing skills evaluations have lacked ongoing supervision following initial training and used self-report measures only. This study therefore aims to assess the feasibility of implementing mentalizing skills training for staff followed by ongoing supervision, using a researcher-rated measure of staff metacognition (essentially, reflective capacity).Design/methodology/approachIn three psychiatric wards, the authors examined staff participation in a two-day mentalizing skills course followed by five-months of supervision. To measure outcomes, the authors used a repeated-measures design (baseline, post-training, five months post-training). They undertook semi-structured interviews ("The Caregiving Interview") to explore participants' responses to patients, applying the Metacognitive Assessment Scale (MAS) to assess reflective capacity.FindingsOf 54 staff members approached, 43 completed the two-day course. Thirty-one participants attended at least one supervision session; seven participants undertook the protocol-intended five or more sessions. Wilcoxon signed-ranked tests showed moderate improvements in MAS from baseline to post-training (r = 0.31) and five-months (r = 0.36).Originality/valueA novel semi-structured interview was developed. The findings extend the literature on mentalizing skills, revealing potential difficulties in engaging staff in ongoing supervision. Despite this attrition, participants' gains in metacognition appear to be maintained.

AVATAR therapy is an innovative form of relational therapy for the treatment of distressing auditory verbal hallucinations, or voice-hearing, targeted at reducing voice-related distress. AVATAR therapy involves the creation of a digital simulation of a single voice, termed an 'avatar', which is used in a series of three-way therapeutic dialogues. This paper presents the AVATAR Therapy Dialogues Corpus, a specialised corpus containing orthographic transcriptions of AVATAR therapy sessions. We offer an overview of the corpus contents, and a detailed discussion of the design and construction of the corpus. We describe the processes and specialised tools created, transcription conventions, and mark-up designed to capture para-linguistic and non-speech features which may have clinical relevance. Finally, we discuss the potential of the corpus to provide a genuine innovation in clinical care, offering clinicians a data stream that could augment their understanding of patient experiences.

Background:Experience sampling methodology (ESM) is an assessment method used in psychosis research. Symptom severity and gender may be associated with ESM engagement. Exploring qualitative experiences of using ESM among people with psychosis should aid developing more relevant, accessible digital assessments. Objective:This study aimed to examine factors that could affect engagement with ESM, such as associations of completion rates with age, ethnicity, gender, and clinical severity. It also aimed to explore qualitatively service users' experiences of using this data collection method. Methods:Data from 134/207 AVATAR2 trial (ISRCTN55682735) participants were used to evaluate associations between demographic variables, symptom severity, and ESM completion rates. Trial participants were purposively sampled to participate in an interview to discuss their experiences of using ESM or to discuss reasons why they chose not to use it. Results:Multiple regression analyses of 134 participants found that age, gender, ethnicity, and clinical severity were not associated with ESM completion rates (F5,128=0.548; P=.74). A thematic analysis of 17 participant interviews found 3 overarching themes: Factors affecting engagement with ESM, Perceived benefits of ESM, and Suggestions for improvement. These themes described how ESM has multiple benefits for people with psychosis, including increasing knowledge and awareness of mental health. ESM was straightforward and easy to use; however, engaging in other activities, experiencing positive symptoms, little experience using technology, and trial involvement impacted engagement. Participant's decision to use ESM could be influenced by concerns about security and privacy. Conclusions:Recommendations are made on how engagement with ESM can be improved, making it easier to use this method with this population, including providing increased support or training when using digital-based assessment or intervention as well as providing information on how digital data are used and recorded.

Deficits in the hippocampus are a consistent finding in schizophrenia and have also been demonstrated in early-stage psychosis. Moreover, alterations in hippocampal anatomy and connectivity have been implicated in aberrant functional interactions in subcortical and cortical networks. However, the nature and extent of these alterations and their association with frontal and subcortical regions remain unclear. To address these questions, we analysed resting state fMRI functional connectivity and graph properties in n = 93 individuals at clinical high-risk for psychosis (CHR-P), n = 26 patients with first-episode psychosis (FEP), n = 31 individuals with affective disorders and substance abuse as well as n = 58 healthy controls. We used novel denoising techniques and individually optimised functional connectivity matrices, which were compared across clinical groups. Finally, the centrality of the hippocampus as well as network segregation and integration were assessed using graph-based analysis. Both the FEP and CHR-P groups were characterised by reduced functional connectivity between the hippocampus and inferior frontal cortex albeit the differences in CHR-P individuals did not survive corrections for multiple comparisons. Compared to CHR-P, FEP show lower centrality of the hippocampus but increased network segregation. Our findings show lower connectivity between the hippocampus and frontal cortex in early-stage psychosis, with FEP patients showing stronger decreases in connectivity compared to CHR-Ps. Furthermore, network-based analyses highlight reduced centrality in FEPs compared to CHR-Ps, indicating reduced influence on the wider network. Thus, altered connectivity along the hippocampal-frontal axis could be a potential marker of illness stage in early-stage psychosis.

Background: Body image is a transdiagnostic construct which appears poorly understood in the context of psychosis. Poor body image is associated with paranoia which makes it a theoretically meaningful treatment target in psychosis. We systematically reviewed associations between body image and psychosis symptoms in both the typical population and people living with psychotic disorders, synthesised known correlates of negative body image in people living with psychotic disorders and performed a meta-synthesis to understand the lived experience of body image in people with psychosis.Method: Ovid MEDLINE, OVID Embase, OVID APA PsycINFO, EBSCOhost Cinahl and the Cochrane Central Register of Controlled Trials were searched in January 2024. The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool.Results: 20,612 participants were included from 31 studies, of which 3203 (15.54%) living with psychotic conditions, 17,301 from the general population, 93 people with other conditions being compared to psychosis (such as bipolar disorder) and 15 carers. There were 25 quantitative studies (24 cross-sectional, 1 prospective), five qualitative studies, and one mixed-methods study. Cross-sectional evidence suggests associations between negative body image and psychotic symptoms, especially paranoia, as well as wider mental and physical health outcomes. Potential factors contributing to the persistence of poor body image include psychosis symptoms, worries about appearance related judgements, negative self-concept, body ambivalence, appearance related safety-seeking behaviours, and traumatic memoriesConclusions: Negative body image is relevant to the lives of people with psychosis spectrum conditions. Recommendations to guide and improve future research are reported.

Background AVATAR therapy, a digitally supported intervention, utilises avatars to promote recovery in people who experience distressing auditory hallucinations. This approach was recently evaluated in a multicentre randomised controlled trial comparing brief (AV-BRF) and extended (AV-EXT) forms of therapy with treatment as usual (TAU). There was evidence for the effectiveness of therapy, particularly for AV-EXT. However, value for money needs to be assessed. Aims To compare separately the cost utility of the brief and extended forms of AVATAR therapy with TAU. Method In a three-arm randomised controlled trial the use of health services was measured, and costs (2021/2022; pounds sterling) calculated from a health and social care perspective over a 28-week follow-up period. Quality-adjusted life years (QALYs; derived from the 5-level version of the EuroQol 5-Dimension questionnaire) were combined with costs. Results AV-BRF resulted in extra costs of £319 (95% CI, −£1558 to £2496), and AV-EXT in lower costs of £1965 (95% CI, −£1912 to £1519), compared with TAU. Over the follow-up, AV-BRF resulted in 0.0159 (95% CI, −0.0103 to 0.0422) and AV-EXT in 0.0173 (95% CI, −0.0049 to 0.0395) more QALYs than TAU. The cost per QALY for AV-BRF compared with TAU was £20 016, while AV-EXT dominated TAU (lower costs and more QALYs). Conclusions Neither version of AVATAR had a substantial impact on QALYs. However, AV-EXT did result in reduced care costs − albeit not statistically significant − and was potentially cost-effective compared with TAU. AV-BRF had an incremental cost-effectiveness ratio that indicated lower potential cost-effectiveness. These findings are uncertain, but could still inform decision-making regarding interventions in this field.

PURPOSE:Body image is a transdiagnostic construct that seems poorly understood in psychosis. Poor body image is associated with paranoia, which makes it a theoretically meaningful treatment target in psychosis. We systematically reviewed associations between body image and psychosis symptoms in both the 'general' population and people living with psychotic disorders, synthesised known correlates of negative body image in people living with psychotic disorders and performed a meta-synthesis to understand the lived experience of body image in people with psychosis. METHODS:Ovid MEDLINE, OVID Embase, OVID APA PsycINFO, EBSCOhost Cinahl and the Cochrane Central Register of Controlled Trials were searched in January 2024. The methodological quality and risk of bias were assessed using the mixed-methods appraisal tool. RESULTS:20,565 participants were included from 31 studies, of which 2127 (10.3%) were living with psychotic conditions, 18,294 from the general population, 129 people with other conditions being compared to psychosis (such as bipolar disorder) and 15 carers. There were 25 quantitative studies (24 cross-sectional, 1 prospective), 5 qualitative studies and 1 mixed-methods study. Cross-sectional evidence suggests associations between negative body image and psychotic symptoms, especially paranoia, as well as wider mental and physical health outcomes. Potential factors contributing to the persistence of poor body image include psychotic symptoms, worries about appearance-related judgements, negative self-concept, body ambivalence, appearance-related safety-seeking behaviours and traumatic memories. CONCLUSIONS:Negative body image is relevant to the lives of people with psychosis spectrum conditions. Recommendations to guide and improve future research are reported.

BackgroundFear of relapse into psychosis is an independent risk factor for future relapse events, indicating its importance as a novel intervention target.MethodsTwenty-five participants responded to daily ecological momentary assessment prompts assessing common early warning signs of relapse and self-reported positive experiences like feeling supported by others. We conducted multilevel vector auto-regression using common symptoms assessed in early warning signs monitoring relapse prevention while controlling for positive self-reported experiences like feeling supported by others to estimate three networks (to explore concurrent, temporal and overall relationships).ResultsReporting fear of relapse was positively associated (within the same cross-sectional time window) with hearing voices, alongside anxiety, negative affect and sleep change. Fear of relapse appeared to predict anxiety, negative affect and greater fear of relapse on the next consecutive day. However, none of the typical early warning signs predicted fear of relapse within the temporal window, and the observed relationships were small.DiscussionEarly warning signs appeared to be poor predictors of experiencing fear of relapse in this study. Fear of relapse predicts later anxiety and negative affect and may be a valuable intervention target within the daily life of people diagnosed with schizophrenia.

BackgroundPeople with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behaviours and reduce avoidable psychiatric admissions.MethodsA multi-stage, multi-arm (MAMS) randomised controlled trial (RCT) with four arms conducted over two stages to determine the clinical and cost effectiveness of three psychosocial treatments, compared to treatment as usual (TAU), for people with SMHP who have had recent suicidal crisis. Primary outcome is any psychiatric hospital admissions over a 6-month period. We will assess the impact on suicidal thoughts and behaviour, hope, recovery, anxiety and depression. The remote treatments delivered over 3 months are structured peer support (PREVAIL); a safety planning approach (SAFETEL) delivered by assistant psychologists; and a CBT-based suicide prevention app accessed via a smartphone (BrighterSide). Recruitment is at five UK sites. Stage 1 includes an internal pilot with a priori progression criteria. In stage 1, the randomisation ratio was 1:1:1:2 in favour of TAU. This has been amended to 2:2:3 in favour of TAU following an unplanned change to remove the BrighterSide arm following the release of efficacy data from an independent RCT. Randomisation is via an independent remote web-based randomisation system using randomly permuted blocks, stratified by site. An interim analysis will be performed using data from the first 385 participants from PREVAIL, SAFETEL and TAU with outcome data at 6 months. If one arm is dropped for lack of benefit in stage 2, the allocation ratio of future participants will be 1:1. The expected total sample size is 1064 participants (1118 inclusive of BrighterSide participants).DiscussionThere is a need for evidence-based interventions to reduce psychiatric admissions, via reduction of suicidality. Our focus on remote delivery of established brief psychosocial interventions, utilisation of different modalities of delivery that can provide sustainable and scalable solutions, which are also suitable for a pandemic or national crisis context, will significantly advance treatment options.Trial registrationISRCTN33079589. Registered on June 20, 2022.