Introduction Le modèle d’intervention précoce dans la psychose (IPP) est devenu le « gold standard » pour le traitement des jeunes patients souffrant d’un trouble psychotique débutant. Toutefois en Suisse ce modèle reste peu implanté avec une disparité importante dans l’accès des patients à ce type de traitement. Dans le but de développer un langage commun et d’adopter une définition partagée de l’IPP, un groupe de travail en Suisse romande s’est penché, entre 2023 et 2024, sur le développement d’une Échelle de Fidélité Romande d’Intervention Précoce dans la Psychose (EFRIPP). Les raisons d’être de l’EFRIPP sont : (i) de définir les critères essentiels et nécessaires pour composer un service d’IPP adapté au contexte romand pour les centres voulant développer cette pratique ; (ii) d’éviter que les modèles mis en place s’éloignent des éléments dont l’efficacité a été démontrée scientifiquement ; (iii) de constituer un document harmonisé utilisable pour la formation de nouveaux professionnels en santé mentale et voulant avoir une connaissance concrète du modèle d’IPP. Méthode Un groupe multidisciplinaire travaillant dans les différents services de psychiatrie publics des cantons suisses de Vaud, Neuchâtel, Genève, Valais, Fribourg et Jura s’est réuni 4 fois par an entre 2023 et 2024 pour l’élaboration de l’EFRIPP. Les auteurs de cet article sont membres de ce groupe. Les normes de l’EFRIPP prennent en compte plusieurs échelles de fidélité existantes (Royaume-Uni, Danemark, Australie, Québec), en se basant principalement sur la grille québécoise, étant donné la proximité culturelle et linguistique entre la Suisse et le Québec. Résultats La structure de l’EFRIPP est basée sur une série de critères fondamentaux de l’IPP. Les critères sont divisés en trois sections pour évaluer : (i) la structure et l’organisation du centre d’IPP ; (ii) les modalités et processus cliniques ; (iii) le soutien à l’intention des intervenants. Dans l’ensemble, l’EFRIPP comprend 44 critères, dont 30 sont cotés de manière continue (1–5) et 14 de manière binaire (0=absent ; 1=présent). Une cotation pondérée permet l’obtention d’un score qui peut être classé entre « adhésion insuffisante » (0–100), « adhésion minimale » (101–120), « adhésion acceptable » (121–140), « bonne adhésion » (141–160) et « adhésion excellente » (161–176). Discussion Nous espérons que cet outil permettra une harmonisation des pratiques de l’IPP en Suisse romande et facilitera leur implantation dans chacun des cantons de manière que les jeunes patients qui développent un trouble psychotique puissent avoir accès au meilleur traitement possible, quel que soit leur lieu de vie.

INTRODUCTION:The Early Intervention in Psychosis (EIP) model has become the "gold standard" for the treatment of young patients with emerging psychotic disorders. In Switzerland, however, the model remains insufficiently developed, and access to care varies substantially across regions. To establish a common language and a shared definition of EIP, a working group from the French-speaking Swiss cantons (Romand) developed the Romand Fidelity Scale for Early Intervention in Psychosis (EFRIPP) between 2023 and 2024. The EFRIPP was designed to: (i) define the essential criteria for establishing an EIP service adapted to the Romand context for centers wishing to implement this practice; (ii) prevent divergence from elements with proven scientific effectiveness; and (iii) create a harmonized tool for training new mental health professionals and supporting a concrete understanding of the EIP model. METHOD:A multidisciplinary group from the public psychiatric services of the Swiss cantons of Vaud, Neuchâtel, Geneva, Valais, Fribourg, and Jura met four times a year between 2023 and 2024 to develop the EFRIPP. The authors of this article are members of this group. The EFRIPP draws on several existing fidelity scales (UK, Denmark, Australia, Quebec) but are primarily based on the Quebec scale, given the cultural and linguistic proximity between Switzerland and Quebec. RESULTS:The EFRIPP is organized around a set of core EIP criteria, divided into three sections assessing: (i) the structure and organization of the EIP center; (ii) clinical modalities and processes; and (iii) support for practitioners. Overall, the EFRIPP includes 44 criteria: 30 rated continuously (1-5) and 14 rated dichotomously (0=absent; 1=present). À weighted scoring system yields a total score, categorized as "insufficient adherence" (0-100), "minimal adherence" (101-120), "acceptable adherence" (121-140), "good adherence" (141-160), or "excellent adherence" (161-176). CONCLUSION:We hope that this tool will help harmonize of EIP practices in French-speaking Switzerland and support their implementation across the cantons, so that young patients developing a psychotic disorder have access to the best possible care, regardless of where they live.

Advances in three-dimensional magnetic resonance spectroscopic imaging (3D-MRSI) allow for the high-resolution mapping of multiple neurometabolites throughout the entire brain in vivo and within clinically compatible time frames. Leveraging this capability, we created a voxel-based pipeline that corrects and spatially normalizes whole-brain maps of total N-acetylaspartate (tNAA), myo-inositol (Ins), choline compounds (Cho), glutamate + glutamine (Glx) and creatine + phosphocreatine (tCr). We examined 2 different 3D-MRSI dataset: first, a clinical sample of adolescents and young adults at risk for psychosis (n = 21) meeting DSM-5 criteria for Attenuated Psychosis Syndrome (APS) or Schizotypal Personality Disorder (SCZT), and age-/sex-matched healthy controls (n = 13); and second, a non-clinical sample of adolescents (n = 61) scanned on a different site. The objective of the study was threefold: first, to assess the reproducibility of 3D-MRSI measures across datasets and scanning sites; second, to validate the feasibility of whole-brain, voxel-based analyses on 3D-MRSI data; and third, to test the sensitivity of this approach. Metabolite distributions showed reproducible regional variation in standard space between the two independent samples and scanning sites (r ranging from 0.82 to 0.99). Relative to controls, at-risk participants exhibited higher tNAA levels in frontal grey matter; the SCZT subgroup additionally displayed widespread cortical and subcortical elevations of Ins levels compared with both APS and controls. Voxel-based analyses of structural (i.e., gray and white matter volumes or densities) and diffusion (i.e., generalized fractional anisotropy) parameters yielded no significant differences between patients and controls. These preliminary findings suggest that high-resolution 3D-MRSI may be sensitive enough to detect subtle neurometabolic alterations at the group level in the early stages of psychotic disorders when structural or diffusion measures show no difference. High-resolution whole-brain metabolic mapping may have the potential to help with early identification of young people at risk for psychosis or other mental disorders.

Overcoming an initial psychotic episode does not always lead to recovery; relapses and subsequent psychotic episodes may happen afterward. Even if the characterization of psychotic disorders can be related to alterations in brain connectivity, clear identification of the brain areas for relapse is missing. Here, we leverage on whole-brain modeling linking anatomical structural information with functional activity as measured by MRI in 196 participants. Patients were classified into Stage II (first episode), IIIa (incomplete remission), IIIb (remission followed by one relapse), and IIIc (remission followed by several relapses), depending on the course of psychosis up to the time of the brain scan. From these data, a low-dimensional manifold reduction of the brain dynamics was obtained using deep learning variational autoencoders in which the different stages are represented, and a classification model can be trained to distinguish them. Then, a dimensionality analysis was performed to find the optimal dimension that allows the distinction between first episode and relapsing cases with high accuracy. Finally, perturbations were introduced in the model to reveal the brain regions associated with the absence of relapse, which could help predict which brain regions to target during therapy and assist the treatment of patients suffering from psychotic disorders.

Introduction: Clinical High Risk for Psychosis (CHR) states are associated with an increased risk of transition to psychosis. However, the predictive value of CHR screening interviews is dependent on pretest risk enrichment in referred patients. This poses a major obstacle to CHR outreach campaigns since they invariably lead to risk dilution through enhanced awareness. A potential compensatory strategy is to use estimates of individual pretest risk as a ‘gatekeeper’ for specialized assessment. We aimed to test a risk stratification model previously developed in London, UK (OASIS) and to train a new predictive model for the Swiss population.Method: The sample was composed of 513 individuals referred for CHR assessment from six Swiss early psychosis detection services. Sociodemographic variables available at referral were used as predictors whereas the outcome variable was transition to psychosis.Results: Replication of the risk stratification model developed in OASIS resulted in poor performance (Harrel’s c = 0.51). Retraining resulted in moderate discrimination (Harrel’s c = 0.67) which significantly differentiated between different risk groups. The lowest risk group had a cumulative transition incidence of 6.4% (CI: 0% - 23.1%) over two years.Conclusion: Failure to replicate the OASIS risk stratification model might reflect differences in the public health care systems and referral structures between Switzerland and London. Retraining resulted in a model with adequate discrimination performance. The developed model in combination with CHR assessment result, might be useful for identifying individuals with high pretest risk, who might benefit most from specialized intervention.

Recent developments in acquisition and reconstruction of 3-dimensional magnetic-resonance spectroscopic imaging (3D-MRSI) enable the high-resolution mapping of multiple neurometabolites in the whole-brain, in vivo. Leveraging this capability, we created a voxel-based pipeline that corrects and spatially normalizes whole-brain maps of total N-acetylaspartate (tNAA), myo-inositol (Ins), choline compounds, glutamate + glutamine, and creatine + phosphocreatine. We examined a clinical cohort of adolescents and young adults at risk for psychosis (n= 21) —meeting DSM-5 criteria for Attenuated Psychosis Syndrome (APS)or Schizotypal Personality Disorder (SCZT)— and age-/sex-matched healthy controls (n =13), as well as an independent non-clinical sample of adolescents (n = 61). We first aimed at assessing the reproducibility of MRSI measures across datasets and scanning sites, then validate the feasibility of a whole-brain voxel-based analyses on 3D-MRSI data and eventually test the sensitivity of this approach. Metabolite distributions showed reproducible regional variation in standard space between the two independent samples and scanning sites (r ranging from 0.82 to 0.99). Relative to controls, at-risk participants exhibited higher tNAA in frontal grey matter; the SCZT subgroup additionally displayed widespread cortical and subcortical Ins elevations compared with both APS and controls. Voxel-based analyses of structural (i.e., gray and white matter volumes or densities) and dijusion (i.e., generalized fractional anisotropy) parameters yielded no significant dijerences between risk participants and controls. These findings suggest the sensitivity of high-resolution 3D-MRSI for detecting subtle neurometabolic alterations at the group level in the early stages of psychotic disorders. Detailed brain metabolic mapping has the potential to help with early identification of young people at risk for psychosis or other mental disorders. ### Competing Interest Statement AK is employed by Siemens Healthineers AG, Switzerland. The other authors have nothing to disclose. Swiss National Science Foundation, https://ror.org/00yjd3n13, 215728 University of Lausanne, https://ror.org/019whta54 Adrian & Simone Frutiger Foundation Fondation Leenaards, https://ror.org/004h88r69

BACKGROUND:Substance use disorder (SUD) is common in first-episode psychosis (FEP) and linked to poorer clinical and functional outcomes. Previous studies were mostly cross-sectional or short-term, leaving the longitudinal impact of SUD course unclear. This study aimed to (A) group patients based on different trajectories of cannabis use disorder (CUD) and alcohol use disorder (AUD) over 3-year follow-up and to (B) examine associations with baseline characteristics and clinical outcomes. METHODS:We included 467 FEP patients enrolled in a 3-year early intervention program. Latent class analysis found subgroups based on cannabis and alcohol use trajectories. Groups were then compared using logistic regressions and mixed-model repeated measures (MMRM), adjusting for relevant confounders. RESULTS:We found different evolution of AUD and CUD: alcohol users tended to maintain consumption over time, while a subset of cannabis users reduced their consumption. Persistent alcohol users showed worst baseline characteristics and outcomes if compared to abstinent or light consumers. Concerning cannabis, MMRM analyses showed that abstinent or light users consistently had better symptom evolution compared to persistent or decreased users. However, the decreased group showed higher hospitalization rates than the other groups. They also showed gradual improvement in negative symptoms, reaching similar levels to abstinent users by the end of the program. CONCLUSIONS:This study outlines the distinct evolution of alcohol and cannabis consumption in FEP patients, suggesting the importance of tailored therapeutic approaches. Consistently with existing literature, abstinence or light use seems to be beneficial, while reducing cannabis use appears to offer a limited clinical improvement.

AIM:We aim to give an insight into the current situation in Switzerland concerning the pathways to care of young people with clinical high risk of psychosis. In a second step we propose a procedure of optimizing pathways to care developed within the project PsyYoung. METHODS:A qualitative survey derived and adapted from Kotlicka-Antczak et al. (2020) was conducted in large early detection services of three Swiss cantons (Geneva, Basel-Stadt, Vaud) focusing on pathways to care. More specifically, using questionnaires delivered to the heads of participating services, information was collected on referral sources, on activities to implement outreach campaigns and on the use of a pre-screening tool. RESULTS:Main results on referral source indicated that sources were variable but seemed to come primarily from the medical sector and more so from the psychiatric sector. Very few referrals came from non-medical sectors. Outreach activities included the contact to other clinics as well as through brochures and posters. All services but one used the Prodromal Questionnaire - 16 as pre-screening tool. CONCLUSIONS:All in all, the results indicate a referral and care pathway system implemented mostly within the medical and particularly mental health sector. Accordingly, the PsyYoung project proposes a procedure for pathways to care which could help overcome the obstacle of referrals being restrained to a narrow field of mental health and to harmonize the referral process within services dedicated to the same aim of helping young people at high risk of developing a psychosis.

Introduction Some aspects of gender differences in patients with schizophrenia spectrum disorders (SSD) have been studied, especially in cross-sectional designs and with a short-term follow-up. However, only a few studies have considered the evolution during the follow-up of SSD patients according to their gender. In this study, we explore gender differences from the time of entry in an early intervention program for psychosis, up to three years follow-up. Methods We conducted a prospective study including a cohort of 474 patients treated at the Treatment and Early Intervention in Psychosis (TIPP) program, 319 men and 155 women, having presented a first episode of psychosis (FEP). Data regarding premorbid and baseline sociodemographic, psychopathological and patient functioning, were collected. These data were reassessed longitudinally after 2, 6, 12, 18, 24, 30 and 36 months after entry in TIPP. Results Regarding premorbid and baseline characteristics, woman developed threshold symptoms of a FEP 1 year later than men on average. Women were more likely to be married, men were more likely to live in pension or care home facility or to be homeless. Women displayed a higher rate of history of suicide attempts and exposure to childhood trauma, while men were more likely to have a forensic history, a history of abuse of alcohol and cannabis as well as a dependency to cannabis at the time of entry in TIPP. Regarding evolution, men were more prone to violent acts and were less likely to decrease their usage of substances. The longitudinal analysis highlighted that men displayed greater negative symptoms over the entire treatment period, lower functioning after 6 months and on all assessment points after. Both genders displayed similar rate of improvement in these 3 dimensions over time. Conclusion Our study confirms that there are some gender differences in the early phase of psychosis that may require differentiation of assessment and treatment to improve recovery.

This study aims to determine whether 1) individuals with treatment-resistant schizophrenia display early cognitive impairment compared to treatment-responders and healthy controls and 2) N-methyl-D-aspartate-receptor hypofunction is an underlying mechanism of cognitive deficits in treatment-resistance. In this case‒control 3-year-follow-up longitudinal study, n = 697 patients with first-episode psychosis, aged 18 to 35, were screened for Treatment Response and Resistance in Psychosis criteria through an algorithm that assigns patients to responder, limited-response or treatment-resistant category (respectively resistant to 0, 1 or 2 antipsychotics). Assessments at baseline: MATRICS Consensus Cognitive Battery; N-methyl-D-aspartate-receptor co-agonists biomarkers in brain by MRS (prefrontal glutamate levels) and plasma (D-serine and glutamate pathways key markers). Patients were compared to age- and sex-matched healthy controls (n = 114). Results: patient mean age 23, 27% female. Treatment-resistant (n = 51) showed lower scores than responders (n = 183) in processing speed, attention/vigilance, working memory, verbal learning and visual learning. Limited responders (n = 59) displayed an intermediary phenotype. Treatment-resistant and limited responders were merged in one group for the subsequent D-serine and glutamate pathway analyses. This group showed D-serine pathway dysregulation, with lower levels of the enzymes serine racemase and serine-hydroxymethyltransferase 1, and higher levels of the glutamate-cysteine transporter 3 than in responders. Better cognition was associated with higher D-serine and lower glutamate-cysteine transporter 3 levels only in responders; this association was disrupted in the treatment resistant group. Treatment resistant patients and limited responders displayed early cognitive and persistent functioning impairment. The dysregulation of NMDAR co-agonist pathways provides underlying molecular mechanisms for cognitive deficits in treatment-resistant first-episode psychosis. If replicated, our findings would open ways to mechanistic biomarkers guiding response-based patient stratification and targeting cognitive improvement in clinical trials.

AIMS:Psychotic disorders are one of the main causes of chronic disability in young people. An at-risk mental state (ARMS) is represented by subclinical symptoms that precede the first episode of psychosis (FEP). The PsyYoung project aims to optimize the detection of an ARMS while reducing unnecessary psychiatric treatments. It investigates the effects of service changes on the referrals and outcomes of young people with ARMS or a FEP. METHODS:Six psychiatric outpatient clinics in three cantons (Basel-Stadt, Vaud, and Geneva) participated in the project. They passed through an implementation phase including service changes and the adaptation of a standardized stepped care model for diagnosis and assessment, in addition to measures for increasing the awareness, networking and training of local professionals. PRELIMINARY RESULTS:All participating cantons had entered the implementation phase. By March 2023, there were 619 referrals to participating sites. A total of 163 patients (37% FEP and 31% ARMS) and 15 close relatives had participated in individual longitudinal assessments, and 26 patients participated in qualitative interviews. CONCLUSION:This national collaborative project addresses the issue of early intervention for emerging psychoses, and creates spaces for fruitful reflections and collaboration in Switzerland. The ultimate aim of PsyYoung is to harmonize clinical practices in early intervention of psychosis on a national level.

BackgroundFrequently associated with early psychosis, depressive and manic dimensions may play an important role in its course and outcome. While manic and depressive symptoms can alternate and co-occur, most of the studies in early intervention investigated these symptoms independently. The aim of this study was therefore to explore the co-occurrence of manic and depressive dimensions, their evolution and impact on outcomes. MethodsWe prospectively studied first-episode psychosis patients (N = 313) within an early intervention program over 3 years. Based on latent transition analysis, we identified sub-groups of patients with different mood profiles considering both manic and depressive dimensions, and studied their outcomes. ResultsOur results revealed six different mood profiles at program entry and after 1.5 years follow-up (absence of mood disturbance, co-occurrence, mild depressive, severe depressive, manic and hypomanic), and four after 3 years (absence of mood disturbance, co-occurrence, mild depressive and hypomanic). Patients with absence of mood disturbance at discharge had better outcomes. All patients with co-occurring symptoms at program entry remained symptomatic at discharge. Patients with mild depressive symptoms were less likely to return to premorbid functional level at discharge than the other subgroups. Patients displaying a depressive component had poorer quality of physical and psychological health at discharge. ConclusionsOur results confirm the major role played by mood dimensions in early psychosis, and show that profiles with co-occurring manic and depressive dimensions are at risk of poorer outcome. An accurate assessment and treatment of these dimensions in people with early psychosis is crucial.

Introduction Over the years, surgical education has dramatically improved and has become increasingly innovative. Almost all educational programs in surgery now rely on sophisticated training boxes and simulators that enable surgical instruments to be handled and surgical procedures to be trained in a safe environment. However, simulators need constant feedback from supervising senior surgeons, who only have limited teaching time available. We describe a cardiac surgery simulator with an integrated supervision system for self-learning how to repair a mitral valve. Methods We developed a mitral surgery simulator with integrated sensors to generate, record, and display quantitative data on trainee performance in relation with the mitral valve repair procedure. A team of experienced cardiac surgeons defined critical areas of the model and an algorithm to identify inconsistent movements, in terms of error types and out-of-bound actions. The device provided real-time feedback on the accuracy of the stitches placed. Four experienced cardiac surgeons and 3 advanced cardiac-surgery used the simulator and were asked to evaluate specific parameters of the system on a scale ranging from 1 to 10. Results All surgeons completed a P2 resection, followed by implanting a 32-mm mitral ring. The simulator detected 2 stitches that were placed in dangerous zones and another stitch that was placed in an inappropriate position. Users scored the real tissue feeling and interactivity of the model 9.5/10. Conclusions This heart-surgery simulator offers a real-life model for learning about and training in mitral valve surgery, which could potentially replace the experienced surgeon's teaching role.

BACKGROUND:While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls. METHODS:Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study. RESULTS:Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life. CONCLUSIONS:Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.

Background: Considerable evidence on general population suggests that an "Affective pathway to psychosis", involving depression and anxiety dimensions, mediates the abuse-psychosis association. However, this has never been tested in Early Psychosis (EP) patients. We aim at testing whether severity of depressive and anxiety mediates the abuse-positive symptoms dyad in an EP prospective sample. Methods: 330 EP subjects aged 18-35 were assessed for psychopathology after 2, 6, 12, 18, 24, 30, and 36 months of treatment. Abuse was considered as facing at least one experience of physical, sexual, or emotional abuse before age 16. Positive psychotic symptoms and anxiety were measured with the Positive and Negative Syndrome Scale and depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Mediation analyses were performed to study whether the abuse-positive symptom's link was mediated by depressive, anxiety, and a combination of anxiety/mood symptoms. Results: Among the 330 EP patient included, 104 (31.5% of the total) were exposed to abuse. Analyses across the 36 months of follow-up showed that depression and anxiety partially mediated 26.7% of the total effect of the abuse-positive symptoms association (indirect effects (IE) = 0.392 and 0.421 respectively), while the combined anxiety/mood model mediated 28.9% (IE = 0.475). Subanalyses at two and 36 months revealed a consistent role of depression, while that of anxiety was only present at baseline. Conclusion: Our work confirms a mediating role of mood and anxiety in the association between abuse and positive symptoms during the first three years of treatment.

BACKGROUND:The factorial structure of schizophrenia symptoms has been much debated but little is known on its degree of unicity, specificity as well as its dynamic over time. Symptom differentiation is a phenomenon according to which patients' symptoms could differentiate from one another during illness to form more independent, distinct dimensions. On the contrary, symptom dedifferentiation is an increase in the correlations between those symptoms over time. The goal of this study was to investigate symptom differentiation or dedifferentiation over time in recent onset psychosis using the Positive and Negative Syndrome Scale. METHODS:A confirmatory factor analysis model based on the consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia was estimated on seven different time points over a three-year period. A general factor capturing common variance between every symptom was also included. Explained common variance was computed for the general factor and each specific factor. RESULTS:Three hundred and sixty-two recent onset psychosis patients were assessed. Results showed no evidence for either symptom differentiation or dedifferentiation over time. Specific symptoms accounted for >70 % of the variance suggesting a high degree of specificity of the symptomatology. CONCLUSIONS:Overall, this study adds support for a highly multidimensional approach to clinical symptom assessment with an explicit focus on depression. The premise behind the staging approach being inherently one-dimensional, implications for further research is discussed.

AIM:Reduction of duration of untreated psychosis (DUP) remains a key goal of early intervention programs. While a significant body of literature suggests that a short DUP has a positive impact on outcome, little is known regarding the threshold above which various dimensions of outcome are impaired. In this study, we explore the DUP threshold that best discriminates subgroups with poorer outcome regarding global functioning and quality of life after 3 years of treatment.METHOD:A total of 432 patients were followed-up prospectively over 3 years. Several hypothetical cut-off points for DUP were tested in order to maximize differences in effect size for quality of life and general functioning.RESULTS:While a DUP cut-off of 86 weeks defined two subpopulations with a difference of greatest effect size in quality of life after 3 years, it is already at a cut-off of 3 weeks of DUP that two subpopulations with a difference in global functioning of the greatest effect size was reached.CONCLUSION:DUP seems to have a differential impact on the various components of outcome, and in particular on quality of life and global functioning. Our data suggest that aiming at very short DUP is justified, but that DUP over 3 weeks are still compatible with good quality of life after 3 years of treatment.

Background: Atypical antipsychotics can induce metabolic side effects, but whether they are dose-dependent remains unclear. Objective: To assess the effect of risperidone and/or paliperidone dosing on weight gain and blood lipids, glucose, and blood pressure alterations. Methods: Data for 438 patients taking risperidone and/or its metabolite (paliperidone) for up to 1 year were obtained between 2007 and 2018 from a longitudinal study monitoring metabolic parameters. Results: For each milligram increase in dose, we observed a weight increase of 0.16% at 1 month of treatment (P = .002) and increases of 0.29%, 0.21%, and 0.25% at 3, 6, and 12 months of treatment, respectively (P < .001 for each). Moreover, dose increases of 1 mg raised the risk of a ≥ 5% weight gain after 1 month (OR = 1.18; P = .012), a strong predictor of important weight gain in the long term. When we split the cohort into age categories, the dose had an effect on weight change after 3 months of treatment (up to 1.63%, P = .008) among adolescents (age ≤ 17 years), at 3 (0.13%, P = .013) and 12 (0.13%, P = .036) months among adults (age > 17 and < 65 years), and at each timepoint (up to 1.58%, P < .001) among older patients (age ≥ 65 years). In the whole cohort, for each additional milligram we observed a 0.05 mmol/L increase in total cholesterol (P = .018) and a 0.04 mmol/L increase in LDL cholesterol (P = .011) after 1 year. Conclusions: Although of small amplitude, these results show an effect of daily risperidone dose on weight gain and blood cholesterol levels. Particular attention should be given to the decision of increasing the drug dose, and minimum effective dosages should be preferred.

Approximately 2% of adolescents and young adults display symptoms indicating a high risk for psychotic disorders. Apart from a risk of 20-35% of developing a psychotic disorder, these individuals show high rates of persisting mental health problems and functional impairment, even in the absence of a psychotic transition. Treatment in specialized centers can improve outcomes in these patients, but the need to provide timely access to care needs to be balanced against the risks of premature psychiatrization, stigmatization and unnecessary medication treatment. The transcantonal project PsyYoung aims to optimize early detection in young people, while at the same time minimizing unnecessary psychiatrization. This will be achieved through improved networking across the entire care chain and a stepped-care intervention approach.

PsyYoung : un projet pluri-cantonal pour faciliter l'accès aux soins des jeunes à risque de développer une psychosePrès de 2 % des adolescents et jeunes adultes présentent des symptômes indiquant un risque élevé de développer une psychose.Outre ce risque se situant entre 20 et 35 %, ces individus présenteront des taux élevés d'autres troubles psychiques et déficits fonctionnels, même en l'absence de transition vers la psychose.Le traitement dans des centres spécialisés peut améliorer l'évolution de ces patients mais les besoins de fournir un accès rapide aux soins doivent être mis en perspective des risques de psychiatrisation prématurée, stigmatisation, et médication inutile.Le projet pluri-cantonal PsyYoung vise à optimiser la détection précoce pour les jeunes, tout en minimisant la psychiatrisation inutile.Ceci sera atteint en améliorant le réseautage de l'ensemble de la chaîne de soins et la mise en oeuvre d'un modèle de soins par étapes. PsyYoung: A transcantonal project for facilitating access to care for young people at risk for psychotic disordersApproximately 2% of adolescents and young adults display symptoms indicating a high risk for psychotic disorders.Apart from a risk of 20-35% of developing a psychotic disorder, these individuals show high rates of persisting mental health problems and functional impairment, even in the absence of a psychotic transition.Treatment in specialized centers can improve outcomes in these patients, but the need to provide timely access to care needs to be balanced against the risks of premature psychiatrization, stigmatization and unnecessary medication treatment.The transcantonal project PsyYoung aims to optimize early detection in young people, while at the same time minimizing unnecessary psychiatrization.This will be achieved through improved networking across the entire care chain and a stepped-care intervention approach.