BACKGROUND:Involuntary admission (IA) is a contentious practice in mental healthcare, justified only to prevent harm to self or others. Previous studies have identified individual sociodemographic characteristics as risk factors for IA. Intersectional theories argue that such approaches overlook the complexities of social identities and related health inequalities. Intersectionality stresses the interconnected nature of social identities, such as race or class, and analyses how these overlapping factors create unique experiences of marginalisation and discrimination. This study aimed to adopt an intersectional framework to identify subgroups with specific sociodemographic characteristics and assess their risk for IA. We hypothesized that groups facing multiple forms of marginalisation would be strongly associated with higher risk for IA. METHODS:We analysed data from 16,024 cases at the Psychiatric University Clinic Zurich, Switzerland, between 2017 and 2020 using Latent Class Analysis to identify subgroups with distinct sociodemographic characteristics. Variables included sex, age, nationality, residence status, educational attainment, employment status, and language proficiency. Classes were validated against clinical factors including IA. RESULTS:Four distinct classes emerged. The class most strongly associated with IA was characterized by unemployment, social welfare dependency, non-European citizenship, temporary residency or refugee status, and low educational attainment. In contrast, classes with Swiss nationality, permanent residency, and employment were significantly less likely to experience IA. CONCLUSION:Adopting an intersectional framework, our findings suggest that individuals facing multiple marginalised identities are at higher risk for IA, indicating possible barriers to voluntary and early treatment. Further research is needed to explore and address these barriers.

Background:We examined the course of cognitive performance in first-episode psychosis (FEP) compared to healthy controls (HC), and whether this varied across subgroups of patients defined by premorbid functioning (PMF) trajectories, using a clustering approach. Methods:Data were collected in 302 FEP and 136 HC subjects participating in PSYSCAN (HEALTH.2013.2.2.1-2-FEP). K-means clustering (Euclidean distance) was used to cluster longitudinal trajectories of different PMF domains simultaneously. Since PMF was assessed retrospectively using the Premorbid Adjustment Scale (PAS), findings should be interpreted with caution, although PAS ratings have shown reasonable validity against prospective data. Results:As expected, FEP showed impaired performance across all cognitive domains compared to HC. We identified four trajectories of PMF: a normal premorbid developmental trajectory (globally-normal, 21 %), stable intermediate PMF across domains (stable-intermediate, 29 %), stable poor or deteriorating PMF in the academic domain (normal-social/poor-academic, 29 %), and a globally impaired group with poor/deteriorating PMF across domains (globally-poor, 21 %). These clusters showed distinct levels of post-onset impairments in sustained visual attention, visual working memory and emotion recognition. Conclusions:This study confirms a positive association between PMF and cognitive performance in the early years following psychosis onset. It aligns with findings that individuals later diagnosed with schizophrenia already show developmental deficits/lags from childhood to early adolescence compared to normally developing children. As PMF can be considered a proxy for cognitive reserve, our results suggest that higher reserve acts as a buffer against cognitive decline and supports better performance on sustained visual attention, complex visual working memory, and aspects of emotion recognition.

Background and hypothesisThis survey explores Swiss mental health professionals', users', and relatives' opinions on re-naming schizophrenia exploiting Switzerland's specific multilingualism to examine possible effects of linguistic and microcultural differences on the issue.Study designOpinions on ‘schizophrenia’ were collected using a self-rated online questionnaire incl. Freetext answers available in the three main Swiss languages, German, French and Italian. It was distributed to the main professional and self-help organizations in Switzerland between June and October 2021.Study resultsOverall, 449 persons completed the questionnaire, 263 in German, 172 in French and 14 in Italian. Of the total sample, 339 identified as mental health professionals, 81 as relatives and 29 as users. Considering the whole sample, almost half favored a name-change with a significant difference between stakeholder- and between language groups. Also, the name ‘schizophrenia’ was evaluated more critically than the diagnostic concept. Qualitative analysis of freetext answers showed a highly heterogenous argumentation, but no difference between language groups.ConclusionsOur results suggest the attitude towards re-naming might itself be subject to (micro)cultural difference, and they highlight the nature of ‘schizophrenia’ as not only a scientific, but also a linguistic and cultural object. Such local factors ought to be taken into consideration in the global debate.

BackgroundWe examined the course of illness over a 12-month period in a large, international multi-center cohort of people with a first-episode schizophrenia spectrum disorder (FES) in a naturalistic, prospective study (PSYSCAN).MethodPatients with a first episode of schizophrenia, schizoaffective disorder (depressive type) or schizophreniform disorder were recruited at 16 institutions in Europe, Israel and Australia. Participants (N = 304) received clinical treatment as usual throughout the study.ResultsThe mean age of the cohort was 24.3 years (SD = 5.6), and 67 % were male. At baseline, participants presented with a range of intensities of psychotic symptoms, 80 % were taking antipsychotic medication, 68 % were receiving psychological treatment, with 46.5 % in symptomatic remission. The mean duration of untreated psychosis was 6.2 months (SD = 17.0). After one year, 67 % were in symptomatic remission and 61 % were in functional remission, but 31 % had been readmitted to hospital at some time after baseline. In the cohort as a whole, depressive symptoms remained stable over the follow-up period. In patients with a current depressive episode at baseline, depressive symptoms slightly improved. Alcohol, tobacco and cannabis were the most commonly used substances, with daily users of cannabis ranging between 9 and 11 % throughout the follow-up period.ConclusionsThis study provides valuable insight into the early course of a broad range of clinical and functional aspects of illness in FES patients in routine clinical practice.

Primary headaches are a common debilitating health condition. Proper diagnosis and treatment depend on patients’ communication. We wanted to explore differences in pain communication with a special interest in potential sex differences. Patients visiting our headache unit for the first time filled in two different questionnaires (one before entering the consultation and one directly after finishing the consultation), through which we captured patients’ descriptions of their pain, its potential impact on daily lives, the well-being of our patients and the satisfaction with our consultation. We included a total of 35 patients (22 female, 13 male). Women reported experiencing a greater loss of socially active days during the last 3 months because of headaches compared to men. Furthermore, women were more satisfied with our consultation. In addition, we revealed migraineurs characterize their pain differently than stated in the International Classification of Headache Disorders (ICHD-3) criteria. The adjective “pressing” (drückend) was used significantly more often by migraineurs compared to patients with tension-type headaches. Nevertheless, in the physicians’ written report, the characterization more often contained the ICHD-3 corresponding adjective “pulsating” (pulsierend). Since the typification of headaches and subsequent therapy depends predominantly on the patients’ communication, consideration of the individual pain description and further research on headache characterization are indispensable.

Delusions have traditionally been considered the hallmark of mental illness, and their conception, diagnosis and treatment raise many of the fundamental conceptual and practical questions of psychopathology. One of these fundamental questions is whether delusions are understandable. In this paper, we propose to consider the question of understandability of delusions from a philosophy of language perspective. For this purpose, we frame the question of how delusions can be understood as a question about the meaning of delusional utterances. Accordingly, we ask: “what meaning(s) can delusional utterances possibly have?”. We argue that in the current literature, there is a standard approach to the meaning of delusional utterances, namely the descriptive account which assumes that a delusional utterance “p” means that p is the case. Drawing on Speech Act Theory, we argue that solely relying on the descriptive account disregards essential ways of how linguistic meaning is constituted. Further, we show that Speech Act Theory can prove a helpful addition to the theoretical and clinical “toolbox” used for attempting to understand delusional utterances. This, we believe, may address some of the theoretical and clinical shortcomings of using only the currently predominant descriptive account.

BACKGROUND: Over the last two decades, the relationship between distance and mental health and the role of distance in psychotherapy has generated considerable research interest. Up to date, operationalisations have primarily focused on verbal content whereas descriptions of distance on the level of communicative form are lacking in the psychological literature.

Über Wahn zu sprechen gilt allgemein als schwierig, ist aber wesentlich in der psychiatrisch-psychotherapeutischen Behandlung und für den Recovery-Prozess. Ausgehend von der Annahme, dass trotz aller Schwierigkeiten vielfältige Ressourcen für die kommunikative Darstellung von Wahn bestehen und kompetent genutzt werden, präsentieren wir in diesem Artikel die gesprächsanalytische Untersuchung zweier narrativer Interviews, in denen über Wahnerfahrungen gesprochen wird. Der Fokus unserer Untersuchung liegt dabei auf dem Wie des Erzählens, weiterhin beachten wir insbesondere die kommunikative Interaktion. Wir zeigen, dass die beiden Sprecher:innen durch Pausen, Abbrüche und Reformulierungen, durch Aushandlung des sog. „common ground“ und durch die Verwendung metaphorischer Ausdrücke vielfältige Aspekte des Wahnerlebens vermitteln. Dabei geht das, was sie auf diese Art zum Ausdruck bringen, weit über das, was sie inhaltlich beschreiben, hinaus. Diese beispielhaft herausgearbeiteten kommunikativen Strategien können eine Hilfestellung für andere sein, sich der Herausforderung, über Wahn zu sprechen, leichter zu stellen – nicht im Sinne normativer Empfehlungen, sondern im Sinne von Anregung, Sichtbarmachen von Ressourcen und Ermutigung.

Language is a potential source of predictors for suicidal thoughts and behaviors (STBs), as changes in speech characteristics, communication habits, and word choice may be indicative of increased suicide risk. We reviewed the current literature on STBs that investigated linguistic features of spoken and written language. Specifically, we performed a search in linguistic, medical, engineering, and general databases for studies that investigated linguistic features as potential predictors of STBs published in peer-reviewed journals until the end of November 2021.We included 75 studies that investigated 279,032 individuals with STBs (age = 29.53 ± 10.29, 35% females). Of those, 34 (45%) focused on lexicon, 20 (27%) on prosody, 15 (20%) on lexicon and first-person singular, four (5%) on (morpho)syntax, and two (3%) were unspecified. Suicidal thoughts were predicted by more intensifiers and superlatives, while suicidal behaviors were predicted by greater usage of pronouns, changes in the amount of verb usage, more prepend and multifunctional words, more nouns and prepositions, and fewer modifiers and numerals. A diverse field of research currently investigates linguistic predictors of STBs, and more focus is needed on their specificity for either suicidal thoughts or behaviors.

Negative symptoms such as anhedonia and apathy are among the most debilitating manifestations of schizophrenia (SZ). Imaging studies have linked these symptoms to morphometric abnormalities in 2 brain regions implicated in reward and motivation: the orbitofrontal cortex (OFC) and striatum. Higher negative symptoms are generally associated with reduced OFC thickness, while higher apathy specifically maps to reduced striatal volume. However, it remains unclear whether these tissue losses are a consequence of chronic illness and its treatment or an underlying phenotypic trait. Here, we use multicentre magnetic resonance imaging data to investigate orbitofrontal-striatal abnormalities across the SZ spectrum from healthy populations with high schizotypy to unmedicated and medicated first-episode psychosis (FEP), and patients with chronic SZ. Putamen, caudate, accumbens volume, and OFC thickness were estimated from T1-weighted images acquired in all 3 diagnostic groups and controls from 4 sites (n = 337). Results were first established in 1 discovery dataset and replicated in 3 independent samples. There was a negative correlation between apathy and putamen/accumbens volume only in healthy individuals with schizotypy; however, medicated patients exhibited larger putamen volume, which appears to be a consequence of antipsychotic medications. The negative association between reduced OFC thickness and total negative symptoms also appeared to vary along the SZ spectrum, being significant only in FEP patients. In schizotypy, there was increased OFC thickness relative to controls. Our findings suggest that negative symptoms are associated with a temporal continuum of orbitofrontal-striatal abnormalities that may predate the occurrence of SZ. Thicker OFC in schizotypy may represent either compensatory or pathological mechanisms prior to the disease onset.

Psychiatric emergencies occur frequently in the community setting, e.g. the patient's home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient's home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.

Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed in light of these considerations.

In the last 2 decades, several neuroimaging studies investigated brain abnormalities associated with the early stages of psychosis in the hope that these could aid the prediction of onset and clinical outcome. Despite advancements in the field, neuroimaging has yet to deliver. This is in part explained by the use of univariate analytical techniques, small samples and lack of statistical power, lack of external validation of potential biomarkers, and lack of integration of nonimaging measures (eg, genetic, clinical, cognitive data). PSYSCAN is an international, longitudinal, multicenter study on the early stages of psychosis which uses machine learning techniques to analyze imaging, clinical, cognitive, and biological data with the aim of facilitating the prediction of psychosis onset and outcome. In this article, we provide an overview of the PSYSCAN protocol and we discuss benefits and methodological challenges of large multicenter studies that employ neuroimaging measures.

Diagnostic terms in psychiatry like 'schizophrenia' and 'bipolar disorder' are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of 'schizophrenia.' Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders.

This chapter situates privacy and confidentiality as central ethical, legal, and anthropological concepts for psychotherapeutic practice. It first provides some conceptual background and clarification of the concepts before considering their specific relevance in the context of psychotherapy. In particular, it explores a unique significance that, it is argued, privacy and confidentiality acquire in the therapeutic process to do with the anthropological dimension of privacy, its psychological function, and the specific dynamics of the therapeutic relationship. Based on four case vignettes, potential ethical conflicts about privacy and confidentiality are then discussed. Finally, principles that can guide practitioners in responding to ethical conflicts about privacy and confidentiality in clinical practice are provided.

Abstract Background The treatment in the years following a first-psychosis episode is most crucial as typically, the illness onset occurs in a delicate phase of the young adults (Correll, 2018). To address the specialities in the care for this patient population both, the Child and Adolescent, together with the adult department of the Psychiatric University Hospital Zürich implemented the ZEN psychosis first episode program. Members of the specialized team connected in their function as network coaches in a systemic approach all players of the patient’s social and medical network. The better communication on transition points such as to adult department, together with possibilities of low-threshold treatment, aimed to improve treatment adherence and reduce repeated hospitalisations. The study’s main objective was to evaluate the efficacy of the program and with that optimize the treatment process in daily clinical routine. A jurisdictional inquiry has been requested by Swiss Ethics Committees on research involving humans in Zurich and the present study project is classified as quality control of the clinical treatment. Methods Participants of the ZEN Program included in 2017 and 2018 were followed up to duration of 24 months. The following measures were assessed before and after enrolment in the program: Satisfaction with life, measured with the Manchester Short Assessment of Quality of Life (MANSA; Priebe et al., 1999); Number of rehospitalisations and coercive treatment; Global assessment of functioning (GAF) (Endicott et al., 1976); and measures of Social and vocational recovery. Results In Florence, results and implications will be presented for included patients. Rates of rehospitalisations will be compared against literature. Mean relaps rates at 24 months have been reported to vary from 38% under specialized integrated care, to up to 49% under treatment as usual (Fusar-Poli et al., 2017). Social and vocational recovery will be rated at follow-up and compared to baseline on a three-point scale (‘no’, ‘partial’ and ‘full’ recovery) (Craig et al., 2004, Garety et al., 2006). In addition, correlation coefficients will be determined to detect any associations among sociodemographic factors and clinical data such as amount of neuroleptic medication. Discussion The ZEN program is specialized for patients with first episode of psychosis. The intensive care together with an intensified communication between players of a patient’s network aims to achieve better outcomes. The evaluation of the clinical program is of importance. The study provides recent data for ongoing discussions about the quality of the treatments and its cost-effectiveness compared to standard treatment.

Apathy, one of the most severe and debilitating symptoms in schizophrenia, is thought to be associated with striatal and orbitofrontal structural abnormalities. However, it is unclear whether this holds across subclinical and early stages of the schizophrenia spectrum. Here, we investigated whether apathy in healthy individuals with schizotypal personality traits (SPT) and patients with first episode psychosis (FEP) is associated with reduced striatal volume and reduced thickness of the orbitofrontal cortex (OFC).