The PANSS Autism Severity Score (PAUSS) has recently become a popular measure of autistic features in psychosis populations, but evidence on its longitudinal reliability and factor configuration is poor. The aims of this investigation were to examine psychometric characteristics of the PAUSS in young patients with First Episode Psychosis (FEP) treated in an early intervention service, with primary interest for its long-term stability across 2 years of follow-up and factor configuration. All FEP participants completed the Positive And Negative Syndrome Scale (PANSS) and Autism Quotient (AQ) at baseline and across the follow-up. Statistical analysis mainly included Cronbach’s α to examine internal consistency of the PAUSS, Cohen’s k statistics and Spearman’s ρ correlation coefficients for its longitudinal stability and convergent validity with AQ scores, and exploratory factor analysis to explore its dimensions’ configuration. 301 FEP participants were recruited (170 with Schizophrenia Spectrum Disorder [SSD]). Cronbach’s α value for the PAUSS was 0.806, but with unacceptable inter-item correlations for PANSS G5 and G15 items. K value for examining PAUSS convergent validity with AQ score was unacceptable (0.295), as well as ρ and k values to quantify long-term test-retest reliability (< 0.750 and < 0.600, respectively). No long-term stability of the PAUSS scores across the follow-up was also found using Wilcoxon’s test for repeated measure. Our EFA found a 2-factor model in the FEP total sample and a 3-factor configuration in the SSD subgroup. Our results suggest that the PAUSS does not represent a valid instrument to assess autistic features in FEP and SSD. Indeed, the it probably captures psychotic symptom severity rather than autistic features, especially reflecting negative symptom load.

Purpose The PANSS Autism Severity Score (PAUSS) is a widely used measure of autism-like features in early psychosis, including mental states at “Clinical High Risk for Psychosis” (CHR-P). However, evidence regarding its relevance to long-term outcomes and treatment response is very scarce. Thus, the main aim of this investigation was to compare baseline clinical characteristics and longitudinal outcomes/treatment response between CHR-P subjects with or without autistic features recruited into a specialist early intervention service during a 2-year follow-up period. Methods CHR-P participants completed the Social and Occupational Functioning Assessment Scale (SOFAS) and the Positive And Negative Syndrome Scale (PANSS) at baseline and over the follow-up. Kaplan-Meyer survival analysis, mixed-design ANOVA, and binary logistic regression analysis were performed. Results Thirty-six (16.8%) of the 214 enrolled CHR-P individuals scored above the PAUSS cut-off of 30 (PAUSS + subgroup). At baseline, they showed higher PANSS and SOFAS scores, as well as higher prevalence rates of substance abuse and individuals not engaged in education, employment, or training. Over the follow-up period, they showed worse clinical and functional outcomes, including higher incidence rates of hospital re-admission (28.7% vs. 11.6%; Hazard Ratio [HR] = 3.38) and conversion to psychosis (26.0% vs. 12.0%; HR = 2.71), as well as lower likelihood of both functional (Hazard Risk [HR] = 4.23) and symptomatic (HR = 6.50) remission. However, our specialist intervention has proven effective in improving psychopathological and functional parameters over time even in the PAUSS + subgroup. Conclusions Our findings suggest that the PAUSS specifically identifies a CHR-P subgroup with greater clinical and functional severity at presentation and worse longitudinal outcomes.

Disorganization is under-treated in early psychosis. We aimed at exploring clinical factors potentially improving disorganization in individuals at Clinical High Risk for Psychosis (CHR-P) across 2 years of follow-up. About 180 participants completed the GAF and the PANSS. Longitudinally, 111 (61.7%) individuals had a decrease in disorganization. Significant associations of this improvement were with shorter duration of untreated illness, higher improvement in negative symptoms, and antipsychotic prescription.

Males with first episode psychosis (FEP) show poorer premorbid functioning, more severe psychopathology, and lower functional remission than females. Preliminary evidence suggests that even in Clinical High-Risk for Psychosis (CHR-P), males and females differ in clinical and psychosocial profiles. However, further investigations are needed, especially about outcomes and in adolescents. This study aimed to examine sex differences in clinical/functional presentation and longitudinal outcomes between CHR-P men and women assessing the impact of specialized “Early Intervention in Psychosis” (EIP) interventions over a two-year follow-up within an Italian program. 179 CHR-P men and women (90 females, 89 males; aged 12–25 years) were assessed using the Health of the Nation Outcome Scale and the Positive and Negative Syndrome Scale at baseline and annually for two years. Of them, 152 (76 males, 76 females) completed the follow-up. At baseline, males were older, had higher rates of substance use and unemployment, more severe negative symptoms, and poorer insight. They frequently suffered from brief limited, intermittent psychotic symptoms, whereas females predominantly from attenuated psychotic symptoms. Over two years, females showed a significantly higher rate of functional remission. Specialist EIP interventions increased across time and potentially contributed to improve outcomes in both sexes. Sex differences are evident at baseline in CHR-P participants, especially regarding psychopathology and social functioning. Nonetheless, clinical trajectories over time are largely comparable, except for greater functional recovery in females. These findings support the time effects of our early interventions regardless of sex but emphasize to further explore sex-specific pathways in psychosis risk and recovery.

INTRODUCTION:Predicting prognosis in subjects at Clinical High Risk for Psychosis (CHR-P) is still challenging. In particular, there are some disregarded factors such as ongoing Antipsychotic (AP) treatment that potentially induce method errors and research bias. The specific purpose of this examination was to examine whether baseline AP exposure and its dosage identify different CHR-P groups with diverse prognostic outcomes across 2 years of follow-up. METHODS:182 CHR-P participants (93 AP-naïve, 60 low-dose AP, 33 high-dose AP) were assessed for a broad range of clinical outcomes, including psychosis transition, clinical and functional remission (measured with the Positive and Negative Syndrome Scale and the Social and Occupational Functioning Assessment Scale). Inter-group comparisons were explored using Kaplan-Meier survival analyses and binary logistic regression analyses. RESULTS:Across the follow-up, the high-dose AP subgroup showed an increased risk of new hospitalisation and poorer functional remission compared to AP-naïve participants. Conversely, the low-dose AP subsample had a higher 2-year rate of symptomatic remission and a lower 2-year rate of self-harm behaviour compared to AP-naïve one. CONCLUSION:APs at low doses are associated with better symptomatic outcomes, whilst APs at high doses correlate to poorer socio-occupational functioning. Promoting personalised treatment strategies and facilitating the identification of specific CHR-P subgroups with divergent prognoses are recommended in clinical practise.

Purpose Evidence showed that music therapy may reduce mental health problems in different clinical settings, including prison. Compared to international experiences, music therapy experiences in Italian prisons are poor. The aim of the current article was to describe a 6-month period of group music therapy activities within the Parma Penitentiary Institute (PPI). Results Different music therapy experiences (improvisation, song listening, song performance) were reported, culminating in the creation of a new song as a spontaneous final product of the group activity. We also commented on thoughts and emotions experienced by group participants and the music therapist during this creative music process. The music therapy group included 6 PPI adult male prisoners with mental health problems. The lyrics of the song (“I ask for forgiveness”) were also reported. Conclusions A song creation process should be implemented together with other music therapy activities in Italian prisons, especially for its high creative value and its intrinsic ability in favoring the expression of prisoners’ subjective emotional, social and cognitive experiences.

PURPOSE:The PANSS Autism Severity Score (PAUSS) is a recent popular measure of autistic characteristics in Schizophrenia Spectrum Disorders (SSD). Evidence on its factor structure, longitudinal course, and treatment response is poor. The main aims of this investigation were: to examine its internal consistency and factor configuration in young patients with first-episode SSD treated in an Early Intervention (EI) service, and to compare clinical outcomes between SSD individuals with or without "autistic features" across 2 years of follow-up, as well as their treatment response. METHODS:SSD participants completed the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), and the Health of the Nation Outcome Scale (HoNOS) across the follow-up. Statistical tests included the α statistic, Exploratory Factor Analysis, Kaplan-Meyer survival analysis, mixed-design ANOVA, and multiple linear regression analysis. RESULTS:170 SSD individuals were enrolled (58 [34.1 %] scoring above the PAUSS cut-off [PAUSS+]). Internal consistency of the PAUSS was acceptable (α = .792). EFA identified a 3-factor model. At baseline, PAUSS + individuals showed greater severity in psychopathology and social decline. Across the follow-up, PAUSS + individuals had lower incidence rates of symptomatic remission. No PAUSS long-term stability was found, but a significant reduction that was predicted by lower antipsychotic dosage and higher number of case management sessions offered along the follow-up. CONCLUSIONS:The PAUSS seems to capture a SSD subgroup characterized by higher baseline severity levels in psychopathology and poorer outcomes.

Males and females with First Episode Psychosis (FEP) usually tend to differ in psychopathology, clinical presentation and their longitudinal trajectory. This study aimed to examine the difference of effectiveness of specialized psychosocial and pharmacological treatments for FEP, focusing on various clinical and functioning outcomes across a 2-years follow-up period. The assessment included the CAARMS, the HoNOS, the PANSS and the GAF scale and was conducted at baseline and every 12 months. 490 FEP patients (age: 12–35 years) were recruited. Of them, 363 completed the follow-up (132 females and 231 males). At baseline, males showed a higher prevalence rate of schizophrenia diagnosis (56.1

BACKGROUND AND HYPOTHESIS:Antipsychotic (AP) prescription in clinical high risk for psychosis (CHR-P) subjects remains a divisive issue. Although official guidelines currently discourage AP treatment in CHR-P, it is common in clinical practice, especially for psychosis prevention. The aim of this study was to investigate whether baseline AP need (especially in high-dose) indexes a CHR-P subgroup with poorer prognosis and differs from AP-naïve subjects in terms of sociodemographic, clinical, and outcome parameters across a 2-year follow-up. STUDY DESIGN:CHR-P participants were treated within an "Early Intervention in Psychosis" program and completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale both at baseline and every 12 months. Individuals with baseline AP prescription were included in the high-dose or low-dose CHR-P-AP+ subgroup. The others were grouped as AP-naïve. Cox regression analyses and mixed-design ANOVA were performed. STUDY RESULTS:180 CHR-P individuals were enrolled (32 high-dose, 60 low-dose, and 88 AP-naïve). Compared to AP-naive, CHR-P AP+ subgroups showed older age and more severe clinical presentation. High-dose subgroup also had grater functioning decline at entry and poorer functional recovery at follow-up. No inter-group differences in psychosis transition and symptomatic remission were found. Significant improvement in clinical outcomes were found over time in all subgroups. Baseline AP prescription was specifically associated with a more relevant improvement in PANSS total score, and in negative and disorganized symptoms. CONCLUSIONS:Our results suggest that baseline AP need is an important prognostic parameter in CHR-P and should be considered in risk/benefit calculators.

INTRODUCTION:There's a general lack of knowledge about autism attributes in early psychosis, although little initial evidence showed that having autistic features contributes to poorer recovery over time. The main aim of this examination was to compare sociodemographic and clinical variables between FEP patients with or without autistic characteristics treated within an "Early Intervention in Psychosis" (EIP) service both at entry and across 2 years of follow-up. We also examined the longitudinal course of autism severity levels in FEP to investigate whether they truly represented trait-like attributes. METHODS:FEP participants completed the AQ-spectrum Questionnaire (AQ), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) at baseline and over time. Inter-group comparisons were examined using Chi-Squared or Mann-Whitney test, Kaplan-Meyer survival analysis, mixed-design ANOVA, and binary logistic regression. AQ score longitudinal stability was explored using Wilcoxon test for repeated measures and Spearman correlation coefficient. RESULTS:132 subjects were recruited (28 [21.20 %] scored above the AQ cut-off score of≥26). At presentation, they showed younger age and higher severity in psychopathology (especially negative symptoms). Across the follow-up, the AQ+ subsample had lower incidence rates of service disengagement, PANSS symptomatic remission, and GAF functional remission. AQ scores showed longitudinal stability over time. CONCLUSIONS:The AQ represents a valid instrument to assess "trait-like" autistic features in FEP subjects. Specifically, it captures a distinct FEP subgroup characterized by more severe clinical presentation, poorer clinical and functional outcomes, and specific therapeutic needs.

The beneficial effects of reducing the duration of untreated psychosis on longitudinal outcomes has led to implement early intervention programs during prodromal phase, especially for young people. However, little is known about psychiatric antecedents in people experiencing First Episode Psychosis (FEP). This study aimed (1) to calculate the proportion of FEP participants with previous contact with Child/Adolescent or/and Adult Mental Healthcare Services (CAMHS/AMHS) recruited within a specialized “Early Intervention in Psychosis” service, and (2) to compare sociodemographic, clinical, and treatment parameters between FEP patients with and without psychiatric antecedents across a 2-year follow-up period. At baseline, all participants (aged 12–35 years) completed the Health of the Nation Outcome Scale (HoNOS). A mixed-design ANOVA and a Kaplan-Meier survival analysis were used. The prevalence of antecedents in our FEP population was 48

Purpose Patients with psychosis have a higher risk of compulsory admission. However, knowledge about its prognostic relevance in First Episode Psychosis (FEP) is poor. The aims of this study were to calculate its baseline prevalence rate in FEP individuals treated within an “Early Intervention” (EI) service, and to longitudinally compare clinical outcomes between FEP patients with and without baseline compulsory admission across 2 years of follow-up. Methods 500 FEP youths completed the PANSS and the GAF. Chi-squared/Mann-Whitney tests, mixed-design ANOVA, logistic regression, and Kaplan-Meier survival analysis were used for inter-group comparisons. Results 53 (10.6 %) FEP participants were compulsory admitted at entry. They were likely to be unemployed and to have lower baseline GAF score and more severe positive symptoms. They showed significant “time x group” effects for improvements in GAF and PANSS uncooperativeness scores. No inter-group difference in terms of service disengagement and new compulsory admission was found. Conclusion A non-negligible portion (1/10) of FEP participants entered the EI program through compulsory admission. However, this did not negatively impact on longitudinal outcomes, suggesting the beneficial effect of EI intervention in longitudinally promoting functional recovery and treatment adherence also in FEP recruited though compulsory admission.

INTRODUCTION:Individuals with First Episode Psychosis (FEP) have a higher risk of compulsory admission, but evidence on its prognostic role on outcomes and its baseline predictors is poor. The aims of this investigation were to calculate incidence rate of compulsory admission in FEP individuals treated within an Italian "Early Intervention in Psychosis" (EIP) service across 2 years of follow-up, and to compare clinical and sociodemographic characteristics between FEP patients with and without compulsory admission during the follow-up. METHODS:500 FEP patients were recruited within the "Parma-Early Psychosis" program and completed a socio-demographic chart, the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale. For inter-group comparisons, Mann-Whitney and Chi-square tests, Kaplan-Meier survival analysis, Cox and binary logistic regression, and mixed-design ANOVA were performed. RESULTS:30 (6 %) FEP participants were compulsory admitted. At baseline, they were likely to be males and to have a diagnosis of schizophrenia and lower GAF scores. Longitudinally, they had higher risk of service disengagement, new attempted suicide, and functioning impairment, and showed significant group effects in terms of more severe positive symptoms, negative symptoms, uncooperativeness, and GAF scores (0.023 < ƞ2 < 0.100). At baseline, the most robust predictor for compulsory treatment was uncooperativeness (HR = 1.460), while the strongest protective factor was family history of psychosis in first-degree relatives (HR = 5.790). CONCLUSIONS:A not negligible part of FEP participants were compulsory admitted across the follow-up. This was longitudinally associated with poor outcomes and worse treatment response. Implementing initiatives to improve the skills of professionals to increase treatment motivation from presentation is crucial to promote positive outcomes.

Language impairment has the potential to predict the onset and progression of psychosis. However, it was mainly examined using automated extraction of quantitative linguistic features and their associations with observable psychopathological aspects of psychosis (e.g., formal thought disorders). Little interest has been paid to subjective language disturbances that should phenomenologically anticipate these more objective clinical features. Therefore, the aim of this examination was to investigate subjective language disorders in a Ultra-High Risk (UHR) sample and their associations with clinical and functional outcomes along 2 years of follow-up. 170 UHR participants (88 [51.8

The PANSS Autism Severity Score (PAUSS) is a popular measure of autistic features in First Episode Psychosis (FEP) samples. However, evidence on its longitudinal stability, course and treatment response is poor. Therefore, the main aim of this research was to compare clinical outcomes between FEP individuals with or without "autistic features" enrolled within an "Early Intervention in Psychosis" (EIP) service across 2 years of follow-up, as well as any significant association with EIP treatment components. FEP subjects completed the Positive And Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), and the Health of the Nation Outcome Scale (HoNOS) at entry and across the follow-up. Statistical tests included Kaplan-Meyer survival analysis, mixed-design ANOVA, and multiple linear logistic regression analysis. 301 FEP subjects were enrolled (85 [28.0%] scored above the PAUSS cut-off score). Across the follow-up, the PAUSS + subgroup showed lower incidence rates of both symptomatic and functional remission. No PAUSS long-term stability was observed, but a statistically significant reduction in its values. This longitudinal change was mainly predicted by the total number of case management sessions offered within the EIP program. Our results suggest that the PAUSS could not represent a valid instrument to assess "trait-like" autistic features in FEP subjects. On contrary, it seems to capture a FEP subgroup characterized by higher severity levels in psychopathology and poorer outcomes and prognosis.

Examining psychiatric antecedents and help-seeking behavior for people with First Episode Psychosis (FEP) could help understand determinants for timely care pathways, decrease the “Duration of Untreated Psychosis” (DUP), and consequently improve their prognosis. The aims of this study were: (1) to calculate the proportion of FEP participants with previous contact with mental healthcare services recruited within a specialized “Early Intervention in Psychosis” service, and (2) to longitudinally compare sociodemographic, clinical, and treatment parameters between FEP patients with and without psychiatric antecedents across a 2-year follow-up period. All participants (aged 12–35 years) were enrolled within the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Health of the Nation Outcome Scale (HoNOS). A mixed-design ANOVA and a Kaplan–Meier survival analysis were used. Of the 489 FEP participants, 204 (41.7

Exploring psychiatric antecedents in youths at Clinical High Risk for Psychosis (CHR-P) could help understand determinants for early detection and timely care pathways, consequently improving outcomes and prognosis. The aims of this investigation were: (1) to examine the proportion of CHR-P individuals with past contact with mental healthcare services enrolled within a specialized CHR-P service, and (2) to longitudinally compare sociodemographic, clinical, and treatment parameters between CHR-P subjects with and without psychiatric antecedents across 2 years of follow-up. All participants (aged 12–25 years) were recruited within the “Parma At Risk Mental States” (PARMS) program. Across the follow-up, they completed the Health of the Nation Outcome Scale (HoNOS) and the Positive And Negative Syndrome Scale (PANSS). A mixed-design ANOVA and a Kaplan-Meier survival analysis were also used. Of the 170 CHR-P subjects, 95 (55.9

Disorganization is a nuclear dimension of psychosis, especially in schizophrenia. Despite its relevant association with poor prognosis and negative outcomes, it is still under-investigated compared to positive and negative symptoms, in particular at the onset of illness. This study explored disorganization in youth at Clinical High Risk for Psychosis (CHR-P) over a 2-year period. A sample of 180 CHR-P participants (50% males; 51.1% with baseline second-generation antipsychotic medication) recruited within a specialized CHR-P service completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Across the follow-up, we examined key associations of disorganization with other domains of psychopathology, functioning, and treatment response using Spearman's rank correlation coefficients and linear regression analyses. Our results showed a significant longitudinal reduction in disorganization severity levels across the follow-up. This decrease was significantly associated with improvements in negative symptoms and daily functioning, with a shorter duration of untreated psychiatric symptoms, and with baseline equivalent dose of antipsychotic medication. No significant longitudinal associations with other treatment component of the PARMS program were found. Our findings suggest a longitudinal improvement in disorganization dimension in CHR-P individuals, especially in the context of early interventions targeting reduction in the duration of untreated psychiatric symptoms and favoring a prompt antipsychotic therapy.

INTRODUCTION:Suicidal ideation has high rates among individuals at Clinical High Risk for Psychosis (CHR-P). CHR-P mental states are currently defined as attenuated psychotic symptoms, brief intermittent psychotic symptoms, or genetic risk and functioning deterioration syndrome. However, the relationship between psychotic experiences and suicidality in CHR-P subjects is still not fully understood. Research emphasizes the need to address suicidality in CHR-P individuals due to its incidence and severe socio-economic impact. This study aimed to assess the baseline prevalence and 2-year incidence rates of suicidal thinking and behaviors in an Italian CHR-P sample, investigate the stability of suicidal ideation over 2 years, and examine its associations with treatment outcomes, sociodemographic characteristics, and clinical factors. METHODS:CHR-P participants were treated in an "Early Intervention in Psychosis" program and completed the PANSS and the GAF scale at baseline and every 12 months. RESULTS:180 CHR-P individuals were enrolled (92 with suicidal ideation [SI+]). SI+ subjects had a higher baseline prevalence of past suicide attempts. Over 2 years, a decrease in suicidal ideation severity was observed in the total group. Longitudinal improvement in disorganized symptoms was a key predictor of the decrease in suicidal ideation. Participants with a history of suicide attempts were more likely to attempt again. CONCLUSION:Addressing disorganization is crucial for suicide prevention in the CHR-P population. Continuous risk monitoring and preventive actions are needed for those with past suicide attempts.

PURPOSE:Diagnostic stability for people with First Episode Psychosis (FEP) is essential for treatment, but it remains poorly investigated, especially in adolescents and within a prospective design. The aims of this research were: (a) to examine diagnostic change in Italian adolescents with FEP treated within an "Early Intervention in Psychosis" program during a 2-year follow-up period and (b) to investigate any sociodemographic and clinical predictors at baseline. METHODS:At baseline, 66 adolescents with FEP was recruited. Their primary diagnosis was formulated both at baseline and at the end of follow-up. At presentation, FEP adolescents completed the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). As for diagnostic stability, the Kappa statistic was calculated. The associations of diagnostic change with baseline clinical and sociodemographic features were analyzed using a logistic model with the diagnostic shift as dependent variable. A propensity score was finally calculated based on logistic analysis results. RESULTS:38 (57.6%) FEP adolescents changed their opening diagnosis. The highest prospective diagnostic stability was for initial diagnosis of schizophrenia (95.4%) and affective spectrum psychoses (75%). Diagnostic instability was high for opening diagnosis of psychosis not otherwise specified, brief psychosis and schizophreniform disorder (100%). The best predictors of diagnostic change were fewer years of education, shorter duration of untreated psychosis and higher baseline levels of psychiatric symptoms. CONCLUSION:Diagnostic stability is crucial for treatment and clinical decision making. Addressing instability in FEP diagnoses is an important challenge for future diagnostic development in early psychosis, especially in adolescence.