OBJECTIVE:Previous research has identified that transnational tobacco companies lack transparency and that they hide their harms to health and nature behind environmental, social and governance (ESG) reporting. Our objective was to find whether independent tobacco supply chain companies similarly lack transparency on tobacco-related activities while prominently displaying ESG. METHODS:In this cross-sectional study, mentions of tobacco supply chain activities and ESG company official documentation and websites were explored for independent tobacco supply chain companies (n=80) with identified annual reports included in the Tobacco Supply Chain Database. Bivariable statistical analysis tested for differences in the visibility of tobacco supply chain contribution and ESG within official documents and websites. In depth exploration was undertaken for seven case study companies. RESULTS:Independent tobacco supply chain companies were significantly less likely to mention their tobacco supply chain contribution than ESG (31% and 80%, respectively p<0.001) in annual reporting. Tobacco supply chain contribution was also less prominent than ESG on websites (29% and 79%, respectively, mentioned on the home page or a home page menu p<0.001). The companies were making median annual profits of over US$2 million (n=76), with a large variation of revenue from tobacco activity (5-100%) where it was reported (n=9). CONCLUSIONS:Independent tobacco supply chain companies undertake ESG activities that they prominently display in official reporting and on websites while often being less transparent about their tobacco supply chain contribution. Potential investors and customers may thus be misled about the companies' true nature. More rigorous reporting requirements are needed.

Whilst intrusive mental imagery represents a diagnostic feature of obsessive-compulsive disorder (OCD), research is lacking with most focussing on intrusive thoughts. Moreover, it has been argued that mental imagery might represent a unique form of OCD symptomatology and could be harnessed to treat symptoms. We performed a systematic review, adopting a two-phased approach, to examine the role of mental imagery in both the psychopathology and treatment of OCD. First, we explored the characteristics and pathological features of intrusive imagery in OCD. Second, we evaluated literature examining imagery-based interventions, i.e., Imagery Rescripting (ImRs) and Eye Movement Desensitisation and Reprocessing (EMDR), in treating symptoms. Findings identify distressing mental imagery as a prominent feature in OCD. Intrusive imagery in OCD was characterised as vivid distressing visual images often accompanied by bodily sensations. Compared to other anxiety disorders, intrusive imagery in OCD occurred more frequently, which often led people to believe they possessed a “dangerous self”. Up to 89% of OCD patients reported experiencing intrusive imagery, with 70% to 79% also reporting that the intrusions related to adverse or traumatic events. Image-based treatments like ImRs and EMDR were found to be promising in reducing symptoms, providing an effective alternative treatment for patients suffering intrusive imagery.

BACKGROUND:Although the processes underlying the relationship between developmental trauma and psychosis remain to be elucidated, alterations in hippocampal-dependent memory (HDM) processing may underlie this relationship. We hypothesized that exposure to developmental trauma would be negatively associated with HDM and hippocampal volume and positively associated with intrusive memories among people with psychosis. METHODS:We conducted a systematic search of studies published from Dec. 18, 2020, to Nov. 14, 2023, using the search terms "childhood," "trauma," "psychosis," and "memory processing" in Embase, PsycINFO, MEDLINE, OpenGrey, Google Scholar, and PTSDpubs. We conducted meta-analyses of studies that measured developmental trauma (self-report questionnaires or interviews), HDM (episodic memory performance and trauma-memory intrusions), semantic and recognition-memory performance, and hippocampal volume among people with psychosis. Subsample analysis determined whether these associations differed across the psychosis spectrum or for specific abuse types. RESULTS:We included 26 studies. Meta-analyses found that developmental trauma was not associated with total hippocampal volume (n = 4, outcomes = 6, d = -0.12, standard error [SE] = 0.20, p = 0.2), episodic memory performance (n = 10, outcomes = 42, d = 0.11, SE = 0.19, p = 0.5), recognition (n = 3, outcomes = 4, d = -0.55, SE = 0.58, p = 0.3), or semantic memory performance (n = 4, outcomes = 6, d = 0.08, SE = 0.13, p = 0.6) in participants across the psychosis spectrum. One study found that developmental trauma was associated with impaired episodic memory performance in participants with schizotypal disorder and participants with a mixed phenotype of affective and psychotic symptoms. Two studies found developmental trauma to be associated with increased involuntary memory intrusions in a sample of people with psychosis. LIMITATIONS:We did not control for age of trauma, sex, or chronicity of trauma. Results should be considered with caution, given the high publication bias and study heterogeneity seen within meta-analyses. CONCLUSION:The association between developmental trauma and memory processing may not affect HDM more than the psychotic symptoms already experienced by affected individuals. However, future studies should focus on the effects of developmental trauma on involuntary memory among people with psychosis.

Background: Among individuals with psychotic experiences, those with a history of developmental trauma face greater symptom severity and worse clinical outcomes compared to those without. Dissociation constitutes a prominent, characteristic of this group's clinical presentation, whose nuances and associated characteristics remain however understudied in psychosis research. We aimed to address this gap by conducting a qualitative study to investigate the phenomenology, context, and impact of dissociative experiences in individuals with subclinical psychosis and a history of developmental trauma.Methods: 25 UK-based participants with a history of developmental trauma and meeting criteria for subclinical psychosis, based on the CAPE-15, were recruited via social media. Participants attended semi-structured interviews online, which were transcribed verbatim and analysed with thematic analysis by two researchers.Results: Thematic analysis yielded the following themes: (1) Phenomenology of Dissociation; (2) Context of Dissociation; (3) Impact of Dissociation; (4) Dissociation and Psychotic-like Phenomena. Participants described experiences of detachment and compartmentalisation, which when experienced were confusing and often distressing. Dissociation was linked to affective experiences, their history of developmental trauma and psychotic-like experiences.Conclusion: This study elucidates the complex and varied nature of dissociative experiences in individuals with subclinical psychosis with a history of developmental trauma. These findings highlight the need for further research to understand the manifestation of dissociation in this population and the links with distress and other aspects of psychopathology. Importantly, it is essential to use this understanding to inform the development of interventions and improve clinical recognition and management.

BACKGROUND:Developmental trauma increases psychosis risk in adulthood and is associated with poor prognosis and treatment response. It has been proposed that developmental trauma may give rise to a distinct psychosis phenotype. Our aim was to explore this by systematically reviewing neuroimaging studies of brain structure and function in adults with psychosis diagnoses, according to whether or not they had survived developmental trauma. We registered our search protocol in PROSPERO (CRD42018105021). METHOD:We systematically searched literature databases for relevant studies published before May 2024. We identified 31 imaging studies (n = 1,761 psychosis patients, n = 1,775 healthy controls or healthy siblings). RESULTS:Developmental trauma was associated with global and regional differences in gray matter; corticolimbic structural dysconnectivity; a potentiated threat detection system; dysfunction in regions associated with mentalization; and elevated striatal dopamine synthesis capacity. CONCLUSION:These findings warrant further research to elucidate vulnerability and resilience mechanisms for psychosis in developmental trauma survivors.

Developmental trauma (DT), defined as abuse or neglect before age 18, is linked with elevated risk and poorer outcomes in psychosis. This systematic review aimed to elucidate the relationship between DT and dissociation in psychosis and discern the potential mediating role of dissociation in the link between DT and psychotic manifestations. Our study protocol was pre-registered with PROSPERO (CRD42022330026). We adopted broad criteria, including a variety of methodologies exploring dissociation post-DT in individuals exhibiting psychosis or psychotic features. Risk of bias was assessed for all included studies. Our review incorporated 40 studies, totalling 6941 participants. A significant moderate association was observed between DT and dissociation (r = 0.33 (95 %CI: 0.28-0.38)), underscored by dose-response effects. Sexual and emotional abuse demonstrated the most robust associations with dissociation. Individuals with psychosis and DT reported elevated dissociation relative to their non-traumatized counterparts. Dissociation mediated the link between DT and positive psychotic symptoms, notably hallucinations, across clinical and general populations. Five studies pinpointed dissociation's mediating role in tying DT to paranoia and delusional ideation. The review delves into clinical considerations, emphasizing screening for psychotic and dissociative symptoms in DT survivors, and outlining dissociation management strategies. Future research, employing longitudinal, qualitative, and experimental approaches, remains paramount.

There is mounting evidence that exposure to psychological stress and trauma increases risk of subsequent psychotic experiences (PE). However, we lack a clear understanding of the relationships between histories of trauma, stressful events in adulthood, and PE. In the present study, our aim was to investigate whether trauma history augments the risk of experiencing PE when exposed to later stressors in adulthood. We sought to address this by examining the relationship between exposure to rocket-warning sirens and PE during the 2014 Israel-Gaza conflict, using experience sampling. Our sample consisted of 97 healthy Israeli civilians who reported their experiences via smartphone twice daily for 30 days. We conducted multilevel models with time and siren exposure as predictors to estimate PE during the conflict. Siren exposure elicited PE, and PE decreased over time as the conflict persisted. People who had experienced previous trauma in adulthood were more likely to have PE when exposed to sirens compared with people who had experienced childhood trauma. Our current findings are broadly consistent with contemporary models of psychosis, which suggest that stress is involved in its aetiology and could have important implications for early detection and intervention in psychosis.

Objective: Health and social care workers (HSCWs) have been shown to be at risk of exposure to potentially morally injurious events (PMIEs) and mental health problems during the COVID-19 pandemic. This study aimed to examine associations between exposure to PMIEs and meeting threshold criteria for probable posttraumatic stress disorder (PTSD) and probable complex PTSD (CPTSD) in U.K. HSCWs immediately after the peak of the first COVID-19 wave. Method: Frontline HSCWs from across the United Kingdom working in diverse roles in hospitals, nursing or care homes, and other community settings were recruited to the Frontline-COVID study via social media. Participants (n = 1,056) completed a cross-sectional online survey (May 27, 2020-July 23, 2020) which assessed exposure to PMIEs (nine-item Moral Injury Events Scale), and meeting symptom thresholds for probable PTSD and probable CPTSD (International Trauma Questionnaire). Results: PMIEs related to witnessing others' wrongful actions and betrayal events were more commonly endorsed than perceived self-transgressions. The rate of probable International Classification of Diseases, 11th Revision (ICD-11) PTSD was 8.3%, and of probable ICD-11 CPTSD was 14.2%. Betrayal-related PMIEs were a significant predictor of probable PTSD or probable CPTSD, together with having been redeployed during the pandemic. The only variable that differentially predicted probable CPTSD as compared with probable PTSD was not having had reliable access to personal protective equipment; none of the PMIE types were differential predictors for screening positive for probable PTSD versus probable CPTSD. Conclusions: Exposure to PIMEs could be important for PTSD and CPTSD development. Interventions for moral injury in HSCWs should be investigated. Clinical Impact Statement Our study examined the links between exposure to potentially morally injurious events and probable posttraumatic stress disorder (PTSD) or probable complex PTSD (CPTSD) in a sample of health and social care workers (HSCWs) in the United Kingdom following the peak of the first COVID-19 wave. In our sample, 8.3% of participants screened positive for probable PTSD and 14.2% for probable CPTSD. Experiences of feeling betrayed by leaders, coworkers, and one's community, and having been redeployed during the pandemic were associated with probable PTSD or probable CPTSD. We recommend that interventions for moral injury in HSCWs should be investigated.

Aims Exposure to traumatic experiences during childhood and adolescence is a significant risk factor for the development of psychiatric disorders in adulthood. An estimated 50% of the worldwide incidence of depression and anxiety can be attributed to childhood maltreatment (Li et al., 2016). In addition, approximately one-third of psychotic experiences are attributable to a history of developmental trauma (McGrath et al., 2017). It is thought that long-lasting, trauma-induced adaptive changes in neurobiological function may lead to a predisposition towards pathophysiology (McCrory and Viding, 2015). However, the precise mechanisms through which developmental trauma exposure alters brain function on cellular and circuit levels remain poorly elucidated. Methods A systematic literature search and meta-analysis was performed to establish how dopaminergic functioning in adulthood is affected by developmental stress in rodents. Three databases, Medline®, Embase®, and PsycINFO®, were systematically searched initially on 2nd December 2023. Terms for three superordinate concepts (‘childhood’ terms, ‘trauma’ terms, and ‘dopamine’ terms) were combined. Cohen's d statistic was used for effect sizes. This protocol is pre-registered on PROSPERO® (ID: CRD42018106382). Results A total of 104 studies met our inclusion criteria. Meta-analysis indicated that developmental stress exposure leads to complex and long-lasting effects in basal and post-amphetamine extracellular dopamine concentrations in the medial prefrontal cortex, amygdala, and nucleus accumbens. In addition, there is a significant downregulation of D1 receptors and upregulation of D2 receptors in prefrontal and striatal regions involved in threat and reward processing. Effect sizes ranged from 0.36 to 1.55. Conclusion These findings strongly suggest that dopaminergic dysfunction is a mechanistic link between developmental trauma and vulnerability towards mental illness in adulthood.

To examine how private regulatory governance reproduces a market logic that always already circumscribes possibilities for radical change, we tarry with Michel Foucault's notion of governmentality and his writings on power. We focus on two major initiatives created to regulate gold supply chains, subjecting their publicly released documents to a discourse analysis. This reveals subtle but tangible examples of how these initiatives discursively shape business preferences and possibilities for engaging with a social change agenda. Through a focus on how power circulating through these initiatives works to shape the identities and interests of business actors themselves, we contribute a new perspective to the literature on business, power, and private regulatory governance, one that highlights the ways through which these discourses both expand and limit business actors' engagement in setting social agendas and the mixed and sometimes seemingly contradictory implications for the public interest.

INTRODUCTION:Psychological trauma is an established risk factor for psychosis. Trauma-focused psychotherapies (TFPT) have been suggested as a potential treatment for reducing psychotic symptoms in those who have experienced trauma. We therefore sought to investigate the effectiveness, tolerability, and acceptability of TFPT for psychotic symptoms. METHODS:We conducted a systematic review of studies of any form of TFPT that measured psychotic symptoms across a broad range of diagnoses. RESULTS:From 2584 papers initially identified, 17 studies (857 participants) met eligibility criteria. TFPT were found to be well tolerated, with very few adverse events. Acceptability was also high, with a mean dropout rate of 20%. CONCLUSIONS:Whilst the evidence of effectiveness for TFPT in reducing psychotic symptoms is weak, we found tentative evidence in favour of exposure-based interventions. Methodologically rigorous trials investigating the efficacy of TFPT for the treatment of psychotic symptoms are needed to assess this promising intervention.

Rationale Attentional bias to drug-related stimuli is hypothesised to contribute towards addiction. However, the acute effects of Δ9-tetrahydrocannabinol (THC) on attentional bias to cannabis cues, the differential response in adults and adolescents, and the moderating effect of cannabidiol (CBD) are unknown. Objectives Our study investigated (1) the acute effects of vaporised cannabis on attentional bias to cannabis-related images in adults and adolescents and (2) the moderating influences of age and CBD. Methods We conducted a randomised, double-blind, placebo-controlled, cross-over study where three weight-adjusted vaporised cannabis preparations: ‘THC’ (8 mg THC for a 75-kg person), ‘THC + CBD’ (8 mg THC and 24 mg CBD for a 75-kg person) and PLA (matched placebo). Cannabis was administered on 3 separate days to 48 participants, who used cannabis 0.5–3 days/week: 24 adolescents (12 females, aged 16–17) and 24 adults (12 females, aged 26–29). Participants completed a visual probe task with cannabis cues. Our primary outcome was attentional bias to cannabis stimuli, measured using the differential reaction time to a cannabis vs. neutral probe, on 200-ms trials. Results In contrast to hypotheses, attention was directed away from cannabis cues on placebo, and there was a main effect of the drug ( F (2,92) = 3.865, p = 0.024, η 2 p = 0.077), indicating THC administration eliminated this bias. There was no significant impact of CBD nor an age-by-drug interaction. Conclusions Acute THC intoxication eliminated attentional bias away from cannabis cues. There was no evidence of differential response in adolescents compared to adults and no evidence that a moderate vaporised dose of CBD altered the impact of cannabis on attentional bias. Trial registration This study was listed with the US National Library of Medicine and registered on ClinicalTrials.gov, URL: Do Adolescents and Adults Differ in Their Acute Response to Cannabis?—Full Text View—ClinicalTrials.gov , registration number: NCT04851392.

PTSD has been associated with negative long-term consequences, including social and occupational impairments. Yet, a nuanced understanding of the interplay between PTSD symptoms and distinct domains of impairments on a short-term basis (weeks/ months) at the within-person level remains underexplored. In a large sample (n wave 1 = 1096, n wave 7 = 304) of UK healthcare workers assessed across seven assessment waves during the COVID-19 pandemic (spaced 6 weeks apart), we employed exploratory graphical vector autoregression models (GVAR) models to discern within-person temporal (across time) and contemporaneous (within same time window) dynamics between PTSD symptoms and functional impairment domains. The contemporaneous network highlighted strong co-occurrences between different symptoms and impairments. The temporal network revealed a mutually reinforcing cycle between intrusion and avoidance symptoms. Intrusion symptoms showed the highest out-strength (i.e., most predictive symptom), predicting avoidance symptoms, elevated sense of current threat, and various functional impairments. Avoidance symptoms, elevated after increased levels of intrusions, predicted work impairments that in turn were associated with difficulties in fulfilling other obligations. Our findings underscore the dynamics between perceived threat and intrusions, and the role intrusions may play in predicting a cascade of adverse effects. Targeted interventions aimed at mitigating intrusions may disrupt this negative cycle.

Background Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct ‘traumatogenic’ phenotype. Aims Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories. Method We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma. Results Of 34 studies included (N = 13 150), 11 were meta-analysed (n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10–0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI −0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma. Conclusions Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.

Abstract Background Cannabis use may be linked with anhedonia and apathy. However, previous studies have shown mixed results, and few have examined the association between cannabis use and specific reward sub-processes. Adolescents may be more vulnerable than adults to harmful effects of cannabis. This study investigated (1) the association between non-acute cannabis use and apathy, anhedonia, pleasure, and effort-based decision-making for reward; and (2) whether these relationships were moderated by age group. Methods We used data from the “CannTeen” study. Participants were 274 adult (26–29 years) and adolescent (16–17 years) cannabis users (1–7 d/wk use in the past 3 months) and gender- and age-matched controls. Anhedonia was measured with the Snaith-Hamilton Pleasure Scale (n = 274), and apathy was measured with the Apathy Evaluation Scale (n = 215). Effort-based decision-making for reward was measured with the Physical Effort task (n = 139), and subjective wanting and liking of rewards was measured with the novel Real Reward Pleasure task (n = 137). Results Controls had higher levels of anhedonia than cannabis users (F1,258 = 5.35, P = .02, η p2 = .02). There were no other significant effects of user-group and no significant user-group*age-group interactions. Null findings were supported by post hoc Bayesian analyses. Conclusion Our results suggest that cannabis use at a frequency of 3 to 4 d/wk is not associated with apathy, effort-based decision-making for reward, reward wanting, or reward liking in adults or adolescents. Cannabis users had lower anhedonia than controls, albeit at a small effect size. These findings are not consistent with the hypothesis that non-acute cannabis use is associated with amotivation.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

BACKGROUND:Childhood maltreatment is a risk factor for the development of post-traumatic stress disorders and psychosis. However, the association between post-traumatic stress disorder (PTSD), including complex PTSD, and psychotic symptoms is unknown. We investigated whether the presence of PTSD and complex PTSD was associated with psychotic symptom severity within survivors of developmental trauma. METHODS:As part of the Investigating Mechanisms underlying Psychosis Associated with Childhood Trauma (IMPACT) study, from Aug 20, 2020, to Jan 24, 2021, and from Sept 9, 2022, to Feb 21, 2023, using study advertisement on online platforms we recruited adult (≥18 years) participants who had experienced developmental trauma without a psychiatric diagnosis in the UK and South Korea. We measured whether participants met diagnostic thresholds for PTSD and complex PTSD using the self-reported International Trauma Questionnaire, and psychotic symptoms using the self-reported Community Assessment of Psychic Experiences. We used linear regression, adjusting for sociodemographic variables such as age, sex, ethnicity, educational attainment, and socioeconomic status, to examine whether there was an association between PTSD and complex PTSD and psychotic symptoms. The study is registered in the UK (University College London Research Ethics Committee [14317/001] and the National Health Service Research Ethics Committee [22/YH/0096]) and South Korea (Institutional Review Board of Seoul National University Bundang Hospital [B-2011-648-306]), and is ongoing. FINDINGS:Of the 2675 participants who took part in the study, 1273 had experienced developmental trauma and were included in the study in the UK (n=475) and South Korea (n=798), comprising 422 (33%) men and 851 (67%) women with a mean age of 26·9 years (SD 6, range 18-40), mostly of White British (n=328) or South Korean (n=798) ethnicity. We found no significant association between PTSD and psychotic symptom severity (total severity β=-2·40 [SE 3·28], p=0·47), compared with participants who did not meet PTSD or complex PTSD caseness. We found a significant relationship between complex PTSD and psychotic symptom severity (total severity β=22·62 [SE 1·65], p<0·0001), including for positive (β=12·07 [SE 0·99], p<0·0001) and negative symptoms (β=10·5 [SE 0·95], p<0·0001), compared with participants who did not meet PTSD or complex PTSD caseness. INTERPRETATION:Health systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis. FUNDING:UKRI Future Leaders Fellowship, British Medical Association Margaret Temple Award for Schizophrenia Research, and the National Research Foundation of Korea-Korea Government.

Background: After a traumatic incident in the workplace organisations want to provide support for their employees to prevent PTSD. However, what is safe and effective to offer has not yet been established, despite many organisations offering some form of intervention after a traumatic event.Objective: To systematically review the evidence for post-incident psychosocial interventions offered within one month of a workplace trauma, and to compare the content, effectiveness and acceptability of these interventions. Given the lack of a yet clearly established evidence-base in this field, we sought to examine both published empirical research as well as guidelines published by expert groups working with staff in high-risk roles.Methods: We conducted systematic searches for empirical research across bibliographic databases and searched online for clinical practice guidelines to April 2023. We were also referred to potentially relevant literature by experts in workplace trauma. Both empirical research and clinical guidelines were appraised for their quality.Results: A total of 80 research studies and 11 clinical practice guidelines were included in the review. Interventions included Critical Incident Stress Debriefing (CISD), Critical Incident Stress Management (CISM), unspecified Debriefing, Trauma Risk Management (TRiM), Psychological First Aid (PFA), EMDR, CBT and group counselling. Most research and guidance were of poor quality. The findings of this review do not demonstrate any harm caused by CISD, CISM, PFA, TRiM, EMDR, group counselling or CBT interventions when delivered in a workplace setting. However, they do not conclusively demonstrate benefits of these interventions nor do they establish superiority of any specific intervention. Generic debriefing was associated with some negative outcomes. Current clinical guidelines were inconsistent with the current research evidence base. Nevertheless, interventions were generally valued by workers.Conclusions: Better quality research and guidance is urgently needed, including more detailed exploration of the specific aspects of delivery of post-incident interventions.

Psychotic experiences (PEs) occur in 5–10% of the general population and are associated with exposure to childhood trauma and obstetric complications. However, the neurobiological mechanisms underlying these associations are unclear. Using the Avon Longitudinal Study of Parents and Children (ALSPAC), we studied 138 young people aged 20 with PEs ( n = 49 suspected, n = 53 definite, n = 36 psychotic disorder) and 275 controls. Voxel-based morphometry assessed whether MRI measures of grey matter volume were associated with (i) PEs, (ii) cumulative childhood psychological trauma (weighted summary score of 6 trauma types), (iii) cumulative pre/peri-natal risk factors for psychosis (weighted summary score of 16 risk factors), and (iv) the interaction between PEs and cumulative trauma or pre/peri-natal risk. PEs were associated with smaller left posterior cingulate ( p FWE < 0.001, Z = 4.19) and thalamus volumes ( p FWE = 0.006, Z = 3.91). Cumulative pre/perinatal risk was associated with smaller left subgenual cingulate volume ( p FWE < 0.001, Z = 4.54). A significant interaction between PEs and cumulative pre/perinatal risk found larger striatum ( p FWE = 0.04, Z = 3.89) and smaller right insula volume extending into the supramarginal gyrus and superior temporal gyrus ( p FWE = 0.002, Z = 4.79), specifically in those with definite PEs and psychotic disorder. Cumulative childhood trauma was associated with larger left dorsal striatum ( p FWE = 0.002, Z = 3.65), right prefrontal cortex ( p FWE < 0.001, Z = 4.63) and smaller left insula volume in all participants ( p FWE = 0.03, Z = 3.60), and there was no interaction with PEs group. In summary, pre/peri-natal risk factors and childhood psychological trauma impact similar brain pathways, namely smaller insula and larger striatum volumes. The effect of pre/perinatal risk was greatest in those with more severe PEs, whereas effects of trauma were seen in all participants. In conclusion, environmental risk factors affect brain networks implicated in schizophrenia, which may increase an individual’s propensity to develop later psychotic disorders.