BACKGROUND AND HYPOTHESIS:Suicide and suicidal behaviour are among the most frequent and serious complications in severe mental disorders, especially in the developmental years. From the early stages of psychosis, i.e., in ultra high risk (UHR) and first psychotic episode (FEP) subjects, the suicide risk (SR) is higher than in the general population. Therefore, assessing suicidal thoughts during the high psychotic risk period is extremely important. This study aims to assess SR in a group of UHR adolescents compared to FEP and clinical help-seeking controls (CHSC) peers. STUDY DESIGN:95 adolescents (13-18 years) were evaluated through psychopathological interviews and self-report questionnaires to assess UHR, FEP or CHSC condition, clinical suicidal behaviour and suicide thoughts, global functioning, self-disorders, and other psychiatric comorbidities. STUDY RESULTS:We identified 17 FEP, 33 UHR, and 45 CHSC. 54.7% of the total sample is at SR, identified in 70.6% of FEP subjects, 81.8% of UHR subjects and 28.9% of CHSC patients. Furthermore, SR correlated with positive symptoms (p = 0.013), negative symptoms (p = 0.032), general symptoms (p = 0.009), and global functioning (p < 0.001) as well as with the total EASE score (p < 0.001). An increasing rate of self-disorders was associated with an increased likelihood of SR. CONCLUSIONS:Monitoring UHR adolescents not only for psychotic onset but also for SR is crucial due to their higher suicidality and worse prognosis. Rigorous management and monitoring can enable more targeted interventions and suicide prevention strategies.

Background and Hypotheses In the past 2 decades, substantial effort has been put into research on therapeutic options for people at ultra-high risk (UHR) for developing a first episode of psychosis (FEP), focusing on omega-3 polyunsaturated fatty acids (PUFAs) in preventing transition to psychosis. Despite an initial positive finding, subsequent studies failed to find a beneficial effect. The current study aimed to further investigate the effect of omega-3 PUFAs in UHR, to determine whether this line of research is worth pursuing. Study Design A double-blind, randomized, placebo-controlled study testing the efficacy of 6-month treatment with omega-3 PUFAs in 135 subjects at UHR for FEP, aged 13 to 20 years on the prevention of a transition to psychosis, followed up for 18 months post-treatment. The trial was conducted at 16 general hospitals and psychiatric specialty centers located in 8 European countries and Israel. Study Results There was no beneficial effect of treatment with omega-3 PUFAs compared to placebo; the rate of transition over 2 years did not differ between treatment arms nor was there a difference in change in symptom severity after 6-month treatment. Dropout rates and serious adverse events were similar across the groups. Conclusions This is the third study that fails to replicate the original finding on the protective effect of omega-3 PUFAs in UHR subjects for transition to psychosis. The accumulating evidence therefore suggests that omega-3 PUFAs do not reduce transition rates to psychosis in those at increased risk at 2 years follow-up.

1. Background: Autism spectrum disorder and psychotic risk show several overlapping symptoms, so differential diagnosis is often difficult. In addition, there is a high rate of comorbidity between the two conditions, which further complicates the work of clinicians. We evaluated the presence of subthreshold psychotic symptoms and/or defined psychotic risk syndromes in autistic children and adolescents; we compared the prevalence, type, and severity of psychotic risk symptoms with those of a group of non-autistic patients at clinical high risk for psychosis (CHR-P). 2. Methods: In total, 23 autistic patients and 14 CHR-P patients without autism (aged 8–17) were enrolled in the study. The main assessment was made through clinical interviews for autism (Autism Diagnostic Observation Schedule, Second Edition—ADOS-2, Autism Diagnostic Interview, Revised—ADI-R) and psychotic risk (Schizophrenia Proneness Instrument, Child and Youth version—SPI-CY, Structured Interview for Psychosis Risk Syndromes—SIPS). 3. Results: No above-threshold psychotic risk symptoms were detected in our autistic patients, but subthreshold psychotic symptoms were identified in all areas. Specific items from all four dimensions of SIPS appear to be more specific for psychotic risk than autism without comorbidity. 4. Conclusions: An a priori screening of psychotic risk in neurodiverse populations is fundamental to prevent more severe conditions. Research should clarify the effective specificity of the available tools to modify them to improve their detection capability.

Introduction Prevention of disorders has become a central element of psychiatric research and clinic. Currently, Ultra High Risk (UHR) criteria are internationally recognized for psychiatric risk assessment. Self Disorders (SD) aroused particular interest because they were found to be specific to schizophrenic spectrum disorders and a marker of vulnerability for psychotic onset. Objectives To evaluate the correlation between psychotic risk and depressive symptoms in at-risk adolescent population. Methods We collected data from 80 patients, aged 14-18, with sufficient skills in the Italian language and an IQ ≥70, excluding patients with disorders related to direct effects of a general medical condition or substance. Psychodiagnostic evaluation included K-SADS-PL, SIPS/SOPS, EASE (for the assessment of SDs) and the CDSS (for the assessment of Depression). Results 35 subjects have UHR criteria, while 45 do not have a psychotic risk syndrome or psychotic features. Between the two groups there is a significant difference in the total SCORE of EASE, in domains 1, 2 and 5. In addition, a positive correlation between SDs and depressive symptoms emerged, in particular with pathological guilt and with reference ideas of guilt. Conclusions The results confirm the validity of SDs for early detection of psychosis. Depressive features appear to be associated with the presence of abnormalities of experience. This results suggest a close care and monitoring of depressive symptoms in adolescence, because they can mask disorders of different nature, particularly pathological guilt and guilty ideas of reference that are depressive “cognitive” symptoms more correlate with psychotic risk. Disclosure No significant relationships.

We investigated the effects of three different interventions on depressive symptoms in adolescents. As a secondary aim, we explored the mediating role of social isolation, anxiety, sleep quality, and cognitive function of the intervention effect on depressive symptoms. We conducted a cluster randomized controlled trial, in which schools were randomly assigned to 1. Doubling physical education (PE) classes (3:20 h of PE/week); 2. Workshop with the PE teachers; 3. Workshop with the PE teachers + Doubling PE classes; and 4. Control group (1:40 h of PE/week). In total, 1279 adolescents were included, 56.4% females. Doubling PE classes and the workshop with the PE teachers + Doubling PE classes groups did not affect depressive symptoms (−0.947, 95% CI −3.176 to 1.281; and, 0.726, 95% CI −1.558 to 3.009, respectively). The workshop with the PE teachers decreased adolescents' depressive symptoms (−2.495, 95% CI −4.668 to −0.323), social isolation (−4.759, 95% CI −9.025 to −0.493), and poor sleep quality (−0.560, 95% CI −1.108 to −0.012) compared with the control group. Social isolation mediated 32% of the workshop effect on depressive symptoms. The workshop with the PE teachers and the workshop with the PE teachers + Doubling PE classes groups lowered in 93% and in 54% the risk of the adolescents in developing high depressive symptomatology compared with the control group, respectively. A workshop updating PE teachers on pedagogical and health‐related topics decreased depressive symptoms in adolescents. Moreover, improvements in the adolescents' social isolation mediated the effect of PE teachers' workshop intervention on the depressive symptoms in adolescents.

IntroductionDepression is very common in adolescent patients and impacts on their quality of life and functioning. Indeed, depression is an important clinical aspect for treatment, outcome, and prognosis.ObjectivesThis pilot study investigated the factorial structure of the Calgary depression scale for schizophrenia (CDSS) in a sample of help seeking adolescent patients, stratified in three clinical diagnostic subgroups: early onset psychosis (EOP), clinical high risk (UHR) and clinical control (CC). The relationships between these factors and SIPS domains and subjective experiences were also explored.MethodsSixty-nine subjects were examined to assess the severity of depressive symptoms and the degree of subjectively felt cognitive-affective vulnerability (i.e. basic symptoms)ResultsPrincipal component analysis revealed CDSS to include two main factors, namely: “guilty idea of reference-pathological guilt” (factor I), “depression-hopelessness” (factor II). Two factors revealed multiple correlations with SIPS domains and subjective experiences.ConclusionsThe results confirm the dual factorial structure of CDSS previously reported in the literature in adult samples, further increase our knowledge of the psychopathological components of depression in adolescents, and strongly suggest that CDSS can also be used in early diagnostic settingsDisclosureNo significant relationships.

Introduction Self-disorders (SDs) have been described as a core feature of schizophrenia-spectrum disorders. Previous studies conducted on heterogeneous clinical adult and adolescents samples demonstrated that SDs aggregate selectively in the schizophrenia spectrum disorders compared to other disorders. Objectives To examine the specificity of SDs for schizophrenia spectrum disorders in adolescent inpatient sample. Methods Fifty-five adolescent inpatients admitted to the Child Psychiatry Unit at the Sapienza University in Rome were assessed for psychopathology using Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), Structured Interview for Prodromal Syndromes (SIPS/SOPS),Examination of Anomalous Self-Experiences (EASE), Multidimensional Anxiety Scale for Children (MASC), Calgary depression scale for schizophrenia (CDSS) Results Patients, aged 14-18 years, were divided in four diagnostic groups: schizophrenia spectrum disorders (5 pts.), mood disorders (19 pts.), anxiety disorders (27 pts.) and other disorders (4 pts.). Frequency of self-disorders was different among the 4 groups. Including patients schizotypal personality disorder in the schizophrenia-spectrum disorder group, the difference is still significant. Mann-Whitney U test shows no differences between EOP and UHR patients in SD. Furthermore, correlations between EASE total score and Calgary and MASC total scores were significant. Conclusions Our results confirm the specificity of SDs for schizophrenia spectrum disorders and also the belonging of schizotypal personality disorder to schizophrenia-spectrum.

IntroductionTrait-like anomalies of subjective experience have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. Recently, Parnas and colleagues have identified and preliminarily explored a composite score (i.e. Self-Disorder Scale, SDO) within the Minnesota Multiphasic Personality Inventory (MMPI) that approximates such construct). SDO differs from the MMPI psychoticism scale, and includes presents items very similar to Self Disorder investigated by EASE (Examination of Anomalous Self-experience).ObjectivesThis study is a confirmatory analysis of the correspondence of Self-Disorder Scale (SDO) of the MMPI with some items of EASE, in a population of adolescents. These items are present in psychotic and in at risk mental state subjects.MethodsWe administered MMPI and EASE to 34 help seeker adolescent patients and correlate all dimensions of MMPI with EASE total score and its domains.ResultsMMPI SDO scores significantly correlated with schizophrenia-spectrum diagnosis and high-risk mental states.ConclusionsSDO is an MMPI analogous of Self Disorders and can be used as a useful screener to detect patients at potential risk for schizophrenia spectrum disorders, that could be further explored with the EASE.DisclosureNo significant relationships.

This study investigates, using an online self-report questionnaire, adolescents’ emotional reactions during the lockdown in a sample of 2105 secondary school students (aged 14–19) in Italy, Romania, and Croatia. We used a self-reported online questionnaire (answers on a 5-point scale or binary), composed of 73 questions investigating the opinions, feelings, and emotions of teenagers, along with sociodemographic information and measures of the exposure to lockdown. The survey was conducted online through a web platform in Italy (between 27 April and 15 June 2020), Romania, and Croatia (3 June and 2 July 2020). Students aged >14 years, living in a small flat, and not spending time outside were more likely to report anger, sadness, boredom/emptiness, and anxiety. Boys were significantly less likely than girls to report all measured emotional reactions. Those who lost someone from COVID-19 were more than twice as likely to experience anger compared to those who did not. Our findings may help identifying adolescents more likely to report negative emotional reactions during the COVID-19 pandemic and inform public health strategies for improving mental health among adolescents during/after the COVID-19 crisis.

INTRODUCTION: Delay in recognizing mental disorders and accessing treatment still remains an unsolved problem in youth mental health strategies.Several studies suggest that increasing mental health literacy (MHL) could reduce stigma and enhance help-seeking behavior.The present study, cofinanced b y t h e European U n i o n as p a r t o f t h e P r o j e c t « M a i P i ù » , was t o evaluate students' knowledge about mental health i n four European countries (Italy, Greece, Romania, Slovenia).

Trait-like anomalies of subjective experience (aka, Basic Self-disturbance or Self-disorder, SD) have been empirically identified as schizophrenia-specific markers of vulnerability in several clinical and genetic high-risk populations. However, such specificity is still to be tested in developmental years, where emerging psychopathology is less crystallized and diagnostic boundaries more blurred. Thus, the current study explores the distribution of SD in adolescent help-seekers (age range 14 to 18) and tests the specificity of SD with respect to the severity of their diagnostic staging (Early Onset schizophrenia-spectrum psychosis [EOP], ultra high-risk [UHR] and clinical help-seeking controls [CHSC]). For this purpose, 96 help-seeking adolescents consecutively referred to specialized Child and Adolescent Units for diagnostic evaluation, underwent a comprehensive psychopathological examination including the specific interview for SD (i.e. the Examination of Anomalous Self-Experience, EASE). One-way ANOVA was used to test the diagnostic distribution of SD (EASE score), whereas multinomial logistic regression was used to test the effect of SD on the diagnostic outcome. SD frequency (both in terms of EASE total score and domain sub-scores) was decreasing progressively from EOP to CHSC, with intermediate levels in UHR. The EASE total score increased the risk of belonging to the more severe diagnostic stages (i.e, UHR and EOP vs CHSC as reference class) and allowed the correct reclassification of the 75% of the sample. The results confirm the schizophrenia-spectrum specificity of SD in adolescence, highlighting their potential value for early differential diagnosis and risk stratification.

Social and occupational impairments are present in the schizophrenia prodrome, and poor social functioning predicts transition to psychosis in Ultra-High Risk (UHR) individuals. We aimed to: 1) validate the Italian version of the Global Functioning: Social (GF: S) and Global Functioning: Role (GF: S) scales; 2) evaluate their association with UHR criteria. Participants were 12-21-years-old (age, mean = 15.2, standard deviation = 2.1, male/female ratio = 117/120) nonpsychotic help-seekers, meeting (N = 39) or not (N = 198) UHR criteria. Inter-rater reliability was excellent for both scales, which also showed good to excellent concurrent validity, as measured by correlation with Global Assessment of Functioning (GAF) scores. Furthermore, GF:S and GF: R were able to discriminate between UHRs and non-UHRs, with UHRs having lower current scores. After adjusting for current GAF scores, only current GF:S scores independently differentiated UHR from non-UHR (OR = 1.33, 95%CI: 1.02-1.75, p = 0.033). Finally, UHR participants showed a steeper decrease from highest GF:S and GF: R scores in the past year to their respective current scores, but not from highest past year GAF scores to current scores. GF:S/GS: R scores were not affected by age or sex. GF:S/GF: R are useful functional level and outcome measures, having the advantage over the GAF to not confound functioning with symptom severity. Additionally, the GF:S may be helpful in identifying UHR individuals.

This text introduces a monographic issue, based on the recent work carried out by a research group on early detection of schizophrenia. Its objective is to illustrate the main features, the limits, the critical points of an interesting research, which was developed in Denmark and coordinated by Josef Parnas. This research suggests that classic psychopathology concepts should be recovered in order to detect the core features of schizophrenia, which these investigators identified in self-disorders. The first article, which describes the main historical phases of research on the Self, is followed by interviews with two experts, who are Parnas himself and Andrea Raballo. Then, the Italian translation of a recent article on the relevance of self-disorders within the context of early intervention in schizophrenia is proposed. The translation of the article is followed by an overview of international studies on the presence of self-disorders in subjects at high risk of developing psychosis. The issue ends with a study on schizotypal personality disorders and an article that, given the limits and the critical points of research on self-disorders, suggests a different evaluation of these symptoms in the light of Human Birth Theory.

AimThe aim of this study was to evaluate the differences between teachers' knowledge about early psychosis among three different Italian cities and a UK sample. MethodsThe sample consisted of 556 secondary school teachers from three different cities in Italy (Milan, Rome and Lamezia Terme) and London (UK). The research was based on the Knowledge and Experience of Social Emotional Difficulties Among Young People Questionnaire. The Italian version of the questionnaire was used in Italy. ResultsOverall, 67.6% of English teachers, 58.5% of Milan's teachers, 41.8% of Rome's teachers and 33.3% of Lamezia Terme's teachers were able to recognize psychotic symptoms from a case vignette. Logistic regression analysis showed that city' was the only independent variable significantly related to the correct/wrong answer about diagnosis. ConclusionsWe found statistically significant differences between the three Italian samples and the UK sample regarding teachers' knowledge about first signs of psychosis. English teachers showed a better knowledge than Italian teachers in general. Teachers from Milan, where a specific early detection program was established in 2000, seemed to be more familiar with early signs of psychosis than teachers in the other two Italian towns.

Objective: The validity of current ultra-high risk (UHR) criteria is under-examined in help-seeking minors, particularly, in children below the age of 12 years. Thus, the present study investigated predictors of one-year outcome in children and adolescents (CAD) with UHR status.Method: Thirty-five children and adolescents (age 9-17 years) meeting UHR criteria according to the Structured Interview for Psychosis-Risk Syndromes were followed-up for 12 months. Regression analyses were employed to detect baseline predictors of conversion to psychosis and of outcome of non-converters (remission and persistence of UHR versus conversion).Results: At one-year follow-up, 20% of patients had developed schizophrenia, 25.7% had remitted from their UHR status that, consequently, had persisted in 54.3%. No patient had fully remitted from mental disorders, even if UHR status was not maintained. Conversion was best predicted by any transient psychotic symptom and a disorganized communication score. No prediction model for outcome beyond conversion was identified.Conclusions: Our findings provide the first evidence for the predictive utility of UHR criteria in CAD in terms of brief intermittent psychotic symptoms (BIPS) when accompanied by signs of cognitive impairment, i.e. disorganized communication. However, because attenuated psychotic symptoms (APS) related to thought content and perception were indicative of non-conversion at 1-year follow-up, their use in early detection of psychosis in CAD needs further study. Overall, the need for more in-depth studies into developmental peculiarities in the early detection and treatment of psychoses with an onset of illness in childhood and early adolescence was further highlighted. (C) 2015 Elsevier B.V. All rights reserved.