Introduction Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Objectives Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period. Methods Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13–18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. Results In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE “Social Cognition” subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Conclusions Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.

Objective The Comprehensive Assessment of At-Risk Mental States (CAARMS) was specifically developed to detect and assess young individuals at Ultra-High Risk (UHR) of psychosis. Aim of the current study was to test the interrater reliability of the authorized Italian version of the CAARMS (CAARMS-ITA) in young adult help-seekers consecutively recruit through the "Reggio Emilia At-Risk Mental States" (ReARMS) project. an early detection and intervention infrastructure developed in the Reggio Emilia Department of Mental Health. Methods We included 51 young adults, aged 18-35 years, seeking help at the Reggio Emilia outpatient mental health services. Two trained raters were paired for each CAARMS interview, both simultaneously in the room with the subject. Interrater reliability of the CAARMS-ITA was tested measuring the Intra-Class Correlation (ICC) coefficients and the Cohen's kappa for interrater agreement on CAARMS-defined diagnosis criteria(i.e. UHR and First-Episode Psychosis [FEP]). Results The CAARMS-ITA showed an excellent interrater reliability. The Cohen's kappa for CAARMS diagnoses was 0.845 (p < 0.001). The ICC coefficients of the seven CAARMS subscale scores ranged from 0.965 and 0.990. Conclusions The CAARMS-ITA is a reliable instrument for detecting and assessing at-risk mental states in Italian clinical setting.

Objective Social cognition is a set of cognitive processes that underlie social interactions. Prior research found that social cognitive impairment is an important determinant of functional outcome in early psychosis. Aim of this study was to assess reliability and validity of the Italian version of GEOPTE scale (i-GEOPTE) of social cognition for psychosis in a clinical sample of adolescent and young adult community help-seekers. Methods The i-GEOPTE scale was completed by 325 individuals (aged 13-35 years) entered the "Reg-gio Emilia At-Risk Mental States" (ReARMS) program. Reliability was evaluated examining internal consistency (using Cronbach(s alpha) and calculating short-term (2-week) coefficient of stability. Concordant validity was established with CAARMS ("Comprehensive Assessment of At-Risk Mental States") subscale scores using Spearman(s correlation coefficients. A confirmatory factor analysis was also carried out. Results The i-GEOPTE showed good to excellent short-term test-retest reliability (coefficient of stability = 0.813 for i-GEOPTE total score) and internal consistency (Cronbach(alpha = 0.90). Moreover, i-GEOPTE total scores had significant positive correlations with CAARMS subscale and item scores measuring subjective change of soco-cognitive functions. Conclusions The i-GEOPTE showed satisfactory psychometric properties. Thus, it appears to be a suitable instrument for assessing subjective experience of social cognition in Italian mental health care services, also in order to evaluate functional outcomes of intervention.

Diphthamide is a S-adenosyl methionine (SAM) derived unique posttranslational modification only found on elongation factor 2 (EF2). The structure of diphthamide was determined decades ago. However, the multistep biosynthetic pathways were only determined recently. Proteins involved in the pathway are still under investigation. As unique modification occurring only on one protein in the cell, diphthamide serves as the target of several bacterial toxins including diphtheria toxin and Pseudomonas exotoxin A. However, the deletion of this modification in many cell lines has no obvious phenotype. The detailed physiological function of diphthamide is still unknown. In this article, we will summarize the current understanding of the biosynthesis pathway, the enzymology of the biosynthetic proteins, the function of diphthamide, and some unanswered questions for future studies.

Objective Among current early screeners for psychosis-risk states, the Prodromal Questionnaire-16 items (PQ-16) is used. We aimed to assess reliability of the Italian version of the PQ-16 in a young help-seeking sample. Methods We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-16 (iPQ-16) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-16 and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach's alpha and Cohen's kappa, respectively. Results The iPQ-16 showed excellent short term test-retest reliability (k = 0.898), high internal consistency (alpha = 0.810) and acceptable diagnostic accuracy (sensitivity = 73.5% and specificity = 75.9% at the proposed cut-off of >= 6 on symptom total score). Conclusions Psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 is a suitable screening tool for routine use in mental health care services. Indeed, it is short and therefore easy to implement in routine assessment.

Objective Among current screeners for psychosis-risk mental states, the Prodromal Questionnaire-Brief (21 items) (PQ-B) is used. We aimed to assess reliability of the Italian version of the PQ-B in a young help-seeking sample. Methods - We included 151 individuals, aged 13-35 years, seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-B (iPQ-B) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined test-retest reliability, internal consistency and diagnostic accuracy (i.e. sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) between PQ-B and CAARMS UHR-defined criteria using coefficient of stability (k), Cronbach's alpha and Cohen's kappa, respectively. Results The iPQ-B showed excellent short term test-retest reliability (k = 0.891), high internal consistency (alpha = 0.876) and acceptable diagnostic accuracy (sensitivity = 91.4% at the proposed cut-off of >= 6 on total distress score). Conclusions Psychometric properties of the iPQ-B were satisfactory. The iPQ-B is a suitable screening tool for routine use in mental health care services. Indeed, it is short and therefore easy to implement in routine assessment of early psychosis.

IntroductionSeveral studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).AimsTo describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.MethodsIn addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:– pharmacotherapy according to international guidelines;– a phase-specific individualized Cognitive-Behavioural therapy;– a psycho-educational intervention addressed to family members;– a case management recovery-oriented.Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.ResultsThe assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).ConclusionsAlthough our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveThe study aims to establish the concordant validity of the "Checklist per la valutazione dell'Esordio Psicotico" (CVEP) in an Italian help-seeking population. The CVEP is the Italian adaptation of the early detection Primary Care Checklist (PCCL), a 20 item tool specifically designed to assist primary care practitioners in identifying young people in the early stages of psychosis.Materials and MethodsThe checklist was completed by the referring practitioners of 102 young people referred to the "Reggio Emilia At Risk Mental States" Project (ReARMS) in the Reggio Emilia Department of Mental Health and Addiction. The concordant validity of the CVEP was established by comparing screen results with the outcome of the Comprehensive Assessment of At Risk Mental States (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis.ResultsThe simple checklist as originally conceived had excellent sensitivity (97.9%), but lower specificity (55.6%). Using only a CVEP total score of 20 or above as cut-off, the tool showed a substantial improvement in specificity (87%). Simple cross-tabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant items in terms of sensitivity and specificity were carried out.ConclusionsIn comparison to other much longer screening tools, the CVEP performed well to identify young people in the early stages of psychosis. Therefore, the CVEP is well suited to optimize appropriate referrals to specialist services, building on the skill and knowledge already available in primary care settings.

Materials and Methods The checklist was completed by the referring practitioners of 102 young people referred to the “Reggio Emilia At Risk Mental States” Project (ReARMS) in the Reggio Emilia Department of Mental Health and Addiction. The concordant validity of the CVEP was established by comparing screen results with the outcome of the Comprehensive Assessment of At Risk Mental States (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis. Results The simple checklist as originally conceived had excellent sensitivity (97.9%), but lower specificity (55.6%). Using only a CVEP total score of 20 or above as cut-off, the tool showed a substantial improvement in specificity (87%). Simple crosstabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant items in terms of sensitivity and specificity were carried out.