This study investigates the expression of aberrant salience (AS) in individuals with autism spectrum disorder (ASD), those at clinical high risk for psychosis (CHR-P) and help-seeking individuals without formal diagnoses.
Ninety-nine participants, 44 males and 55 females (age range 17–39 years), met the inclusion criteria of absence of major neurological disorders, intellectual disabilities or substance-related conditions. None were receiving antipsychotic treatment. Based on clinical evaluations, participants were categorised into three groups: ASD (n = 23), Attenuated Psychosis Syndrome (APS) (n = 27) and help-seekers (n = 49). The Aberrant Salience Inventory (ASI) was administered.
Significant differences were observed in ASI total and subscale scores among groups. Post hoc analyses showed significantly higher ASI scores in the ASD and APS groups compared to help-seekers, but no significant differences between ASD and APS.
These findings suggest an overlap in AS processing between ASD and psychosis-spectrum conditions, supporting AS as a transdiagnostic construct.
Severe mental disorders in young people (< 25 years) are often preceded by subtle changes in communication and thinking, detectable in speech. Speech and language markers are promising for early detection; however, no systematic review has evaluated their prospective utility in predicting mental disorders in youth. We comprehensively reviewed longitudinal studies assessing speech/language markers as predictors of major mental disorder onset or symptom progression in youth.
We searched for longitudinal studies using recorded speech samples from youth or family members to predict diagnostic changes or symptom severity in major depressive disorder (MDD), psychosis, ADHD, substance use disorder, bipolar disorder, OCD and eating disorders. Risk of bias was assessed using the Newcastle–Ottawa Scale. Our protocol was pre-registered (CRD42024579798).
Of 2260 articles, 11 studies met inclusion criteria, covering MDD (n = 3), psychosis (n = 5) and ADHD (n = 3). No eligible studies were found for OCD, substance use, bipolar or eating disorders. Both manual and computational speech analyses were used, with speech samples from parents and youth. Predictive speech/language markers included parental expressed emotion (MDD, ADHD), formal thought disorder (psychosis) and acoustic/linguistic features (psychosis, ADHD). Study quality was moderate to good (mean score: 5.45/8).
Externally validated longitudinal studies on the predictive value of speech/language markers of youth-onset mental disorders are scarce, restricted to a few target disorders and do not allow for variations due to the developmental stage of the samples. Nonetheless, existing studies highlight the potential of applying Natural Language Processing methods to speech samples from both youth and parents for early identification.
Trauma exposure is pervasive in people with an At Risk Mental State (ARMS) and is associated with adverse clinical and functional outcomes. While promising developments have been made in treating trauma in psychosis, evidence regarding the efficacy of trauma therapies in ARMS individuals is limited. This trial aims to evaluate the feasibility of conducting a future randomised controlled trial (RCT) to determine the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (TF-CBT) in people with ARMS.
Seventy ARMS individuals with a history of trauma will be randomised to receive 24 sessions of EMDR plus treatment as usual (TAU), 24 sessions of TF-CBT+TAU, or TAU alone. Feasibility will be determined against pre-specified thresholds for recruitment, retention, treatment engagement, and fidelity. To examine the promise of efficacy of EMDR and TF-CBT, participants will complete a battery of clinical and mechanistic measures at baseline and 9-month post-randomisation, including assessments of attenuated psychotic symptoms and post-traumatic symptoms. Clinical notes will be reviewed to identify transitions to first episode psychosis up to 12 months post-randomisation. Qualitative interviews with trial participants, therapists, and professional stakeholders will explore the acceptability of EMDR and TF-CBT and factors to facilitate future implementation of trauma therapies in routine practice.
If a large-scale RCT is deemed feasible, it will be possible to establish whether EMDR and/or TF-CBT represent beneficial treatments to augment existing evidence-based care for individuals at ultra-high risk for future psychosis, potentially reducing transition rates and improving clinical outcomes for ARMS individuals.
In 2016, the Access and Waiting Time Standard (AWTS) was introduced in England, UK, outlining that people with first-episode psychosis should receive treatment from an early intervention for psychosis (EIP) service within 2 weeks. We examined sociodemographic, pathways to care (PtC), and clinical factors associated with EIP service wait time.
We collected de-identified data from a large mental health provider in South London, UK. We included patients referred and accepted to EIP services as inpatient or community contacts between 1 May 2016 and 30 April 2019, providing 3 years of data from the introduction of AWTS. Descriptive statistics and multivariable linear regression were performed.
A total of 1806 patients were identified with a mean age of 30 (SD: 10.7) years, of whom 86.3% (n = 1559) accessed community EIP and 13.7% (n = 247) accessed inpatient EIP; of these, 26.7% were not seen within 2 weeks. Community EIP patients waited longer adj.β = 2.21 days (95% CI: 2.05–2.37) compared with inpatient EIP patients, and being older was associated with longer wait time. Conversely, a shorter wait time was associated with A&E [adj.β = −0.22 days (95% CI: −0.36, −0.10)] and ‘other’ [adj.β = −0.21 days (95% CI: −0.36, −0.03)] PtC characteristics. White non-British and South Asian patients had shorter wait times compared with White British patients; however, this difference diminished after adjusting for PtC and clinical factors.
Our findings indicate that individual factors, PtC, and mode of contact influence wait time for EIP services. More than a quarter of patients were not seen within 2 weeks, indicating that targeted support in community EIP services is needed to meet clinical guidelines.
Individuals at clinical high risk for psychosis (CHR) constitute a very high-risk group for suicide and suicidal behaviour, yet they are typically excluded from trials of suicide prevention interventions. As such, there are no evidence-based suicide prevention approaches tailored to the unique needs of this population. This study aimed to adapt the Youth-Nominated Support Team (YST), a suicide prevention strategy with demonstrated efficacy, for use with CHR youth (YST-CHR).
YST-CHR was designed as an adjunctive intervention, offered alongside ongoing clinical care to mobilise informed support from trusted adults in a youths' life. Using a formative adaptation approach, we conducted focus group interviews with key informants and convened expert consensus meetings to guide the adaptation process.
Modifications were made to (1) pre-intervention preparatory activities, (2) availability of resources for clinicians, (3) the support person nomination and orientation process and (4) the format and schedule of contacts between support persons and clients. Additional recommendations that could not be incorporated into our preliminary test of YST-CHR, but may be considered in future studies, included an expanded role for peer providers and the incorporation of virtual reality to educate support persons about psychotic symptoms.
A small feasibility study currently underway will inform further development of YST-CHR. The modifications described here lay the groundwork for a scalable, key-informant-informed model of suicide prevention tailored to the unique needs of youth at CHR.
Body image dissatisfaction is a risk and maintenance factor for disordered eating. Parents may contribute to offspring body image dissatisfaction through weight-related criticism (direct influence), as well as expressed parental body image dissatisfaction and dieting (indirect influence). This study retrospectively investigated the contribution of parental influence towards adult offspring's body image dissatisfaction.
One hundred and fifty six participants from a general community sample completed a survey recording their experience of direct and indirect parental influence throughout adolescence, in addition to their current body image satisfaction.
While controlling for peer and media influences, hierarchical linear regression determined that parental influence was a significant contributor to offspring body image dissatisfaction (p < 0.001), and this effect was driven by direct influence (p < 0.001). Indirect parental influence was non-significant (p = 0.899).
The observed strength of direct influence supports the need for parents to reinforce positive weight-related behaviours at home as a method of reducing and managing body image dissatisfaction levels in their offspring.
Early intervention services for psychosis are clinically and cost-effective. Despite the availability of national and international guidelines and well-identified essential components of high-quality services, the implementation of early intervention services varies greatly. However, factors underpinning this are poorly understood and infrequently studied. In Quebec, the provision of earmarked funding and political support since 2017 has resulted in widespread dissemination of early intervention, which presented a valuable context to examine what shapes and influences the implementation of early intervention for psychosis.
An online survey was sent to leaders of all early intervention programmes (n = 33) in Quebec to assess service organisation and delivery. The survey's qualitative component included open-ended questions about factors impacting implementation, which are the focus of this report. Deductive and inductive thematic analysis was conducted through multiple iterations to reach consensus.
Twenty-seven programmes responded to the questionnaire. Factors influencing implementation were separated into eight themes: human resources, workload, finances, physical resources, training, service delivery, service users and relationship with management. Every theme and subtheme was represented as a potential barrier or facilitator, with work atmosphere, quality of the clinic's premises, and management buy-in of early intervention more frequently noted as facilitators.
Factors at the organisational, service and staff levels affect the implementation of early psychosis programmes. Despite political support and increased funding, insufficient funding and its consequences, along with limited implementation supports, remain important barriers to successful implementation. Rapid learning health systems can provide effective feedback to programmes to identify strategies to overcome identified barriers and enhance understanding of interactions between the identified factors. Lived experiences perspectives should also be included in future implementation research.
Staff engagement with individuals with first-episode psychosis (FEP) in early intervention services (EIS) settings is important to reduce the longer-term impact of this condition and promote recovery. There is a paucity of qualitative evidence exploring engagement from the perspectives of staff in these settings. This study aimed to explore and understand Case Managers' experiences of engagement with service users in EIS settings in the United Kingdom.
Hermeneutic interpretive phenomenological analysis (IPA) using semi-structured interviews with purposively sampled EIS case managers with mental health nursing backgrounds from a single NHS Trust in the North of England. Data analysis followed IPA's six stages.
Five master themes were identified as being key to effective engagement: (1) Being on the same page, (2) Engagement as an interpersonal relationship, (3) Managing self and emotions, (4) The practicalities of engagement and (5) The impact of organisational factors upon engagement. Engagement was experienced as multi-faceted, complex and changeable. Key engagement strategies identified as helpful were trust, therapeutic dialogue, shared understanding, collaboration and practical approaches.
Engagement in the context of EIS can be defined as a mutually beneficial connection that takes place between service users and staff which allows for the implementation of treatment. Engagement strategies are an important consideration to reduce the potentially devastating impact of FEP, and to facilitate recovery. Further exploratory research should be conducted across multiple settings to further build on and understand engagement within the wider EIS context.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：