Bipolar disorder (BD) is a heterogeneous disease in terms of clinical course, neurocognitive and social-cognitive features, and functioning. Given the overlap between BD and schizophrenia, psychosis high-risk criteria that persist during euthymia may define a subgroup that differs in clinical features and functioning. In this study, we defined a subgroup of BD as ' Bipolar Disorder with Clinical High-Risk for Psychosis (BD-CHR-P)'. Our main aim was to investigate the differences in neurocognition, social cognition, psychosocial functioning, thought disorder, and clinical features in this subgroup and compare them with the BD group without this syndrome. 77 participants are included in this study. According to the Structured Interview for Prodromal Syndromes (SIPS), 25 participants were included in the BD-CHR-P group. Clinical features, cognition, functionality, thought disorder, apathy, impulsivity, and schizotypy were compared between the groups. Individuals with BD-CHR-P showed a higher rate of psychotic features in their manic episodes, and they displayed more Schneiderian symptoms in psychotic manic episodes (p = 0.049). BD-CHR-P group displayed worse functioning (F = 14.153, p < 0.001). The scores of anticipatory anhedonia (F = 5.27, p = 0.024) and positive formal thought disorder were higher in BD-CHR-P (F = 4.486, p = 0.037). In self-report evaluations impulsivity, self-report apathy, and schizotypy scores in the BD-CHR-P group were significantly higher than the BD-nonCHR-P group (F = 5.305, p = 0.024, F = 5.487, p = 0.022, F = 22.759, p < 0.001, respectively). The BD-CHR-P group exhibited poorer functioning. Further studies are needed to elucidate the mechanisms underlying the between-group differences. Moreover, cross-sectional characteristics of the BD-CHR-P group may help identify a subgroup that will develop psychotic disorders in the future.

A global mental health crisis is threatening a generation of young people with a lifetime of symptoms that do not fit neatly into diagnostic systems. Optimal decisions regarding treatments, services, research, and policies are critically needed, yet such decisions are based on idiosyncratic categorization of clinical courses. This review suggests clinical staging approaches may unite mental health stakeholders around shared targets to reduce mental illness. It first presents key approaches to clinical staging and then outlines how clinical knowledge has been translated into a unified transdiagnostic staging heuristic and clinical service structure over the past 30 years. Directions for short-, medium-, and long-term action are recommended with global community engagement. With investment from the mental health community, staging could reduce suffering through the use of an ethical, organized, and targeted system of communication.

The worldwide prevalence of mental disorders among young people is a cause for concern. In France, there is a long delay in accessing appropriate care for psychotic disorders, which worsens the prognosis. The University Hospital Adult Psychiatry Unit in Rennes offers an early intervention program called Ipope, which has shown that specific monitoring of emerging mental disorders improves engagement in care, reduces the risk of relapse and promotes recovery. This scheme is part of a dynamic of decompartmentalizing psychiatric structures and collaborating with external players, thus promoting an integrated, seamless care pathway for the user.

Contemporary theoretical models underlying development of psychotic- and functional disorders show similarities, including attribution of aberrant salience to everyday (bodily) sensations and an increased tendency of top-down generation of perception. In two general population samples of adolescents, we aimed to examine potential associations between subclinical phenomena, namely functional somatic symptoms (FSS) and psychotic experiences (PE).

We used data from two cohorts of adolescents aged 15-17 years: the Copenhagen Child Cohort 2000 (Denmark, n = 2550) and the TRacking Adolescents' Individual Lives Survey (the Netherlands, n = 1665). We identified comparable self-reported symptoms of FSS and PE respectively in each cohort. The cohort data were analyzed separately to enable replication, and mixed graphical models were used to estimate symptom networks. First, networks including only FSS and PE were modelled. Second, an emotional symptom score was included in the networks.

While numerous specific symptom-to-symptom cross-domain associations were not replicated, symptom networks of the two cohorts overall showed relatively comparable patterns. Delusions of persecution showed the strongest connection with FSS in both cohorts. In the models including emotional symptoms, emotional problems were associated with many PE and FSS, but did not fundamentally change the structure of the original networks.

Using a symptom-based approach the current study lent little support to the notion of specific associations between PE and FSS, yet associations between FSS and PE in adolescence were found in both cohorts. The associations between the two domains could not be fully explained by shared associations with emotional problems.

Predicting outcomes in individuals at clinical high risk (CHR) of developing psychosis remains challenging using clinical metrics alone. The PSYSCAN project aimed to enhance predictive value by integrating data across clinical, environmental, neuroimaging, cognitive, and peripheral blood biomarkers. PSYSCAN employed a naturalistic, prospective design across 12 sites (Europe, Australia, Asia, Americas). Assessments were conducted at baseline, 3, 6, and 12 months, with follow-ups at 18 and 24 months to evaluate clinical and functional outcomes. The study included 238 CHR individuals and 134 healthy controls (HC). At baseline, CHR and HC groups differed significantly in age, education, IQ, and vocational and relationship status. Cannabis and tobacco use did not significantly differ between groups, however CHR individuals had higher proportion of moderate to high risk of tobacco abuse. A substantial portion of the CHR sample met DSM criteria for anxiety (53.4%) and/or mood disorders (52.9%), with some prescribed antidepressants (38.7%), antipsychotics (13.9%), or benzodiazepines (16.4%). Over the follow-up period, 25 CHR individuals (10.5%) transitioned to psychosis. However, the CHR group as a whole showed improvements in functioning and attenuated psychotic symptoms. Similar to other recent multi-centre studies, the CHR cohort exhibits high comorbidity rates and relatively low psychosis transition rates. These findings highlight the clinical heterogeneity within CHR populations and suggest that outcomes extend beyond psychosis onset, reinforcing the need for broader prognostic models that consider functional and transdiagnostic outcomes.

Psychotic symptoms are common in adolescents and predictive of psychiatric disorders. Numerous risk factors have been shown to precede psychiatric disorders. However, investigating individual risk factors does not account for the cumulative effect these risk factors may have. Therefore, we combined well-researched environmental risk factors for psychotic disorder in a composite measure: the poly-environmental risk score (PERS).

Risk factors were assessed in a cohort of 801 adolescents (aged 15) at risk for psychopathology. Binarized risk factors included winter birth, low gestational age, low birth weight, ethnic minority status, urban living environment, cannabis use, victim of bullying, emotional abuse, physical abuse, sexual abuse, high paternal age, parental severe mental illness, parental divorce, and parental death. The PERS was weighted with the log odds derived from recent meta-analyses. At age 18, self-reported psychotic experiences (PE) and clinician-rated psychotic symptoms (PS) were assessed. This updated PERS was compared to previous PERS models, which included fewer risk factors and different weightings.

The PERS was associated with PE and PS. Specifically, a PERS between 3 and 4, and PERS > 4 corresponded with a 2.2- and 5.2-fold increase in the odds of psychotic symptoms in late adolescence. The updated 14-item PERS performed better compared to previous compositions of the PERS.

A composite score of childhood and adolescent risk factors measured at age 15 was associated with psychotic symptoms at age 18. Future research should consider the cumulative effect of risk factors when examining the determinants of psychopathology.

Adolescence constitutes a critical window for preventing depression, but efforts have mostly targeted single risk factors. The Identifying Depression Early in Adolescence Risk Score (IDEA-RS) integrates easily obtainable sociodemographic variables and has been able to predict future depression across diverse populations. However, its performance within a prospective cohort remains untested.

To evaluate the performance of the IDEA-RS in a prospective sample of adolescents participating in the IDEA Risk Stratified Cohort.

Using the IDEA-RS, we screened 7720 adolescents aged 14-16 years in 101 public schools in Porto Alegre, Brazil, and recruited 50 low-risk (LR) and 50 high-risk (HR) participants without depression. The incidence of depressive disorders over 3 years was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Statistical analysis involved Poisson regression with robust variance to estimate incidence rate ratios (IRRs) for depression onset.

In the HR group, 14/45 developed depression, in comparison to 5/43 in the LR group. Poisson regression analysis confirmed a higher probability of developing depression in the HR group compared with the LR group (IRR of 2.68, 95% CI 1.05 to 6.79, p=0.04).

In a prospective cohort of Brazilian adolescents, the IDEA-RS effectively distinguished between those at HR and LR for developing depression.

These results support the usefulness of an easy-to-administer sociodemographic composite risk score for stratifying the probability of developing depression among adolescents, a promising tool to be used in a variety of global contexts, including resource-limited settings.

The Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ) project assesses a large sample of individuals at clinical high-risk for developing psychosis (CHR) and community controls. Subjects are enrolled in 43 sites across 5 continents. The assessments include domains similar to those acquired in previous CHR studies along with novel domains that are collected longitudinally across a period of 2 years. In parallel with the data acquisition, multidisciplinary teams of experts have been working to formulate the data analysis strategy for the AMP SCZ project. Here, we describe the key principles for the data analysis. The primary AMP SCZ analysis aim is to use baseline clinical assessments and multimodal biomarkers to predict clinical endpoints of CHR individuals. These endpoints are defined for the AMP SCZ study as transition to psychosis (i.e., conversion), remission from CHR syndrome, and persistent CHR syndrome (non-conversion/non-remission) obtained at one year and two years after baseline assessment. The secondary aim is to use longitudinal clinical assessments and multimodal biomarkers from all time points to identify clinical trajectories that differentiate subgroups of CHR individuals. The design of the analysis plan is informed by reviewing legacy data and the analytic approaches from similar international CHR studies. In addition, we consider properties of the newly acquired data that are distinct from the available legacy data. Legacy data are used to assist analysis pipeline building, perform benchmark experiments, quantify clinical concepts and to make design decisions meant to overcome the challenges encountered in previous studies. We present the analytic design of the AMP SCZ project, mitigation strategies to address challenges related to the analysis plan, provide rationales for key decisions, and present examples of how the legacy data have been used to support design decisions for the analysis of the multimodal and longitudinal data. Watch Prof. Ofer Pasternak discuss his work and this article: https://vimeo.com/1023394132?share=copy#t=0 .

Clinical ascertainment and clinical outcome are key features of any large multisite study. In the ProNET and PRESCIENT research networks, the Accelerating Medicines Partnership® Schizophrenia (AMP®SCZ) Clinical Ascertainment and Outcome Measures Team aimed to establish a harmonized clinical assessment protocol across these two research networks and to define ascertainment criteria and primary and secondary endpoints. In addition to developing the assessment protocol, the goals of this aspect of the AMP SCZ project were: (1) to implement and monitor clinical training, ascertainment of participants, and clinical assessments; (2) to provide expert clinical input to the Psychosis Risk Evaluation, Data Integration and Computational Technologies: Data Processing, Analysis, and Coordination Center (PREDICT-DPACC) for data collection, quality control, and preparation of data for the analysis of the clinical measures; and (3) to provide ongoing support to the collection, analysis, and reporting of clinical data. This paper describes the (1) protocol clinical endpoints and outcomes, (2) rationale for the selection of the clinical measures, (3) extensive training of clinical staff, (4) preparation of clinical measures for a multisite study which includes several sites where English is not the native language; and (5) the assessment of measure stability over time in the AMP SCZ observational study comparing clinical ratings at baseline and at the 2-month follow up. Watch Dr. Jean Addington discuss her work and this article: https://vimeo.com/1040425281 .

This study aimed to develop and pilot the Clinical High Risk for Psychosis Services Fidelity Scale (CHRPS-FS).

A literature review was conducted to identify evidence-based treatments for individuals at clinical high risk for psychosis (CHRP). These findings were compared with the First-Episode Psychosis Services Fidelity Scale (FEPS-FS). Common items were retained, and others were added, modified, or deleted. Next, the Delphi process was conducted with 17 clinical and academic experts in CHRP care to determine consensus on the importance and validity of each item. Concurrently, the preliminary tool was piloted in eight coordinated specialty care (CSC) clinics serving individuals with CHRP.

The literature review identified two components of CHRP care that were not detailed in the FEPS-FS and were added to the CHRPS-FS; furthermore, one FEPS-FS item was modified and six were removed. In the Delphi process, clinical and academic experts achieved a consensus of >80% in two rounds, with some changes in item wording and the addition of one item (stepped care approach). A CHRPS-FS assessment was successfully piloted in eight CSC clinics. The mean CHRPS-FS rating score was 3.96 (range 3.75-4.23), and the median proportion of items rated at good to high fidelity was 72% (range 66%-78%).

The CHRP-FS is feasible to implement, has face validity based on expert consensus, can be completed in conjunction with a FEPS-FS assessment or alone, and captures variability across programs. The CHRPS-FS measures service delivery and is suitable for clinical trials, learning health care systems, and quality improvement efforts.

One of the main goals for supporting people with a psychotic disorder is early detection and intervention, and the detection of Clinical High Risk (CHR) is a major challenge in this respect. This study sought to compare core symptoms of CHR for psychosis networks based on two CHR self-assessment tools, across different risk thresholds and age groups. This cross-sectional online investigation analyzed 936 individuals for CHR, in France and the UK, with the Prodromal Questionnaire-16 (PQ-16) and the Perceptual and Cognitive Aberrations (PCA). Twelve different symptom networks were constructed, assessing relationships, compactness, centrality, predictability, and comparisons between them, based on different thresholds and age groups. In the above-threshold PQ-16 network, the most central symptom was "Voices or whispers"; in the PCA network, the most central symptom was "Non-relevant thoughts distract or bother". They presented low overall predictability. No significant difference was found between them. This study makes three key contributions. First, this cross-network analyses highlight the relative importance of some central symptoms. Secondly, comparisons between networks demonstrate the unity of the CHR construct across scales, thresholds, and ages, affirming its phenotypic homogeneity, an essential issue for patient care pathways. Thirdly, the low average network predictability suggests the existence of unconsidered symptoms within these CHR networks. These results shed light on the organization of CHR symptoms using routine clinical questionnaires, offering insights for preventive targets in a logic of precision semiology.

Emotion dysregulation (ED) is a key transdiagnostic symptom in several psychiatric disorders such as borderline personality disorder (BPD), bipolar disorder (BD), and attention-deficit/hyperactivity disorder (ADHD). These disorders, here defined as ED disorders (EDD), share similarities in symptoms, comorbidity, and heritability, emphasizing the importance of a transdiagnostic approach to identify markers of vulnerability to EDD in high-risk populations, such as EDD patients' offspring (EDDoff). The hippocampus, central to ED, exhibits alterations across EDD.

We employed a state-of-the-art approach (micro-co-activation patterns, μCAPs) to study the transdiagnostic dynamic functional connectivity (dFC) of hippocampal subregions from resting-state functional MRI of 201 participants (74 EDD patients, 57 EDDoff, 70 controls). μCAPs provide a data-driven differentiation within the seed region.

DFC between the sensorimotor network (SMN) and the hippocampal body was lower in EDD patients (pFDR=0.0002) and EDDoff (pFDR=0.01) compared to controls, with EDDoff displaying an intermediate pattern between EDD patients and controls. dFC between the limbic network (LN) and the hippocampal head was higher in EDD patients than in controls (pFDR=0.01) and in EDDoff (pFDR=0.01). A negative correlation was found between ED and SMN (pFDR=0.01), suggesting increasing ED with decreasing SMN dFC with the hippocampus.

Increased dFC between the hippocampal head and the LN, at the expense of the SMN, may represent a marker of disease in EDD patients. Lower dFC between the SMN and the hippocampal body may represent a marker of vulnerability to EDD in EDDoff, correlating with ED. Such a transdiagnostic construct represents a clinically relevant target for early interventions aimed at reducing vulnerability to EDD in high-risk populations.

Objectives: Evidence-based psychosocial treatments for the early stages of mood or psychotic spectrum disorders are difficult to find in public health settings, and the efficacy of these treatments is limited by inconsistent behavioral skill practice among youth between sessions. Treatments can be made more accessible and efficacious when delivered through a group format that makes use of mobile applications to remind users to practice skills. Method: We conducted a 9-week, randomized controlled trial of the unified protocol (UP) for cognitive behavioral therapy (CBT) delivered via telehealth in a group format, comparing an app-enhanced version of the treatment (AppUP) to standard UP for adolescents with mood and psychotic spectrum conditions. The app was designed to help participants review session content, practice treatment skills, and log their psychiatric symptoms. Study assessors evaluated adolescents for psychiatric symptom severity and psychosocial functioning prior to treatment, at posttreatment, and 3 months posttreatment. Results: Sixty adolescents (Mage = 15.0, SD = 1.3) initiated the trial (30 were randomly assigned to each condition) with 49 retained at posttreatment (9 weeks) and 48 retained at 3 months posttreatment. Adolescents in AppUP showed greater improvements in psychosocial functioning over the 5-month study compared with those in standard UP. AppUP was also associated with greater reductions in depression severity among youth with more self-reported skill practice compared to those in standard UP. Conclusions: This study supports the benefits of transdiagnostic CBT for youth with mood and psychotic symptoms. An adjunctive app appears to improve psychosocial functioning and mood among these youth, especially among those who practice behavioral skills regularly. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Earlier research suggested that psychotic experiences (PEs), the extended-psychosis phenotype, are associated with cognitive impairment. Recent studies, however, revealed more mixed findings, and patterns and magnitude of cognitive deficits in PEs remain uncertain. We aimed to systematically review and quantitatively synthesize estimates of cognitive functioning covering a wide array of domains in individuals with versus without PEs. We systematically searched four databases from inception to 6 July 2023. We generated pooled effect size (Hedges'g) using random-effects models. Subgroup analyses and meta-regression examining the moderating effect of sex, age at PE assessment, study design, cognitive task, and PE assessment instrument on cognitive functioning were performed when applicable. The study was registered with PROSPERO (CRD42023442528). Twenty-seven and six studies were included for meta-analysis of cognitive functioning comparing individuals with versus without PEs (n = 82,561; 10,251 individuals with PEs) and individuals with high-level versus low-level PEs (n = 8062; 813 individuals with high-level PEs), respectively. Individuals with PEs exhibited worse cognitive performance in general cognition (Hedges'g = -0.10 [95%CI = -0.18 to -0.02]), verbal fluency (Hedges'g = -0.05 [95%CI = -0.10 to -0.00]), visual memory (Hedges'g = -0.21 [95%CI = -0.38 to -0.03]), and working memory (Hedges'g = -0.16 [95%CI = -0.28 to -0.04]). Meta-regression revealed that general cognition associated with PEs was related to younger age (z = 3.37, p = 0.001), male sex (z = -2.59, p = 0.010), and cognitive assessment before PE assessment (z = -2.15, p = 0.031), whereas working memory in individuals with PEs was associated with concurrent cognitive and PE assessment (z = 6.19, p < 0.001). We failed to find moderating effect of the choice of PE assessment instrument or cognitive task on cognitive functioning in PEs. Additional analysis showed no significant difference in the performance of any cognitive domains between individuals with high-level versus low-level PEs. Limitations included studies primarily derived from Western countries, no social-cognitive domains, and varied PE measurement. In sum, PEs are associated with milder and more circumscribed cognitive impairment relative to psychotic disorders. Future research is required to clarify differential cognitive trajectories between individuals with transient PEs and persistent/recurrent-PEs.

Genome-wide studies are yielding a growing catalog of common and rare variants that confer risk for psychopathology. However, despite representing unprecedented progress, emerging data also indicate that the full promise of psychiatric genetics-including understanding pathophysiology and improving personalized care-will not be fully realized by targeting traditional dichotomous diagnostic categories. The current article provides reflections on themes that emerged from a 2021 National Institute of Mental Health-sponsored conference convened to address strategies for the evolving field of psychiatric genetics. As anticipated by the National Institute of Mental Health's Research Domain Criteria framework, multilevel investigations of dimensional and transdiagnostic phenotypes, particularly when integrated with biobanks and big data, will be critical to advancing knowledge. The path forward will also require more diverse representation in source studies. Additionally, progress will be catalyzed by a range of converging approaches, including capitalizing on computational methods, pursuing biological insights, working within a developmental framework, and engaging health care systems and patient communities.

There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates the risk of later Bipolar Spectrum Disorder (BD). However, it remains unclear whether different trajectories of ADHD symptoms confer differential risk for BD.

Data from the Avon Longitudinal Study of Parents and Children were available from 7811 children at age 8 years, 7435 at 10, 6798 at 13, and 1217 at 21-23 years. ADHD symptoms were assessed at 8, 10, and 13 years with the Development and Well-Being Assessment. Clinically significant hypomanic symptoms (CSHS) at 21-23 years were assessed using the Hypomania Symptom Checklist (HCL-32). Group trajectories of ADHD and its subtypes were estimated using latent class growth analysis. The prospective associations between different ADHD trajectories and CSHS were tested using logistic regression analysis.

Persistently high, increasing, remitting, and persistently low ADHD symptom trajectories were identified for the three ADHD-related categories. Individuals with persistently high and increasing levels of ADHD symptoms had increased odds of CSHS compared to persistently low class. Sensitivity analyses validated these results. In separate analyses, persistently high levels of hyperactivity and inattentive, and increasing levels of inattentive symptoms were also independently associated with CSHS.

Young people with a longitudinal pattern of high and increasing ADHD symptoms are at higher risk for developing CSHS in young adulthood compared to individuals with low symptom patterns. These two trajectories in childhood and adolescence may represent distinct phenotypic risk profiles for subsequently developing BD and be clinically significant targets for prevention and treatment of BD.

Previous work showed that young people prefer youth-oriented mental health services that offer individual help in houses in urban areas, with short wait times and low costs. The present paper aims to examine which service options professionals working in social welfare or mental health services prefer for addressing young people's mental health needs, comparing their views with those of young people.

Professionals (N = 176) and youth aged 16-24 years (N = 258) participated in a discrete choice experiment (DCE). Panel mixed logit (PML) models were used in both stakeholder groups to ascertain relative differences in attribute weights. We also estimated an overall PML model incorporating the effect of stakeholder group on the attributes.

Professionals found the attributes 'cost' and 'wait times' most relevant to young people's mental health service needs, indicating a preference for services characterised by affordability and minimal wait periods. In contrast, young people adhered more importance to the attribute 'format' (individual rather than group therapy). Furthermore, professionals considered a café or youth centre the most suitable location for a service, rather than a house in the city, and they disfavoured care provision by professionals in adult mental health services more than young people did. Finally, the attributes 'peer support', 'opening hours' and 'anonymity' were deemed relevant by professionals but not by young people.

The perspectives of both professionals and young people offer a unique point of view on care provision, stressing the importance of integrating them in preference-based research and service design.

Advanced empirical research and clinical theory suggest that narcissistic personality states fluctuate over time. However, these fluctuations are poorly understood. To address this, we recruited 88 undergraduates to complete baseline measures and respond to smartphone prompts assessing narcissistic states and emotions in daily life seven times a day for 10 days. Narcissistic states were assessed using a state-adapted version of the Super Brief Pathological Narcissism Inventory (SB-PNI). Findings showed that within-person covariation of narcissistic states ranged from -.55 to .52 and was negatively associated with trait grandiosity, guilt, and mood activation. In addition, there was a significant quadratic relationship between narcissistic covariation and trait vulnerability and between narcissistic covariation and mean state vulnerability, self-esteem, pleasant and activated mood, and shame across 10 days. These findings suggest a potential state-based dynamic taxonomy of narcissistic presentations and highlight the importance of understanding distinctions between co-occurring, contrasting, and dissociated narcissistic states.

Modelling the prodrome to severe mental disorders (SMD), including unipolar mood disorders (UMD), bipolar mood disorders (BMD) and psychotic disorders (PSY), should consider both the evolution and interactions of symptoms and substance use (prodromal features) over time. Temporal network analysis can detect causal dependence between and within prodromal features by representing prodromal features as nodes, with their connections (edges) indicating the likelihood of one feature preceding the other. In SMD, node centrality could reveal insights into important prodromal features and potential intervention targets. Community analysis can identify commonly occurring feature groups to define SMD at-risk states. This retrospective (2-year) cohort study aimed to develop a global transdiagnostic SMD network of the temporal relationships between prodromal features and to examine within-group differences with sub-networks specific to UMD, BMD and PSY. Electronic health records (EHRs) from South London and Maudsley (SLaM) NHS Foundation Trust were included from 6462 individuals with SMD diagnoses (UMD:2066; BMD:740; PSY:3656). Validated natural language processing algorithms extracted the occurrence of 61 prodromal features every three months from two years to six months before SMD onset. Temporal networks of prodromal features were constructed using generalised vector autoregression panel analysis, adjusting for covariates. Edge weights (partial directed correlation coefficients, z) were reported in autocorrelative, unidirectional and bidirectional relationships. Centrality was calculated as the sum of (non-autoregressive) connections leaving (out-centrality, cout) or entering (in-centrality, cin) a node. The three sub-networks (UMD, BMD, PSY) were compared using permutation analysis, and community analysis was performed using Spinglass. The SMD network revealed strong autocorrelations (0.04 ≤ z ≤ 0.10), predominantly positive connections, and identified aggression (cout = 0.103) and tearfulness (cin = 0.134) as the most central features. Sub-networks for UMD, BMD, and PSY showed minimal differences, with 3.5% of edges differing between UMD and PSY, 0.8% between UMD and BMD, and 0.4% between BMD and PSY. Community analysis identified one positive psychotic community (delusional thinking-hallucinations-paranoia) and two behavioural communities (aggression-cannabis use-cocaine use-hostility, aggression-agitation-hostility) as the most common. This study represents the most extensive temporal network analysis conducted on the longitudinal interplay of SMD prodromal features. The findings provide further evidence to support transdiagnostic early detection services across SMD, refine assessments to detect individuals at risk and identify central features as potential intervention targets.

Since the mid-20th century, mental illness has become a leading cause of health burden, particularly among adolescents and emerging adults, with most disorders emerging before the age of 25. Over the past two decades, mental ill health has surged to alarming levels, with evidence confirming that the increase is not just due to better awareness or diagnosis but reflects a genuine public health crisis.

We explore the evolving landscape of youth mental health and its contributing factors, including family dynamics, educational pressures, climate change, social media, and socio-economic challenges, potentially linked to neoliberal policies. A narrative review methodology was employed to analyze these factors and their role in the trends of mental ill-health among young people.

We document mental health trends since the mid-1990s, focusing on mental and substance use disorders among young people and their current needs. Potential new explanatory factors and megatrends, potentially flowing from a paradigm shift in the global political economy which has largely passed under the radar, yet which has produced fragmentation and inequality, are identified, with the COVID-19 pandemic further intensifying these trends. We discuss methodologies to estimate the contribution of these megatrends and outline potential barriers to implementation, along with strategies to overcome them.

This review calls for a comprehensive global action plan, emphasizing prevention, early intervention, and improved treatment strategies. In addition to strengthening prevention, which may take time and be elusive, immediate action is needed to innovate and expand services, which are currently under-resourced and overwhelmed.

Mismatch negativity (MMN) has gained attention as a biomarker for psychosis and a translational intermediate phenotype in animal models of psychosis, including rodents and non-human primates. MMN has been linked to global functioning (Global Assessment of Functioning [GAF] score) and prognosis (psychosis onset or remission), suggesting that MMN reflects activities beyond auditory processing alone. This review examines the 45-year history of MMN from the perspective of psychiatric researchers and discusses current advances in computational and translational research on MMN, summarizing the current understanding of the MMN generation mechanism. We then address the essential question, "What do we observe through MMN?" Currently, we regard the relationship between global functioning in the real world and MMN as the key to answering this question. As a preliminary investigation, we analyzed the relationship between GAF as an objective variable and MMN, diagnosis, and basic epidemiological factors (age, sex, premorbid intelligence quotient) as explanatory variables (total n = 201, healthy controls: n = 41, patients with psychiatric disorders: n = 160) without assuming diagnostic categories. The relationship between functional outcomes and MMN was confirmed without a case-control design. Finally, we propose that new neurophysiological studies should acknowledge psychophysiological responses such as emotion, intention, and autonomic responses, as well as behavioral differences among participants beyond the dichotomy between healthy controls and patients. Measurements could be conducted in various settings from the participant's perspective. We discuss the potential for research investigating psychosis based on the interaction between individuals and the environment, using MMN as an illustrative model.

To be relevant to healthcare systems, the clinical high risk for psychosis (CHR-P) concept should denote a specific (i.e., unique) clinical population and provide useful information to guide the choice of intervention. The current study applied network analyses to examine the clinical specificities of CHR-P youths compared to general help-seekers and non-CHR-P youth. 146 CHR-P (mean age = 14.32 years) and 103 non-CHR-P (mean age = 12.58 years) help-seeking youth were recruited from a neuropsychiatric unit and assessed using the Structured Interview for Psychosis-Risk Syndromes, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, Global Functioning: Social, Global Functioning: Role, and Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale. The first network structure comprised the entire help-seeking sample (i.e., help-seekers network), the second only CHR-P patients (i.e., CHR-P network), and the third only non-CHR-P patients (i.e., non-CHR-P network). In the help-seekers network, each variable presented at least one edge. In the CHR-P network, two isolated "archipelagos of symptoms" were identified: (a) a subgraph including functioning, anxiety, depressive, negative, disorganization, and general symptoms; and (b) a subgraph including positive symptoms and the intelligence quotient. In the non-CHR-P network, positive symptoms were negatively connected to functioning, disorganization, and negative symptoms. Positive symptoms were less connected in the CHR-P network, indicating a need for specific interventions alongside those treating comorbid disorders. The findings suggest specific clinical characteristics of CHR-P youth to guide the development of tailored interventions, thereby supporting the clinical utility of the CHR-P concept.

The most common reason for help-seeking in ultra-high risk (UHR) for psychosis patients is comorbid symptoms, mainly anxiety and depression. However, psychological interventions are mainly focused on subthreshold psychotic symptoms. There is a growing push to include transdiagnostic therapies in specialized intervention teams for psychosis in young people. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy in emotional disorders, and its application has recently expanded to other pathologies such as borderline personality disorder (BPD) and bipolar disorder (BD).

This pilot study was conducted with 36 patients with UHR for psychosis and symptoms of comorbid emotional disorders who were receiving treatment in an early intervention programme for psychosis. This is a randomised control trial (RCT) with two conditions: treatment as usual (TAU) with the group and online application of the UP (UP+TAU) (n = 18) and TAU (n = 18). Evaluations were conducted at baseline, after treatment, and at the three-month follow-up.

Comorbid anxiety and depression symptoms improved significantly in patients in the UP+TAU group compared to those in the TAU. Significant improvements in negative affect, emotional dysregulation, neuroticism, extraversion, functioning, and quality of life were also observed, and satisfaction with the intervention was high.

UP may be an acceptable and effective intervention for the treatment of symptoms of comorbid emotional disorders in patients with UHR for psychosis.

The sample size was small, and further studies are needed to test this intervention with larger samples of patients with UHR for psychosis with emotional comorbidities.

An optimistic view of the future child/youth mental health system is that it will be oriented toward prevention and shaped by innovations in early detection and treatment of functional problems, coupled with the power of digital technology to provide new ways to help individuals and families monitor their well-being and seek or agree to help as it is needed. These innovations will be deployed within a community-based health care system, centered on primary care that fully implements ideas about continuity and comprehensiveness (including social determinants, substance use, and multigenerational care) that have been around for decades.

The iBerry Study, a Dutch population-based high-risk cohort (n = 1022) examines the transition from subclinical symptoms to psychiatric disorders in adolescents. Here, we present the first follow-up measurement, approximately 3 years after baseline assessment and 5 years after the screening based on self-reported emotional and behavioral problems (SDQ-Y). We give an update on the data collection, details on the (non)response, and the results on psychopathology outcomes. The first follow-up (2019-2022) had a response rate of 79% (n = 807). Our results at baseline (mean age 15.0 years) have shown the effectiveness of using the SDQ-Y to select a cohort oversampled for the risk of psychopathology. At first follow-up (mean age 18.1 years), the previously administered SDQ-Y remains predictive for selecting adolescents at risk. At follow-up, 47% of the high-risk adolescents showed significant mental health problems based on self- and parent reports and 46% of the high-risk adolescents met the criteria for multiple DSM-5 diagnoses. Compared to low-risk adolescents, high-risk adolescents had a sevenfold higher odds of significant emotional and behavioral problems at follow-up. Comprehensive assessment on psychopathology, substance abuse, psychotic symptoms, suicidality, nonsuicidal self-injury, addiction to social media and/or video gaming, and delinquency, as well as social development, and the utilization of healthcare and social services were conducted. This wave, as well as the ones to follow, track these adolescents into their young adulthood to identify risk factors, elucidate causal mechanisms, and discern pathways leading to both common and severe mental disorders. Results from the iBerry Study will provide leads for preventive interventions.

The aim of this study was to identify the impact of staging on a six-months transition in Ultra-High Risk (UHR) youth. Subjects were enrolled at assessment; evolution was monitored for six months. Clinical determinants (unusual thought content, perceptual abnormalities, cognitive complaint, etc.) were collected. 37 non-psychotic and 39 UHR subjects were included. 13 UHR (35.2 %) experienced psychotic transition, while none of non-psychotic subjects did log-rank p < 0.001. Self-reported cognitive complaint was inversely associated to transition OR 0.13 95 % IC [0.03-0.64]. Unusual Thought Content was associated to psychotic transition 0R 8.57 95 % IC [1.17-63]. Self-reported cognitive complaint could be a protective transition marker in UHR.

Adolescent mental health is a global public health challenge as most cases remain undetected and untreated, and consequently, have a high likelihood of persistence or recurrence. It is critical to improve early detection of mental disorders and to target individuals experiencing subclinical symptoms. However, most indicated prevention approaches have been developed for risk syndromes of specific mental disorders. This contradicts the increasing recognition of emerging psychopathology as a complex system characterised by rapid shifts in subclinical symptoms, cutting across diagnostic categories and interacting with each other over time. Therefore, this study aims to examine the dynamic course, pattern and network of subclinical symptoms and transdiagnostic mechanisms over time.

The EMERGE-study is a prospective, naturalistic, 1-year follow-up study. A general population sample of 1196 adolescents will be recruited. Inclusion criteria are age between 11 and 17 years, German language skills, main residency in Switzerland and access to internet. Individuals will be excluded if they have a current or lifetime axis I mental disorder. Assessments of subclinical symptoms of several mental disorders and potential transdiagnostic mechanisms will be conducted at baseline and at 3-month, 6-month, 9-month and 12-month follow-up. Structural equation modelling will be used to estimate the homotypic and heterotypic patterns of subclinical symptoms and the associations with transdiagnostic mechanisms. Latent growth mixture modelling and growth mixture survival analysis will be carried out to identify subclasses of individuals with different trajectories of subclinical symptoms that may be predictive of an onset of a mental disorder. Network analysis will be applied to assess the centrality of subclinical symptoms and how networks of emerging psychopathology change over time.

Ethical approval was obtained from the Bern Cantonal Ethics Committee (ID 2020-02108). All findings will be disseminated by publication in peer-reviewed scientific journals and by presentation of the results to conferences and stakeholder organisation events.

The majority of individuals at ultra-high risk (UHR) for psychosis do not transition to a full threshold psychotic disorder. It is therefore important to understand their longer-term clinical and functional outcomes, particularly given the high prevalence of comorbid mental disorders in this population at baseline.

This study investigated the prevalence of non-psychotic disorders in the UHR population at entry and long-term follow-up and their association with functional outcomes. Persistence of UHR status was also investigated.

The sample comprised 102 UHR young people from the Personal Assessment and Crisis Evaluation (PACE) Clinic who had not transitioned to psychosis by long-term follow-up (mean = 8.8 years, range = 6.8-12.1 years since baseline).

Eighty-eight percent of participants at baseline were diagnosed with at least one mental disorder, the majority of which were mood disorders (78%), anxiety disorders (35%), and substance use disorders (SUDs) (18%). This pattern of disorder prevalence continued at follow-up, though prevalence was reduced, with 52% not meeting criteria for current non-psychotic mental disorder. However, 35% of participants developed a new non-psychotic mental disorder by follow-up. Presence of a continuous non-psychotic mental disorder was associated with poorer functional outcomes at follow-up. 28% of participants still met UHR criteria at follow-up.

The study adds to the evidence base that a substantial proportion of UHR individuals who do not transition to psychosis experience persistent attenuated psychotic symptoms and persistent and incident non-psychotic disorders over the long term. Long-term treatment and re-entry into services is indicated.

Effective prevention of severe mental disorders (SMD), including non-psychotic unipolar mood disorders (UMD), non-psychotic bipolar mood disorders (BMD), and psychotic disorders (PSY), rely on accurate knowledge of the duration, first presentation, time course and transdiagnosticity of their prodromal stages. Here we present a retrospective, real-world, cohort study using electronic health records, adhering to RECORD guidelines. Natural language processing algorithms were used to extract monthly occurrences of 65 prodromal features (symptoms and substance use), grouped into eight prodromal clusters. The duration, first presentation, and transdiagnosticity of the prodrome were compared between SMD groups with one-way ANOVA, Cohen's f and d. The time course (mean occurrences) of prodromal clusters was compared between SMD groups with linear mixed-effects models. 26,975 individuals diagnosed with ICD-10 SMD were followed up for up to 12 years (UMD = 13,422; BMD = 2506; PSY = 11,047; median[IQR] age 39.8[23.7] years; 55% female; 52% white). The duration of the UMD prodrome (18[36] months) was shorter than BMD (26[35], d = 0.21) and PSY (24[38], d = 0.18). Most individuals presented with multiple first prodromal clusters, with the most common being non-specific ('other'; 88% UMD, 85% BMD, 78% PSY). The only first prodromal cluster that showed a medium-sized difference between the three SMD groups was positive symptoms (f = 0.30). Time course analysis showed an increase in prodromal cluster occurrences approaching SMD onset. Feature occurrence across the prodromal period showed small/negligible differences between SMD groups, suggesting that most features are transdiagnostic, except for positive symptoms (e.g. paranoia, f = 0.40). Taken together, our findings show minimal differences in the duration and first presentation of the SMD prodromes as recorded in secondary mental health care. All the prodromal clusters intensified as individuals approached SMD onset, and all the prodromal features other than positive symptoms are transdiagnostic. These results support proposals to develop transdiagnostic preventive services for affective and psychotic disorders detected in secondary mental healthcare.

We aim to give an insight into the current situation in Switzerland concerning the pathways to care of young people with clinical high risk of psychosis. In a second step we propose a procedure of optimizing pathways to care developed within the project PsyYoung.

A qualitative survey derived and adapted from Kotlicka-Antczak et al. (2020) was conducted in large early detection services of three Swiss cantons (Geneva, Basel-Stadt, Vaud) focusing on pathways to care. More specifically, using questionnaires delivered to the heads of participating services, information was collected on referral sources, on activities to implement outreach campaigns and on the use of a pre-screening tool.

Main results on referral source indicated that sources were variable but seemed to come primarily from the medical sector and more so from the psychiatric sector. Very few referrals came from non-medical sectors. Outreach activities included the contact to other clinics as well as through brochures and posters. All services but one used the Prodromal Questionnaire - 16 as pre-screening tool.

All in all, the results indicate a referral and care pathway system implemented mostly within the medical and particularly mental health sector. Accordingly, the PsyYoung project proposes a procedure for pathways to care which could help overcome the obstacle of referrals being restrained to a narrow field of mental health and to harmonize the referral process within services dedicated to the same aim of helping young people at high risk of developing a psychosis.

Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers.

Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes.

Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.