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Background: There is some limited evidence of an association between technology addictions and emergence of pre-psychotic symptoms, high psychoticism, psychotic like experiences and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk. We aimed to compare smartphone, Internet and Facebook addictions between low and high schizotypal individuals; and to explore the association between these addictions and distress in the high schizotypy group., Methods: From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. The Schizotypal Personality Questionnaire, the Bergen Facebook Addiction Scale, the Internet Addiction Test, the Smartphone Addiction Scale-Short Version and the Depression, Anxiety and Stress Scales., Results: Students of the high schizotypy group displayed significantly greater scores on smartphone (p < .001), Internet (p < .001) and Facebook (p = .001) addictions scales, as compared to those of the low schizotypy group. After controlling for potential confounders, Internet addiction predicted psychological distress in the high schizotypy group (R 2  = 0.380, F (13,55)  = 2.597, p < .001) and explained an additional 19.7% of variation in Depression, Anxiety and Stress Scales total scores in the final model., Conclusion: Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. It is recommended to raise awareness about Internet addiction risks, particularly among vulnerable young adults; and to find ways to turn Internet into a protective rather than stressor factor, by utilizing it as a resource in the care pathway., (© 2022 John Wiley & Sons Australia, Ltd.)

Aim: While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group., Methods: Patients (N = 55), siblings (N = 55) and healthy controls (N = 71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group., Results: The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p = .023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p = .010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p = .023) and non-planning (p = .004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β = .446, p = .0244) and psychopathy traits (β = .359, p = .010) helped predict AQ total scores among patients., Conclusion: Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis., (© 2022 John Wiley & Sons Australia, Ltd.)

Aim: We aimed to further elucidate the under-researched, underdiagnosed and misunderstood comorbid pica in the context of psychosis., Method: We report a case of teen-onset plastophagia in an antipsychotic-naïve girl at ultra-high risk (UHR) for psychosis., Results: HA is a 17-year-old unmarried girl who had a history of good premorbid functioning, no personal psychiatric history and an uncle with schizophrenia. She was referred to our psychiatry department with the complaint of having the habit of eating plastic for about 2 years. A thorough clinical history revealed that she developed, since more than a year, difficulty in school and interpersonal functioning. After clinical evaluation, a diagnosis of UHR with major depressive disorder, iron deficiency anaemia and pica was made., Conclusion: We draw attention to the possibility of an overlap between the pathogenesis of pica and psychosis, and we highlight the importance of early diagnosis and management of both pica and UHR since they can lead to serious medical and mental consequences., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Similarly to patients with schizophrenia, non-clinical individuals with schizotypal traits have been reported to show an increased risk for suicide-related outcomes. We aimed to assess suicidal ideation, and to determine factors that may have associations with help-seeking attitudes in high schizotypal individuals as compared to low schizotypal individuals., Method: We carried out a cross-sectional survey. The Schizotypal Personality Questionnaire, the attitudes toward seeking professional psychological help scale-short form, the disclosure expectations scale, the scale of suicide ideation, the stigma of suicide scale-short form, the literacy of suicide scale, and the depression anxiety stress scales were administered to 504 college students. A total of 51 students were classified in the high-schizotypy group, and 50 were classified in the low-schizotypy group., Results: High-schizotypal students experienced significantly more suicidal ideation, had greater literacy of suicide, had more glorification of suicide, had higher anticipated risks of disclosure and more negative help-seeking attitudes than low-schizotypal students. After controlling for sociodemographic (age, gender, income and tobacco use) and psychosocial variables (personal psychiatric history, family history of suicide, personal history of suicide attempt[s]), depression and suicide ideation), disclosure expectations had both a significant negative independent effect through anticipated risks, and a positive independent effect through anticipated benefits, on high-schizotypal students' help-seeking attitudes., Conclusion: The apprehension and reluctance to seek help found in high-schizotypal students highlight an urgent need to further understand barriers to help-seeking among at-risk adolescents, and what may motivate them to reach out for support when they are more at-risk for suicide., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Early identification and prevention research has provided huge advances in our understanding of early screening and identification of young people at clinical high-risk (CHR). Most of these procedures were developed in high-income countries, yet middle-income countries in North Africa such as Tunisia can benefit from these empirically-based assessment approaches., Methods: Using established procedures, nine Tunisian psychiatric raters were trained on structured assessments: the CAARMS, BPRS, and SCID to high standards of interrater reliability. These raters developed a clinical high-risk program (CHiRP) in Tunisia and recruited 10 patients who were exhibiting possible signs of CHR. These patients were evaluated to determine if they met criteria for a CHR group, such as Attenuated Psychosis., Results: Trained raters met the following interrater reliability criteria for the CAARMS and BPRS (ICC = .80 or greater) and the SCID (Kappa = .75 or greater). Of 10 pilot patients, six were classified as CHR and belonging to the Attenuated Psychosis Group. One of the six patients converted to psychosis 3 months after study entry for a conversion rate of 17% which is comparable with currently published rates globally., Discussion: The first CHR program has been established in Tunisia, a middle-income country using methods developed in high income countries. Efforts aimed at assembling a group of prevention-oriented psychiatrists, obtaining administrative support, and training raters to high levels of interrater reliability were successful. The feasibility was demonstrated for screening, assessing, treating, and following-up of 10 CHR patients suggesting that conversion rates are comparable to those of Western and European countries., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Sleep disturbances in schizophrenia are common throughout its course including in the prodrome, and have been mainly attributed to severity of symptoms and antipsychotic use. We aimed to investigate whether early course patients with schizophrenia and young non-psychotic siblings of patients with schizophrenia also show sleep disturbances and whether sleep correlates with symptoms and functioning., Methods: Three study groups, that is, adults newly diagnosed with schizophrenia (n = 54), young non-psychotic siblings of schizophrenia patients (n = 56) and a sample of healthy controls matched to the patients and siblings (n = 61) were evaluated on Horne and Ostberg Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Severity of symptoms and functioning are assessed using the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale, respectively. Age, gender, occupation and marital status were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance., Results: Early course schizophrenia patients and non-psychotic siblings of schizophrenia patients showed significantly reduced sleep quality relative to healthy controls (P < .001). Schizophrenia patients had significantly higher daytime sleepiness compared to controls (P < .001). Chronotypes in schizophrenia patients and unaffected siblings did not significantly differ from those of the healthy controls., Conclusions: Like chronic medicated schizophrenia patients, early course schizophrenia patients and young non-psychotic siblings of individuals with schizophrenia have sleep disturbances. These findings indicate that sleep markers can distinguish unaffected siblings of schizophrenia from healthy controls and serve as an endophenotype for schizophrenia., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Mental disorders are widespread among students. However, mental health help-seeking remains low. Several reviews and meta-analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help-seeking intentions and comfort with disclosing a mental illness., Method: The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9)., Results: We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help-seeking intentions (p < .001) and knowledge of mental illness (p = .019). Students' age negatively correlated with knowledge (p < .001, r = -.147). Pearson correlations indicated that help-seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p < .001, r = .103) and greater mental health knowledge (p < .001, r = .163); and that comfort with disclosing significantly and negatively correlated with attitudes (p < .001, r = -.125)., Conclusion: To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group., (© 2020 John Wiley & Sons Australia, Ltd.)

Aim: Prior research has consistently demonstrated a relationship between childhood trauma (CT) exposure and an increased risk of developing psychotic-like experiences (PLE) and disorders. Studying the link between CT and PLE in non-clinical populations with or without genetic risk factors could help elucidate the etiopathogeny of psychotic disorders, by removing the effect of confounding variables related to psychotic-spectrum illnesses., Method: A total of 60 non-affected siblings of patients with schizophrenia and 75 controls (aged 18-35 years) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences (CAPE) and the CT Questionnaire were used., Results: We found no significant difference with regard to positive dimension of the CAPE between the two groups. Siblings have reported higher CAPE negative symptoms scores than controls (27.9 vs 24.2; P = .015), and more emotional abuse and physical neglect during childhood than controls. After controlling for demographic and psychosocial variables, sexual abuse, emotional neglect and physical neglect were positively related to positive psychotic symptoms in the control group, whereas no dimension of CT has been linked to these symptoms in the sibling group., Conclusion: The link between CT and psychosis seems to be complex, not only dependent on genetic vulnerability or early environmental factors shared by siblings of patients with psychotic disorders, but also several other confounding factors, including other psychopathological symptoms. Prevention strategies for individuals at genetic risk of psychosis should pay particular attention to CT as a potential predictor of sub-clinical depression and psychosis., (© 2020 John Wiley & Sons Australia, Ltd.)