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Aim The duration of untreated psychosis ( DUP) refers to the period of time between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment. Prolonged DUP is associated with a range of adverse consequences, including more severe illness course, cognitive deficits and poor functioning. Problems with recognition of illness and in seeking help contribute to DUP, but another major cause of prolonged DUP is delays within secondary mental health services. In an attempt to reduce these delays, National Health Service England and the Department of Health have set new targets to improve access to early intervention services which will come into effect in April 2016. Given this background, we aimed to examine the DUP and pathways to care of new patients entering an early intervention service. We also examined whether they were receiving National Institute for Health and Care Excellence (NICE) concordant treatment. This will enable us to establish a baseline so that the impact of the new targets can be determined and to assess the degree of change that will be required to implement these. Methods De-identified electronic records of 165 patients accepted into the service over a 12-month period were analysed. Results Median DUP was 6 months. There was a median of 2 contacts prior to service entry. Community Mental Health Teams were the largest source of referrals. Conclusions The majority of patients had a DUP exceeding the international target of 3 months. The findings appear to support previous evidence that this may be partially attributable to significant delays within the mental health care system. [ABSTRACT FROM AUTHOR]

Aim On the basis of applying 'ultra-high-risk' ( UHR) criteria, initially high rates of transition to psychosis were reported. However, a decline in transition to psychosis has been observed in recent years. The current descriptive paper aims to investigate if this drop in transition rate may be due to potential changes in patterns of referral to a large UHR clinic. Methods One hundred fifty young people who were referred to the Personal Assessment and Crisis Evaluation ( PACE) Clinic in Melbourne, Australia, between August 2000 and July 2004 were included. Their referral pathways were assessed using a semistructured interview. Results were compared with a similar study of a cohort referred to the same clinic between 1995 and 1996. Results The mean number of contacts prior to referral to the PACE Clinic was 1.93 (standard deviation ( SD) = 1.15), and the average time between symptom onset and referral to PACE was 46.5 weeks ( SD = 57.4). In comparison with the earlier cohort (mean = 2.36; SD = 1.32), our results indicate a lower number of contacts ( Cohen's d = 0.35, r = 0.17). Furthermore, participants in the current study were referred twice as fast to the PACE Clinic. Conclusions Increasing awareness of UHR symptoms among professionals and in the general population seems to have resulted in faster referral of young people to specialized mental health services. The global drop in transition rate might be due to a change in referral pathways to UHR services. [ABSTRACT FROM AUTHOR]

Aim Disturbance in the basic sense of self has previously been found to characterize schizophrenia spectrum disorders and to predict onset of psychosis in the ultra-high-risk population. The current study examined basic self-disturbance in a first-episode psychosis (FEP) population. We hypothesized that basic self-disturbance would be more prominent in cases with a schizophrenia spectrum disorder compared to those with other psychoses. Method Sixteen FEP patients from Orygen Youth Health, Melbourne, were recruited to the study. Participants were assessed using the Examination of Anomalous Self-Experience and the Structured Clinical Interview for DSM- IV. Results Basic self-disturbance scores were significantly higher in patients with a schizophrenia spectrum diagnosis ( n = 8) compared to patients with other psychotic diagnoses ( n = 8). Conclusions The findings are consistent with previous work indicating that the disturbance of the basic sense of self is more characteristic of schizophrenia spectrum psychosis than other psychoses. This may have implications for early diagnosis, clinical formulation and intervention. [ABSTRACT FROM AUTHOR]

Background: Different subtypes of psychotic experiences (PEs) have been identified in clinical and non-clinical samples. Researchers have considered these PEs to either be variations of personality or expressions of vulnerability to psychotic disorder. This study aimed to determine which particular subtypes of PEs were more likely to be associated with poor mental health status and help-seeking behaviour in a non-clinical sample of young adults. Methods: The study was conducted on a community sample of 997 young adults. The prevalence of PEs and distress was measured using the Community Assessment of Psychic Experiences ( CAPE), depressive and anxiety symptoms were measured using Beck Depression Inventory-II and Beck Anxiety Inventory, and general functioning was measured using the General Health Questionnaire-12. Factorial analysis of the CAPE positive dimension was conducted and correlations between factors and clinical variables were analysed. Results: Four PE subtypes were identified: perceptual abnormalities, persecutory ideas (PI), bizarre experiences, and magical thinking. At least one high frequency PI was endorsed by 60.8% ( n = 606) of the sample and proved to be significantly associated both with poor mental health status and help-seeking behaviour. Conclusion: PEs subtypes are differentially associated with various markers of poor mental health status. PI seem to have stronger psychopathological significance than other subtypes of PEs. Further longitudinal studies are required to extend these findings. [ABSTRACT FROM AUTHOR]

Aim: Although the different approaches to psychosis research have made significant advances in their own fields, integration between the approaches is often lacking. This paper attempts to integrate a strand of cognitive research in psychotic disorders (specifically, social cognition research) with phenomenological accounts of schizophrenia and other psychotic disorders. Method: The paper is a critical investigation of phenomenological models of disturbed selfhood in schizophrenia in relation to cognitive theories of social cognition in psychotic disorders. Results: We argue that disturbance of the basic sense of self, as articulated in the phenomenological literature, may underlie the social cognition difficulties present in psychotic disorders. This argument is based on phenomenological thinking about self-presence (‘ipseity’) being the primary or most basic ground for the intentionality of consciousness – that is, the directedness of consciousness towards others and the world. A disruption in this basic ground of conscious life has a reverberating effect through other areas of cognitive and social functioning. We propose three routes whereby self-disturbance may compromise social cognition, including dissimilarity, disruption of lived body and disturbed mental coherence. Conclusions: If this model is supported, then social cognition difficulties may be thought of as a secondary index or marker of the more primary disturbance of self in psychotic disorders. Further empirical work examining the relationship between cognitive and phenomenological variables may be of value in identifying risk markers for psychosis onset, thus contributing to early intervention efforts, as well as in clarifying the essential psychopathological features of schizophrenia and other psychotic disorders. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Exercise can improve psychiatric symptoms, neurocognitive functioning and physical health in schizophrenia. However, the effects in early psychosis have not been explored. This study aimed to assess the feasibility of an exercise intervention for early psychosis and to determine if it was associated with changes in physical and mental health. Methods: Thirty‐one patients with first‐episode psychosis (FEP) were recruited from early intervention services to a 10‐week exercise intervention. The intervention group received individualized training programmes, aiming to achieve ≥90 min of moderate‐to‐vigorous activity each week, using exercise programmes tailored to individual preferences and needs. A comparison FEP sample from the same services (n = 7) received treatment as usual. Results: Rates of consent and retention in the exercise group were 94% and 81%, respectively. Participants achieved an average of 107 min of moderate‐to‐vigorous exercise per week. Positive and Negative Syndrome Scale total scores reduced by 13.3 points after 10 weeks of exercise, which was significantly greater than the treatment as usual comparison group (P = 0.010). The greatest differences were observed in negative symptoms, which reduced by 33% in the intervention group (P = 0.013). Significant improvements were also observed in psychosocial functioning and verbal short‐term memory. Increases in cardiovascular fitness and processing speed were positively associated with the amounts of exercise achieved by participants. Conclusion: Individualized exercise training could provide a feasible treatment option for improving symptomatic, neurocognitive and metabolic outcomes in FEP. [ABSTRACT FROM AUTHOR]