Anxiety in youth at clinical high-risk for psychosis: A two-year follow-up

Individuals at clinical high-risk (CHR) for psychosis comprise a heterogeneous group with respect to symptoms and functioning both at presentation and at a later outcome. Even those who do not develop psychosis are troubled by comorbid symptoms and poor functioning (Addington et al., 2018). A recent commentary in this journal (Woods et al., 2021) reports on several papers demonstrating that longitudinally CHR individuals are troubled by unresolved attenuated psychotic symptoms (APS), functional deficits, persistent negative symptoms, and depression. It is argued that before adequate treatments can be developed, a specific core battery of outcome variables is needed

Clinical and functional characteristics of youth at clinical high-risk for psychosis who do not transition to psychosis

Background Much of the interest in youth at clinical high risk (CHR) of psychosis has been in understanding conversion. Recent literature has suggested that less than 25% of those who meet established criteria for being at CHR of psychosis go on to develop a psychotic illness. However, little is known about the outcome of those who do not make the transition to psychosis. The aim of this paper was to examine clinical symptoms and functioning in the second North American Prodrome Longitudinal Study (NAPLS 2) of those individuals whose by the end of 2 years in the study had not developed psychosis.Methods In NAPLS-2 278 CHR participants completed 2-year follow-ups and had not made the transition to psychosis. At 2-years the sample was divided into three groups - those whose symptoms were in remission, those who were still symptomatic and those whose symptoms had become more severe.Results There was no difference between those who remitted early in the study compared with those who remitted at one or 2 years. At 2-years, those in remission had fewer symptoms and improved functioning compared with the two symptomatic groups. However, all three groups had poorer social functioning and cognition than healthy controls.Conclusions A detailed examination of the clinical and functional outcomes of those who did not make the transition to psychosis did not contribute to predicting who may make the transition or who may have an earlier remission of attenuated psychotic symptoms

HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services.

INTRODUCTION: Specialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care. METHODS AND ANALYSIS: This study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16-27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool. ETHICS AND DISSEMINATION: Melbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. TRIAL REGISTRATION NUMBER: ACTRN12614000009617; Pre-results

A next-generation social media-based relapse prevention intervention for youth depression: Qualitative data on user experience outcomes for social networking, safety, and clinical benefit.

Major depressive disorder (MDD) has a high prevalence and relapse rate among young people. For many individuals depression exhibits a severe course, and it is therefore critical to invest in innovative online interventions for depression that are cost-effective, acceptable and feasible. At present, there is a scarcity of research reporting on qualitative data regarding the subjective user experience of young people using social networking-based interventions for depression. This study provides in-depth qualitative insights generated from 38 semi-structured interviews, and a follow-up focus group, with young people (15-25 years) after the implementation of a moderated online social therapy intervention for depression relapse prevention ("Rebound"). Exploratory analysis identified patterns of content from interview data related to three main themes: 1) preferred content compared to perceived helpfulness of the online platform, 2) interest in social networking, and 3) protective environment. Two clear groups emerged; those who perceived the social networking component of the intervention as the most helpful component; and those who preferred to engage in therapy content, receiving individualized content suggested by moderators. The Rebound intervention was shown to be acceptable for young people with major depression. Integration of social networking features appears to enhance intervention engagement for some young people recovering from depression

A next-generation social media-based relapse prevention intervention for youth depression: Qualitative data on user experience outcomes for social networking, safety, and clinical benefit

Major depressive disorder (MDD) has a high prevalence and relapse rate among young people. For many individuals depression exhibits a severe course, and it is therefore critical to invest in innovative online interventions for depression that are cost-effective, acceptable and feasible. At present, there is a scarcity of research reporting on qualitative data regarding the subjective user experience of young people using social networking-based interventions for depression. This study provides in-depth qualitative insights generated from 38 semi-structured interviews, and a follow-up focus group, with young people (15-25 years) after the implementation of a moderated online social therapy intervention for depression relapse prevention ("Rebound"). Exploratory analysis identified patterns of content from interview data related to three main themes: 1) preferred content compared to perceived helpfulness of the online platform, 2) interest in social networking, and 3) protective environment. Two clear groups emerged; those who perceived the social networking component of the intervention as the most helpful component; and those who preferred to engage in therapy content, receiving individualized content suggested by moderators. The Rebound intervention was shown to be acceptable for young people with major depression. Integration of social networking features appears to enhance intervention engagement for some young people recovering from depression

A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service.

BACKGROUND: Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. OBJECTIVE: The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. METHODS: Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. RESULTS: Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=-0.39; P<.001), perceived stress (d=-0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=-0.29; P<.001), loneliness (d=-0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. CONCLUSIONS: MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services

F32. DIFFERENCES BETWEEN YOUTH AT CLINICAL HIGH-RISK FOR PSYCHOSIS WHO DO NOT TRANSITION TO PSYCHOSIS: THE NORTH AMERICAN PRODROME LONGITUDINAL STUDY (NAPLS-2)

Abstract Background: In the clinical high risk (CHR) for psychosis literature, typically, the focus is on determining the risk of conversion to psychosis. However, between 70% and 85% of youth who meet CHR criteria do not develop psychosis during the follow-up period of the study in which they participate. The aim of this study is to focus on CHR youth who did not transition to psychosis and to determine whether there are differences amongst them. Methods: The North American Prodrome Longitudinal Study (NAPLS-2) is an 8-site prospective, longitudinal study including 764 help-seeking youth, age 12–35, meeting criteria for a psychosis risk syndrome based on the Structured Interview for Psychosis-risk Syndromes (SIPS), and 279 healthy controls (HC). For this analysis, only youth who did not make a transition to psychosis and completed 2 years of follow-up (n=278, 154 males, 124 females; mean age 18.8) were included. At the 24-month final assessment, the sample was divided into 3 groups: 1) those in remission, determined by scores ≤2 on all 5 attenuated psychotic symptoms on The Scale of Psychosis-risk Symptoms (SOPS); 2) symptomatic, determined by still having a rating of 3–5 on any one of the 5 attenuated psychotic symptoms on the SOPS; 3) prodromal progression, determined by continuing to meet the Criteria of Psychosis-risk Syndromes (COPS). The groups were compared at baseline and at 24-month follow-up on: age, gender, the presence of a current and lifetime psychiatric diagnosis, and social and role functioning. The use of antipsychotic medication was examined across all assessments (baseline, 6-, 12-, 18- & 24 months) using Generalized Linear Models to examine differences among the 3 groups. Results: Among the participants, 110 (39.57%) were in-remission, 93 (33.45%) symptomatic, and 75 (26.98%) prodromal progression. At baseline there were no significant differences in age, gender, social and role functioning, or SCID diagnoses except on current PTSD (p=.001) with most cases in the prodromal progression group, and on current anxiety disorder (p=≤.0001) with most cases in the symptomatic group. The prodromal progression had significantly higher ratings on unusual thought content compared to the in-remission group and significantly higher ratings on suspiciousness than the symptomatic group. At 24-month follow-up there were significant differences in negative symptoms (p=≤.0001) between prodromal progression (M=9.19), symptomatic (M=8.84), and in remission (M=5.99) groups; and social functioning (p=≤.005; M=6.56, M=6.68, M=7.20 respectively). Although the in-remission group had the highest ratings on social functioning these were significantly lower in social (M=7.20) and role (M=6.68) functioning than HC (M=8.73, M=8.62 respectively). The groups did not differ on their use of antipsychotics over the course of their 2 years in the study. Discussion There were very few differences on baseline measures amongst the different two-year outcome groups. At 2 years, even though those in remission had improved social and role functioning relative to the other 2 groups, they still had lower social and role functioning than HC