Anhedonia and suicidal ideation in young people with early psychosis: Further findings from the 2-year follow-up of the ReARMS program.

Hedonic deficits have been extensively studied in schizophrenia, but little is known about their association with suicidal ideation in early psychosis. The aim of this research was to examine the relationship between anhedonia and suicidal thoughts across a 2-year follow-up period in people with First Episode Psychosis (FEP) and at Ultra High Risk (UHR) of psychosis. Ninty-six UHR and 146 FEP, aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II). The BDI-II "Anhedonia" subscale score to assess anhedonia and the CAARMS "Depression" item 7.2 subscore to measure depression were used across the 2 years of follow-up. Hierarchical regression analyses were performed. No difference in anhedonia scores between FEP and UHR individuals was found. In the FEP group, a significant enduring association between anhedonia and suicidal ideation was found at baseline and across the follow-up, independent of clinical depression. In the UHR subgroup, the enduring relationship between anhedonia and suicidal thoughts were not completely independent from depression severity. Anhedonia is relevant in predicting suicidal ideation in early psychosis. Specific pharmacological and/or psychosocial interventions on anhedonia within specialized EIP program could reduce suicide risk overtime.

Examining subjective experience of aberrant salience in young individuals at ultra-high risk (UHR) of psychosis: A 1-year longitudinal study.

Aberrant salience (AS) is considered as a predisposing factor in early psychosis. Although it has been frequently examined in the general population as a measure of vulnerability to psychotic disorder, empirical evidence on AS in prodromal phases of psychosis is still relatively scarce. Thus, the aims of this research were (1) to investigate any significant association of AS with functioning, psychopathology and treatment components of an "early intervention in psychosis" program in a sample of young community help-seekers at Ultra-High Risk (UHR) of psychosis along a 1-year follow-up period, and (2) to longitudinally monitor the stability of AS across the 1 year of follow-up. Participants (87 UHR), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B) at baseline and after the 1 year of follow-up. Spearman correlation analyses among psychopathological parameters and specialized treatment components were performed. A multiple linear regression analysis was also carried out. After a 1-year follow-up period, UHR subjects had a statistically relevant decrease in ASI total scores. This was significantly related to the number of individual cognitive-behavioral therapy (CBT) sessions and the number of family psychoeducational sessions offered to UHR participants and their family members during the same 12-month period. In conclusion, AS is clinically relevant in UHR individuals. However, it seems to improve over time along with the delivery of tailored, specialized psychosocial interventions for early psychosis.

Subjective experience of aberrant salience in young people at Ultra-High Risk (UHR) for psychosis: a cross-sectional study.

PURPOSE: Aberrant salience (AS) is conceptualized as a potential predisposing factor for psychotic states of mind. Despite several studies in the general population, research on AS in the early phases of psychosis is still relatively scarce. The aim of this cross-sectional study is (1) to evaluate the AS subjective experience in Ultra-High Risk (UHR) adolescents and young adults compared to help-seeking peers with First Episode Psychosis (FEP) and (2) to assess any significant association of baseline AS with psychopathology and functioning in UHR participants. MATERIALS AND METHODS: Participants (87 UHR and 139 FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Aberrant Salience Inventory (ASI) and the brief version of the Schizotypal Personality Questionnaire (SPQ-B). Within the UHR subgroup, Spearman correlation and multiple linear regression analyses among psychopathological parameters were performed. RESULTS: No difference in baseline AS subjective levels was found between UHR and FEP participants (median [interquartile range]: 14.50 [7-19] vs 14 [9-21]; z = -1.576; p = 0.115). In UHR individuals, the ASI total score was significantly associated with attenuated positive symptoms (ρ = 0.284, p = 0.008), depression (ρ = 0.256; p = 0.018) and specific schizotypal personality traits (i.e. cognitive-perceptual deficits and disorganization [respectively, ρ = 0.487, p = 0.001, and ρ = 0.295, p = 0.008]). CONCLUSIONS: AS is clinically relevant in UHR subjects, comparable to FEP patients. Moreover, it seems to mutually interact with schizotypy in the clinical manifestation of attenuated positive psychopathology.

Aberrant salience in first-episode psychosis: Longitudinal stability and treatment-response.

AIM: Aberrant salience (AS) is considered a putative predisposing factor for the onset of psychosis. However, despite several studies conducted in the general population, research in early psychosis is still relatively scarce. The main purposes of this study were to investigate any relevant correlation of AS with functioning and psychopathology in young patients with first episode psychosis (FEP), and to analyse the longitudinal stability of AS across a 1 year follow-up period. METHODS: All the participants (139 FEP), aged 13-35 years, completed the Aberrant Salience Inventory (ASI), the Comprehensive Assessment of At-Risk Mental States (CAARMS), and the Positive And Negative Syndrome Scale (PANSS). Spearman correlation analysis among psychopathological parameters were performed both at baseline and after the 1 year of follow-up. RESULTS: Across the follow-up, FEP patients showed a significant decrease in the ASI total score. This reduction was specifically associated with the number of individual cognitive-behavioural therapy sessions offered to FEP individuals in the same time period (and not with antipsychotic dose at baseline). CONCLUSIONS: AS is clinically significant in FEP patients. However, it tends to ameliorate over time together with the delivery of specialized, person-tailored FEP treatments within a specific "Early Intervention in Psychosis" protocol.

Identifying adolescents in the early stage of psychosis: A screening checklist for referrers.

OBJECTIVE: The early identification of adolescents at the onset of psychosis is crucial to provide effective interventions. The aim of this study is to examine the validity of the "early detection Primary Care Checklist" (PCC) in an Italian adolescent population. The PCC is a 20-item tool designed to assist primary care practitioners in identifying young people with early psychosis. METHODS: The checklist was completed by the referring practitioners of 129 adolescents. The validity of this instrument was established by comparing screen results with the "Comprehensive Assessment of At-Risk Mental States." RESULTS: The simple checklist had excellent 98% sensitivity, but low specificity (58%). Using only a PCC total score of ≥20 as cutoff, there was a substantial improvement in specificity (87%). CONCLUSION: The Italian version of the PCC performed well to identify adolescents in the early stage of psychosis and may be used in primary care settings.

Anhedonia in the Psychosis Risk Syndrome: State and Trait Characteristics.

BACKGROUND: Previous studies reported deficits in pleasure experience in schizophrenia, but little is known about anhedonia in psychosis risk syndrome. Aim of this study was: (1) to assess anhedonia in distinct help-seeking subgroups of young people identified through the Ultra-High Risk (UHR) criteria, (2) to explore its association with functioning and psychopathology in the UHR group, and (3) to monitor longitudinally its stability in UHR individuals along 1-year follow-up period. SUBJECTS AND METHODS: All participants (78 UHR, 137 with a First Episode Psychosis (FEP), and 95 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II (BDI-II), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We adopted two different indexes of anhedonia: i.e. CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. RESULTS: In comparison with non-UHR/FEP, UHR individuals showed higher baseline CAARMS item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia scores between UHR and FEP patients was found. After 1-year follow-up period, UHR subjects had a significant decrease in severity exclusively on CAARMS item 4.3 subscore. CONCLUSIONS: In the UHR group, CAARMS anhedonia showed significant correlations with functioning deterioration, negative symptoms, and comorbid depression (including suicide ideation), while BOL anhedonia with a poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits and disorganization). Anhedonia is prominent in the psychosis risk syndrome and its severity is indistinguishable from that of FEP patients.

Overcoming the gap between child and adult mental health services: The Reggio Emilia experience in an early intervention in psychosis program.

AIM: Early intervention in psychosis (EIP) can reduce severity and persistence of illness. From September 2012, the Reggio Emilia Department of Mental Health developed the 'Reggio Emilia At-Risk Mental States' (ReARMS) protocol as a specific EIP infrastructure in all its adult and child/adolescent mental health services. Aims of this study were (a) to describe the ReARMS macroscopic organization and (b) to analyse some specific process indicators (i.e., the amount of individuals referred to the ReARMS program, the number of subjects who met defined diagnostic criteria of early psychosis and accepted the intervention, and the 1-year drop-out rate) during the first 5 years of its clinical activity, in order to examine feasibility and quality of its procedures on the adolescent help-seeking subgroup. METHODS: Adolescent participants (n = 125), aged 13-18 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) to investigate the clinical status. Descriptive quantitative analyses were then used. RESULTS: Fifty (40%) individuals did not meet early psychosis-defined criteria, while 75 (60%: i.e., 44 Ultra-High Risk [UHR] and 31 First Episode Psychosis [FEP] subjects) were offered an EIP dedicated care protocol: of them, 66 (88%) were enrolled in the program and 9 (12%) dropped out during the first year of treatment). Adolescents enrolled in the ReARMS protocol were mainly referred by general practitioners (32%), family members (16%), or school/social services (15.2%). Seventy (56%) participants had a history of previous specialist contact (especially for learning and anxiety disorders). CONCLUSIONS: An EIP program for adolescents with early psychosis in Italian child/adolescent mental health services are feasible, clinically relevant and recommended, specifically in this age group with a high risk of falling through the child/adult service gap.

Suicidal thinking and behaviours in First Episode Psychosis: Findings from a 3-year longitudinal study.

AIM: Suicide risk is greater at the beginning of the course of psychosis. Purpose of this research was: (a) to investigate prevalence and incidence rates of suicide attempts, suicidal thinking and completed suicide in First Episode Psychosis (FEP) help-seekers as compared with non-FEP help-seeking peers, and (b) to examine any correlation of suicidal ideation with other baseline psychopathological predictors. METHODS: Two hundred and forty-one young people (13-35 years) were assessed with the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF), the Beck Depression Inventory - II Edition (BDI-II) and the Comprehensive Assessment of At-Risk Mental States (CAARMS) at the enrollment and over a 36-month follow-up period. A Kaplan-Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was used. RESULTS: FEP patients showed more severe levels of CAARMS "Suicidality/Self-Harm" item than non-FEP peers. They also had higher 3-year incidence rates of attempted suicide (11%) and completed suicide (13%). Within the FEP total group, suicidal ideation was positively correlated with BDI-II and CAARMS "Perceptual Abnormalities" item scores, and showed negative associations with younger age and WHOQOL-BREF "Social Relationships" factor sub-score. CONCLUSIONS: Suicidal ideation is relevant in FEP patents, supporting the routine monitoring of suicide risk in baseline assessment of adolescents and young adults with early psychosis. Suicidal thinking seems to be correlated to younger age, perceptual aberrations and depression severity, as well as to poorer quality of social relationships.

Negative symptom dimensions in first episode psychosis: Is there a difference between schizophrenia and non-schizophrenia spectrum disorders?

AIM: Identifying discrete dimensions that underline negative symptoms in First Episode Psychosis (FEP) could improve the understanding and the treatment of such invalidating symptomatology. The aim of this study is to examine the negative symptom structure in FEP individuals and to compare the resulting factor configurations between FEP subjects with and without Schizophrenia Spectrum Disorders (SSD vs non-SSD). METHODS: One hundred and seventy participants (88 SSD and 82 non-SSD), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Positive and Negative Syndrome Scale (PANSS). A principal component analysis was then performed to investigate PANSS negative symptom structure in both non-SSD and SSD groups. RESULTS: Whereas in the SSD sample a 3-factor model solution (i.e., "Socio-Emotional Disengagement", "Motor/Thought Poverty", and "Avolition/Apathy" dimensions) was identified, a 2-factor model solution (with a mixed alogia/avolition domain in addition to a mixed socio-emotional disengagement/expressive deficits dimension) appeared more appropriate in the non-SSD group. CONCLUSIONS: Our results show a relevant difference in the negative symptom factor structure between SSD and non-SSD individuals. In particular, a different specificity and significance of negative symptom models in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered. Notably, a "Motor/Thought Poverty" domain, which specifically includes alogia and motor retardation separately from the other PANSS negative items, appears to specifically characterize FEP young patients with the schizophrenia spectrum.

Assessing aberrant salience in young community help-seekers with early psychosis: The approved Italian version of the Aberrant Salience Inventory.

OBJECTIVES: Aberrant salience (AS) has a crucial role in the onset of psychosis. The Aberrant Salience Inventory (ASI) is the only self-report instrument specifically developed for the assessment of AS. Aim of this study was to examine the reliability and the validity of the approved Italian version of the ASI in a clinical sample of young help-seekers. METHODS: The ASI was completed by 204 individuals, aged 13-35 years. Reliability was assessed examining internal consistency and test-retest reliability. Concordant validity was established with CAARMS ("Comprehensive Assessment of At-Risk Mental States"). RESULTS: The ASI showed high test-retest reliability and excellent internal consistency. The ASI total score had significant positive correlations with CAARMS "Positive Symptoms" subscores. CONCLUSIONS: The ASI showed satisfactory psychometric properties and seems to be a suitable instrument for early detection of psychosis in Italian mental health services.

Subjective experience of social cognition in young people at Ultra-High Risk of psychosis: a 2-year longitudinal study.

PURPOSE: Impairments in SC have been reported in people at Ultra-High Risk (UHR) of psychosis exclusively using neurocognitive tasks. The aims of this study are (1) to assess subjective experience of SC in adolescent and young adult community help-seekers identified through UHR criteria, (2) to explore significant associations of SC with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally the SC stability after a 2-year follow-up period. Methods: Participants (97 UHR, 141 First-Episode Psychosis [FEP], and 98 non-UHR/FEP), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the GEOPTE scale of social cognition for psychosis. Within the UHR group, a multiple linear regression analysis (with GEOPTE scores as independent variables and CAARMS dimension subscores and treatment measures as dependent variables) was also performed across the 2-year longitudinal design. Results: In comparison with non-UHR/FEP, both UHR and FEP subjects showed significantly higher GEOPTE scores. Both after 12 and 24 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE SC subscore. In the UHR group, GEOPTE scores showed significant positive correlations with general psychopathology, positive and negative symptoms. Regression analysis showed a significant contribution of SC in predicting baseline social isolation, impaired role functioning, and general psychopathology. After 1 year of follow-up, improvement in SC was predicted by the number of psychotherapy sessions and lower doses of antipsychotics. Conclusions: SC deficits are prominent in UHR individuals and are similar in severity to those of FEP patients. However, they tend to decrease over time along with the delivery of targeted, specialized interventions for early psychosis.

Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study.

BACKGROUND: Suicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. METHODS: 273 young people (13-35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory - II Edition (BDI), and the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. RESULTS: UHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS "Anhedonia" scores, and showed a negative correlation with all WHOQOL-BREF scores. CONCLUSIONS: Suicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.

Subjective experience of social cognition in adolescents at ultra-high risk of psychosis: findings from a 24-month follow-up study.

Deficits in social cognition have been reported in people at ultra-high risk (UHR) of psychosis exclusively using socio-cognitive tasks and in adolescent and young adult mixed population. Aim of this study was (1) to assess subjective experience of social cognition in adolescent help-seekers identified through UHR criteria, (2) to explore its significant correlations with psychopathology and functioning in UHR individuals; and (3) to monitor longitudinally its stability after a 24-month follow-up period. Participants [51 UHR, 91 first-episode psychosis (FEP), and 48 non-UHR/FEP patients], aged 13-18 years, completed the comprehensive assessment of at-risk mental states and the GEOPTE scale of social cognition for psychosis. In comparison with non-UHR/FEP patients, both UHR and FEP adolescents showed significantly higher GEOPTE total scores. After 12 months of follow-up, UHR individuals had a significant decrease in severity on GEOPTE "Social Cognition" subscore. In the UHR group at baseline, GEOPTE scores had significant positive correlations with general psychopathology, positive and negative dimensions. Across the 2-year follow-up period, social cognition subscores specifically showed more stable associations with general psychopathology and negative symptoms. Social cognition deficits are prominent in UHR adolescents and similar in severity to those of FEP patients at baseline. However, these impairments decreased over time, presumably together with delivery of targeted, specialized models for early intervention in psychosis.

Anhedonia in young people with first episode psychosis: a longitudinal study.

Aim: Previous research observed deficits in pleasure experience in chronic schizophrenia, but little is known about anhedonia in early psychosis. Aim of this study is: (1) to examine anhedonia in distinct help-seeking subgroups of young people identified through the First Episode Psychosis (FEP) criteria, (2) to investigate its correlations with psychopathology in the FEP sample, and (3) to monitor longitudinally its stability in the FEP group along 1-year follow-up period.Materials and methods: All participants (137 FEP and 95 nonpsychotic psychiatric controls [i.e. non-FEP]), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Schizotypal Personality Questionnaire - Brief version (SPQ-B), the Brief O-LIFE questionnaire (BOL), and the World Health Organization Quality of Life - Brief version (WHOQOL-BREF). We used two different indexes of anhedonia: CAARMS 'Anhedonia' item 4.3 and BOL 'Introvertive Anhedonia' subscale scores.Results: In comparison with non-FEP, FEP patients showed higher baseline anhedonia scores. After 1-year follow-up period, FEP individuals had a significant decrease in severity of anhedonia scores. In the FEP group, anhedonia showed significant, enduring (over time) correlations with impaired role functioning, negative symptoms, comorbid depression, poorer self-perceived quality of life and specific schizotypal personality traits (i.e. interpersonal deficits).Conclusions: Anhedonia is relevant in the early phase of psychosis and its severity is associated with functioning deterioration and a bad quality of life.

Familiarity for Serious Mental Illness in Help-Seeking Adolescents at Clinical High Risk of Psychosis.

Aim: Ultrahigh-risk (UHR) individuals have an increased vulnerability to psychosis because of accumulating environmental and/or genetic risk factors. Although original research examined established risk factors for psychosis in the UHR state, these findings are scarce and often contradictory. The aims of this study were (a) to investigate the prevalence of severe mental illness (SMI) in family members of distinct subgroups of adolescents identified through the UHR criteria [i.e., non-UHR vs. UHR vs. first-episode psychosis (FEP)] and (b) to examine any relevant associations of family vulnerability and genetic risk and functioning deterioration (GRFD) syndrome with clinical and psychopathological characteristics in the UHR group. Methods: Adolescents (n = 147) completed an ad hoc sociodemographic/clinical schedule and the Comprehensive Assessment of At-Risk Mental States to investigate the clinical status. Results: More than 60% UHR patients had a family history of SMI, and approximately a third of them had at least a first-degree relative with psychosis or other SMI. A GRFD syndrome was detected in ~35% of UHR adolescents. GRFD adolescents showed baseline high levels of positive symptoms (especially non-bizarre ideas) and emotional disturbances (specifically, observed inappropriate affect). Conclusions: Our results confirm the importance of genetic and/or within-family risk factors in UHR adolescents, suggesting the crucial need of their early detection, also within the network of general practitioners, general hospitals, and the other community agencies (e.g., social services and school).

A 2-year longitudinal study on subjective experience of social cognition in young people with first episode psychosis.

Impairments in Social Cognition (SC) in First Episode Psychosis (FEP) were reported exclusively using neurocognitive tests. Aim of this study is (1) to assess subjective experience of SC in FEP adolescent and young adults compared to non-FEP help-seeking peers, (2) to investigate any significant association of SC with psychopathology and functioning in FEP individuals; and (3) to monitor longitudinally the stability of SC after a 2-year follow-up period.

Anhedonia in adolescents at ultra-high risk (UHR) of psychosis: findings from a 1-year longitudinal study.

Previous findings suggested deficits in pleasure experience in schizophrenia, but little is known in psychosis risk prodrome, especially in adolescence. Aim of this study was (1) to assess anhedonia in distinct help-seeking subgroups of adolescents identified through the ultra-high risk (UHR) criteria, (2) to explore any association of anhedonia with other psychopathological aspects in the UHR group, and (3) to monitor longitudinally the stability of anhedonia in UHR individuals across 1-year follow-up period. 123 participants (13-18 years) completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II, the Schizotypal Personality Questionnaire-Brief version, the Brief-O-LIFE questionnaire (BOL), and the Brief version of the World Health Organization Quality of Life scale (WHOQOL-BREF). Two different indexes of anhedonia were used: CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia levels between UHR and First Episode Psychosis (FEP) groups was found. UHR adolescents showed higher CAARMS and BOL anhedonia scores than non-UHR/FEP. After 1-year follow-up period, UHR adolescents had a significant decrease in severity only in CAARMS anhedonia subscores. In UHR subgroup, CAARMS anhedonia measures showed significant correlations with impaired role functioning and negative symptoms, while BOL anhedonia was significantly correlated with specific schizotypal personality traits concerning interpersonal deficits. Anhedonia is prominent in the psychosis prodrome, also in adolescence. Its severity is not statistically different from that of FEP adolescents and is related to more severe functioning impairment and a worse quality of life.

The "Reggio Emilia At-Risk Mental States" program: A diffused, "liquid" model of early intervention in psychosis implemented in an Italian Department of Mental Health.

AIM: From September 2012, the Reggio Emilia Department of Mental Health developed a specific program (the "Reggio Emilia At-Risk Mental States" [ReARMS] protocol) as a diffused, "liquid" infrastructure for early intervention in psychosis. Aims of the current study are (a) to describe the ReARMS macroscopic organization and (b) to examine specific process indicators during the first 5 years of clinical activity. METHODS: All participants (n = 300) were young help-seekers, aged 13 to 35 years, who completed the Comprehensive Assessment of At-Risk Mental States (CAARMS). RESULTS: At baseline, 95 (31.7%) participants did not meet CAARMS-defined criteria, while 205 (68.3%) were offered a dedicated protocol of care: 154 (75.1%) of them were enrolled in the program, 19 (9.3%) refused and 32 (15.6%) dropped out during the first year of treatment. Individuals enrolled in the ReARMS protocol were mainly referred by general practitioners (33.3%), emergency room/general hospital (24%) or they were self-referred (15%). In comparison with ultra-high risk individuals, patients with first episode psychosis showed significantly higher mean age at entry and preponderance of males, as well as higher percentages of history of substance abuse and previous hospitalization. CONCLUSIONS: An early intervention in psychosis service in Italian child/adolescent and adult mental health services are feasible and clinically relevant, also in adolescents, who have a high risk of falling through the child-adult service gap as they cross the transition boundary between services.

Suicidal Thinking and Behavior in Adolescents at Ultra-High Risk of Psychosis: A Two-year Longitudinal Study.

OBJECTIVE: Suicide risk in subjects at Ultra-High Risk of psychosis (UHR) has been rarely assessed in adolescence, but it is of obvious importance for prognostic and clinical care reasons. In this study, we aimed to prospectively assess suicide risk and behaviors in UHR adolescents. METHOD: We examined 112 help-seeking adolescents (13-18 years, 50% males, 83.9% Caucasian) that were enrolled in the Reggio Emilia At-Risk Mental States (ReARMS) project and followed up for 2 years. Specific items derived from the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II) were used to assess suicide risk. Suicide attempts and completed suicides were also recorded. RESULTS: Baseline assessment detected 40 UHR adolescents, 32 FEP (first-episode psychosis), and 40 non-UHR/FEP. We found that 67.5% of UHR adolescents had suicidal ideation, and 18.5% to severe degree. Attempted suicide before enrollment was higher in the UHR group than in non-UHR/FEP peers (17.5% vs. 2.5%). BDI-II suicidal ideation severity was stable at 12-month follow-up and decreased at 24-month follow-up. CONCLUSIONS: A high prevalence of suicidal ideation among UHR adolescents was found and supports the routine monitoring of risk of self-injurious thinking and behavior in this at-risk population.