Gender differences in salivary alpha-amylase and attentional bias towards negative facial expressions following acute stress induction.

This study investigated gender differences in two key processes involved in anxiety, arousal and attentional bias towards threat. Arousal was assessed using salivary alpha-amylase (sAA), a biomarker of noradrenergic arousal and attention bias using a dot-probe task. Twenty-nine women and 27 men completed the dot-probe task and provided saliva samples before and after a stress induction [cold pressor stress (CPS) test]. Women displayed a significant increase in arousal (sAA) following the stressor compared to men, who displayed a significant reduction in arousal. Reaction time data revealed a significant avoidance of threat in women at baseline, but a significant change to an attention bias towards threat following the stressor. Men did not significantly respond to the stressor in terms of attentional bias. These findings suggest that women are more reactive to a stressor than men, and display an initial avoidance response to threat, but an attentional bias towards threat following stress.

A supported education programme implemented in youth mental health services: Outcomes and lessons from the first year of COVID-disrupted delivery.

AIM: Educational attainment is consistently highly valued by young people with mental ill health, yet maintenance and completion of education is a challenge. This paper reports on the implementation of a supported education programme for youth mental health. METHODS: Between 10 October 2019 and 10 October 2020, a supported education programme was delivered within primary and tertiary youth mental health services. A description of the programme, context, and adjustments required due to COVID-19 is presented, and the educational outcomes of young people referred to the programme were explored. Two case studies are also presented. RESULTS: The programme received 71 referrals over this period, of which 70.4% had not yet completed secondary school and 68% were experiencing multiple mental health conditions. Overall outcomes were positive, with 47.5% of the 40 young people who chose to engage with the programme maintaining or re-engaging with education. However, the remainder of those who engaged withdrew from the programme, often reporting challenges due to COVID-19 such as social isolation or increased uncertainty. Additionally, a number of young people declined or disengaged from the programme to focus on employment. CONCLUSION: This report of the experience of integrating a supported employment programme in Australian youth mental health services reinforces the need for such support, and provides preliminary evidence for its successful implementation as part of routine care. The disengagement in response to COVID-19 highlights the real-world challenges of the pandemic, while young people's voicing of employment goals indicates the need for combined educational and vocational support-to assist transition and progression between these goals.

Validating cognitive screening in young people with first-episode psychosis: The CogScreen protocol.

AIM: Cognitive impairments are a core feature of first-episode psychosis (FEP) and one of the strongest predictors of long-term psychosocial functioning. Cognition should be assessed and treated as part of routine clinical care for FEP. Cognitive screening offers the opportunity to rapidly identify and triage those in most need of cognitive support. However, there are currently no validated screening measures for young people with FEP. CogScreen is a hybrid effectiveness-implementation study which aims to evaluate the classification accuracy (relative to a neuropsychological assessment as a reference standard), test-retest reliability and acceptability of two cognitive screening tools in young people with FEP. METHODS: Participants will be 350 young people (aged 12-25) attending primary and specialist FEP treatment centres in three large metropolitan cities (Adelaide, Sydney, and Melbourne) in Australia. All participants will complete a cross-sectional assessment over two sessions including two cognitive screening tools (Screen for Cognitive Impairment in Psychiatry and Montreal Cognitive Assessment), a comprehensive neuropsychological assessment battery, psychiatric and neurodevelopmental assessments, and other supplementary clinical measures. To determine the test-retest reliability of the cognitive screening tools, a subset of 120 participants will repeat the screening measures two weeks later. RESULTS: The protocol, rationale, and hypotheses for CogScreen are presented. CONCLUSIONS: CogScreen will provide empirical evidence for the validity and reliability of two cognitive screening tools when compared to a comprehensive neuropsychological assessment. The screening measures may later be incorporated into clinical practice to assist with rapid identification and treatment of cognitive deficits commonly experienced by young people with FEP.

A pilot study of a mindfulness informed yoga intervention in young people with psychosis.

AIM: To determine the acceptability and safety of a mindfulness informed yoga intervention as adjunct to usual care for young people with early psychosis. METHODS: People aged 16-25 years attending a community-based specialist early psychosis clinic were invited to participate in a 12-week yoga intervention. The intervention consisted of 1-h weekly classes of mindfulness informed yoga. Acceptability was measured by uptake, attendance and participants' satisfaction. Safety was measured by incidence of physical injury, participants' level of comfort, distress and anxiety during the sessions, and the following mental health outcomes: positive and negative psychotic, depression, anxiety and stress symptoms, sleep quality and functioning. RESULTS: Of those who consented to the study, 80% (12) participated and on average attended 4.4 yoga classes. There were no physical injuries and participants reported minimal distress and anxiety. Post-intervention, there was a significant reduction in anxiety symptoms and an improvement in function. CONCLUSIONS: Mindfulness-based yoga interventions are both acceptable and safe as an intervention for youth with early psychosis. Though numbers were small, the study shows promise for yoga as a potentially useful intervention. Importantly, there was no deterioration in mental health outcomes. A larger trial evaluating clinical effectiveness is now timely.

Extinction in human learning and memory.

In two experiments, participants were given extinction training in a human causal learning task. In both experiments, three critical experimental cues were paired with different outcomes in a first phase of training and were then extinguished in a second phase. Three control cues were given the same treatment in the first phase of training, but were not then presented in the second phase. Participants' ability to correctly identify the outcome with which each cue had been paired in the first phase was lower for extinguished than for control cues. Causal attributions to the extinguished cues were also lower than those to the control cues, a difference that correlated with outcome memory. These data are consistent with the idea that extinction in causal judgement is due, at least in part, to a failure to remember the cue-outcome relationship encoded in the first phase of training.