ABSTRACTIntroductionPsychotic disorders are major contributors to disability and mortality, disproportionately affecting young people. Despite advances in early psychosis care, there are still barriers to treatment, suboptimal outcomes, and limited therapeutic options. Given limited funding for psychosis research, priority setting that incorporates perspectives from across the sector, but especially those with lived experience, is vital for directing resources. This paper outlines the Australian Early Psychosis Collaborative Consortium's process for identifying priorities to guide early psychosis clinical trial research in Australia.MethodsQualitative data were collected via online surveys and stakeholder workshops with people with lived experience, carers, clinicians and researchers. Content analysis was conducted, followed by iterative refinement and ranking of priority research questions across multiple stages.ResultsSix broad themes and 55 research questions were identified through both the initial survey and stakeholder consultations, culminating in ten research questions for ranking in the final poll. The top‐ranked priority was identifying treatments with the most enduring benefits for individuals with early psychosis. Other priorities included: identifying effective treatments for negative symptoms; addressing trauma in psychosis risk and treatment; focusing on supports for neurodevelopmental conditions; understanding and targeting risk factors to prevent psychosis onset; translation of research findings to clinical care; considerations of cultural diversity; and effective support for people leaving early psychosis services.ConclusionThese findings reaffirm the core objective of specialised early intervention for psychosis: to support long‐term recovery and improved outcomes. Identified priorities offer direction for future research and resource allocation that reflects diverse stakeholder perspectives.

Climate change exposure is predicted to contribute to significant mental health problems for younger people; however, little research has examined this stressor in the context of other psychosocial stressors experienced by this age group. In the immediate aftermath of Australia's severe bushfire season of 2019/2020 and at the onset of the COVID-19 pandemic, 712 Australian youth (Mage = 21.07, range 16-25 years) completed standardised clinical screening measures of psychological distress, adjustment disorder, and substance misuse. Objective exposure to extreme drought, bushfire, and bushfire smoke (air quality index) was quantified using data from the NSW Department of Primary Industries and Energy. Subjective exposure was quantified by responses to questions about direct exposure to drought, bushfire, and bushfire smoke. In contrast to expectations, neither subjective nor objective exposure to climate extremes meaningfully contributed to mental health outcomes, with little variance explained. However, common psychosocial stressors did account for significant amounts of variance in psychological distress (range: 2%-6%), adjustment disorder (range: 1%-3%), and substance misuse (range: 1%-2%) symptom endorsement. These results indicate-for the first time-that although extreme climate events may cause significant distress in some young people, other stressful events may have more of an impact on overall mental health.

Eating disorders (EDs) are serious illnesses and a better understanding of initial symptom phases could inform early intervention. This study aims to evaluate duration of untreated eating disorder (DUED) and duration/characteristics of the preceding prodrome period in young people diagnosed with an ED. Fifty-four young people (28 adolescents aged 13-17 and 26 emerging adults aged 18-25) with recent onset EDs (< 3 years) completed a retrospective onset interview and life chart. DUED, prodrome duration and prodrome characteristics (ED-specific and more broad psychiatric symptoms) were compared according to developmental stage and diagnosis. The relationships between DUED and prodrome duration with early outcomes were evaluated. Emerging adults had a longer DUED than adolescents. This group also had a longer prodrome but only when broad psychiatric symptoms (i.e., not ED-specific) were considered. Those with bulimia-type EDs had a longer ED-specific and broad psychiatric prodrome compared to those with anorexia-type EDs. There were no significant developmental stage or diagnosis-related differences in symptom severity during prodrome. In those who were underweight at presentation to services, a shorter broad prodrome duration was associated with greater weight gain after 3 months of treatment. When both ED and broad psychiatric symptoms are considered, DUED and prodromal symptoms of EDs differ according to developmental stage and diagnosis. Duration of prodrome may also impact early outcomes but further research is needed.

There is evidence that anticipated and self-stigma are associated with decreased engagement in first episode psychosis (FEP) treatment. It is therefore plausible that addressing stigma in FEP treatment could potentially improve treatment engagement and facilitate outcomes related to recovery. Narrative Enhancement and Cognitive Therapy (NECT) is a structured group-based intervention that has been found to be effective at reducing self-stigma among persons diagnosed with severe mental illnesses in multiple RCTs; however, a review of the manual determined that it was not appropriate for use with people with FEP in its standard form. The purpose of the present study was to adapt NECT for FEP youth and determine its acceptability/feasibility. We discuss the process of manual adaptation, including: optimising fidelity, optimising fit, balancing fidelity and fit, and pilot testing. Acceptability and feasibility were assessed as a function of treatment fidelity, attendance, and treatment satisfaction in an initial implementation (using a modified version of the Narrative Evaluation of Intervention Interview [NEII]). A case example of a group implementation is also presented. Mean overall fidelity ratings were good (4.33 on a 1-5 scale); among the three participants who attended at least one session, attendance was acceptable, with 77.8% of scheduled meetings attended. Findings from the NEII revealed that all participants perceived benefit from the intervention. Findings supported the potential acceptability and feasibility of the adapted form of NECT geared towards youth who have experienced FEP (NECT-YA).

ABSTRACTBackgroundAdverse events and substance misuse are rarely examined together among people in early phase psychosis, although both are frequently examined in isolation given their high prevalence in this population. As a result, the frequency of the three‐way overlap is unclear. Moreover, adverse events are often limited to childhood abuse and rarely include illness‐related events (e.g., threatening hallucinations). This study aims to explore the overlap between these variables and provide a more detailed understanding of adversity in this population and their desire to disclose experiences.MethodsWe surveyed 110 individuals aged 16–35 years with early phase psychosis about substance misuse, lifetime adverse events, disclosure of adverse events, and PTSD symptoms.ResultsNearly all participants (97.2%) had experienced at least 1 adverse event, recalling an average of 8 adverse events over lifetime (SD = 3.8). Over 22% met the cutoff for a probable PTSD diagnosis on a validated measure. Substance misuse was present in 67% of participants, often involving multiple substances (M = 2.7 substances, SD = 1.5), most commonly alcohol, cannabis, and tobacco. There was an overlap between early phase psychosis, substance misuse, and a history of at least 1 adverse event in 66.4% of the sample. Most participants (78.7%) had disclosed their adverse events to someone, and 72.7% expressed interest in speaking to a mental health professional about their experiences.ConclusionAdverse events and substance misuse commonly co‐occur in early phase psychosis, and these results have important clinical ramifications for assessment and treatment in an early phase psychosis population.

ABSTRACTAimStaff engagement with individuals with first‐episode psychosis (FEP) in early intervention services (EIS) settings is important to reduce the longer‐term impact of this condition and promote recovery. There is a paucity of qualitative evidence exploring engagement from the perspectives of staff in these settings. This study aimed to explore and understand Case Managers' experiences of engagement with service users in EIS settings in the United Kingdom.MethodHermeneutic interpretive phenomenological analysis (IPA) using semi‐structured interviews with purposively sampled EIS case managers with mental health nursing backgrounds from a single NHS Trust in the North of England. Data analysis followed IPA's six stages.ResultsFive master themes were identified as being key to effective engagement: (1) Being on the same page, (2) Engagement as an interpersonal relationship, (3) Managing self and emotions, (4) The practicalities of engagement and (5) The impact of organisational factors upon engagement. Engagement was experienced as multi‐faceted, complex and changeable. Key engagement strategies identified as helpful were trust, therapeutic dialogue, shared understanding, collaboration and practical approaches.ConclusionEngagement in the context of EIS can be defined as a mutually beneficial connection that takes place between service users and staff which allows for the implementation of treatment. Engagement strategies are an important consideration to reduce the potentially devastating impact of FEP, and to facilitate recovery. Further exploratory research should be conducted across multiple settings to further build on and understand engagement within the wider EIS context.

ABSTRACTIntroductionBody image dissatisfaction is a risk and maintenance factor for disordered eating. Parents may contribute to offspring body image dissatisfaction through weight‐related criticism (direct influence), as well as expressed parental body image dissatisfaction and dieting (indirect influence). This study retrospectively investigated the contribution of parental influence towards adult offspring's body image dissatisfaction.MethodsOne hundred and fifty six participants from a general community sample completed a survey recording their experience of direct and indirect parental influence throughout adolescence, in addition to their current body image satisfaction.ResultsWhile controlling for peer and media influences, hierarchical linear regression determined that parental influence was a significant contributor to offspring body image dissatisfaction (p < 0.001), and this effect was driven by direct influence (p < 0.001). Indirect parental influence was non‐significant (p = 0.899).ConclusionsThe observed strength of direct influence supports the need for parents to reinforce positive weight‐related behaviours at home as a method of reducing and managing body image dissatisfaction levels in their offspring.