The Canadian Journal of Psychiatry

Despite well-known benefits of family involvement and interventions, gaps remain in their implementation in early intervention for psychosis. Guidelines have been developed for early psychosis services to bridge evidence-implementation gaps. Little attention has been paid to their nature, quality and recommendations regarding family involvement and interventions. We aimed to identify, describe, and appraise family-focused recommendations in Canadian early psychosis guidelines.

We conducted a systematic review (PROSPERO#CR042020208974), including Canadian guidelines/standards for first-episode psychosis/early intervention in psychosis, or for psychosis/schizophrenia with a section on first-episode psychosis/early intervention for psychosis. The search was conducted in Google and Google Advanced of 58 websites (April 2024). From each document, bibliographic information and family-focused recommendations were extracted. All family-focused recommendations were subject to content analysis and mapped against a patient and family engagement framework. All guidelines were appraised using Appraisal of Guidelines Research & Evaluation—Recommendation EXcellence (AGREE-REX), assessing rigor and implementability. Family-focused recommendations were rated on three AGREE-REX items. Findings were narratively synthesized.

Seven documents were included, with five provincial early psychosis guidelines and two Canada-wide schizophrenia-spectrum guidelines. 96 family-focused recommendations were extracted covering 21 themes (19 appeared in ≤4 guidelines; two (family psychoeducation; involving families in treatment-planning) in five guidelines). No guidelines had recommendations regarding families in inpatient care; only two guidelines had recommendations for navigating consent vis-à-vis family involvement. 77.4% of recommendations were about direct care; 22.5% about involving families in organizational design/governance; and none about policymaking involvement. AGREE-REX ratings for relevant outcomes and local applicability were lower for family-focused recommendations than overall guidelines. Most guidelines fared poorly in eliciting families’ values/preferences.

Few family-focused recommendations featured consistently across early psychosis guidelines. There was little guidance on navigating barriers to family involvement. Our analysis revealed critical gaps, including in viewing families as partners in treatment decision-making and services/policy design. Future guidelines must integrate stakeholders’ values/preferences and guidance on real-world implementation.

There are clinical and radiological sex differences in people with multiple sclerosis (pwMS); however, the influence of sex on the neuropsychiatric symptoms of MS remains unclear. This study aimed to clarify whether there are sex differences in the neuropsychiatric symptoms of MS.

A consecutive clinical cohort of 1530 pwMS completed the Hospital Anxiety and Depression Scale for symptoms of anxiety (HADS-A) and depression (HADS-D), the Modified Fatigue Impact Scale (MFIS), the Perceived Deficits Questionnaire (PDQ) for subjective cognitive concerns, and the Minimal Assessment of Cognitive Function in MS neurocognitive battery. Linear regression analyses were undertaken to predict neuropsychiatric raw scores from sex, adjusting for age, educational years, Expanded Disability Status Scale (EDSS) scores, disease duration, and disease subtype. The significance threshold was set at p < .01.

Mean age was 43.2 years (SD = 10.6), mean disease duration was 9.7 years (SD = 8.4), and median EDSS was 2.0 (IQR = 1.5–3.5). Seventy-three percent of participants were female. Controlling for covariates, females had higher MFIS, PDQ, California Verbal Learning Test, and Brief Visuospatial Memory Test total learning scores, and lower Judgment of Line Orientation and Paced Auditory Serial Addition Test scores than males, all p < .01. Sex was not independently predictive of scores on the HADS-A, HADS-D, Controlled Oral Word Association Test, Brief Visuospatial Memory Test delayed recall, Symbol Digit Modalities Test, or Delis-Kaplan Executive Function System.

Among pwMS, females experience greater fatigue, cognitive complaints, and dysfunction in spatial rotation and working memory than males, while males have elevated learning/memory difficulties. The absence of differences in symptoms of depression and anxiety between males and females contrasts with well-described sex differences in the general population. These data support future research that can explain sex-specific mechanisms of neuropsychiatric symptoms in pwMS.

We adapted and evaluated a transdiagnostic psychosocial intervention, the Optimal Health Program (OHP), to meet the unique mental health needs of youth at clinical high risk for psychosis (CHR). This study aimed to establish the acceptability of OHP for CHR (OHP-CHR), the feasibility of conducting a confirmatory clinical trial, and the preliminary efficacy of the intervention in improving clinical and functional outcomes.

In this single-arm clinical trial, youth aged 16–29 years meeting CHR criteria were recruited between September 2023 and August 2024. Nine OHP-CHR sessions were delivered over 12 weeks. Acceptability of the intervention was assessed through session attendance rates and the Client Satisfaction Questionnaire (CSQ-8). Feasibility of conducting a confirmatory clinical trial was informed by recruitment, retention, adherence, intervention fidelity, and completion of the outcome schedule. Psychiatric symptoms, resilience, and functioning were assessed at baseline and after 12 weeks.

Acceptability of OHP-CHR was demonstrated by high session attendance (n = 26; 86.7% attended all nine sessions) and participant satisfaction scores (CSQ-8: mean = 28.35, SD = 3.68). Feasibility of conducting a confirmatory clinical trial was supported by strong recruitment over 12 months (n = 30; rate of 2–3/month) high retention (n = 26; 86.7% at 12 weeks), intervention fidelity, and ease of completing the clinical assessment schedule. Preliminary indicators of clinical efficacy were demonstrated by a decrease in psychiatric symptoms, improvement in resilience, and enhanced functioning.

OHP-CHR is a promising psychosocial intervention co-designed by CHR youth. Our data support the acceptability of the intervention, the feasibility of conducting a confirmatory clinical trial, and preliminary evidence of efficacy in improving clinical and functional outcomes.

Trial is registered at ClinicalTrials.gov NCT05757128.

Testing a well-being and self-efficacy programme for Canadian youth at risk for psychosis

We adapted and tested a mental health programme called the Optimal Health Program (OHP) to better support youth who are at clinical high risk for psychosis (CHR). The goal of this study was to see if the adapted version, called OHP-CHR, was acceptable to young people, whether it would be possible to run a larger clinical trial in the future, and whether the programme could help improve mental health and daily functioning.

We invited youth aged 16 to 29 who met CHR criteria to take part between September 2023 and August 2024. Participants attended nine OHP-CHR sessions over 12 weeks. We looked at how many sessions people attended and how satisfied they were to understand if the programme was acceptable. To see if a larger study would be feasible, we tracked recruitment, retention, session attendance, programme delivery, and completion of assessments. We measured psychiatric symptoms, resilience, and functioning before and after the programme.

The programme was well accepted. We successfully recruited 30 participants over 12 months and retained 87% through the end of the study. Most participants (87%) attended all sessions and reported high satisfaction. The programme was delivered as planned, and participants found the assessments easy to complete. After completing OHP-CHR, participants showed fewer symptoms, greater resilience, and better functioning.

OHP-CHR is a promising mental health programme developed with input from CHR youth. Our findings show that young people find it acceptable and engaging, and that a larger clinical trial would be feasible.

A proportion of patients suffering from obsessive-compulsive disorder (OCD) achieves clinical recovery. However, research is sparse on the functional recovery of clinically recovered subjects with OCD. This study examines functionality in clinically recovered OCD subjects compared to healthy controls (HCs).

Patients who had clinically recovered from OCD (n = 102) were compared to HCs (n = 52) with respect to global functioning, well-being, disability, and quality of life (QOL) using the Global Assessment of Functioning (GAF) Scale, the WHO-5 Well-Being Scale, the WHO-Disability Assessment Schedule, and the WHO-Quality of Life-Brief Version respectively. They also underwent a comprehensive neuropsychological assessment.

Clinically recovered OCD patients had lower global functioning, higher disability scores, impaired environment QOL, and poorer neuropsychological performance in the domains of working memory and response inhibition compared to HCs. In the Spearman's correlation analysis, better global functioning in clinically recovered OCD patients correlated with a longer period of clinical recovery, receiving pharmacological augmentation, not receiving cognitive behavioural therapy, lower disability scores, a higher well-being score, and a higher total QOL score. Neuropsychological correlates of better functioning included faster processing speed and greater accuracy in working memory tasks. In a stepwise quantile (median) regression analysis, improved functioning was associated with an older age of onset, longer duration of remission, faster processing speed, better working memory, lower total disability scores, and higher total QOL scores.

Clinically recovered OCD patients have a lower functionality. Functional recovery may be defined as clinical recovery and a GAF score of >70 (no more than slight impairment in functioning and minimal symptoms, if any). It is important to identify those who have not achieved functional recovery and offer interventions, including cognitive remediation to improve functional outcomes.

Building on prior population-level studies, this replication study explored the predictive accuracy of retrospectively-reported early-life adversity (ELA) for individual psychopathology risk in a Canadian population survey, with measurements focused on direct/severe ELA and occurring during the COVID-19 pandemic.

Nationally-representative, cross-sectional data from 7,608 Canadians surveyed in 2022 were analysed. Group-level differences were assessed via logistic regression, and predictive accuracy of ELA was tested via area under the curve (AUC) analyses.

Group-based analyses found that the odds of mental health problems rose with increasing ELA, albeit nonlinearly. Across psychopathology domains, predictive accuracy was poor (AUC = 0.62–0.67). Using a high-risk cut-off of ≥4 ELAs, sensitivity values were low (0.14–0.23), while specificity was high (0.93–0.94). Similarly, positive predictive values were low (0.08–0.22), while negative predictive values were high (0.92–0.97).

ELA screening performs poorly at the individual level. While high-risk cut-offs may rule out poor mental health for individuals with fewer ELAs, it fails to accurately identify those with psychopathology. Predictive accuracy does not improve under conditions of collective stress or by focusing on direct/severe ELA. Presently, ELA screening is unsuitable for guiding intervention allocation. Further research is needed to determine whether screening can be refined to improve mental health risk prediction.

Early-life adversity and adult mental health: Is Canadian screening getting it right?