Schizophrenia is a chronic severe mental illness affecting 24-million people globally, associated with a life expectancy 15 years shorter than the general population. Approximately 70% of people with schizophrenia experience auditory verbal hallucinations (AVHs), i.e. ‘hearing voices’. Current treatment approaches remain unsuccessful in up to 30% of cases.

This systematic review and meta-analysis evaluated randomised controlled trials (RCTs) of non-pharmacological treatments for AVHs in schizophrenia spectrum disorders, assessing emerging treatment effectiveness and identifying research gaps.

A literature search was performed between 2013-2024 across five databases: PubMed, Embase, PsycINFO, Medline, and Web of Science. The meta-analysis included 45 studies based on predefined criteria and bias assessment. Effect sizes (Hedge’s g) were calculated using a random effects model with 95% confidence intervals. The study followed PRISMA guidelines and was pre-registered (PROSPERO ID: CRD42024598615).

Our sample included 2,314 patients and fourteen interventions. The overall mean effect size was -0.298 (95% CI, [-0.470, -0.126]), representing a medium, statistically significant effect. Subgroup analyses revealed medium, statistically significant effects for both AVATAR therapy and cognitive behavioural therapy (CBT). Conversely, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed small, non-significant effects.

AVATAR therapy has the strongest evidence for treating AVHs, highlighting the need for large-scale RCTs and integration into treatment guidelines. CBT requires methodological standardisation. Acceptance and commitment therapy shows promise but needs further high-quality RCTs. Non-invasive brain stimulation techniques require additional trials before clinical implementation.

The functional outcome of patients with psychotic disturbances is associated with several overlapping premorbid, societal, neuropsychological, and clinical factors. Extracting the factors associated with functional outcomes is important for designing effective mental health interventions.

In a naturalistic prospective European multicentre study, we analysed the effects of sociodemographic, preadmission, admission, and postadmission precursors on functional outcomes in 296 patients with recent-onset psychosis (ROP) and 262 patients at clinically high risk of psychosis (CHR-P). Functioning was assessed with the Global Assessment of Functioning—symptoms and deficits version—at baseline and at the 9- and 18-month follow-ups.

In the overall sample, male sex, childhood adversities, poor sociability, scholastic problems, neurocognitive deficits, and greater severity of baseline and follow-up symptoms were associated with poor functional outcomes. In contrast, a favourable work/educational situation and preadmission treatment for nonpsychotic disorders were associated with better functional outcomes. Among ROP patients, neurocognitive deficits and the severity of baseline and follow-up affective and psychotic symptoms were strongly associated with functional outcomes. Among CHR-P patients, premorbid sociability, previous treatment for affective disorders, and follow-up affective symptoms played more significant roles.

To improve functioning in patients in the early stages of psychosis, several factors should be considered, such as sex, childhood adversities, psychosocial development, baseline neurocognitive deficits, work/educational situation, clinical presentations, and follow-up symptoms. Personalized and integrated treatment and rehabilitation measures should be actively continued beyond the first admission period, with a particular focus on addressing both baseline and follow-up affective disturbances.

Psychosocial interventions for people with mental illness are increasingly focusing on facilitating recovery and self-care. Despite evidence from Europe on the short-term effects of recovery self-planning programs for people discharged from crisis resolution teams, similar programs and supporting evidence in other countries or healthcare contexts are lacking, particularly regarding cultural adaptation and long-term assessment. This randomized controlled trial compared a 4-month peer-facilitated, recovery-focused self-illness management (Peer-RESIM) program for Chinese adults with first-episode psychosis with psychoeducation (PE) and treatment as usual (TAU).

Patients (N = 198) were recruited from four Integrated Community Centres for Mental Wellness in Hong Kong and randomly assigned to the Peer-RESIM, PE, or TAU group (66/group). The primary outcomes were recovery and functioning levels; the secondary outcomes were psychotic symptoms, problem-solving ability, rehospitalization rate, and service satisfaction. Assessments were conducted at baseline and immediate, 9, and 18 months postintervention.

The generalized estimating equation test revealed that the Peer-RESIM group reported significantly greater improvements in recovery, functioning, problem-solving ability, psychotic symptoms, average duration of rehospitalizations, and service satisfaction (p = 0.01–0.04, small to large effect sizes) than the TAU group at all three posttests and the PE group at 18 months postintervention.

The Peer-RESIM can enhance long-term recovery and self-care in adults with early-stage psychosis.

Transition from a categorical to a dimensional approach has been proposed in the field of psychosis. However, whether key features of schizophrenia, such as cognitive deficits, really do lie along a linear continuum remains uncertain. To explore this, we compared for the first time verbal learning impairments in six entities of the psychosis spectrum using linear, nonlinear, and categorical models.

Studies involving verbal learning tests in familial high risk, clinical high risk, schizotypy/schizotypal, ultra-high risk, first episode of psychosis (FEP), and chronic schizophrenia populations were systematically searched in three databases in September 2024. Studies were included if they reported an immediate, delayed, or total recall measure in subclinical or clinical entities and healthy controls. The metafor package was used to compute effect sizes for the comparison between cases and control groups, categorized by psychosis entities. Model comparisons were also performed to compare linear, nonlinear, and categorical distributions of the effect sizes.

The meta-analysis aggregated a total of 262 studies in the psychosis spectrum. Effect sizes were moderate in at-risk populations (<0.50) and large in clinical populations (−1.00 for FEP and >1.00 for chronic schizophrenia). A nonlinear model best explained our data in immediate recall, while the results in delayed and total recall suggest the inferiority of linear models.

Our findings suggest a discontinuity in verbal learning between at-risk populations and clinical entities, challenging a purely linear dimensional model of cognitive impairment in the psychosis spectrum.

This analysis evaluated potential differences in subjective well-being (SW) among patients with early-phase schizophrenia (SZ) randomized to treatment with either long-acting injectable (LAI) or oral aripiprazole or paliperidone within the “European Long-acting Antipsychotics in Schizophrenia Trial” (EULAST).

A total of 478 patients were followed for up to 19 months. SW was measured using the Subjective Well-being under Neuroleptic Treatment scale (SWN). Linear mixed-effects models assessed treatment differences. Comprehensive analyses included age, sex, symptomatology (Positive and Negative Syndrome Scale [PANSS]), and side effects (Systematic Monitoring of Adverse Events Related to Treatments [SMARTS] and St. Hans rating scale [SHRS] for extrapyramidal syndromes) on SWN changes.

Overall, SW improved over the course of the study. No significant differences emerged between LAI and oral administration (p = 0.1533) or between aripiprazole and paliperidone (p = 0.2008). Similarly, age and sex were not relevant in this regard. In contrast, negative, positive, and affective symptoms (all p < 0.0001) as well as the overall side effect burden (SMARTS sum-score, p < 0.0001) showed significant inverse associations with SW. Certain SHRS subscales correlated with SW in partial models, but associations disappeared in the fully adjusted model.

Patients with SZ initiating LAI or oral treatment with aripiprazole or paliperidone reported comparable SW improvements. Findings emphasize that treatment choice should be guided less by formulation or substance and more by individual patient needs, prioritizing symptom control while minimizing adverse effects. A patient-centered approach remains essential to optimize both clinical outcomes and subjective well-being in early-phase SZ.

Cognitive impairment is central to psychosis and strongly linked to functional outcomes. The Brief Assessment of Cognition (BAC) app is a tablet-based, automated tool for assessing key cognitive domains but has not been validated in Spanish-speaking populations or across illness stages.

A total of 402 participants (117 with first-episode psychosis [FEP], 125 with schizophrenia, and 160 controls) completed the BAC app along with clinical and functional assessments. We evaluated internal consistency, group differences, convergent and discriminant validity, and the effects of sex, age, and education. Normative percentiles were derived from controls.

The BAC app showed good internal consistency across groups (α = 0.76–0.87) and effectively differentiated individuals with psychosis from controls (area under the curve [AUC] = 0.862), with performance declining from controls to FEP to schizophrenia. Discrimination between FEP and schizophrenia was limited (AUC = 0.649). BAC App correlated positively with estimated intelligence quotient and functional capacity, and negatively with symptom severity, particularly in FEP. Performance varied by age, sex, and education, supporting the need for stratified normative data.

The BAC app showed strong reliability and validity for cognitive assessment in Spanish-speaking individuals with psychosis. Its brevity, automated scoring, and normative data support its clinical and research applications for cognitive screening, monitoring, and treatment evaluation.

We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations – the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects – while assessing clinicians’ adherence to guidelines.

A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A–F). Additionally, a review of multiple guidelines/guidance papers was performed.

The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.

These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians’ unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear.

To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes.

Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP.

Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [−0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [−0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = −0.21, 95% CI [−0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [−0.36, 0.674], p = 0.551), triglycerides (SMD = −0.041, 95% CI [−0.461, 0.38], p = 0.849), or glucose (SMD = −0.071, 95% CI [−0.213, 0.071], p = 0.326). Heterogeneity was moderate to high.

Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.

Psychotic disorders, including schizophrenia (SZ), schizoaffective disorder (SZA), bipolar disorder (BD), psychotic depression (PD), and other nonaffective psychoses (ONAP), are associated with increased risk of suicidal acts. Few studies have compared suicidal act prevalence across psychotic disorders using both self-report and register data. The impact of hospitalization duration on subsequent suicidal acts is unclear.

We used data from the SUPER-Finland study, involving 7067 participants with register-based ICD-10 diagnoses of psychotic disorders (SZ, SZA, BD, PD, ONAP). Lifetime suicidal acts were identified through self-report and register-based records of intentional self-harm events requiring medical treatment. Associations between diagnostic categories and suicidal acts were assessed using logistic regression, adjusted for sex, duration of illness, socioeconomic status, childhood abuse, and substance use. Survival analysis was used to examine the impact of hospital stay length on postdischarge self-harm.

Lifetime suicide attempts (39.1%) and register self-harm (19.3%) were prevalent. of those with self-reported suicide attempts, 40.5% also had register-based self-harm. Self-harm and suicide attempts were significantly more prevalent in SZA, BD, and PD compared to schizophrenia, with large differences between groups (24.1–46.4% for suicide attempts, 11.1–23.9% for self-harm). Adjusted odds of self-harm were higher for disorders with a mood component. Shorter hospitalizations were associated with an elevated hazard ratio for subsequent self-harm.

Prevalence of register-based self-harm and self-reported suicide attempts differ markedly. Suicidal acts are common in psychotic disorders, particularly in those with a mood component. Very short inpatient stays may not be adequate in these disorders.

Cognitive deficits and immune system dysregulation are core features of psychotic disorders. Among inflammatory markers, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) have been linked to both psychosis pathophysiology and related cognitive impairments.

We investigated associations among IL-6, TNF-α, and neurocognitive performance in 107 participants: individuals at clinical high risk for psychosis (CHR-P, n = 35), first-episode psychosis (FEP, n = 39), and healthy controls (HC, n = 33). Assessments included memory, processing speed, executive function, and social cognition. Cytokines were measured from fasting serum samples. Analyses included ANOVA, correlations, and multivariate regressions controlling for age, sex, IQ, group, and symptom severity.

TNF-α levels were significantly elevated in FEP compared to CHR-P (p = 0.0251); IL-6 differences were non-significant. FEP showed poorer performance in multiple cognitive domains, especially social cognition. CHR-P individuals exhibited intermediate profiles between FEP and HC in cognition. In adjusted regression models, IL-6 was significantly associated with undermentalization on the MASC task (β = 0.28, p = 0.0337) and showed a trend-level association with slower processing speed (β = 0.98, p = 0.075). TNF-α levels predicted poorer facial emotion recognition (β = −1.37, p = 0.0022). IQ and group were significant covariates in most models.

Our findings suggest that peripheral inflammation, particularly IL-6 and TNF-α, may selectively impact social cognitive functioning in early psychosis. Though modest, these associations highlight potential inflammatory contributions to functional impairment and support further investigation of immunological targets in early intervention.

Cognitive Behavioural Therapy for psychosis (CBTp) is an effective psychological treatment for Schizophrenia Spectrum and other psychotic Disorders (SSD). Despite guidelines recommending CBTp for all psychotic disorder patients, many SSD patients lack access to the treatment and little is known about its long-term cost-effectiveness. The aim of this study is to evaluate the cost-effectiveness of CBTp for the treatment of psychotic disorders through scenario analysis from a healthcare perspective.

Increased implementation of CBTp was evaluated using a real-world SSD population (N = 12,835) from the northern Netherlands (2010–2019). A patient-level model was used to simulate the long-term effects of rehospitalisation rate. We compared treatment as usual (TAU) with the same TAU plus hypothetical CBTp for all individuals not having received such in TAU, hence patients who received any CBTp sessions prior were excluded (N = 2,679). Outcomes considered were quality-adjusted life years gained and total costs of mental healthcare. Additional sensitivity and scenario analyses were performed to evaluate structural and parameter uncertainty.

TAU+CBTp was a cost-effective treatment in 61.2% of the simulations. The simulated net present values for QALY gains were 0.038, and for incremental costs were €492 per patient on average, resulting in an expected incremental cost-effectiveness ratio (ICER) of €12,947.

The evaluation shows that CBTp is likely a cost-effective treatment, although results were uncertain. These findings stress the importance of sufficient availability of CBTp for SSD patients. Making CBTp available for all eligible SSD patients may lead to substantial health gains for the SSD population and cost savings from the healthcare perspective in The Netherlands.

Psychotic disorders are frequently preceded by depressive disorders, and it has been hypothesized that treatment of depression in youth may reduce risk for later psychosis. Using quasi-experimental methods, we estimated the causal relationship between the treatment of adolescent depression with selective serotonin reuptake inhibitors (SSRIs) and the risk of later psychosis.

We used data linkage from multiple national Finnish registries for all individuals (n = 697,289) born between 1987 and 1997 to identify depression diagnosed before age 18, cumulative SSRI treatment within three years of diagnosis, and diagnoses of non-affective psychotic disorders by end of follow-up (age 20–29). We used instrumental variable analyses, exploiting variability in prescribing across hospital districts to estimate causal effects. Analyses were conducted using two-stage least squares modelling. Sensitivity analyses examined effects stratified by confounders and effects of specific SSRIs.

Our final sample included 22,666 individuals diagnosed with depression in adolescence, of whom 60.2% (n = 13,650) had used SSRIs. 10.7% of adolescents with depression went on to be diagnosed with a non-affective psychotic disorder. SSRI treatment for adolescent depression was not associated with a reduced risk of developing a psychotic disorder (one-year β = 0.04,CI:−0.01 to 0.09; two-years β = 0.02,CI:−0.06 to 0.09; three-years β = −0.02,CI:−0.08 to 0.05).

Our quasi-experimental investigation does not support the hypothesis that treatment of adolescent depression reduces the subsequent risk of psychosis. Our findings question the assumption that treatment of common mental health disorders in youth may impact the risk of developing severe mental illnesses in adulthood.

Violence and suicidality are common in forensic inpatients, most commonly with schizophrenia (SZ), personality disorder (PD), or comorbid SZ and PD (dual diagnosis, DD). There are no biological markers used in risk assessment tools. Lipids may provide a useful biomarker to aid violence prediction, but the roles of diagnosis and sex remain unclear. We therefore investigated lipids in adult forensic inpatients in association with the risk of violence and suicidality by primary diagnosis and sex.

Anonymized data were obtained for all eligible inpatients [n = 230; 114 SZ (75 males), 77 PD (40 males), 39 DD (20 males)] who had been admitted (2002–2021) to Elysium Healthcare (UK-wide) medium/low-secure facilities on lipids, age, sex, diagnosis, medication, risk of violence and suicidality, as well as days in seclusion and on high observations due to violence.

Mean total cholesterol (TC) in the patient sample (4.57, s.d. = 1.09) was lower, relative to the age- and sex-corrected UK population norm (4.91 mmol/l). PD (4.46 ± 1.08 mmol/l) and DD (4.24 ± 0.82 mmol/l), compared to SZ patients (4.77 ± 1.14 mmol/l), had significantly lower TC (not explained by statin use; no effect or interaction involving sex). Lower TC had significant though small associations with more days in seclusion or high observation levels due to violence across all patients, and marginally with suicidality in females.

A low TC-violence (towards others) link exists not only for SZ but also for PD and DD and for males and females, encouraging further enquiry into lipids as a biomarker to aid violence prediction in secure care.

Due to limited inpatient care resources and high healthcare expenditures, understanding factors that affect lengths of stay (LOS) is highly relevant. We aimed to investigate associations between metabolic disturbances and LOS in a psychiatric hospital and to identify other clinical and sociodemographic LOS predictors.

Patients admitted to one of the units of the general psychiatric or psychogeriatric departments between January 1, 2007 and December 31, 2020, were included. Metabolic disturbances (i.e., the metabolic syndrome and its five components) were defined using the International Diabetes Federation definition. Cox frailty regression models with time-varying coefficients were used to investigate the association between metabolic disturbances and LOS. Hazard ratios (HR) >1 and HR < 1 indicated the relative likelihood of shorter and extended LOS, respectively.

A total of 7,771 patients for 16,959 hospital stays throughout 14 years of follow-up were included. Central obesity (HR = 0.82; 95% confidence interval [CI] = [0.76–0.89]), hyperglycemia (HR = 0.83; 95% CI = [0.78–0.89]), hypertriglyceridemia (HR = 0.87; 95% CI = [0.80–0.92]), and the metabolic syndrome (HR = 0.76; 95% CI = [0.70–0.82]) were associated with an increased risk of extended LOS in the psychiatric hospital, while underweight (HR = 1.30, 95% CI = [1.09–1.56]) and HDL hypocholesterolemia (HR = 1.10, 95% CI = [1.03–1.18]) were associated with a higher likelihood of shorter LOS. In first-episode psychosis patients, hypertriglyceridemia (HR = 0.82; 95% CI = [0.67–0.99]) and hypertension (HR = 0.76, 95% CI = [0.58–0.99]) were associated with extended LOS when considering all stays, while no association was found when considering the first stay per patient.

Future studies should determine whether better metabolic monitoring and treatment of metabolic disturbances can contribute to reducing LOS.

Recent meta-analyses support the inclusion of cognitive behavioral therapy (CBT) in schizophrenia treatment. Metacognitive Training (MCT) for psychosis is a psychoeducational program derived from CBT, with most meta-analyses showing favorable results. Although meta-analyses are commonly used in clinical practice to guide evidence-based decision-making, the grading system provides complementary results by offering a structured approach for assessing the strength and reliability of evidence and deriving grades of recommendations accordingly.

Our research applies the guidelines from the World Federation of Societies of Biological Psychiatry (WFSBP) to propose grades of recommendation for MCT for psychosis, analyzing 38 randomized controlled trials (RCTs) (n = 1942) and 10 meta-analyses. The primary outcome was positive symptoms, with secondary measures including negative symptoms, general psychopathology, self-esteem, functioning, insight, and cognitive function.

Our findings are primarily based on the risks of bias attributed to RCTs (11 high, 19 moderate, 6 low) and, when necessary, on the overall confidence attributed to meta-analyses (3 low, 7 critically low). According to the WFSBP guidelines, strong recommendations should be made for using MCT for psychosis to improve post-treatment positive symptoms, delusions, and total psychotic symptoms (WFSBP-grade 1). Limited recommendations (WFSBP-grade 2) could be made for using MCT to improve post-treatment visuospatial abilities and to maintain benefits over time in psychopathology, functioning, self-esteem, episodic memory, and attention.

MCT for psychosis is an evidence-based program, especially for positive symptoms, with long-lasting clinical benefits. These recommendations should be interpreted with caution given potential residual biases and heterogeneity among studies.

Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.

A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.

The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.

These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.

Schizophrenia is a multifactorial disorder with a range of risk factors. Dysregulation in the systems involved in the stress response is a key component of its pathophysiology. Individuals at risk of developing schizophrenia exhibit hyperreactivity to stress and altered cognitive performance, both known as vulnerability markers. This study aims to determine whether stimulation of the prefrontal cortex can reduce reactivity to stress in unaffected siblings of patients with schizophrenia.

In a randomized, sham-controlled trial, 27 participants were assigned to receive either active (n = 14) or sham (n = 13) transcranial direct current stimulation (tDCS) over the prefrontal cortex for 30 min during exposure to an acute stressor. The stress response was measured biologically, via salivary cortisol levels, and cognitively, through a reality monitoring task, which serves as an intermediate cognitive vulnerability marker.

In contrast to the sham condition, active stimulation significantly reduced cortisol release in response to stress (F(9,216) = 1.972; p = 0.04) and prevented stress-induced impairment in reality monitoring (F(1,23) = 9.954; p = 0.004).

These findings suggest that tDCS should be a promising tool for reducing stress-induced biological and cognitive reactivity in a population at risk of schizophrenia.

Suicide remains a major risk factor for individuals suffering from schizophrenia and its prodromal state (i.e., Ultra-High Risk for Psychosis). However, less is known about the prevalence of suicidal behaviour among the adolescent and youth UHR population, a demographic vulnerable to the psychosocial and environmental risk factors of suicide. This review aims to synthesise existing literature on the prevalence of suicidal ideation and behaviour in the adolescent and youth at Ultra-High Risk for Psychosis (UHR), and the associations between suicidal behaviour and its correlates.

The databases PsycINFO, PubMed, Embase, Cochrane Library, Web of Science, and Scopus were accessed up to July 2024. A meta-analysis of prevalence was subsequently performed for lifetime suicidal ideation, lifetime non-suicidal self-injury, lifetime suicidal attempt, and current suicidal ideation. A narrative review was also carried out for the correlates of suicidal behaviour amongst adolescents and youth in the UHR population.

Studies were included in this meta-analysis. Meta-analysis revealed a high prevalence of lifetime suicidal ideation (58%), lifetime non-suicidal self-injury (37%), lifetime suicidal attempt (25%), and current (2 week) suicidal ideation (56%). The narrative review revealed that a personal transition to psychosis and a positive family history of psychosis were associated with suicidal attempts, while depression was associated with both suicidal attempts and suicidal ideation.

The prevalence of suicidal ideation and behaviour among UHR adolescents and youth is high and comparable to that of the general UHR population. Existing measures that mitigate suicide risk in the general UHR population should be adopted for the youth context.

Medication-induced dystonia (MID) is a movement disorder (MD), characterized by involuntary sustained or intermittent muscle contractions, causing abnormal, often repetitive, movements, postures, or both. Although MID is commonly associated with the use of antipsychotics, it also occurs with many other medications widely used in clinical practice.

A systematic literature search (from inception to November 2023), using the PubMed and Embase databases, was conducted without language restriction for articles reporting on MID in people without pre-existing MDs, and this for all potentially relevant non-antipsychotic medications. A narrative synthesis of the available evidence was undertaken.

MID is common (1 to 10%) with certain antiemetics. Selective serotonin reuptake inhibitors and the antiepileptics valproate, carbamazepine, and lamotrigine are rarely (0.01 to 0.1%) or very rarely (<0.01%) associated with MID. All other medications are very rarely (<0.01%) associated with MID or have a risk that cannot be precisely estimated. The actual rate of dystonic reactions with most non-antipsychotic agents remains unknown, owing to misdiagnosis and underreporting in the scientific literature. In general, MID seems to occur more often in children and adolescents, even with a single low dose, and with polymedication. In most cases, MID is acute in onset (occurring within hours to days) and involves the head and neck.

Although MID is most common with dopamine receptor-blocking antiemetics, many other medications may also produce dystonic reactions, particularly in children and adolescents. Although such incidents remain rare, there are indications that MID is underreported for many classes of medications.

The development of guidelines is time-consuming and cost-intensive. The heterogeneity of clinical practice, evidence, and patients’ needs is an issue across Europe. An European core guidance for a specific psychiatric disorder may help to overcome this issue. Here, we present a progress report on the European Psychiatric Association (EPA) proof-of-concept approach to develop a European consensus guidance on the pharmacological treatment of schizophrenia.

All national psychiatric associations in Europe were contacted to provide their schizophrenia guidelines. Six guidelines were rated by three experts, experienced in the development of national and international guidelines, from three different countries (Italy, Hungary, and Germany), and the German schizophrenia guideline published in 2019 was found to have the highest quality. For this proof-of-concept approach, 45 recommendations on the pharmacological treatment of schizophrenia from the German guideline were evaluated in a two-step Delphi process to determine their acceptability throughout the European continent.

44 experts participated in the first round and 40 experts in the second round of the Delphi process. Agreement among the involved experts was reached for 75% of the presented recommendations from the German schizophrenia guidelines. 11 out of 45 recommendations (24.4%) did not reach this level of agreement.

This progress report highlights the possibility of developing a pan-European core guidance on the pharmacological treatment of schizophrenia by adapting national guidelines and reconciling their recommendations. However, several barriers in this adaptation process, such as non-agreement in recommendations with strong scientific evidence in the reconciling process, were identified and must be considered when developing the final guidance.