Exposure to stress is a well-established risk factor for psychotic experiences, yet the cognitive mechanisms underlying this association remain insufficiently understood. This study examined whether longitudinal changes in cognitive biases mediate the relationship between stress exposure and changes in psychotic-like experiences (PLEs) in the general population sample of adults aged 18–40 years.

Adults without a history of psychiatric treatment were assessed at baseline and at 12-month follow-up. Change-score mediation models with bootstrap confidence intervals were estimated, adjusting for age, gender, and education.

Of 5,126 adults who completed the baseline assessment, 2,290 (44.7%) participated in the follow-up. Greater stress exposure predicted increases in PLEs, negative, and depressive symptoms. After correction for multiple testing, significant indirect effects consistent with mediation by cognitive biases were observed for PLEs, but not for negative or depressive symptoms. These effects were significant for changes in belief inflexibility, safety behaviors, external attribution, and subjective cognitive and social cognitive problems, but not for attention to threat or jumping to conclusions. Reverse mediation models indicated consistently smaller indirect effects. In parallel multiple-mediator models, no individual bias showed a unique indirect effect on PLEs, yet the total indirect effect remained significant, suggesting mediation through interrelated biases. Social cognitive problems emerged as the only bias with a specific indirect effect on negative and depressive symptoms.

Longitudinal changes in cognitive biases might represent an indirect pathway to the association between stress exposure and increases in PLEs. These findings highlight cognitive biases as potential targets for preventive interventions.

Early intervention increases the likelihood of eating disorder recovery but many young people delay help-seeking. We developed a smartphone-friendly, online decision-making tool to address this gap (FREED-Mobile (FREED-M)).

To conduct a randomised controlled feasibility trial of the FREED-M decision-making tool with 16- to 25-year-olds with a suspected eating disorder and no previous treatment for this.

Participants were randomly allocated to FREED-M or an active control in a parallel group, two-arm trial. Outcomes were measured at weeks 0 (baseline), 4 (post-intervention) and 12 (follow-up). The primary feasibility outcome was attrition at follow-up. Other outcomes included motivational, clinical and economic measures.

We over-recruited with 204 randomised participants (including 20 fraudulent participants). Main analyses were conducted with 184 genuine responders (FREED-M: n = 91, control: n = 93). At baseline, participants’ mean age was 21.0 (s.d. 2.0) years, 89% identified as female and 64% as White. Mean body mass index was 23.1 kg/m2 (6.3). N = 83 participants had an anorexia nervosa-like disorder, 101 had another eating disorder or high eating disorder risk. Attrition at week 12 was n = 112 (61%). Of the n = 42 FREED-M participants who provided acceptability ratings, 79% liked the intervention and 66% found it useful. Between-group effect sizes for motivation and readiness to change were small to medium at 4 weeks (d = 0.27 and d = 0.15, respectively) favouring FREED-M, but differences were not sustained at follow-up (d = −0.02 and d = −0.12, respectively).

Although the attrition rate was high, recruitment exceeded expectations. Acceptability of FREED-M was high among participants who provided acceptability ratings. Motivation/readiness to change and help-seeking are candidates for primary outcomes in a future randomised controlled trial.

The 7 October 2023, terrorist attack at the Nova Festival in southern Israel caused deaths, injuries, hostage-taking and prolonged life-threatening exposure, creating an urgent need for early interventions to reduce post-traumatic morbidity. Although prolonged exposure is an established post-traumatic stress disorder (PTSD) treatment, its feasibility and benefit during ongoing threat remain unclear.

This preliminary study evaluated a war-adapted brief prolonged exposure protocol (WBPE) delivered shortly after trauma in Nova Festival survivors with acute stress disorder.

Forty survivors completed the WBPE and were assessed at baseline and immediately post treatment. A subsample of 27 WBPE completers and 18 untreated wait-list controls was reassessed after 5 months. Outcomes were PTSD (PDS-5), depression (PHQ-9) and anxiety (GAD-7) symptom severity.

WBPE was associated with significant reductions in PTSD, depression and anxiety immediately after treatment. At 5 months, WBPE participants showed greater reductions in PTSD and depressive symptom severity and lower PTSD and depression symptom scores than controls, with large effect sizes. Anxiety symptoms improved in both groups, consistent with possible natural recovery. Clinically significant depressive symptoms (48.15 v. 77.78%) and anxiety symptoms (37.04 v. 72.22%) were less frequent in WBPE participants than controls, whereas probable PTSD rates did not differ significantly. Substance use during the study period was associated with poorer outcomes and smaller symptom reductions.

WBPE appears feasible and potentially beneficial under wartime conditions, with meaningful improvements in PTSD and depression despite persistent threat. Substance use was linked to poorer recovery and should be systematically assessed in post-trauma care.

Functional impairment in psychosis often persists despite symptomatic remission. There is a paucity of research examining early-course psychosocial functioning trajectories, and none has been conducted to examine relationship between the trajectories and prospective long-term functional outcomes in early psychosis sample.

We conducted 12-year follow-up of a randomized controlled trial on extended early intervention for first-episode psychosis to identify early-course social-occupational functioning trajectories and their baseline predictors and associations with 12-year outcomes. Participants who completed Social and Occupational Functioning Scale (SOFAS) scores at three or more timepoints between baseline and 3-year follow-up were included in the study. Premorbid adjustment, illness characteristics, symptom severity, functioning, and treatment profiles were assessed. Latent growth mixture modeling was employed to derive early-course social-occupational functioning trajectories based on SOFAS scores over 3-year follow-up.

A total of 148 participants were included in this study, with 106 patients having completed the 12-year follow-up. Our results identified four distinct trajectories, including persistently-good class, gradually-improved class, suboptimal-stable class, and persistently-poor class. Patients in persistently-poor class had more severe negative symptoms at baseline compared to patients in persistently-good class. Patients with persistently-poor trajectory had worse long-term outcomes than those with other classes in the majority of functional measures at 12-year follow-up.

The majority of patients were classified in early-stage suboptimal or poor functional trajectories. Above one-fourth of the participants exhibited persistently-poor social-occupational functioning trajectory, which predicted worse functional outcomes at 12-year follow-up. These findings highlighted the importance of tracking functional changes during the initial years of illness.

Executive function (EF) deficits are consistently linked to psychopathology symptoms, though the mechanisms linking poor EF to symptom expression remain unclear.

The study used the Research Domain Criteria (RDoC) approach to examine relationships between teacher-reported latent psychopathology symptoms, including a general psychopathology factor (P-Factor), and EF in young children with emerging mental health problems. Participants were 804 children (70.8% male; aged 49–89 months) referred by their teachers for cognitive, emotional, or behavioral problems at school. To assess psychopathology, teachers completed the Strengths and Difficulties Questionnaire (SDQ). EF measures included inhibition, cognitive flexibility, working memory, sustained attention, and episodic memory, assessed using the NIH Toolbox, Automated Working Memory Assessment, and the Amsterdam Neuropsychological Test battery.

Structural equation modeling (incorporating confirmatory factor analysis) showed reasonable model fit and supported a P-Factor structure. Correlational analyses explored EF–psychopathology associations, followed by a sensitivity analysis controlling for sex. We observed patterns of cognitive processes that showed inverse associations between EF performance and specific clinical problems. Sustained attention was positively associated with emotional problems but negatively associated with hyperactivity problems. Sex-stratified analyses revealed distinct patterns, with inhibition problems strongly linked to conduct and hyperactivity problems, but in females only.

The findings support poor EF as a transdiagnostic risk factor associated with incremental vulnerability for childhood psychopathology. Divergent findings for sustained attentional processes suggest they can be adaptive in some contexts but maladaptive in others. Screening for EF difficulties in children could enhance early identification and inform interventions.

Extreme hot weather poses increasing risks to mental health. Yet, factors affecting vulnerability are under-researched. This mixed-method study integrates a systematic review and qualitative investigation to identify risk and protective factors for heat-related mental health issues, leading to the co-development of a screening tool. This could inform future research and, pending validation in clinical settings, support mental health professionals in assessing vulnerability among service users.

We searched PubMed and Web of Science for publications on extreme heat, mental health, and risk/protective factors. In addition, we conducted six focus groups with 21 people with lived experience of heat and/or mental illness and 12 healthcare professionals. Transcripts were analyzed using thematic content analysis and informed the co-development of the screening tool.

Out of 764 articles identified by the systematic review, 47 were included. Evidence emerged for age, sex, existing mental illness, ethnicity, and socioeconomic status as risk factors. However, findings were inconsistent between studies, likely due to differences in study population and methodology. Protective effects included good physical health, social support, and exposure to green spaces. Our qualitative investigation identified additional risk and protective factors related to: (1) behavioral adaptability, (2) personal heat sensitivity, and (3) disparities in heat exposure. The resulting screening tool, HEAT-MH (Heat Exposure Assessment Tool for Mental Health), contains 15 questions on previous experiences of heat, general health, and lifestyle.

The mental health impacts of extreme heat depend on a range of risk and protective factors, including demographic, socioeconomic, health, and lifestyle characteristics.

Psychotic-like experiences (PLEs) are common in adolescence and often associated with later mental health difficulties. Although many psychosocial factors are related to PLEs, little is known about how these factors interact over time. Longitudinal network analysis allows examination of the stability of symptom associations and identification of potential intervention targets. This study investigated the structure and temporal stability of PLE networks in a large community-based adolescent cohort.

Adolescents aged 13–19 years (N = 605 with complete data across all time points) completed assessments at baseline, 12 months, and 24 months. Measures included positive and negative PLEs, cognitive biases, depression, anxiety, trauma, and interpersonal sensitivity. Networks were estimated at each time point, and permutation-based tests were used to compare network structure and overall connectivity across time. Centrality stability was assessed using bootstrapping procedures.

Network structures were stable across the 2-year period, with no significant differences in overall organization or connectivity between time points. Depression consistently showed the highest centrality, followed by anxiety and attributional bias. Positive PLEs were most strongly associated with anxiety, while negative PLEs showed their strongest associations with depression. Attributional bias remained centrally positioned and was strongly linked to trauma. All networks showed robust accuracy and high stability.

Despite considerable developmental change during adolescence, the psychosocial architecture of PLEs remained notably stable. Depression, anxiety, and attributional biases emerged as consistent key nodes, highlighting them as promising targets for prevention and early intervention in adolescents at risk for persistent PLEs.

Restrictive interventions are used in the treatment of some people with severe mental disorders such as psychosis – including psychiatric intensive care unit (PICU) admission, seclusion and restraint. Early Intervention in Psychosis (EIP) service input may improve outcomes in psychosis, but it is unclear whether specific components of EIP care reduce the need for restrictive practice.

To examine associations between EIP care components, demographic characteristics and restrictive interventions.

We conducted a retrospective cohort study of 14 874 people who used EIP services in England, using linked data from the National Clinical Audit of Psychosis and the Mental Health Services Data Set. We examined associations between EIP components and time to PICU admission (primary outcome) alongside seclusion/physical restraint/injected chemical restraint/requests for police assistance (secondary outcomes), using multilevel Cox regression, adjusting for demographic factors and clustering by service.

Higher hazards of restrictive interventions were observed among men, younger people and several minority ethnic groups. Individuals eligible for clozapine who were not offered it (hazard ratio 1.51, 95% CI 1.20–1.91) or refused it (hazard ratio 1.46, 95% CI 1.02–2.10) had higher hazards of PICU admission than those not eligible, whereas those who were eligible for clozapine and received it did not. There was weaker evidence of similar effects on hazards of physical restraint and seclusion. Receipt of CBT for psychosis was associated with reduced hazards of PICU admission (hazard ratio 0.80, 95% CI 0.67–0.95) and physical restraint (hazard ratio 0.68, 95% CI 0.47–0.98). Substance use was associated with increased hazards of PICU admission and requests for police assistance, although substance use interventions appeared to partially mitigate this.

Marked demographic disparities exist in the use of restrictive practice. Specific EIP care components may be associated with reductions. Strengthening evidence-based EIP provision and addressing structural inequalities may support progress towards less coercive and more equitable care.

Infants with single ventricle CHD commonly experience gross motor delays due to physiological and environmental factors, including increased risk for white matter injury, reduced aerobic capacity, restrictive post-operative protocols, and limited movement opportunities. These delays persist in adolescence, affecting physical and social development. This study examines a quality improvement initiative within the National Pediatric Cardiology Quality Improvement Collaborative to enhance gross motor development.

Fifteen centres participated. Gross motor skills were assessed using the Ages and Stages Questionnaires, Third Edition, at 6 and 12 months. A key driver diagram, Plan-Do-Study-Act cycles, baseline data, and ongoing process measures were collected. Interventions were implemented, including education, therapy support, and mobilisation protocols. Control charts were used to evaluate the data.

Scores from the Ages and Stages Questionnaires indicated delays in gross motor skills at baseline, with improvement over time. Participating centres showed a centerline shift from 41% to 89% of infants achieving on-target or improved motor scores, compared with 54% to 68% of infants at non-participating centres. Establishment of customised infant developmental plans increased from 62% to 74% for participating centres and from 53% to 61% for non-participating centres. Interventions included establishing processes for consistent screening, developmental plan administration, review of prone positioning, access to therapies, and early intervention referrals.

This targeted quality improvement project increased the use of inpatient practices to support gross motor development for infants with single ventricle CHD. Collaborative, interdisciplinary efforts remain critical for addressing neurodevelopmental challenges in this high-risk population.

This systematic review evaluates specialized psychosocial and complex interventions for early bipolar disorder (BD), early borderline personality disorder (BPD), early depression, early psychosis, and first-episode mental illness in general (FEMI).

We included systematic reviews and randomized controlled trials (RCTs) of interventions with psychosocial components, excluding trials that focused on pharmacological-only interventions and stand-alone psychotherapies. Searches were conducted in January 2023 across five databases. Review quality was assessed using AMSTAR-2 and risk of bias for RCTs using the Cochrane tool.

Ten studies met the inclusion criteria: seven reviews and three RCTs. High-to moderate-quality evidence supports complex psychosocial interventions combined with pharmacotherapy for early psychosis. The most robust effects were reductions in relapse and improvements in psychosocial functioning; additional benefits were observed for symptom burden, remission, treatment discontinuation, and hospital admissions. Benefits were most sustained in longer-duration, community-based programs. For early BD, limited evidence suggests that combining pharmacotherapy with family-focused therapy or structured psychoeducation may improve the course of illness and treatment satisfaction. One RCT in early BPD reported improved engagement with a developmentally tailored program. Two FEMI RCTs found that nurse-led psychoeducation and psychosocial programs improved in-patient duration, symptoms, insight, self-efficacy, quality of life, and engagement. No eligible studies addressed early-stage depression, indicating a notable evidence gap for multimodal psychosocial interventions.

Complex psychosocial interventions are strongly supported for early psychosis. Preliminary data in BD, BPD, and FEMI suggest consistent benefits for engagement, but further rigorous trials – especially in early depression – focusing on different outcomes – are required.