The construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. To address the specialities in the care for this patient population a specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS) is established. The interdisciplinary team (psychiatrists and psychologists) supports children and adolescents with psychotic disorders or at clinical high risk for developing psychosis. The early intervention service offers specialized assessment, treatment and case management for minors with a first psychosis or CHR-state in an outpatient or inpatient setting as well as by day clinic care.

The evaluation main objective was to get a better understanding about this vulnerable patient group. Therefore we analysed the clinical data about CHR-state, comorbid diagnosis, treatment, medication and hospitalisation of the patients who entered the service for early intervention in psychosis.

Participants who entered the service for early intervention in psychosis were followed up in the years 2017-2021 and descriptive analysis was used to summarize the data. For the evaluation of the risk construct the participants have been classified in “no increased risk”, “CHR” or “early onset psychosis” (EOP). Additionally, ICD diagnosis, demographics and treatment (medication, psychotherapy, treatment setting) were assessed. Therapy was either psychotherapy and/or group training called DBT2P (Dialectical behavioral group training for adolescents, to prevent psychiatric disorders). Additionally, the use of a smartphone application “Robin Z”(add-on treatment tool to support the patients between the sessions) was assessed.

In the last five years we saw 300 patients (112 female, mean age 15.7) who sought the care unit for early intervention. The evaluation of the risk showed that 44 patients had no increased risk, 205 were classified with a CHR and 51 fulfilled the criteria of an early onset psychosis (18.5%). Most of the patients showed comorbid diagnosis, mainly depressive disorders (42%). The data about the treatment will be analyzed for the congress.

Despite clinical implications, there is little data about early detection and early intervention in psychosis for children and adolescent. Therefore, the evaluation of the clinical data of the CAPS is of clinical importance and expected to add essential information in the fields of prevention and early intervention in psychosis.

None Declared

Interest in the development of innovative technologies in the health sector has increased due to their potential to improve accessibility, efficacy, quality, and cost-effectiveness of treatment. Based on these considerations, we developed the app Robin Z to support adolescents in psychiatric treatment. Robin Z is intended as an add on therapy-tool. It aims to assess symptoms in real time, offer help in coping with symptoms and everyday life and to support medication adherence. Despite initial encouraging research findings supporting the use of smartphone technology in psychotherapy, it remains unclear whether the consistent use of smartphone technology in outpatient clinics is practical outside of research projects. Thus, it is uncertain whether patients will engage with this technology over an extended period of time and whether clinicians will be willing to integrate this new technology into their routine. In view of these factors, it is crucial to evaluate the use of smartphone apps for their applicability, effectiveness, and efficiency in clinical routine. In our investigation, we want to address these questions and fill the gap between research and clinical practice.

The aim of our evaluation is to identify barriers in clinical implementation plus to assess the usability and applicability of the Robin Z app in clinical practice.

We started the clinical implementation of Robin Z in four community-based outpatient services. We collected data of 27 adolescent patients and their caregivers (N=15) over a six-week period. They all completed questionnaires on user-friendliness and satisfaction. Further, user data about mood logs, symptom trajectories, achieved weekly goals and entries for positive reinforcement were gathered to examine the clinical impact of using the app.

The clinical implementation and evaluation will provide data on feasibility, user-friendliness, clinical implication and satisfaction of patients and therapists with the smartphone app Robin Z.

Although many apps are available for young people with mental health problems, most of these have not been developed by professionals, and their effectiveness has not been evaluated. To the best of our knowledge, Robin Z is one of the first apps of its kind to be specifically developed by clinical experts as an additional tool to support psychotherapy for adolescent patients. The results of this evaluation are of clinical importance to the field of eMental Health. They will provide preliminary evidence of the clinical utility of the app. In addition, the results will improve our understanding of potential barriers and facilitators to using Robin Z for both patients and therapists.

None Declared

The goal of psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and treatment of CHR symptoms. CHR symptoms typically occur in adolescence and young adulthood. This is a very sensitive developmental period, and CHR-state is associated with increased functional impairment. Age-appropriate treatment approaches that address youth-specific interests, complex symptomatology, associated distress, and functional impairment are needed. However, there is a lack of research on treatment strategies for this vulnerable age group. To address this gap, we developed the combined treatment program “Robin” (standardized manual and smartphone app). The treatment program targets CHR symptoms, comorbid symptoms, and improvement of quality of life and daily functioning. The smartphone app “Robin Z” is an add-on treatment tool to support patients between their sessions. While a number of studies using smartphone apps in therapy have shown promising effects with adult psychosis patients, little is known about their use in therapy with minor patients. “Robin Z” is one of the first smartphone apps targeting adolescent patients with CHR or full-blown psychotic symptoms.

The investigation of efficacy of this specific intervention versus treatment as usual

Our study was designed as a naturalistic clinical intervention study with a matched controlled design (treatment as usual). A total of 40 help-seeking adolescents (67% female) with CHR symptoms aged 13-18 years (mean age 15.86) were recruited to the intervention condition between September 2017 and May 2022. For the control group, data from 62 patients from a previous study are available and will be matched for age and gender. CHR symptoms, comorbid symptoms, functioning, self-efficacy, and quality of life will be monitored at six time points (baseline, during the treatment phase, immediately after the intervention, and 6, 12, and 24 months later).

All participants have now completed the intervention phase. In Paris, the first results on treatment effects will be presented at the symposium. This will include baseline data for the intervention group and their intraindividual changes in symptomatology, well-being, and level of functioning during and immediately after treatment. In addition, the results of the first follow up examinations compared to the control group will be presented.

To our knowledge, this is the first controlled trial to evaluate the effectiveness of a specific treatment for adolescents with early psychosis combined with a smartphone app. The results of our evaluation are of clinical importance and should provide essential information for both the field of eMental Health and the topic of early intervention in psychosis.

None Declared

With persistent incidence, incomplete vaccination rates, confounding respiratory illnesses, and few therapeutic interventions available, COVID-19 continues to be a burden on the pediatric population. During a surge, it is difficult for hospitals to direct limited healthcare resources effectively. While the overwhelming majority of pediatric infections are mild, there have been life-threatening exceptions that illuminated the need to proactively identify pediatric patients at risk of severe COVID-19 and other respiratory infectious diseases. However, a nationwide capability for developing validated computational tools to identify pediatric patients at risk using real-world data does not exist.

HHS ASPR BARDA sought, through the power of competition in a challenge, to create computational models to address two clinically important questions using the National COVID Cohort Collaborative: (1) Of pediatric patients who test positive for COVID-19 in an outpatient setting, who are at risk for hospitalization? (2) Of pediatric patients who test positive for COVID-19 and are hospitalized, who are at risk for needing mechanical ventilation or cardiovascular interventions?

This challenge was the first, multi-agency, coordinated computational challenge carried out by the federal government as a response to a public health emergency. Fifty-five computational models were evaluated across both tasks and two winners and three honorable mentions were selected.

This challenge serves as a framework for how the government, research communities, and large data repositories can be brought together to source solutions when resources are strapped during a pandemic.

Negative symptoms (avolition, anhedonia, asociality) are a prevalent symptom in those across the psychosis-spectrum and also occur at subclinical levels in the general population. Recent work has begun to examine how environmental contexts (e.g. locations) influence negative symptoms. However, limited work has evaluated how environments may contribute to negative symptoms among youth at clinical high risk for psychosis (CHR). The current study uses Ecological Momentary Assessment to assess how four environmental contexts (locations, activities, social interactions, social interaction method) impact state fluctuations in negative symptoms in CHR and healthy control (CN) participants.

CHR youth (n = 116) and CN (n = 61) completed 8 daily surveys for 6 days assessing negative symptoms and contexts.

Mixed-effects modeling demonstrated that negative symptoms largely varied across contexts in both groups. CHR participants had higher negative symptoms than CN participants in most contexts, but groups had similar symptom reductions during recreational activities and phone call interactions. Among CHR participants, negative symptoms were elevated in several contexts, including studying/working, commuting, eating, running errands, and being at home.

Results demonstrate that negative symptoms dynamically change across some contexts in CHR participants. Negative symptoms were more intact in some contexts, while other contexts, notably some used to promote functional recovery, may exacerbate negative symptoms in CHR. Findings suggest that environmental factors should be considered when understanding state fluctuations in negative symptoms among those at CHR participants.

The purpose of this scoping review is two-fold: to assess the literature that quantitatively measures outcomes of mentorship programs designed to support research-focused junior faculty and to identify mentoring strategies that promote diversity within academic medicine mentoring programs.

Studies were identified by searching Medline using MESH terms for mentoring and academic medicine. Eligibility criteria included studies focused on junior faculty in research-focused positions, receiving mentorship, in an academic medical center in the USA, with outcomes collected to measure career success (career trajectory, career satisfaction, quality of life, research productivity, leadership positions). Data were abstracted using a standardized data collection form, and best practices were summarized.

Search terms resulted in 1,842 articles for title and abstract review, with 27 manuscripts meeting inclusion criteria. Two studies focused specifically on women, and four studies focused on junior faculty from racial/ethnic backgrounds underrepresented in medicine. From the initial search, few studies were designed to specifically increase diversity or capture outcomes relevant to promotion within academic medicine. Of those which did, most studies captured the impact on research productivity and career satisfaction. Traditional one-on-one mentorship, structured peer mentorship facilitated by a senior mentor, and peer mentorship in combination with one-on-one mentorship were found to be effective strategies to facilitate research productivity.

Efforts are needed at the mentee, mentor, and institutional level to provide mentorship to diverse junior faculty on research competencies and career trajectory, create a sense of belonging, and connect junior faculty with institutional resources to support career success.

Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with decreased gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC).

We hypothesize that greater ARI will be associated with reduced right posterior CMFG and rACC GMVs.

Data were collected at baseline as part of the North American Prodrome Longitudinal Study. Counties where participants resided during childhood were geographically coded using the US Censuses to area-level factors. ARI was defined as the percentage of residents living in a different house five years ago. Generalized linear mixed models tested associations between ARI and GMVs.

This study included 29 HC and 64 CHR-P individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 – -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 – -0.023). The interaction terms (ARI X diagnostic group) in the prediction of both brain regions were not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs.

Like urban upbringing, ARI may be an important social environmental characteristic that adversely impacts brain regions related to schizophrenia.

No significant relationships.

Based on high rates of non-converters to psychosis, especially in children and adolescents, it was suggested that CHR criteria were (1) pluripotential, (2) a transdiagnostic risk factor, or (3) simply a severity marker of mental disorders rather than specifically psychosis-predictive. If any of these three alternative explanatory models were true, their prevalence should differ between persons with and without mental disorders, and their severity should be associated with functional impairment as a measure of severity.

To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.

We compared CHR criteria/symptoms in 8-17-year-olds of the community and of inpatients not clinically suspected to develop psychosis.

The 7.3%-prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%-rate in inpatients. Frequency/severity of CHR criteria never differed between the community and the four inpatient groups, while the frequency and severity of CHR symptoms differed only minimally. Group differences were found in only four CHR symptoms: suspiciousness/persecutory ideas of the SIPS, and thought pressure, derealization and visual perception disturbances of the SPI-CY. These were consistent with a transdiagnostic risk factor or dimension, i.e., displayed higher frequency and severity in inpatients. Low functioning, however, was at most weakly related to the severity of CHR criteria/symptoms, with the highest, yet still weak correlation yielded for suspiciousness/persecutory ideas.

The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes, or merely markers of symptom severity

No significant relationships.