@article{pmid42413522,

title = {Return on investment of enhanced primary youth mental health services in a large Canadian urban centre: a retrospective cohort study},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Eric Latimer and Neil Andersson and Patricia Boksa and Ridha Joober and Shalini Lal and Srividya N Iyer and Ashok Malla and Philip Jacobs and },

doi = {10.1016/S2215-0366(26)00165-3},

issn = {2215-0374},

year  = {2026},

date = {2026-08-01},

journal = {Lancet Psychiatry},

volume = {13},

number = {8},

pages = {657--668},

abstract = {BACKGROUND: Many youth mental health reforms aim to shift care away from acute, hospital, or institutional settings and into community-based services, but few such initiatives have been subject to economic evaluations. We aimed to examine service utilisation and the corresponding return on investment for individuals receiving care via an enhanced primary-care youth mental health service.nnMETHODS: We conducted a retrospective cohort study of an enhanced primary-care youth mental health service transformation in a major urban site of the pan-Canadian ACCESS Open Minds network, which provides assessment and interventions for all types and severities of mental health problems, with priorities co-designed by individuals with lived experience (young people, families, and carers). Administrative datasets were used to determine service utilisation and the associated costs, including programme implementation, for help-seeking youth aged 15-25 years with any mental health problem. A difference-in-differences approach compared outcomes pre-exposure with outcomes post-exposure to the ACCESS Open Minds service over 1 year, in relation to youth receiving a non-transformed service. Propensity score matching and sensitivity analyses ensured bias reduction and robustness of observations, respectively.nnFINDINGS: Between April 6, 2016, and Sept 30, 2019, 10 632 help-seeking youth (4821 [45·4%] males and 5801 [54·6%] females) were included. 1415 youths (mean age 20·1 years) received care from ACCESS Open Minds, and 9217 youths (19·3 years) received standard community mental health services. No ethnicity data were available in this administrative dataset. Compared with those receiving services in community mental health clinics, those receiving ACCESS Open Minds had more intensive service needs throughout the study period and had greater and statistically significant reductions in hospital admissions (CA$1961 savings); outpatient ($613 savings), specialist ($432 savings), and general practitioner visits ($47 savings); and public residential admissions ($1256 savings) per-person per-year. There were no significant differences in emergency department visits, the number of prescriptions dispensed, community mental health visits, or contracted residential admissions. Net cost reduction associated with ACCESS Open Minds was $4355 per-person per-year, with implementation costs of $448, representing a net benefit of $3907 (return on investment 9·7).nnINTERPRETATION: Consistent with principles of early intervention in mental health, ACCESS Open Minds implementation resulted in improved or equivalent outcomes but also shifted care towards community-based settings, with substantial net cost savings. These cost savings can be realised if novel services identify and treat not only new cases but also include those who were previously intensive users of standard services. The long-term return on investment of enhanced primary youth mental health models such as ACCESS Open Minds will likely rest on their commitment to including this population.nnFUNDING: Canadian Institutes of Health Research and the Graham Boeckh Foundation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42418951,

title = {An appraisal of practice guidelines for early intervention services for psychosis: Using AGREE II (Appraisal of Guidelines for Research and Evaluation) to enhance the quality and trustworthiness of guidelines in the future},

author = {Manuela Ferrari and Nicole Pawliuk and Jai Shah and Amal Abdel-Baki and Phil Tibbo and Donald Addington and Marc-André Roy and Ridha Joober and Kevin MacDonald and Srividya N Iyer},

doi = {10.1016/j.schres.2026.06.005},

issn = {1573-2509},

year  = {2026},

date = {2026-07-01},

journal = {Schizophr Res},

volume = {295},

pages = {282--291},

abstract = {BACKGROUND: Early intervention services (EIS) for psychosis have expanded internationally. Yet, the quality of the guidelines to support and monitor them has never been evaluated. We therefore aimed to systematically appraise the quality of EIS guidelines.nnSTUDY DESIGN: We conducted a systematic review of grey literature websites, supplemented by guidelines identified in a prior scoping review. Eligible documents were guidelines focused on/with a section on early intervention or first episode psychosis. Two independent reviewers appraised each guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II).nnSTUDY RESULTS: Thirty-two guidelines were included. Guidelines varied widely on scores for the AGREE II domains. Many scored high (≥70%) on Scope and Purpose (24/32; 75%) and Clarity of Presentation (22/32; 69%). Only 22% (7/32) scored well on Rigour of Development, primarily due to the lack of methods for evidence identification and appraisal. The lowest scoring domain was Applicability; only two guidelines scored ≥70%, while more than half provided no information on barriers or facilitators to implementation. Stakeholder involvement, especially from service users, was limited in developing EIS-specific guidelines. Guidelines performing consistently well were from large guideline development groups and used established evidence-grading methods.nnCONCLUSIONS: This first systematic appraisal shows that while many EIS guidelines clearly articulate aims and recommendations, substantial methodological and implementation gaps remain. Nonetheless, EIS guidelines score like others in psychiatry. Still, limited stakeholder engagement and applicability may impede consistent, evidence-based EIS delivery. Future guidelines should explicitly describe evidence-based review processes, integrate service user input, and use AGREE II-like tools to enhance their usability and impact.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40971561,

title = {Subcategories of the Clinical High-Risk State for Psychosis and Their Relationship to a Full First-Episode Psychosis Sample: An Exploratory Analysis of Longitudinal Outcomes},

author = {Olivier Renaud-Charest and Vincent Paquin and Jean-Gabriel Daneault and Ashok K Malla and Ridha Joober and Srividya N Iyer and Martin Lepage and Jai L Shah},

doi = {10.1093/schbul/sbaf155},

issn = {1745-1701},

year  = {2026},

date = {2026-07-01},

journal = {Schizophr Bull},

volume = {52},

number = {4},

abstract = {BACKGROUND AND HYPOTHESIS: Subcategories of the Clinical High-Risk state for psychosis (CHR-P) have been associated with differential risk for transition to first-episode psychosis (FEP), but their relevance for longer term FEP outcomes remains unclear. We aimed to determine the prevalence of 2 CHR-P subcategories - attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BIPS) - in a full sample of FEP patients, along with their association with outcome trajectories following psychosis onset.nnSTUDY DESIGN: Participants were recruited from an early intervention service and followed over 2 years, with repeated measures of psychotic symptoms, affective symptoms, and functioning. Pre-onset symptoms were assessed using follow-back methods to reconstruct subgroups and their prevalence within the sample. Linear mixed models were applied to examine associations between putative CHR-P subcategories and longitudinal outcomes.nnSTUDY RESULTS: Of 319 patients, 240 (75.24%) experienced subthreshold psychotic symptoms indicative of a CHR-P state; of these, 51 (21.25%) had potential BIPS (either alone or with APS) and 189 (78.75%) potential APS only. There were no mean differences in scores for psychotic symptoms, affective symptoms, or functioning between subgroups. However, there was a slower improvement in Global Assessment of Functioning (GAF) scores in the putative APS subgroup, which converged with the putative BIPS subgroup by year 2.nnCONCLUSIONS: Putative CHR-P subcategories of APS and BIPS exhibited similar outcome trajectories beyond psychosis onset, except for a possibly slower functional recovery in the putative APS subgroup. Longer term studies across stages of illness are needed to better understand the prognostic utility of these identifiers after FEP.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42201755,

title = {Guidelines for the prevention of psychosis from the World Federation of Societies of Biological Psychiatry (WFSBP) and EPI Canada},

author = {Marco Solmi and Christoph U Correll and Tommaso Boldrini and Jean M Addington and Edgar Barbezat and Stella Bassetto and Andreas Bechdolf and Dan Devoe and Joseph Firth and Paolo Fusar-Poli and Ary Gadelha and Renan Göksal and Matcheri Keshavan and Eoin Killackey and Nikolaos Koutsouleris and Gabriele Lo Buglio and Mirko Manchia and Patrick McGorry and Jai Shah and Helen J Stain and Philip G Tibbo and Thomas Hastings and Howard C Margolese and Nicola Otter and Eduard Vieta and Liang-Jen Wang and Scott W Woods and Lakshmi N Yatham and Alison R Yung and Muhammad Omair Husain and Peter Falkai and Michael Berk and Andre F Carvalho},

doi = {10.1080/15622975.2026.2651738},

issn = {1814-1412},

year  = {2026},

date = {2026-05-01},

journal = {World J Biol Psychiatry},

pages = {1--44},

abstract = {OBJECTIVE: To prepare evidence-based guidelines on psychosis prevention.nnMETHODS: We reviewed evidence on risk factors for/age at onset of psychosis, tools to assess clinical high-risk of psychosis (CHR-P), transition rates, risk calculation/ethical considerations around risk communication, CHR-P biological/clinical correlates, efficacy/cost-effectiveness of interventions/psychosis prevention services. The World Federation of Societies of Biological Psychiatry framework was used to grade evidence regarding interventions/services, elaborating guidelines with evidence-/consensus-based clinical recommendations to prevent psychosis in CHR-P subjects.nnRESULTS: At the service organisation level, (i) psychosis indicated prevention services might be implemented in close collaboration with early intervention services for psychosis to minimise duration of untreated illness, (ii) intake age criteria should be between 14 to 35, (iii) services should allow access to persons with cannabis use disorder. At the assessment and risk communication level, in clinical settings: (iv) staff in mental health services should be trained in administering/rating CHR-P assessment tools, (v) administer them, (vi) be trained in using/interpreting risk calculators, and (vii) in communicating risk, (viii) only use validated risk calculators, keeping a human-to-human interaction. Also, (ix) prevention services should assess comorbid mental disorders. At the intervention level: (x) staff should offer treatment for abstinence from cannabis, (xi) offer evidence-based treatment for comorbid mental disorders, and (xii) offer treatment for CHR-P based on patient preference, following the 'first do no harm' principle.nnCONCLUSIONS: Prevention services should be implemented, including interventions for cannabis use, reducing the duration of untreated psychosis, and treating comorbid mental disorders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41632632,

title = {Health-Related Outcome Improvements Via the ACCESS Open Minds Youth Mental Health Service Transformation Project in Edmonton, Canada: Amélioration des résultats en matière de santé grâce au projet de transformation des services de santé mentale jeunes d'ACCESS Open Minds/Esprits ouverts à Edmonton, Canada},

author = {Jai L Shah and Nguyen Xuan Thanh and Shireen Surood and April Gusnowski and Surya Poudel and Liana Urichuk and Giuseppe D'Andrea and Srividya N Iyer and Ashok K Malla and Eric Latimer and Philip Jacobs and },

doi = {10.1177/07067437251412570},

issn = {1497-0015},

year  = {2026},

date = {2026-05-01},

journal = {Can J Psychiatry},

volume = {71},

number = {5},

pages = {359--368},

abstract = {ObjectiveGrowing efforts to transform youth mental health (YMH) services rest on the assumption that they will produce superior outcomes to those of traditional services. We therefore aimed to determine whether implementation of a broad YMH service model in Edmonton, Alberta (the largest site in the pan-Canadian ACCESS Open Minds [AOM] network) resulted in greater improvements in individual-level outcomes compared to a matched control group seen at non-AOM community mental health services.MethodThis retrospective cohort study used data on the Health of Nation Outcomes Scale (HoNOS) collected by trained clinicians, in youth aged 15-25 attending AOM or comparator services for any mental health problem between April 2016 and September 2019. A difference-in-differences approach compared HoNOS outcomes pre- versus post-exposure to the AOM service over a 1-year time horizon, in relation to youth attending a non-transformed service. Propensity score matching and sensitivity analyses were conducted to ensure bias reduction and robustness of observations, respectively.ResultsThe number of referrals to AOM Edmonton increased over time (36.3% [95%CI = 11.0%-68.0%] per month), and the site met benchmarks for rapid assessment (within 72 hours) and time to appropriate care (within 30 days). Of 1,078 youth (344 in the intervention [AOM] group and 734 in the control [non-AOM] group) aged 15-25 visiting community mental health centres, the intervention group had statistically greater improvements (7.4% absolute improvement or 1.2× relative improvement) in total HoNOS scores and its behavioural and symptom subscales.ConclusionsIn addition to improving the reach and timeliness of YMH services, AOM Edmonton produced greater improvements in HoNOS total scores (and two of four subscale scores) compared to a matched control group. Comparative evaluations such as these are essential to demonstrating the value of such services and generating continuous cycles of learning and improvement.Plain Language Summary TitleWhat are the outcomes of transforming youth mental health services in community settings?},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42126077,

title = {Fostering Accessibility to Mental Health Services for Youth Experiencing Homelessness in Montreal, Canada: A Historical Cohort Comparison Study},

author = {Amal Abdel-Baki and Giuseppe D'Andrea and Charles Tessier and Diane Aubin and Nora Morrison and Marie-Eve Dupont and Camille Arbaud and Pasquale Bauco and Jai L Shah and Ashok Malla and Srividya N Iyer},

doi = {10.1177/00207640261446109},

issn = {1741-2854},

year  = {2026},

date = {2026-05-01},

journal = {Int J Soc Psychiatry},

pages = {207640261446109},

abstract = {BACKGROUND: Youth experiencing homelessness face significant barriers to mental healthcare. To address this gap, the  (RIPAJ) was established in Montréal in 2003 through collaboration between community and governmental health organizations. In 2016, RIPAJ joined the national Adolescent/Young Adult Connections to Community-driven Early Strengths-based Stigma-free services-Open Minds (ACCESS-OM) initiative, aiming to enhance mental healthcare accessibility for youth experiencing homelessness.nnAIMS: This study evaluates the impact of this integrated approach on referral trends and wait times before and during ACCESS-OM RIPAJ implementation.nnMETHOD: Monthly referrals and wait times for first appointment were recorded for a historical cohort (2014-2015) and the ACCESS-OM RIPAJ period (2016-2020). We used Poisson and Cox regression models to analyze trends in referral rates and wait times, with 2014 as reference period. Seasonality was controlled by incorporating calendar month in the models. Additional Cox regressions examined individual-level sociodemographic and clinical factors associated with post-implementation wait times.nnRESULTS: We analyzed 158 referrals for 2014 to 2015 and 681 for 2016 to 2020. Monthly referrals increased significantly, peaking at 2.5 times the 2014 level. Wait times remained stable, with 73.5% evaluated within 72 hr. The hazard ratio for wait times during the peak period was 0.87 (95% CI [0.63, 1.20]) indicating no significant change despite the surge in referrals. Older age and self-referral were associated with reduced wait times.nnCONCLUSIONS: This collaborative model successfully increased mental healthcare utilization among youth experiencing homelessness, providing valuable insights for addressing the unmet needs of this vulnerable population and potentially reducing homelessness perpetuation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41992106,

title = {Satisfaction With Youth Mental Health Services in Diverse Settings: Results From a Pan-Canadian Initiative},

author = {John Bedirian and Tovah Cowan and Valérie Noël and Shalini Lal and Ridha Joober and Jai Shah and Amal Abdel-Baki and Rebecca Fuhrer and Patricia Boksa and Neil Andersson and Kathleen MacDonald and Charles-Albert Morin and Mary-Anne Levasseur and Helen Vallianatos and Lacey Augustine and Kevin Friese and Isabelle Godin and Liana Urichuk and Daphne Hutt-MacLeod and Vickie Plourde and Norma Rabbitskin and Paula Reaume-Zimmer and Cécile Rousseau and Ashok Malla and Srividya N Iyer},

doi = {10.1176/appi.ps.20250441},

issn = {1557-9700},

year  = {2026},

date = {2026-04-01},

journal = {Psychiatr Serv},

pages = {appips20250441},

abstract = {OBJECTIVE: Increasing concern about youth mental health has brought interest in service reform. Given the importance of positive care experiences, the authors aimed to study rates of satisfaction, as well as characteristics associated with satisfaction, in ACCESS Open Minds, a cocreated network of enhanced primary and community youth mental health services across Canada.nnMETHODS: A total of 482 youths receiving services at 10 ACCESS Open Minds sites (urban, rural, and Indigenous) completed the Client Satisfaction Questionnaire-4 and responded to additional demographic and service use questions.nnRESULTS: Ninety-one percent of youths were satisfied with their mental health services, substantially higher than the predefined goal of 75%. Youths who preferred virtual services (23%) were less satisfied than those who preferred in-person services.nnCONCLUSIONS: The findings are comparable with those from similar initiatives, highlighting the value of youth-friendly, holistic primary mental health care. High satisfaction across sociodemographic groups and sites suggests that such services are acceptable in diverse communities.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42054343,

title = {The Readability of Patient-Reported Measures in Early Psychosis},

author = {Maria Abou Farhat and Negin Zamani and Simran Bajaj and Nicole Pawliuk and Navdeep Kaur and Jai Shah and Manuela Ferrari and Srividya N Iyer},

doi = {10.1093/schbul/sbag018},

issn = {1745-1701},

year  = {2026},

date = {2026-04-01},

journal = {Schizophr Bull},

volume = {52},

number = {3},

abstract = {BACKGROUND: Patient-reported measures are increasingly central to early intervention in psychosis. Many persons with psychosis have lower educational attainment than the general population and cognitive difficulties, making the readability of measures salient for this population. However, the readability of patient-reported measures in psychosis has never been investigated. This study assessed the readability levels of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in early intervention in psychosis.nnSTUDY DESIGN: PROMs and PREMs were identified from a scoping review of measures used in early intervention services for psychosis (January 2000-January 2024). Of 111 measures identified, 104 (89 PROMs; 15 PREMs) were assessed using mean grade levels derived from 3 established readability formulas (Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook index, FORCAST formula), applied to instructions, items, and total scales.nnSTUDY RESULTS: Overall, 82.7% of patient-reported measures exceeded the recommended 6th-grade reading level. Instructions were harder to read than items (mean readability: 9.44 vs. 7.95; t(90) = 6.54, P < .001). PREMs demanded higher readability levels than PROMs. Readability scores were different across formulas, with Flesch-Kincaid consistently producing lower scores. Except for one, the strikingly few measures co-developed with patients (n = 14) also exceeded 6th-grade reading level.nnCONCLUSIONS: Most patient-reported measures in early psychosis exceed recommended readability levels, raising concerns about accessibility, validity, and whose experiences are represented in patient-reported data. This creates impetus for integrating readability assessments into measures development. More fundamentally, centering the participation of persons with lived experience can support readable, relevant, and patient-centered assessments reflecting the language, priorities, and realities of people with psychosis, and advance epistemic justice.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41720568,

title = {How public policies can influence the landscape of psychosis},

author = {Giuseppe D'Andrea and Jai L Shah and Didier Jutras-Aswad and Srividya N Iyer and Amal Abdel-Baki},

doi = {10.1016/S2215-0366(26)00020-9},

issn = {2215-0374},

year  = {2026},

date = {2026-03-01},

journal = {Lancet Psychiatry},

volume = {13},

number = {3},

pages = {179--180},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41868958,

title = {Exploring the Presenting Problems and Services Received by Youth with Diverse Mental Health Presentations in Integrated Youth Mental Health Services Across Canada},

author = {Sarah Mughal and Alba Sanchez-Allakhverdieva and Amal Abdel-Baki and Neil Andersson and Patricia Boksa and Daphne Hutt-Macleod and Ridha Joober and Shalini Lal and Jessica Chisholm-Nelson and Nora Morrison and Alyssa Frampton and Mary Anne Levasseur and Lacey Augustine and Kevin Friese and Isabelle Godin and Katherine Hay and Norma Rabbitskin and Paula Reaume-Zimmer and Helen Vallianatos and Srividya N Iyer and Ashok Malla and Jai L Shah and },

doi = {10.5334/ijic.10147},

issn = {1568-4156},

year  = {2026},

date = {2026-01-01},

journal = {Int J Integr Care},

volume = {26},

number = {1},

pages = {11},

abstract = {BACKGROUND: Integrated youth mental health (YMH) primary care initiatives have the potential to improve Canada's treatment gap. However, there is no current standard for implementing these services, and offerings vary greatly across models and sites. This has equity implications for the care received by youth with severe presentations.nnMETHODS: We describe the provider-rated problems with which 2995 youth presented to ACCESS Open Minds, a multi-site, Canadian YMH integrated care initiative and the services they received, based on the severity of their needs at intake.nnRESULTS: The largest proportion of youth had both moderate-severe presentations and moderate-to-significant difficulties in functioning (41.67%). The first instance of receiving services following intake for most participants (71.42%) entailed a single service. The highest proportion of youth for whom the type of service received was not documented was those who presented with neither moderate-severe presentations nor poor functioning (15.01%). There was substantial variability in services provided across sites.nnCONCLUSION: Variability in service delivery confirms the need for greater standardization of core service offerings across sites. Future research should assess the appropriateness of services for different presentations to ensure equitable support is provided for all youth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42459164,

title = {Relationship among Sleep Disturbance, Stress, and Suicidal Ideation in Clinical High Risk for Psychosis},

author = {Heather M Wastler and Aubrey Moe and Alexandra M Blouin and Melanie Bozzay and Melissa F V Kilicoglu and Celso Arango and Sylvain Bouix and Matthew R Broome and Monica E Calkins and Philippe Conus and Cheryl M Corcoran and Courtney Crawford and Covadonga M Diaz-Caneja and Stefano Damiani and Paolo Fusar-Poli and Matcheri S Keshavan and Vijay A Mittal and Josh Nguyen and Jason Schiffman and Jai L Shah and Walid Yassin and Alison Yung and Jean Addington and Luis Alameda and Kristin S Cadenhead and Ricardo E Carrion and Rolando I Castillo-Passi and Eric Yu Hai Chen and Jimmy Choi and Barbara A Cornblatt and Lauren M Ellman and Pablo A Gaspar and Carla Gerber and Louise Birkedal Glenthøj and Leslie E Horton and Christy Lai Ming Hui and Joseph Kambeitz and Lana Kambeitz-Ilankovic and Minah Kim and Sung-Wan Kim and Nikolaos Koutsouleris and Jun Soo Kwon and Kerstin Langbein and Daniel Mamah and Daniel H Mathalon and Merete Nordentoft and Godfrey D Pearlson and Jesus Perez and Diana O Perkins and Albert R Powers Iii and Jack Rogers and Fred W Sabb and Steven M Silverstein and Stefan Smesny and William S Stone and Gregory P Strauss and Judy L Thompson and Rachel Upthegrove and Swapna Verma and Jijun Wang and Daniel H Wolf and Tianhong Zhang and Ofer Pasternak and Rene S Kahn and Martha E Shenton and Patrick D McGorry and Barnaby Nelson and John M Kane and Carrie E Bearden and Scott W Woods and  and Nicholas Breitborde and },

doi = {10.1093/schizbullopen/sgag024},

issn = {2632-7899},

year  = {2026},

date = {2026-01-01},

journal = {Schizophr Bull Open},

volume = {7},

number = {1},

pages = {sgag024},

abstract = {BACKGROUND AND HYPOTHESIS: Sleep disturbance is a well-established risk factor for suicide, though few studies to date have examined whether sleep disturbance contributes to suicide risk among individuals at clinical high risk for psychosis (CHR). The current study addressed this gap in the literature. We hypothesized that sleep disturbance would have a unique relationship with suicidal ideation/attempts when accounting for other variables in the model. We also hypothesized that the interaction between sleep disturbance/attenuated positive symptoms and sleep disturbance/stress would be related to suicidal ideation/attempts in CHR.nnSTUDY DESIGN: The current study used data generated by the Accelerating Medicines Partnership® Schizophrenia Observational Study. The total sample included 1,048 participants (827 CHR and 221 community controls). Participants completed measures of suicidal ideation/attempts, attenuated positive symptoms, depressive symptoms, perceived stress, and sleep disturbance.nnSTUDY RESULTS: Results supported a relationship between sleep disturbance and suicidal ideation/attempts in CHR, with participants who had lifetime ideation and attempts experiencing more sleep disturbance than those with no ideation or attempts. We also found small, but significant positive correlations between sleep disturbance and suicide risk in CHR. When accounting for other variables in the model, the effect of sleep disturbance remained significant for past month ideation, but not lifetime ideation or attempts. Both interaction models were non-significant.nnCONCLUSIONS: Our findings highlight the potential value of sleep measures in early identification and treatment of suicide risk in CHR. Further research in this area is warranted.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42113000,

title = {The Clinical Staging Model in Psychosis: a Cross-Disciplinary Critical Appraisal Informed by Oncology},

author = {Jai L Shah and Suzanne P MacFarland and Jennifer M Kalish and Jesus Perez and Paolo Fusar-Poli and Monica E Calkins},

doi = {10.1093/schbul/sbaf211},

issn = {1745-1701},

year  = {2025},

date = {2025-12-01},

journal = {Schizophr Bull},

abstract = {Categorical models of mental illness have come under increasing scrutiny in recent years, but there is no uniformly accepted alternative. One option that has gained attention in psychiatry is clinical staging, which frequently refers to staging models in other areas of healthcare, most prominently that of oncology/cancer. Yet, such comparisons are often inadvertently broad and leave unanswered questions about the applicability of cancer staging models to mental health. To address this gap, we convene expertise in oncology and psychiatry to better understand features of the clinical staging model in theory and practice as applied to cancer, and its potential translation to psychosis as an example of a mental illness. We compare and contrast features of the staging model in the context of illness development in cancer, consider how these features might port over to psychosis, and finally, the ways in which staging might need to be adapted if it is to have validity and clinical utility for psychosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid42113003,

title = {Premorbid adjustment problems, negative symptoms, and cognitive impairment in a large international sample at clinical high risk for psychosis: Findings from the Accelerating Medicines Partnership-Schizophrenia},

author = {Henry R Cowan and Danielle Pratt and Jai L Shah and Scott W Woods and Luis Alameda and Martin Lepage and Stewart A Shankman and Jean Addington and Celso Arango and Carrie E Bearden and Sylvain Bouix and Nicholas J K Breitborde and Matthew R Broome and Kristin S Cadenhead and Monica E Calkins and Rolando I Castillo-Passi and Eric Yu Hai Chen and Jimmy Choi and Philippe Conus and Cheryl M Corcoran and Barbara A Cornblatt and Covadonga M Diaz-Caneja and Lauren M Ellman and Paolo Fusar-Poli and Pablo A Gaspar and Carla Gerber and Louise Birkedal Glenthøj and Cláudia Gonçalves and Leslie E Horton and Christy Lai Ming Hui and Joseph Kambeitz and Lana Kambeitz-Ilankovic and Rene S Kahn and John M Kane and Matcheri S Keshavan and Minah Kim and Sung-Wan Kim and Nikolaos Koutsouleris and Jun Soo Kwon and Kerstin Langbein and Daniel Mamah and Daniel H Mathalon and Patrick D McGorry and Barnaby Nelson and Merete Nordentoft and Ofer Pasternak and Godfrey D Pearlson and Jesus Perez and Diana O Perkins and Albert R Powers and Jack Rogers and Fred W Sabb and Jason Schiffman and Martha E Shenton and Steven M Silverstein and Stefan Smesny and William S Stone and Gregory P Strauss and Judy L Thompson and Rachel Upthegrove and Swapna Verma and Jijun Wang and Daniel H Wolf and Alison Yung and Tianhong Zhang and Courtney Crawford and Walid Yassin and Sinead Kelly and Michael Coleman and Grace Jacobs and Kathryn E Lewandowski and Nora Penzel and Justin Baker and Guillermo Cecci and Kelly Allott and Kate Buccilli and Sophie Tod and Lauren Addamo and Lihua Xu and  and Vijay A Mittal},

doi = {10.1093/schbul/sbaf197},

issn = {1745-1701},

year  = {2025},

date = {2025-12-01},

journal = {Schizophr Bull},

abstract = {BACKGROUND AND HYPOTHESES: Functional impairment often precedes attenuated psychotic symptoms (APS) in youth at clinical high risk (CHR) for psychosis. This impairment has been linked to baseline symptoms and cognition, but the roles of developmental stage of APS onset and comorbid depression/anxiety are not well understood. Accelerating Medicines Partnership-Schizophrenia's diverse international sample and broad symptom assessment facilitate a detailed analysis of premorbid functioning.nnSTUDY DESIGN: Premorbid adjustment and baseline symptoms and cognition were examined in 1056 individuals at CHR (n = 482 early-symptom, n = 574 late-symptom [first CHR-level APS in childhood/early adolescence vs. late adolescence/adulthood]). In the late-symptom group, growth curve models tested adjustment trends from childhood through late adolescence. Incremental relationships between adjustment, symptoms, and cognition were tested controlling for depression/anxiety.nnSTUDY RESULTS: Premorbid social maladjustment correlated with baseline negative symptoms (r ≥ .25, P < .001). Premorbid academic maladjustment correlated with baseline negative symptoms (r ≥ .17, P ≤ .007) and cognitive impairment (r ≥ .27, P ≤ .001). Effects did not differ between early- and late-symptom subgroups (Δr ≤ .12, z ≤ 2.00, P > .05). Social adjustment deteriorated over time in participants with more baseline negative symptoms (γ = 0.14, P < .001) or cognitive impairment (γ ≥ -0.01, P < .004), even when controlling for depression/anxiety. APS were generally unrelated to premorbid functioning. Effects were consistent in the subsample residing outside North America (n = 579).nnCONCLUSIONS: Relationships between premorbid adjustment, negative symptoms, and cognition were independent of depression/anxiety and developmental stage of CHR symptom onset. Baseline negative symptoms and cognitive impairment follow insidious and worsening functional problems originating in early clinical stages, prior to onset of APS.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41103137,

title = {The Needs of Most or Most in Need: How Integrated and Transdiagnostic Youth Services Assess and Address Mental Health Needs},

author = {Sarah Mughal and Marie-Pier Alègre and Alba Sanchez-Allakhverdieva and Liliane Amoura and Yun Shan Liu and Srividya Iyer and William Capon and Frank Iorfino and Jai Shah},

doi = {10.1176/appi.ps.20250050},

issn = {1557-9700},

year  = {2025},

date = {2025-11-01},

journal = {Psychiatr Serv},

volume = {76},

number = {11},

pages = {997--1017},

abstract = {OBJECTIVE: This review aimed to explore how integrated and transdiagnostic youth service models assess varied mental health needs and operationalize them to provide appropriate care. Furthermore, given the wide treatment gap for youths with severe needs, it highlights how models identify these youths and direct them to appropriate care.nnMETHODS: This scoping review includes peer-reviewed and gray literature available in English. PsycInfo, MEDLINE, Embase, and CINAHL databases were searched for academic literature (January 2005-June 2023). Gray literature was acquired through outreach to service representatives. Eligible studies described an integrated and transdiagnostic youth mental health service model and included content related to the research objectives.nnRESULTS: This review included 121 pieces of literature describing 49 service models. Findings indicated substantial variability in the services provided and methods used to assess needs, as well as offerings and processes that were frequently insufficient for supporting youths with severe needs. Most models used two intake assessment tools, and approximately one-quarter had no service option for youths with severe needs. Multiple models did not explicitly describe how identified needs were operationalized into care decisions, with some incorporating exclusions for severe case presentations.nnCONCLUSIONS: Little evidence has been found for how integrated and transdiagnostic youth mental health service models should be operationalized, and their implementation varies considerably-potentially leaving young people without care or with needs that go unnoticed. Prioritizing research to enhance the operations of these initiatives is critical to ensure that they consistently meet the full breadth of needs experienced by youth populations.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid40991272,

title = {Progression of Transdiagnostic Stages From Childhood to Young Adulthood},

author = {Aswin Ratheesh and Yufan Chen and Dylan Hammond and Zoe Aitken and Jai Shah and Frank Iorfino and Jan Scott and Ian Hickie and Chris Davey and Andrew Chanen and Michael Berk and Patrick McGorry and Steven Marwaha and Andrew Thompson and Barnaby Nelson},

doi = {10.1001/jamapsychiatry.2025.2648},

issn = {2168-6238},

year  = {2025},

date = {2025-11-01},

journal = {JAMA Psychiatry},

volume = {82},

number = {11},

pages = {1113--1122},

abstract = {IMPORTANCE: Transdiagnostic clinical staging models for mental disorders are receiving increased attention. However, their underlying assumptions are underresearched; for example, it is not clear whether the observed progression across stages occurs independently of preexisting risk factors.nnOBJECTIVES: To test the likelihood of progression from stage 0 (familial risk) in childhood to stage 1a (mild symptoms) in adolescence and subsequently to stage 1b (clinically significant symptoms) in young adulthood, accounting for confounders, and to explore potential mediators.nnDESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC included pregnant women and their offspring residing in Avon, United Kingdom, between 1991 and 1992, with a proportion of offspring followed up into young adulthood. Eligible participants provided data on stage determinants and potential confounders from birth until age 24 years. Data were collected from 1991 to 2015 and analyzed from January 2002 to June 2025.nnEXPOSURES: Exposures were clinical stages 0 and 1a in separate tests of association with stages 1a and 1b, respectively. Criteria for stage 0 were the presence of schizophrenia or severe depression in a first-degree relative. Criteria for stage 1a were the presence of 1 to 2 symptoms of depression, anxiety, or psychosis at ages 12 to 13 years.nnMAIN OUTCOMES AND MEASURES: Outcomes were stage 1a in adolescence and stage 1b in young adulthood. Criteria for stage 1b were at least moderate symptoms of depression, anxiety, or psychosis, with associated functional impact at ages 18 to 24 years. Confounders were sex assigned at birth, obstetric risk, parental social class, ethnicity, family adversity, temperament, early life events, and neurocognition, measured in childhood.nnRESULTS: Among those with complete data at all 3 time points (1375 participants; weighted, 7342), 796 participants (57.9%; weighted, 51.5%) were female and 579 (42.1%; weighted, 48.5%) were male. After adjusting for potential confounders, there was an association between stage 0 in childhood and stage 1a in adolescence (3860 participants; weighted, 7388 participants; odds ratio [OR], 1.65, 95% CI, 1.30-2.11) and between stage 1a in adolescence and stage 1b in young adulthood (1661 participants; weighted, 7466 participants; OR, 2.07; 95% CI, 1.07-4.01). Level of neuroticism in adolescence mediated 18% of the association between stage 1a in adolescence and stage 1b in young adulthood.nnCONCLUSIONS AND RELEVANCE: In this cohort study, young people with mental health problems meeting criteria for early clinical stages were at heightened risk of developing subsequent stages, independent of early life risk factors. This study supports the assumption of progression underlying clinical staging models for mental disorders.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41271418,

title = {Integrating the digital culture of youth in clinical mental health assessments: protocol for the codesign and pilot test of an interview method},

author = {Vincent Paquin and Samantha Aversa and Elizabeth Nickrenz and G Eric Jarvis and Melissa Park and Manuela Ferrari and Jai Shah},

doi = {10.1136/bmjopen-2025-104200},

issn = {2044-6055},

year  = {2025},

date = {2025-11-01},

journal = {BMJ Open},

volume = {15},

number = {11},

pages = {e104200},

abstract = {INTRODUCTION: Digital media practices have varied implications for the mental health of youth, notably as a function of sociocultural and environmental factors. However, there are limited tools available to guide the assessment of digital culture in clinical practice. This study will aim to design and pilot test an interview tool for the assessment of youth digital culture, as a companion to the Cultural Formulation Interview which broadly assesses cultural factors in mental healthcare.nnMETHODS AND ANALYSIS: We will recruit youth aged 16-35 years and receiving mental healthcare in Montreal, Canada, to codesign (n=10) and evaluate (n=20) the interview tool. We will also recruit clinician participants (n=10) to provide feedback on the interview. The tool will be developed with codesign participants using the nominal group technique and subsequently tested with the evaluation participants. We will provide the evaluation participants and clinicians with a written summary of the interview and will assess their perspectives on the feasibility, acceptability and utility of the interview method through surveys and debriefing interviews. We will conduct reflexive thematic analysis of the interview transcripts and descriptive quantitative analyses of the feasibility, acceptability and utility scores.nnETHICS AND DISSEMINATION: The study received ethical approval from the Research Ethics Board of the CIUSSS de l'Ouest-de-l'Île-de-Montréal (MP-18-2025-1164). The results will be interpreted in consultation with codesign participants and will be disseminated through peer-reviewed publications, workshops for clinicians and academic conferences.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41263966,

title = {Can We Detect the Undetected? Comparing the Prodromes of Individuals with First Episode Psychosis Detected and Undetected by Clinical High-Risk for Psychosis Services: An Electronic Health Record Study},

author = {Maisie Inns and Madison Gill and Maite Arribas and Yanakan Logeswaran and Amedeo Minichino and Thomas J Reilly and Andrea De Micheli and Jai L Shah and Philip McGuire and Paolo Fusar-Poli and Dominic Oliver},

doi = {10.1093/schbul/sbaf201},

issn = {1745-1701},

year  = {2025},

date = {2025-11-01},

journal = {Schizophr Bull},

abstract = {BACKGROUND AND HYPOTHESIS: The majority of first episode psychosis (FEP) patients are undetected (DET-) by clinical high-risk for psychosis (CHR-P) services prior to onset and therefore do not receive preventive care for psychosis. We compared features of the psychosis prodrome (symptoms and substance use) between DET- and FEP patients detected by CHR-P services (DET+) to determine whether they share a common prodromal phase.nnSTUDY DESIGN: Retrospective Reporting of Studies Conducted Using Observational Routinely Collected Health Data statement-compliant electronic health record cohort study. We extracted 65 prodromal features (symptoms and substance use before FEP onset) using natural language processing to assess the presence, duration, and first presentation of the psychosis prodrome and occurrences of features across the prodrome. Duration and feature occurrences were compared between DET+ and DET- individuals using Mann-Whitney U tests and Wilcoxon Effect Size, while presence and first presentation were compared using logistic regression.nnSTUDY RESULTS: A total of 1545 FEP patients (n = 119 DET+ [mean age 28.7 years; SD = 9.4; 61.6% male]) were included. There were no significant differences in the presence (DET + =85.0%, DET- = 85.6%, P = .83) or duration (DET + =18.8 months, DET- = 18.4 months, P = .89) of the psychosis prodrome. There were no significant differences in first presentation of psychotic symptoms between groups (Pcorr > .05). Frequency of occurrences of thought broadcasting (r = 0.07, Pcorr = .04) was higher and hostility (r = 0.08, Pcorr = .04) lower in DET+ compared to DET- across the prodrome, though effect sizes were small.nnCONCLUSIONS: DET+ and DET- individuals experience similar psychosis prodromes prior to FEP onset. DET- individuals can likely be identified earlier if detection strategies are improved.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid41093845,

title = {Collecting language, speech acoustics, and facial expression to predict psychosis and other clinical outcomes: strategies from the AMP® SCZ initiative},

author = {Zarina R Bilgrami and Eduardo Castro and Carla Agurto and Einat Liebenthal and Michaela Ennis and Justin T Baker and Isabelle Scott and Beau-Luke Colton and Kang Ik K Cho and Linying Li and Zailyn Tamayo and Mara Henecks and Habiballah Rahimi Eichi and Tae'lar Henry and Jean Addington and Luis K Alameda and Celso Arango and Nicholas J K Breitborde and Matthew R Broome and Kristin S Cadenhead and Monica E Calkins and Eric Yu Hai Chen and Jimmy Choi and Philippe Conus and Barbara A Cornblatt and Lauren M Ellman and Paolo Fusar-Poli and Pablo A Gaspar and Carla Gerber and Louise Birkedal Glenthøj and Leslie E Horton and Christy Hui and Joseph Kambeitz and Lana Kambeitz-Ilankovic and Matcheri S Keshavan and Sung-Wan Kim and Nikolaos Koutsouleris and Jun Soo Kwon and Kerstin Langbein and Daniel Mamah and Covadonga M Diaz-Caneja and Daniel H Mathalon and Vijay A Mittal and Merete Nordentoft and Godfrey D Pearlson and Jesus Perez and Diana O Perkins and Albert R Powers and Jack Rogers and Fred W Sabb and Jason Schiffman and Jai L Shah and Steven M Silverstein and Stefan Smesny and William S Stone and Walid Yassin and Gregory P Strauss and Judy L Thompson and Rachel Upthegrove and Swapna Verma and Jijun Wang and Daniel H Wolf and Patrick D McGorry and Rene S Kahn and John M Kane and Alan Anticevic and Carrie E Bearden and Dominic Dwyer and Tashrif Billah and Sylvain Bouix and Ofer Pasternak and Martha E Shenton and Scott W Woods and Barnaby Nelson and  and Guillermo A Cecchi and Cheryl M Corcoran and Phillip M Wolff},

doi = {10.1038/s41537-025-00669-z},

issn = {2754-6993},

year  = {2025},

date = {2025-10-01},

journal = {Schizophrenia (Heidelb)},

volume = {11},

number = {1},

pages = {125},

abstract = {Speech-based detection of early psychosis is progressing at a rapid pace. Within this evolving field, the Accelerating Medicines Partnership® in Schizophrenia (AMP® SCZ) is uniquely positioned to deepen our understanding of how language and related behaviors reflect early psychosis. We begin with detailed standard operating procedures (SOPs) that govern every stage of collection. These SOPs specify how to elicit speech, capture facial expressions, and record acoustics in synchronized audio-video files-both on-site and through remote platforms. We then explain how we chose our sampling tasks, hardware, and software, and how we built streamlined pipelines for data acquisition, aggregation, and processing. Robust quality-assurance and quality-control (QA/QC) routines, along with standardized interviewer training and certification, ensure data integrity across sites. Using natural language processing parsers, large language models, and machine-learning classifiers, we analyzed Data Release 3.0 to uncover systematic grammatical markers of psychosis risk. Speakers at clinical high risk (CHR) produced more referential language but fewer adjectives, adverbs, and nouns than community controls (CC), a pattern that replicated across sampling tasks. Some effects were task-specific: CHR participants showed elevated use of complex syntactic embeddings in two elicitation conditions but not the third, underscoring the importance of the language sampling task. Together, these results demonstrate how computational linguistics can turn everyday speech into a scalable, objective biomarker, paving the way for earlier and more precise detection of psychosis.Video Link: https://vimeo.com/1112291965?fl=pl&fe=sh.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40413924,

title = {From resting-state functional hippocampal centrality to functional outcome: An extended neurocognitive model of psychosis},

author = {Jana F Totzek and Jai L Shah and Alexandra L Young and Ashok Malla and Ridha Joober and Delphine Raucher-Chéné and Martin Lepage and Katie M Lavigne},

doi = {10.1016/j.psychres.2025.116538},

issn = {1872-7123},

year  = {2025},

date = {2025-08-01},

journal = {Psychiatry Res},

volume = {350},

pages = {116538},

abstract = {BACKGROUND: We previously proposed a neurocognitive model of psychosis in which reduced morphometric hippocampal-cortical connectivity precedes impaired episodic memory, social cognition, negative symptoms, and functional outcome. We provided support for this model in a patient subtype, and aimed to extend these findings to resting-state functional MRI to potentially explain the progression for a broader range of patients.nnMETHODS: We used a subsample of our previous analysis consisting of 54 patients with first-episode psychosis and 52 controls and applied the machine-learning algorithm Subtype and Stage Inference, which combines clustering and disease progression modeling, to the patient data for rs-functional hippocampal connectivity, episodic memory, social cognition, negative symptoms and functioning.nnRESULTS: We identified three subtypes, with Subtype 0 being unimpaired on the markers, Subtype 1 showing impaired hippocampal connectivity and episodic memory, and Subtype 2 showing impaired memory and a trend for impaired functioning. We identified similar progression patterns to our previously published morphometric results in functional MRI data (hippocampal dysconnectivity preceded cognition, symptoms, and functioning in one subtype and followed these alterations in another subtype). We further show that the impairments in our previously published and current findings across modalities do not necessarily overlap in patients, hinting towards an additive effect of morphometric and resting-state connectivity in explaining the neurocognitive underpinnings of this model.nnCONCLUSION: Our results provide an extension of our previous work and build the foundation for a multimodal neurocognitive model of psychosis, potentially elucidating this aspect of illness progression in psychosis for a broader range of patients.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid40286435,

title = {Pathways to early intervention services involving police or ambulance and disengagement rates in racialized and immigrant youth compared to the White majority},

author = {Ines Boujelben and Giuseppe D'Andrea and Clairelaine Ouellet-Plamondon and Laurence Artaud and Marie Villeneuve and Jai Shah and Srividya N Iyer and Amal Abdel-Baki},

doi = {10.1016/j.schres.2025.04.021},

issn = {1573-2509},

year  = {2025},

date = {2025-06-01},

journal = {Schizophr Res},

volume = {280},

pages = {122--129},

abstract = {OBJECTIVES: Early-intervention services (EIS) are the gold standard for first-episode psychosis (FEP). Immigrants and racialized youth with FEP are more likely to access EIS through adverse pathways (police and/or ambulance-mediated) and to disengage from treatment. We aimed to use a comprehensive, intersectional approach to examine inequalities in pathways to care and EIS disengagement, comparing immigrants stratified by generational and racialized minority status, with White majority non-immigrants.nnMETHODS: Incident FEP cases from two Canadian EIS were stratified according to immigrant generation and racialized minority status. Pathways to care and disengagement were examined using logistic regression models adjusted for potential confounders.nnRESULTS: Of 567 participants, 173 (30.8 %) experienced an adverse pathway. The proportion of adverse pathway was highest among racialized first-generation immigrants (N = 52, 38.2 %), followed by non-racialized (N = 13, 32.5 %) and racialized second-generation immigrants (N = 23, 32.4 %). White non-immigrants (N = 77, 26.9 %) and non-racialized first-generation immigrants (N = 6, 23.1 %) presented lower rates. Odds of adverse pathways were only significantly increased for racialized first-generation immigrants (OR = 1.72, 95 % CI = 1.06-2.80) compared with White non-immigrants. Disengagement was associated with adverse pathways to care (OR = 1.80, 95 % CI = 1.09-2.97), but not with immigrant stratified groups. The relationship between adverse pathways and disengagement was not moderated by immigrant status.nnCONCLUSIONS: Racialized first-generation immigrants are more likely to encounter adverse pathways. The interplay between systemic, cultural, and individual factors, including perceived need for mental healthcare knowledge and trust towards healthcare institutions can hinder access to services. Racially differing practices in emergency response may play a role. Further research is needed to understand inequities in EIS access.},

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pubstate = {published},

tppubtype = {article}

}