which they completed on random moments for up to 10 times a day on 7 consecutive days. Attachment anxiety and avoidance were assessed with the Psychosis Attachment Measure and symptoms were assessed with the positive and negative syndrome scale (PANSS). Results: Patients were 2.7 to 3.9 times more likely to be alone than healthy controls and relatives, respectively. In addition, patients showed significantly lower levels of trust compared to relatives and healthy controls around close others (i.e., family or friends) but not when in company of strangers or more distant others. Relatives and controls did not differ from each other in their levels of trust. There were no group differences in attachment anxiety or avoidance. In patients, negative but not positive symptoms were associated with a lower frequency of social engagement. Conclusion:The current study shows reduced trust and social engagement in patients with nonaffective psychosis within real-life contexts. Interestingly, patients' levels of trust were specifically reduced in relationships with close others. This effect was not accounted for by attachment insecurity. The absence of differences in trust and social engagement between controls and relatives suggests that the effects seen in patients are illness specific. Social networks with close others are crucial for wellbeing and recovery and the current findings support the need for improving these in patients. Background: Autism and schizophrenia are associated with difficulties in social perception and understanding. However, the relationship between these conditions and the way they affect social functioning have been a contentious issue. In addition, a dimensional view of psychopathology suggests that subclinical expressions can explain interindividual differences within the healthy population. However, it is debated whether effects found in healthy populations can extend to clinical populations. Methods: We examined covariation of mentalizing abilities as a function of autism and positive symptoms in 162 patients with schizophrenia. We also examined these abilities in 53 healthy adults as a function of attenuated, subclinical expressions of autism and positive symptoms. Mentalizing abilities in both populations were assessed using the Movie for the Assessment of Social Cognition, an ecologically valid task that distinguishes between different types of mentalizing errors, namely underand over-mentalizing. Results: We found that while autism and positive symptom expressions are associated with unique profiles of mentalizing difficulties, they interact in a compensatory manner. In healthy participants, autistic expressions are associated with increased undermentalism, and positive psychotic-like experiences are associated with reduced undermentalism. In schizophrenia patients, autism symptoms are associated with reduced overmentalism and positive symptoms are associated with increased overmentalism. Conclusion: Co-occurring expressions of autistic and positive symptoms exert opposing influences on men...

No abstract

BackgroundA territory-wide specialized early intervention (EI) service for psychosis (EASY) has been implemented in Hong Kong since 2001, providing 2-year phase-specific early assessment and clinical care to young people aged 15–25 years presenting with first-episode psychosis (FEP). Previous evaluation demonstrated superiority of EASY programme over standard care in outcome improvement in FEP. Recently, EASY has been extended to provide 3-year EI service to FEP patients aged 15 to 64 years. However, effectiveness of EI on adult FEP populations has not been well examined.MethodsThis study adopted case versus historical-control design, comparing patients received 3-year EASY treatment (EI group) with those managed by standard psychiatric care (SC group) prior to implementation of EASY extension in terms of treatment delay and outcomes in symptom and functioning. In total, 320 Chinese adult FEP patients aged 26–55 years (160 in EI group, 160 in SC group) were included in the study. Retrospective record review detailing service utilization over 3-year treatment period was conducted. Follow-up interview assessment (on average 48.3 months after service entry) encompassing premorbid adjustment, duration of untreated psychosis (DUP), clinical (Positive and Negative Syndrome Scale, PANSS; Calgary Depression Scale, CDS), functional (Role Functioning Scale, RFS) and treatment profiles was administered. Comparison analyses on DUP and service utilization were based on record review data of 320 patients. Clinical and functional outcome analyses focused on data collected from follow-up interview assessment (251 patients completed follow-up assessment, 130 from EI and 121 from SC groups).ResultsEI and SC groups were comparable regarding demographics, premorbid and baseline characteristics, except the use of second-generation antipsychotic (SGA) treatment (EI patients were more likely to receive SGA than SC patients). EI patients had significantly shorter DUP than SC counterparts (p=0.015). Regarding follow-up outcomes, EI patients displayed lower levels of negative (p=0.044) and depressive symptoms (p=0.055), higher scores in RFS immediate social network (p=0.027) and lower rates of service disengagement (p=0.048) than SC patients even when SGA use and DUP were adjusted as covariates in analysis of covariance for comparison. There were no significant group differences in admission and suicide rates.DiscussionOur results indicate that extended EASY service achieve favorable outcomes in adult FEP patients on shortening of treatment delay and improvement in negative symptoms and social functioning, and service disengagement reduction. Further evaluation is required to assess the sustainability of positive effects.