Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions.

The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective.

Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes.

Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia.

The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.

Despite evidence of disparities in care received by Black communities, limited interventions exist to address them. The SEE ME training is a co-produced intervention using video testimonials to improve the care of Black individuals with psychosis within NHS early intervention in psychosis (EIP) services. This study explored mental health professionals’ experiences of the SEE ME training and its impact on addressing racial inequalities within EIP services. Semi-structured interviews were conducted with 21 mental health professionals, and the data were analysed with thematic analysis.

Thematic analysis identified six superordinate themes and 17 subthemes, encompassing the importance of adopting clients’ perspectives, prioritising individuals’ voices, enabling reflection, fostering shared humanity and creating psychological safety.

This is the first qualitative study exploring the impact of SEE ME training. Findings offer valuable insights for improving anti-racist practice and service development in mental healthcare.

Adverse childhood experiences (ACEs) are associated with increased risk of psychotic-like experiences (PLEs), but the relationship between specific adversities and the persistence of PLEs in young people remains unclear. We examined associations between distinct ACEs and the persistence of PLEs until 24 years old.

Using longitudinal data from participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort with at least one PLE datapoint, we used group-based trajectory modeling to estimate longitudinal trajectories of PLEs from age 12–24. We examined their associations with bullying victimization, maltreatment, parental mental health problems, parental substance abuse, parental separation, and parental intimate partner violence prior to first PLE experiences.

Among 4,448 participants, a three-group trajectory model provided the best fit, revealing low, increasing and persistent PLE groups from ages 12–24. In fully adjusted multinomial logistic regression models, those exposed to bullying were more likely to belong to either the increasing (relative risk ratio [RRR]: 1.83, 95%CIs: 1.26–2.66) or high (RRR: 1.78, 95%CIs: 1.07–2.93) PLEs group than the low PLE group; those exposed to maltreatment were more likely to be in the increasing PLE group (RRR: 1.47, 95%CIs: 1.03–2.10). No other ACEs were associated with PLE trajectories.

Bullying was associated with persistent PLEs up to 24 years old, independent of other forms of childhood adversity, with timing-specific effects of maltreatment on increasing symptoms emerging later in adolescence. Findings provide further evidence for the importance of prioritizing bullying and maltreatment reduction as public health targets.

Shared decision-making is essential to patient-centred care, but remains underutilised in psychiatry, particularly when deciding whether to continue, reduce or stop antipsychotic medication after remission from first-episode psychosis (FEP). Existing decision aids do not fully address recovery goals such as autonomy, identity and social reintegration.

To co-develop a patient decision aid (PDA) prototype that supports individuals in making the decision to continue, reduce or stop antipsychotics following remission from FEP.

We used a patient-centred design process informed by International Patient Decision Aid Standards (IPDAS), User Centered Design (UCD-11) and the CHIME framework. A multidisciplinary steering group – including individuals with lived experience, clinicians, and researchers – co-developed the PDA. Iterative feedback was collected from an external advisory group of patient partners, caregivers and healthcare providers (n = 7). Acceptability was evaluated with structured questionnaires.

The final prototype, structured into five sections (decision overview, personal values, risks and benefits, planning and real-life experiences), demonstrated strong acceptability across stakeholders. Ratings improved with each iteration, with version 3 receiving near-perfect scores on clarity, usefulness and balance. Users described the tool as relatable and empowering. The inclusion of real-life stories and visual decision exercises were particularly valued. However, some clinicians expressed concerns about time constraints and workflow integration.

This recovery-oriented PDA prototype offers a practical, evidence-based resource to facilitate shared decision-making with respect to continuing, reducing or stopping antipsychotics after FEP. Although early feedback is promising, pilot testing is needed to evaluate its impact on decision quality, satisfaction and treatment outcomes.

In recent decades, the potency of cannabis resin increased globally, raising concerns, as higher potency has been associated with increased risk of psychiatric harms at the individual level. The aim here was to examine whether changes over time in the potency of seized cannabis resin samples were associated with psychiatric harms at the population level.

Data on ∆-9-tetrahydrocannabinol (THC) concentration in seized cannabis resin were obtained from forensic departments in Denmark (2000–2022), the country reporting the highest potency in Europe. Data on admissions to cannabis treatment, incidence of cannabis-induced psychosis, and dual diagnosis (schizophrenia and cannabis use disorder) were obtained from national registers. Time-dependent associations between potency and the outcomes were examined with mixed-effects linear regression models and associations across age and sex were explored. Candidate time lags were 0–10 years.

THC concentration increased almost fourfold: mean 8.3–31.2% from 2000 to 2022. In fully adjusted models, THC was positively associated with first-time cannabis treatment entry at lags of 0–6, strongest at year 0 (p < 0.0001); incidence of cannabis-induced psychosis at lags of 0–4, strongest at year 0 (p < 0.0001); and incidence of dual diagnosis at lags of 0–1, strongest at year 0 (p < 0.01). No positive associations were found in unadjusted models. Subgroup analyses indicated associations in older patients and women.

Potency of seized cannabis resin increased almost fourfold from 2000 to 2022. Changes in cannabis potency were positively associated with psychiatric harms at the population level across all outcomes.

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.

People with affective psychotic disorders often face diagnostic delays and presentations are under-recognised at first contact with early intervention services (EIS). Despite their clinical significance, most research and service models for first-episode psychosis (FEP) have focused on non-affective psychoses.

We sought to clarify the relative prevalence of affective psychoses in EIS.

A systematic review and random-effects meta-analysis of observational studies reporting proportion of affective psychotic disorders among individuals presenting to EIS with FEP was conducted. Eligible studies included treated FEP populations diagnosed using DSM/ICD criteria. Searches were conducted in Web of Science, Medline and PsycINFO (inception to July 2025). The primary outcome was pooled proportion of affective psychotic disorders. Heterogeneity was assessed using Q-statistics and I2-statistics. Meta-regressions examined potential moderators, including urbanicity, national income level and geographical region.

Eighty-three studies (N = 30 946; mean age 24.95 years; 34.78% female) were included. Random-effects pooled proportion was 18.0% (95% CI 15.4–20.6; 95% prediction interval 3.6–39.4%; I2 = 95.6%). Schizoaffective disorder represented 7.4% (k = 49; 95% CI 5.8–9.2). Schizophrenia was the most frequent diagnosis, with a pooled proportion of 45.5% (k = 79; 95% CI 40.3–50.7). Meta-regression analyses identified that affective psychoses were less common in Asia and more common in North America compared with Europe. Higher urbanicity was also associated with increased prevalence. Associations with national income level (NIL) were limited by small subgroup sizes.

Affective psychotic disorders constitute a meaningful subgroup within EIS. This suggests better screening, targeted treatments and adaptive service models of care.

Cognitive impairment in first-episode schizophrenia (FES) is a major contributor to functional decline, but antipsychotics provide limited cognitive improvement, and few repetitive transcranial magnetic stimulation (rTMS) studies have targeted the orbitofrontal cortex (OFC). This study investigated whether right OFC rTMS enhances specific cognitive functions in FES and its relationship with symptom reduction.

Ninety drug-naive FES patients were enrolled, with 48 receiving active right OFC rTMS and 42 sham stimulation for 20 sessions over 8 weeks, while all patients took olanzapine (10–20 mg/day). Cognitive function was assessed using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) at baseline and week 4, and psychotic symptoms were rated with the Positive and Negative Syndrome Scale (PANSS).

Repeated-measures analysis of variance (RMANOVA) demonstrated a significant Time×Group interaction for visuospatial memory (assessed via the Brief Visuospatial Memory Test-Revised, BVMT; F = 5.079, df = 1, 83, p = 0.027, η2 = 0.058). Post hoc tests revealed significant BVMT improvement in the active group (p < 0.001) but not in the sham group (p = 0.312). In the active group, improvements in BVMT and Neuropsychological Assessment Battery (NAB) scores were significantly correlated with lower PANSS total scores after Bonferroni correction.

These findings indicate that right OFC rTMS improves specific cognitive functions in FES, with cognitive benefits associated with symptom alleviation, supporting the right OFC as a promising target for cognitive intervention in FES.

The positive valence systems (PVS) domain, a key focus of the Research Domains Criteria framework, divides reward-related processes into three constructs: reward responsiveness, reward learning, and reward valuation. Difficulties with several of these reward constructs have been reported in people with mood-psychosis spectrum disorders. This study aims to examine how performance on tasks corresponding to these three constructs covaries, and how performance relates to mood and psychotic symptoms in adults with mood-psychosis spectrum disorders, those at familial risk, and controls.

Data from two studies (N = 278 and N = 332) were analyzed, which both included people with a psychotic disorder or bipolar disorder (patients), their first-degree relatives (FDRs), and controls. PVS constructs were measured using the Multi-Armed Bandit Task, Effort-Expenditure for Rewards Task, and Monetary Incentive Delay Task. Depression, mania, and psychosis symptoms were measured with self-report and interview instruments. Confirmatory factor analysis was used to examine covariation, and path analysis to test associations with symptoms.

The three reward constructs showed weak (nonsignificant) covariance in all groups. There were a few impairments in reward-related performance in patients or FDRs, none that survived multiple-comparison correction. There were no associations between symptoms and performance on the PVS constructs after multiple comparisons correction.

The findings showed no evidence that performance on any of the three PVS constructs could constitute an endophenotype of mood-psychosis spectrum disorders. We recommend future research examining the contribution of specific cognitive skills to reward-related behavior, and to sources of heterogeneity in reward functioning within the patient group.

Cognitive reserve (CR) is a protective factor in first-episode psychosis (FEP), influencing cognitive, clinical, and functional outcomes. CR is shaped by a combination of genetic, clinical, and environmental factors, yet the extent of their respective contributions remains unclear. This study investigates the influence of polygenic risk scores (PRS), clinical and environmental variables on CR in FEP.

A cohort of 174 individuals with non-affective FEP, aged 25.5 (SD=5.3), was analyzed. CR was assessed using a socio-behavioral proxy. PRS for educational attainment (PRSEA), intelligence (PRSIQ), cognitive performance (PRSCP), occupational attainment (PRSOA), physical activity (PRSPA), and schizophrenia (PRSSZ) were calculated. Age at onset, socioeconomic status, birth weight, and family history of psychosis were considered. Multiple regression models were employed to evaluate the impact of the different predictors on CR.

PRSEA (p=0.002), age at onset (p=5.32x10-5), and family history of psychosis (p=0.001) emerged as the strongest contributors to CR. Higher PRSEA was associated with higher levels of CR, while earlier age at onset and positive family history were associated with lower CR. The model incorporating environmental, clinical, and genetic variables explained 17.7% of the variance in CR, and the one without PRS explained 13.5%. The inclusion of PRSEA in the model improved the explanatory power (Δadj.R2=0.042) and predictive accuracy (ΔRMSE=−0.288).

These findings highlight the role of precision psychiatry in better understanding CR. Early identification of individuals with earlier onset, family history of psychosis, and lower genetic predisposition to educational attainment may help characterize those with lower CR.

People with schizophrenia spectrum disorders (SSD) experience high rates of type 2 diabetes (T2D), mainly due to antipsychotic medication side-effects and lifestyle factors (e.g. suboptimal nutrition and physical inactivity). Digital technologies may reduce T2D risk by complementing face-to-face and pharmacological treatments, through the provision of flexible and personalised psychoeducation and behavioural prompts tailored to end-users.

This study tested the preliminary efficacy of the Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART), a co-designed text message-facilitated intervention, designed to reduce the risk and/or improve self-management of T2D, along with its acceptability and feasibility.

Using an uncontrolled pre–post design, 29 out-patients of an endocrinology mental health clinic and two community-based rehabilitation mental health facilities used SMART for 12 weeks. The primary outcome was patient activation, measured using the Patient Activation Measure. Secondary outcomes were combined objective cardiometabolic and self-reported health and mental health indicators. Pre–post changes were analysed with a linear mixed model, accounting for within-participant variation.

Significant improvements (p < 0.05) were detected in patient activation, confidence in diabetes self-management and general health management, health literacy and mental health recovery. High levels of acceptability and feasibility were confirmed, with recruitment, retention and adherence rates of 67.4, 92.9 and 93.0%, respectively.

SMART is a world-first digital intervention aimed at improving metabolic health in individuals with SSD. This study provides evidence of its preliminary efficacy in self-management of metabolic health while confirming its high acceptability and feasibility, supporting expansion towards a sufficiently powered controlled trial to assess its clinical effectiveness.

This exploratory study examined baseline characteristics modifying treatment effects on paranoia in individuals diagnosed with schizophrenia spectrum disorders following a 10-session virtual reality-based cognitive behavioral therapy for psychosis (VR-CBTp) or standard CBTp.

All participants in the FaceYourFears trial were included (n=254; CBTp n=128; VR-CBTp n=126). General linear and logistic regression models examined baseline variables associated with end-of-treatment paranoia. In covariate analyses, regression coefficients quantified associations across treatments. In moderation analyses, interaction terms (randomization x moderator) were tested, with corresponding regression coefficients estimated and assessed at the 25th (low), 50th (medium), and 75th (high) percentiles of continuous variables.

Across treatments, higher baseline avolition, safety behavior, delusion severity, and cognitive biases were associated with end-of-treatment paranoia. Moderation analyses revealed interactions for avolition, delusion severity, and negative other-beliefs. Although avolition and delusion severity were associated with poorer outcomes overall, individuals with high avolition and those with moderate-to-high delusion severity improved more in VR-CBTp than CBTp, whereas participants with lower delusion severity showed better outcomes in CBTp. No demographic (age, gender, education, and occupation) or other clinical characteristics (diagnosis, paranoia, social anxiety, depression, anhedonia, total negative symptoms, functioning, core beliefs, or interpersonal trauma) were significantly associated with outcome.

This exploratory study generates hypotheses for future research, including VR-CBTp’s potential to engage individuals with high avolition. Given the modest effects and largely nonsignificant findings, both CBTp and VR-CBTp appear suitable for a wide range of individuals with paranoia, highlighting the importance of considering patient preferences.

Thought disorder (TD) is a core feature of severe mental illnesses such as schizophrenia, characterized by disruptions in speech, language, and communication. People with TD face unique barriers that hinder their involvement in research, both as participants and as partners. Their systematic underrepresentation in psychiatric research is driven by pervasive assumptions about their decisional capacity, willingness to participate, and ability to engage in research. This perpetuates a biased evidence base, likely hindering the therapeutic progress toward addressing this core problem.

This review, informed by professional (clinical and research) and lived (bottom-up and phenomenological) experience of TD, examines how flawed assumptions regarding capacity, engagement, and participatory abilities serve as active barriers to inclusion.

We argue for a shift toward supported inclusion through tailored capacity assessments, enhanced informed consent procedures, targeted training of research personnel, and systemic institutional practices. Incorporating lived experiences of those with TD as research partners is integral to this approach, fostering co-production of research that is more valid, inclusive, and applicable.

Without these inclusion-focused changes, the development of treatments for TD is likely to have very slow progress and a critical segment of the severely unwell population will continue to be underrepresented from the scientific process, undermining both the utility and generalizability of psychiatric research.