Patrick D Mcgorry

Orygen The National Centre of Excellence in Youth Mental health · Centre for Youth Mental Health

Background: Suicide is the fourth leading cause of death among young people aged 15–29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time,...

Aim: The sexual health of adults with schizophrenia is poorer than the general population; however, less is known about young people experiencing a first episode of psychosis (FEP). The aim of this study was to explore the high-risk sexual behaviours and sexual well-being indicators of a cohort of young people with FEP. Methods: Data collected f...

Objective: Understanding the pathways to care for migrants experiencing a first episode of psychosis (FEP) is important, as they are more likely to experience longer delays to treatment and negative experiences, such as involuntary treatment. Despite the increased risk of developing a psychotic illness and barriers associated with pathways to care...

Introduction: Despite the established finding that migrants are at higher risk of developing a first-episode psychosis, they are under-represented in cohorts of young people identified as being at ultra-high risk for psychosis (UHR). Therefore, in order to determine the reasons for these conflicting findings, this study examined the pathways to ca...

The COVID-19 pandemic has had a profound effect on global mental health, with one-third of infected individuals developing a psychiatric or neurological disorder 6 months after infection. The risk of infection and the associated restrictions introduced to reduce the spread of the virus have also impacted help-seeking behaviours. Therefore, this stu...

Background. Young people present high rates of cannabis use, abuse, and dependence. The United Nations estimates that roughly 3.8% of the global population aged 15–64 years used cannabis at least once in 2017. Cannabis use in young people may impair cognitive skills, interfere with learning, impact relationships, and lead to long term behavioural a...

This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-ep...

Objective: Targeted, highly accessible early intervention for youths with emerging and complex psychiatric presentations is increasingly needed. The Youth Community Assessment and Treatment Team (YCATT) multidisciplinary service was established to provide intensive intervention for youths in Perth, Australia. Methods: The authors conducted a ret...

While COVID‐19 pandemic has allegedly passed its first peak in most western countries, health systems are progressively adapting to the ‘new normality’. In child and adolescent mental health services (CAMHS), such organizational envisioning is needed to cope with the foreseeable psychological effects of prolonged social isolation induced by nation‐...

Objective: To assess the demographic, social, and clinical characteristics of young Australians who die by suicide. Design: Retrospective analysis of National Coronial Information System (NCIS) data. Setting, participants: People aged 10–24 years who died by suicide in Australia during 2006–2015. Main outcome measures: Demographic, social, and cli...

Background: Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this...

Objective: This paper provides the rationale for the development of sub-specialty training in youth psychiatry. Method: Training needs for youth psychiatry are discussed and the opportunities provided by sub-specialisation in youth psychiatry are presented. Results: The majority of mental disorders have their onset prior to 25 years. There has been...

Training needs for Youth Psychiatry are discussed and the opportunities provided by sub-specialisation in youth psychiatry presented.

The strategic value of early, preventive intervention in psychosis has been a catalytic stepping stone to promoting early intervention in Mental Health. Central to such momentum is the construct of clinical high risk states for psychosis (CHR). While CHR emerge in developmental years, the meta-analytical risk of psychosis among children and adolesc...

Background: First-episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cogn...

Importance The development of adverse clinical outcomes in patients with psychosis has been associated with behavioral and neuroanatomical deficits related to emotion processing. However, the association between alterations in brain regions subserving emotion processing and clinical outcomes remains unclear. Objective To examine the association be...

for the EU-GEI High Risk Study Group IMPORTANCE The development of adverse clinical outcomes in patients with psychosis has been associated with behavioral and neuroanatomical deficits related to emotion processing. However, the association between alterations in brain regions subserving emotion processing and clinical outcomes remains unclear. OBJ...

Background: The intersect and blurring of boundaries between schizophrenia spectrum disorders and autism spectrum disorder (ASD) has long been an area of confusion, in both nosology and clinical practice. Individuals with a comorbid presentation of the two spectra can present with a distinct phenomenological profile to those with psychosis or ASD...

Background: The integration of various domains or levels of analysis (clinical, neurobiological, genetic, etc.) has been a challenge in schizophrenia research. A promising approach is to use the core phenomenological features of the disorder as an organising principle for other levels of analysis. Minimal self-disturbance (fragility in implicit fi...

Background In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. R...

Introduction Depression is highly prevalent and the leading contributor to the burden of disease in young people worldwide, making it an ongoing priority for early intervention. As the current evidence-based interventions of medication and psychological therapy are only modestly effective, there is an urgent need for additional treatment strategies...

Background: Certain migrant groups are more likely to develop a psychotic disorder compared to the native-born populations and a younger age at migration is associated with greater risk. However, it is not known at which stage migration has an effect on the development of psychotic disorders. We examined whether migrants were more likely to be ide...

Introduction: Individuals who experience a first episode of psychosis require early intervention and regular follow-up in order to improve their prognosis and avoid long-term negative outcomes. However, approximately 30% of individuals accessing support will end up disengaging from early intervention (EI) services. Although we know that individual...

Objective: Cortical thickness reductions in schizophrenia are irregularly distributed across multiple loci. The authors hypothesized that cortical connectivity networks would explain the distribution of cortical thickness reductions across the cortex, and, specifically, that cortico-cortical connectivity between loci with these reductions would be...

Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis met...

Objectives: Psychotic disorder incidence varies geographically and is associated with neighbourhood characteristics, including social deprivation, population density, unemployment, social capital or social fragmentation. Yet it is not known whether these findings are applicable to Australia's unique geography. This study aimed to determine whether...

Objective: The current international trend is to create large datasets with existing data and/or deposit newly collected data into repositories accessible to the scientific community. These practices lead to more efficient data sharing, better detection of small effects, modelling of confounders, establishment of sample generalizability and identi...

Background Certain migrant groups have an increased risk of psychosis compared to the native-born population, however the majority of these studies have originated from Europe and the Americas and it is not yet known whether migrants to Australia have an increased risk of developing a psychotic disorder. In addition, there is very limited knowledge...

Background Previous studies indicate that visuospatial associative memory ability deteriorates over the course of psychotic illness, with substantial impairments observed in individuals with chronic schizophrenia. However, the neural underpinnings of poor performance on this task in schizophrenia have not previously been investigated. While previou...

Background A number of ethical issues arise in relation to medical research and to the early diagnosis of potentially serious illnesses in medicine. While these apply in a similar way in psychiatry, additional issues have been raised by an ethicist and some critics. These related to stigma and a lack of consensus regarding the nature and course of...

Background A core component of treatment provided by early intervention for psychosis (EI) services is ensuring individuals remain successfully engaged with the service. This ensures they can receive the care they may need at this critical early stage of illness. Unfortunately, rates of disengagement are high in individuals with a first episode of...

Mounting evidence suggests that a history of childhood trauma (CT) is associated with an increased risk of developing a psychotic disorder. Whereas the majority of studies in this area have focused on onset (“transition”) of psychosis as their primary outcome, few studies have examined the impact of CT on distress associated with attenuated psychot...

Dysregulation of the ubiquitin proteasome system (UPS) has been linked to schizophrenia but it is not clear if this dysregulation is detectable in both brain and blood. We examined free mono-ubiquitin, ubiquitinated proteins, catalytic ubiquitination, and proteasome activities in frozen postmortem OFC tissue from 76 (38 schizophrenia, 38 control) m...

Background: Community treatment orders (CTOs) are a controversial form of involuntary treatment for individuals affected by mental health disorders and yet little is known about the use of CTOs in first presentations. Therefore, this study aimed to determine the rates, determinants and outcomes associated with the use of CTOs in young people with...

This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of...

Abstract Background Substance induced psychotic disorders (SIPD) have been historically considered as associated with better clinical and functional outcomes than other psychotic diagnoses. As a result, treatments for those with SIPD are often considerably less intensive, yet this is not based on evidence. The present study aimed to examine whether...

Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence...

Background: Mindfulness-based online interventions (MOI) are increasingly being delivered through the Internet to treat mental health conditions. Objectives: To determine the effectiveness of MOI in clinical mental health populations. Secondary aims are to explore the impact of study variables on the effectiveness of MOI. Methods: Systematic review...

Introduction: Specialised early intervention services have demonstrated improved outcomes in first episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many FEP patients remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has d...

Theory of mind (ToM), the ability to infer one's own and others’ mental states, is the social cognitive process shown to have the greatest impact on functional outcome in schizophrenia. It is not yet known if neural abnormalities underlying ToM present early, during the first episode of psychosis (FEP). Fourteen FEP participants and twenty-two heal...

Aim: It is now necessary to investigate whether recovery in psychosis is possible without the use of antipsychotic medication. This study will determine (1) whether a first-episode psychosis (FEP) group receiving intensive psychosocial interventions alone can achieve symptomatic remission and functional recovery; (2) whether prolonging the duratio...

Aim Childhood trauma (CT), abuse and neglect are commonly reported by individuals experiencing psychosis. However, there are concerns that acute psychotic symptoms, in particular delusions, may contribute to inaccurate reporting of CT. As a result, individuals experiencing psychosis may not be asked about their experiences of abuse when they are be...

Considerable research has been conducted seeking risk factors and constructing prediction models for transition to psychosis in individuals at ultra-high risk (UHR). Nearly all such research has only employed baseline predictors, i.e. data collected at the baseline time point, even though longitudinal data on relevant measures such as psychopatholo...

Background: Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. Aims: The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel interventi...

During the study period, 544 individuals presented with a FEP. Of these, 332 (61%) had a trial of discontinuation of whom 113 (34%) experienced a relapse within a median follow up of 372 days (IQR 183.5–536.0 days). Of these 113 individuals, ten were discharged, six were lost to follow up, one was deceased, and data was missing for ten. Therefore,...

Identifying young people at risk of developing serious mental illness and identifying predictors of onset of illness has been a focus of psychiatric prediction research, particularly in the field of psychosis. Work in this area has facilitated the adoption of the clinical staging model of early clinical phenotypes, ranging from at-risk mental state...

Aim To examine reasons for referral to a specialist ultra‐high risk (UHR) for psychosis clinic and whether these reasons are associated with risk for subsequent transition to psychosis. Methods Data for 127 patients referred to the Personal Assessment and Crisis Evaluation clinic were collected by medical record audit. Time to transition to psycho...

The screening properties of the PQ16 for selected cut-off points are presented in Table 1 and the full screening properties are presented in the Supplementary Tables 2–5. A score of ≥6 resulted in a sensitivity of 0.82, specificity of 0.47, PPV of 0.54 and a NGV of 0.78. In 100 assessments, this would result in 35 true positives, 27 true negatives,...

Introduction: Schizophrenia is increasingly conceived as a disorder of brain network connectivity and organization. However, reports of network abnormalities during the early illness stage of psychosis are mixed. This study adopted a data-driven whole-brain approach to investigate functional connectivity and network architecture in a first-episode...

The “at risk mental state” for psychosis approach has been a catalytic, highly productive research paradigm over the last 25 years. In this paper we review that paradigm and summarize its key lessons, which include the valence of this phenotype for future psychosis outcomes, but also for comorbid, persistent or incident non‐psychotic disorders; and...

For many decades, early intervention (EI) has been a central pillar of treatment of all the major physical noncommunicable diseases (NCDs). Early intervention can be defined as diagnosis at the earliest possible point, even presymptomatically, followed by proportional or stage-specific intervention adapted and sustained for as long as is necessary...

Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions...

Background The complement system - a key component of the innate immune system, has been proposed to contribute to the pathogenesis of schizophrenia. Recently, complement C4 was associated with increased risk of schizophrenia, and in a mouse model, developmentally-timed synaptic pruning. These observations have led to proposals that abnormal activa...

Background In traditional psychosis prediction research, the assumption is that a single “snapshot” of clinical disturbance at time point one (i.e. baseline) can reliably predict the future emergence of psychosis over time (i.e., follow-up). This is a linear, static approach to psychosis prediction. However, the field increasingly recognizes that m...

Background The development of the ultra-high risk (UHR) criteria for psychosis over 20 years ago created a new framework for research into subthreshold states in psychiatry. Since (i) early clinical phenotypes are overlapping and non-specific, and (ii) prevention research faces the challenge of achieving adequate statistical power when focusing on...

Background There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. Robust predictors of relapse after discontinuation are yet to be identified. The present study aimed to determine the proportion of young people who discontinue their antipsychotic medication after a firs...

Background Clinical Practice Guidelines are developed to improve clinical standards, encourage use of evidence-based treatments, and provide a foundation for audits, service evaluation, and research. This presentation by the expert writing group responsible for the updated RANZCP Clinical Practice Guidelines for Schizophrenia and Related Disorders...

Background Ever since the establishment of strategies for identifying people at ultra-high risk (UHR) of developing psychosis about twenty years ago, much research has been conducted in seeking risk factors and in developing prediction models for predicting which UHR individuals will actually make a transition to psychosis. The goal is to provide s...

Background Adherence to a medication is generally defined as the extent to which patients take medications as prescribed by their health care providers. Poor adherence to study medication is not uncommon posing a major challenge to treatment trails. However, poor adherence may not be randomly distributed but rather be associated with demographic or...

Background Specialized early intervention services have demonstrated improved outcomes in first episode psychosis (FEP); however, functional recovery lags behind symptomatic remission, and many FEP patients remain socially isolated with poor functional outcomes. Similarly, psychological and pharmacological treatments have been demonstrated to reduc...

Background While antipsychotic medication (AP) is a very effective treatment for positive psychotic symptoms in first-episode psychosis (FEP), it is also associated with risks. These include adverse neurological and metabolic effects and measurable changes in brain structure. APs may even be associated with poorer functional recovery. Due to advanc...

Background Vitamin B12, vitamin B6 and folic acid are homocysteine-reducing agents. People with schizophrenia have been found to have increased homocysteine levels. Elevated homocysteine has been associated with impaired cognition. Previous research in chronic schizophrenia has shown that supplementation with folate plus vitamin B12 can improve cog...

Background Converging evidence suggests that people at ultra-high risk (UHR) for psychosis have depleted levels of several fatty acids (FAs), and that changes in omega-3 (n-3) FA levels may indicate a higher risk for transition to psychosis. However, limited information is available on how FA deficiencies relate to psychopathology in individuals wi...

Background The incidence of psychotic disorders varies between geographical areas and is associated with neighbourhood characteristics. However, the research to date has been mainly confined to Northern European and North American populations. This study will determine whether the incidence of first episode psychosis (FEP) is associated with neighb...

Background Neurocognitive impairments are a core feature of psychosis and major depressive disorder (MDD) and are associated with poorer functioning outcomes in these illnesses. Individuals at ultra-high risk (UHR) for psychosis have been shown to experience mild but significant cognitive impairments relative to healthy controls. Evidence suggests...

Background Certain migrants groups are at an increased risk of psychosis compared to the native-born population, however these findings relate to certain countries, mainly in Europe and America where the research has been conducted. It is not yet known whether migrants to Australia are at an increased risk for developing a psychotic disorder. This...

Background The NEURAPRO multicentre randomised controlled trial (RCT) of long-chain polyunsaturated omega-3 fatty acids (ω-3 PUFAs) (‘fish oil’) in combination with high-quality psychosocial intervention (cognitive behavioural case management [CBCM]) vs. placebo in combination with CBCM in young people at ultrahigh risk (UHR) of psychosis showed th...

Background Current pathophysiological models of psychotic disorders suggest that stress contributes to the aetiology and trajectory of the disorder. Allostatic load (AL), a multisystem index of immune, neuroendocrine and metabolic dysregulation, is thought to represent the cumulative biological impact of stress. Two recent studies suggest that AL i...

Mood disturbances seen in first-episode mania (FEM) are linked to disturbed functional connectivity of the striatum. Lithium and quetiapine are effective treatments for mania but their neurobiological effects remain largely unknown. We conducted a single-blinded randomized controlled maintenance trial in 61 FEM patients and 30 healthy controls. Pat...

Adolescent and young adult men do poorly on indicators of mental health evidenced by elevated rates of suicide, conduct disorder, substance use, and interpersonal violence relative to their female peers. Data on global health burden clearly demonstrate that young men have a markedly distinct health risk profile from young women, underscoring differ...

This review will provide an overview of the prevalence of, and risk factors for, depression and suicide in medical practitioners. It will also discuss the barriers to accessing appropriate care and potential interventions for this population.