Rodrigo Affonsecca Bressan

Introduction: Early-onset schizophrenia (EOS), defined as onset <18 years , is associated with diagnostic complexity, high comorbidity, and poor outcomes if not recognized early. Although early intervention improves prognosis, evidence-based pharmacological recommendations for EOS remain limited.Materials and Methods: A modified Delphi questionnaire on the management of first-episode psychosis (FEP)/EOS was translated into Spanish and Portuguese and adapted by Latin American experts. The final questionnaire included 100 items grouped into six domains. A total of 139 psychiatrists from 13 Latin American countries completed Round I, and 90 participated in Round II. Consensus was predefined according to Delphi methodology.Results: Consensus was achieved for 96 (96%) of 100 items after Round I, and for 4 (44%) of the remaining 9 items after Round II. Experts agreed on diagnostic standards, multimodal treatment, and monitoring of adverse events. Main areas of disagreement concerned the optimal duration of treatment within specialized early intervention services and of antipsychotic treatment for FEP/EOS, particularly in pediatric patients and those with non-schizophrenia psychotic disorders, related to adverse antipsychotic effects concerns.Conclusions: This Delphi study provides region-specific expert recommendations for the assessment and management of adolescents and young adults with FEP/EOS, helping to inform clinical practice in Latin America.

Background: Transdiagnostic staging models have emerged as a promising framework for characterizing mental disorders in help-seeking youth, particularly by capturing subthreshold presentations and the pluripotentiality inherent to early stages. However, the field remains uncertain whether key assumptions from clinical staging generalize to community-based cohorts. Specifically, it is unknown whether the prevalence and external correlates of stage allocation mirror those observed in clinical samples, whether the model performs consistently across the full 12–25-year developmental window, and whether all individuals in the general population can be meaningfully classified within this framework.Methods: A transdiagnostic staging algorithm, based on published criteria and expert consensus, was retrospectively and independently applied to adolescents (mean age 14.7, SD = 1.69) and young adults (mean age 18.6, SD = 1.78) from the Brazilian High Risk Cohort (BHRC). Participants were categorized as Stage 2+ (threshold-level syndromes to unremitting illness), Stage 1b (subthreshold syndromes), Stage 1a (nonspecific symptoms), Stage 0 (family history), or “Not Assigned to Staging” (NAS). Generalized mixed-effects models were used to examine associations between stage allocation and dimensional psychopathology, psychosocial impact, functional correlates, and treatment-seeking behavior.Outcomes: A total of 1288 participants were included. Weighted prevalences during adolescence and young adulthood were, respectively: Stage 2+ (1.9% vs. 7.7%), Stage 1b (8.2% vs. 12.0%), and Stage 1a (26.6% vs. 25.4%), while 49.0% and 42.6% of participants did not meet criteria for staging (NAS). Symptom severity and psychosocial impact increased progressively across stages, whereas functional impairment was primarily associated with later stages (1b and 2+). Post-hoc analyses indicated clear differences between earlier (0 and 1a) and later stages (1b and 2+) across most correlates, but minimal differentiation between early stages and the NAS group. The probability of treatment-seeking increased in Stages 1b and 2+ relative to earlier stages; however, rates did not differ significantly between Stages 1b and 2+, and a substantial treatment gap persisted. Interpretation: This is the first compilation of the structure of transdiagnostic stages in a large, community-based cohort. The findings do not support a clear stratification across all stages, nor a meaningful distinction between early stages and individuals not assigned within the model. Later stages, including Stage 1b, were already associated with significant psychopathology and adverse outcomes in this community sample. Although treatment-seeking increased with stage severity, reliance on this framework in community and public mental health settings may result in substantial under-identification. Future studies should explore psychosocial correlates as additional criteria for stage allocation.

Introduction: Personal recovery has been the focus of mental health policy and practice in recent years. Aim/Question: This study aimed to assess personal recovery and its associated factors in a Brazilian sample of people with schizophrenia. Methods: This study included 104 people with schizophrenia attending an university outpatient psychiatric center. Personal Recovery was measured using the short Brazilian version of the Recovery Assessment Scale (RAS). Functioning and Clinical and measures were also assessed: ILSS-SR (Independent Life Skills Inventory), SAOF (Self-Assessment Questionnaire of Occupational Functioning), PANSS (Positive and Negative Syndrome Scale), CGI (Clinical Global Impression) and Calgary Depression Scale. Measures associated with the total RAS score were identified using multiple linear regression. The Benjamini-Hochberg (BH) procedure was applied to control for multiple comparisons. Results: After applying the BH correction, a higher total RAS score was significantly associated with a higher score of occupational functioning (SAOF). No other clinical or sociodemographic variables were significantly associated with the outcome. The overall model explained 20% of the variance in RAS scores. Conclusions: This study suggests a correlational link between self-perceived occupational functioning and personal recovery in a Brazilian context. However, this finding must be interpreted with caution given the study’s cross-sectional design and modest explanatory power. The results serve as a descriptive contribution to guide recovery-oriented practices in Brazilian mental health services.

Stigma associated with schizophrenia has been well-documented in both society and healthcare settings. However, the use of stigmatizing language in research papers remains largely unexplored. This study examined how researchers refer to schizophrenia in peer-reviewed articles, aiming to characterize the descriptive terms used to refer to individuals with schizophrenia and assess the adoption of person-first language. We conducted an electronic search on PubMed using the MeSH term “schizophrenia” and randomly selected 500 articles. Descriptive terminology was categorized as neutral (e.g., “schizophrenia patients”), person-first (e.g., “person with schizophrenia”), or identity-first (e.g., “schizophrenic patient”). Reference terms were assessed based on their alignment with a person-first perspective. Of the 500 studies, 475 (95%) included at least one term referring to people affected by schizophrenia. Among them, 238 (50.1%) used identity-first terms, 228 (48%) used person-first terms, and 91 (18.2%) employed both. Over time, the use of identity-first terms decreased. The decline in identity-first terms over time suggests a positive impact of the person-first movement. Despite these encouraging findings, our data also indicate that there is still room for improvement in reducing the use of identity-first terms. We propose recommendations for researchers to promote less stigmatizing language.

BACKGROUND Schools play a critical role in identifying adolescent mental health needs early, yet the effectiveness of school-based strategies often depends on how well health information is communicated to educators. OBJECTIVE This study explores how pedagogical leaders perceive a proposed model for adolescent mental health check-ups and identifies key factors for designing effective communication tools between healthcare professionals and schools. METHODS Two participatory workshops were conducted with 44 pedagogical coordinators and educational counselors from elite private schools in São Paulo, Brazil. Structured group discussions and collaborative design activities were used to elicit responses to proposed mental health report formats. Data were analyzed thematically using an inductive approach supported by manual coding and cross-checking by two independent reviewers. No software was used; inter-rater reliability was achieved through iterative discussion. RESULTS Participants expressed a strong preference for mental health reports that are clear, context-sensitive, and co-developed with educators. Key themes included the need for pedagogical rather than clinical language, the importance of mediation by coordinators, and the value of aggregate data for family engagement and institutional planning. Co-creation of communication tools was reported to enhance educators’ sense of relevance and confidence in discussing mental health. These preferences were consistently reported across participants regardless of years of experience, suggesting shared epistemic needs across the field. CONCLUSIONS The study highlights the value of user-informed communication models in mental health screening. Co-created tools aligned with pedagogical practices are more likely to be used and trusted. Effective communication design should be prioritized alongside the development of screening instruments themselves. Further research is needed to adapt this approach to low-resource public school contexts.

Background Screen time has been linked with inattention/hyperactivity symptoms, but studies often do not distinguish within-from between-person associations over long developmental periods. Methods Data were drawn from the Brazilian High-Risk Cohort for Mental Health Conditions, a school-based cohort with assessments at baseline (2010) and follow-ups in 2013–2014 and 2018–2019, 76% retention. The sample included 2,511 children (mean age = 10.2 years at baseline, 54.7% males). Daily screen time (hours spent exposed to computer, television or video games) was obtained by asking the parent or the primary caregiver (94.9% mothers). Inattention/hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire (SDQ). Analysis was carried out using random intercept cross-lagged panel models, adjusting for sample representativeness, attrition, and demographic covariates. Sensitivity analysis was carried out using the Attention Scale of the Child and Behavior Checklist (CBCL), harmonized with the Adult Behavior Checklist (ABCL). Results We found no within-person relationship between screen time and inattention/hyperactivity symptoms from childhood to early adulthood. Significant between-person associations were found in the SDQ but not in the adjusted SDQ models (respectively: β = 0.25; 95%CI = 0.02, 0.45; p = 0.029, and β = 0.22; 95%CI = -0.00, 0.45; p = 0.052). For instance, the history of primary caregiver’s psychiatric diagnoses was associated with higher average screen time (β = 0.16; 95% CI, 0.07, 0.25; p < 0.001) and inattention/hyperactivity symptoms (β = 0.27; 95% CI, 0.21, 0.34; p < 0.001). Findings were replicated in the CBCL-ABCL model. Conclusion We found no longitudinal association between increasing screen time exposure beyond an individual’s average and inattention/hyperactivity symptomatology. Furthermore, between-person associations were absent after covariate adjustment and results weren’t sensitive to the questionnaire.

Predicting outcomes in individuals at clinical high risk (CHR) of developing psychosis remains challenging using clinical metrics alone. The PSYSCAN project aimed to enhance predictive value by integrating data across clinical, environmental, neuroimaging, cognitive, and peripheral blood biomarkers. PSYSCAN employed a naturalistic, prospective design across 12 sites (Europe, Australia, Asia, Americas). Assessments were conducted at baseline, 3, 6, and 12 months, with follow-ups at 18 and 24 months to evaluate clinical and functional outcomes. The study included 238 CHR individuals and 134 healthy controls (HC). At baseline, CHR and HC groups differed significantly in age, education, IQ, and vocational and relationship status. Cannabis and tobacco use did not significantly differ between groups, however CHR individuals had higher proportion of moderate to high risk of tobacco abuse. A substantial portion of the CHR sample met DSM criteria for anxiety (53.4%) and/or mood disorders (52.9%), with some prescribed antidepressants (38.7%), antipsychotics (13.9%), or benzodiazepines (16.4%). Over the follow-up period, 25 CHR individuals (10.5%) transitioned to psychosis. However, the CHR group as a whole showed improvements in functioning and attenuated psychotic symptoms. Similar to other recent multi-centre studies, the CHR cohort exhibits high comorbidity rates and relatively low psychosis transition rates. These findings highlight the clinical heterogeneity within CHR populations and suggest that outcomes extend beyond psychosis onset, reinforcing the need for broader prognostic models that consider functional and transdiagnostic outcomes.

Background: The Short Mood and Feelings Questionnaire (SMFQ) is a validated tool for assessing depressive symptoms in youth, though no specific cut-point exists for the Brazilian population. Item response theory (IRT) and interval likelihood ratios (ILRs) offer refined methods to monitor symptoms but involve complex calculations that hinder clinical implementation. Methods: Cross-sectional data were drawn from an urban school-based sample (Brazilian High-Risk Cohort Study in 2018-2019, n=1,905, aged 14-23, 46.6% females). Diagnoses were based on Development and Well-Being Assessment (DAWBA) clinical ratings. SMFQ factor scores were estimated using IRT and transformed into T-scores. ROC curves evaluated diagnostic properties for internalizing- and externalizing-spectrum disorders. A calculator was developed to estimate post-test probabilities from T-scores using ILRs. Sensitivity analysis excluded MDD as a comorbid diagnosis. Results: ROC curve analyses suggested a sum score cut-off of >6 and a T-score of >55 for detecting MDD. The SMFQ showed good accuracy for internalizing conditions (AUC > 0.8) but low for attention and externalizing disorders (AUC < 0.7). ILRs for internalizing conditions ranged from 0.12 (95% CI: 0.07–0.19) to 29.98 (95% CI: 11.99–75), with post-test probabilities exceeding pre-test probabilities for scores above the cut-off. Sensitivity analysis confirmed findings when excluding MDD. Including ILRs significantly improved predictive models over dichotomous cut-offs. Conclusion: The application of ILRs based on IRT T-scores improved SMFQ’s predictive ability for internalizing-spectrum conditions, regardless of comorbidity. A calculator can integrate these methods into clinical practice, supporting real-time data-driven decisions.