Abstract Objective Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes. Methods Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge’s g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration’s risk of bias tool. Results Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge’s g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge’s g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified. Conclusion Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.

Objective: To determine the perceived met and unmet need for clinical neuropsychological assessment (CNA) in headspace youth mental health services Australia wide. Method: Brief online survey of headspace service providers exploring the number and types of clients seen, confidence in identifying neurocognitive impairments, and need, availability and usefulness of CNA. A total of 532 salaried, private, and in-kind service providers working across 103 primary headspace and headspace Youth Early Psychosis Programs completed the survey from May to December 2017. Results: Survey respondents were 76% female with a mean age of 38 (range 22-74 years). The majority had psychology (42%) or social work (21%) backgrounds. CNA was believed to be beneficial for 35% of headspace clients on average, but 86% of service providers reported that CNA was unavailable. Only 12% of clients were estimated to have received CNA when it was needed. On average, 36% of headspace clients were estimated to present with neurocognitive impairment and 38% were described as diagnostically complex (e.g., comorbid medical, developmental, substance use, trauma presentations). A mean of 27% were described as having a suspected or diagnosed developmental condition (e.g., intellectual disability, learning disorder, autism spectrum disorder, attentiondeficit/hyperactivity disorder). Respondents rated their confidence in identifying cognitive impairment as moderate. Conclusions: There is marked unmet need for CNA to provide diagnostic clarification and inform treatment approaches in youth mental health care. Funding for CNA under the Medicare Benefits Schedule, headspace workforce development in neurocognitive screening and cognitive interventions, and tele-neuropsychological services should be explored.

Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.

Aim A growing number of quantitative studies have investigated the utility of neuropsychological assessment in mental health settings. However, to the best of our knowledge, no previous study has qualitatively explored youth mental health providers' perceptions of neuropsychological assessment services. A more in‐depth understanding of the perceived advantages and barriers associated with neuropsychological assessment in youth mental health settings is critical to better inform policy, practice and service uptake. Thus, the aim of this study was to qualitatively explore clinicians' views about neuropsychological assessments for youth with mental health concerns. Methods A single open‐ended qualitative question, included as part of an anonymous cross‐sectional online survey, was completed by clinicians (N = 206) treating or assessing adolescents and young adults within Australian primary care mental health centres (headspace). Responses were analysed using an inductive approach to thematic analysis. Results Five main themes were identified. Clinicians (a) identified barriers to accessing neuropsychological assessments (53%), (b) indicated a range of mixed outcomes following neuropsychological assessment (39%), (c) highlighted a need for neuropsychological assessments (22%), (d) reported a lack of awareness about this resource (10%) and (e) described practice issues associated with neuropsychological services (4%). Conclusion This study uncovered perceived factors contributing to reduced access to neuropsychological assessment in Australian youth mental health settings. Given potential adverse outcomes resulting from this clinical service gap, efforts should be made to address factors contributing to poorer access, thereby mitigating the impact of poor access on the management of mental illness in youth. Several strategies, including funding neuropsychological assessments, are discussed.

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BackgroundCognitive impairments in domains such as attention, memory, processing speed and executive functions are a central feature of psychotic disorders that have significant negative consequences for daily functioning, including activities of daily living, social and vocational roles. Compensatory approaches aim to minimise the impact of cognitive impairment on daily functioning through the use of aids or strategies to reduce cognitive load, in much the same way as glasses reduce the impact of vision impairment. The primary treatment target is real world community functioning and functional capacity, rather than cognition. There is now a need to synthesise the available evidence in this field so that treatment recommendations and future research directions can be better informed. A large body of research into compensatory approaches to cognition in psychosis exists, but this has never been comprehensively synthesised. The aim of this systematic review and meta-analysis is to examine the effects of compensatory approaches for cognitive deficits in psychotic disorders on i) functional outcomes and ii) other outcomes such as symptoms and quality of life.MethodsA systematic review and meta-analysis was conducted according to PRISMA guidelines. PsycINFO and MEDLINE electronic databases were searched from inception to October 2017 using multiple terms for ‘psychosis’, ‘cognition’ and ‘compensatory’. All papers retrieved from this search were double-screened and final inclusion/exclusion was determine by consensus. Data were double-extracted and risk of bias rated by two independent authors. Meta-analysis only included randomised-controlled trials. Standardised Mean Differences (SMD) were calculated to produce a single summary estimate using the random-effects model with 95% Confidence Intervals using Comprehensive Meta-Analysis (CMA) software. When means or standard deviations were not reported in the original articles, SMDs were calculated from data provided by the study authors.Results2192 articles were identified via electronic and manual searches. Forty-two papers describing 40 independent studies were included in the review: case studies (n=4), case series (n=2), uncontrolled single arm pilot studies (n=5), within-subjects designs (n=1), quasi-randomised trials (n=2), and randomised controlled trials (n=26). The types of compensatory interventions included environmental adaptation and supports, internal and external self-management strategies, and errorless learning. Compensatory interventions were associated with improvements in global functioning post intervention (N=1,449; SMD=0.506; 95%CI=0.347, 0.665; p<.001). Improvements in global symptoms (N=849; SMD=-0.297; 95%CI=-0.484, -0.111; p=.002) and positive symptoms (N=784; SMD=-0.227; 95%CI=-0.416, -0.038; p=.018) were also found. Compensatory interventions were not associated with improvements in negative symptoms (N=736; SMD=-0.162; 95%CI=-0.382, 0.058; p=.150). The heterogeneity of findings was low.DiscussionCompensatory approaches are effective f...