Social anxiety is a significant comorbidity in first-episode psychosis. It is not simply an epiphenomenon of psychotic symptoms and clinical paranoia, and it has more than one causal pathway. For a subgroup of socially anxious people with psychosis, anticipated harm is present and the processes that underlie its relationship with social anxiety warrant further investigation.

UK Medical Research Council and the National Institute for Health Research.

ObjectiveTo explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs’ perceived needs.DesignQualitative focus group study using framework analysis.Setting5 inner city general practices in Nottingham.Participants28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate.Results3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs’ knowledge and clinical skills in this field.ConclusionsThe findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.

Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AimTo assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. Design of studyStratified cluster randomised controlled trial, clustered at practice level. SettingBirmingham, England. MethodPractices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to earlyintervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. ResultsA total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). ConclusionGP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis. Keywordseducation; primary health care; psychosis. INTRODUCTIONDuring the last two decades, the importance of intervening as early as possible when a young person develops a first episode of psychosis has become accepted internationally. This has been underpinned by studies demonstrating that young people with first-episode psychosis experience lengthy delays between the onset of psychotic symptoms and receipt of treatment (duration of untreated psychosis) of up to 2 years, 1-3 and that delays in accessing care are significantly associated with poorer treatment response. 4 There is a limited evidence base in this area of primary care, but GPs may be key to the identification and management of first-episode psychosis, as they are usually the first point of patient contact, 5 their involvement in the management of psychosis is associated with a reduction of the use of the Mental Health Act, 6 and they are the most common final referral agent to early-intervention services.7 However, early detection presents challenges as psychosis can take several months to emerge, 8 and may be difficult to distinguish from normal adolescent behaviour and substance misuse.9,10 There can be changes in

ObjectivesGeneral practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people’s opinions and experiences related to GPs’ practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people’s perspectives. This study aimed to explore young people’s views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs.Design, setting and participantsTwo qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16–24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis.ResultsFive major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist—disliking the terms ‘risk’ and ‘risk assessment’, and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs’ attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations.ConclusionsOur study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.

These findings suggest that shame cognitions arising from a stigmatizing illness play a significant role in social anxiety in psychosis. Psychological interventions could be enhanced by taking into consideration these idiosyncratic shame appraisals when addressing symptoms of social anxiety and associated distress in psychosis. Further investigation into the content of shame cognitions and their role in motivating concealment of the stigmatized identity of being 'ill' is needed.

Background LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. Objectives The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. Data sources MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). Study eligibility criteria Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12–25 years). Synthesis methods 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. Results Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. Conclusions Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. PROSPERO registration number CRD42019130037.

BackgroundThe strengths-based approach is considered a paradigm shift from the deficits- focused service delivery models. The aim of this review was to systematically review randomised controlled trials (RCTs) and quasi experimental studies examining the impact of the strengths-based approach on level of functioning and quality of life as primary outcomes and psychotic symptoms as secondary outcomes in people diagnosed with severe mental illness.MethodsThis review was conducted in the School of Health Sciences, University of Nottingham, United Kingdom. Participants in the primary studies were adults diagnosed with psychotic disorders. The methodological quality of the included studies was assessed independently by two reviewers using “Consort 2010” checklist for the randomized controlled trials or “TREND” for the quasi-experimental studies. The EPOC checklist was used for data extraction while management of data and meta-analysis were performed using Review Manager software (RevMan version 5.2).ResultsNo significant difference was found between the strengths-based approach and other service delivery models in level of functioning and quality of life. However, a significant effect on symptoms favouring other service delivery models was reported.ConclusionBased upon evidence of moderate quality, this review suggests there is no effect of the strengths-based model of service delivery in level of functioning and quality of life in adults diagnosed with severe mental illness. The number of trials is low; therefore further evidence is required to ascertain the impact of the strengths-based approach in community mental health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0243-6) contains supplementary material, which is available to authorized users.