Assessing Family Involvement in Early Psychosis Recovery: A Descriptive Analysis of Demographic Patterns in Boston Medical Center’s First-Episode Psychosis Program

Julie Ngo BA (1,2), Amelia Blanton BS (2), Berneece Tam BS (1), Brittany Gouse MD (2), Hannah Brown MD (2)
1. Boston University Chobanian & Avedisian School of Medicine
2. WRAP Research Program, Boston Medical Center, Boston, MA

Background: Family involvement plays a vital role in patient recovery from first-episode psychosis (FEP), contributing to improved medication adherence and decreased relapse1. However, the demands of supporting a loved one through psychosis can place significant strain on families. Therefore, services including family therapy and psychoeducation are essential for patient recovery and family resilience. This study examines patterns of family involvement through the Family Involvement questionnaire across race, ethnicity, age, gender, and primary psychiatric diagnosis.

Methods: We conducted a descriptive analysis of demographic data through chart reviews of FEP patients (N=230) enrolled in the Wellness and Recovery After Psychosis (WRAP) program whose Family Involvement questionnaire was completed at baseline. The questionnaire evaluates four aspects of family involvement on a categorical scale: frequency of contact, preference for family involvement, family engagement in services, and resistance to participation.

Results: Family contact frequency was predominantly high with most patients maintaining daily interactions, most notably White patients at 89%. Family preference for involvement varied across groups, however most patients preferred some degree of involvement, with 85% of White patients endorsing involvement with some or no restrictions. Family participation in treatment ranged across groups, however a large percentage did not take part in treatment, particularly Black patients at 73.5%. Most families did not refuse participation in treatment programs, with White families accepting treatment 88% of the time.

Conclusion: Our findings highlight strong family contact at baseline evaluation. Despite high frequency of contact, the low family engagement in services provided suggests a gap in outreach to families regarding the types of services provided. Abundant preference for family involvement illustrates potential for treatment plans emphasizing family involvement. Family involvement and treatment can not only further support patients’ recovery but also address challenges faced by families in supporting loved ones, cultivating a comprehensive approach to psychosis recovery.

Substance Use in Clinical High-Risk for Psychosis

Cheryl Y. S. Foo (1-4), Lauren A. Utter (2-4), Catherine Leonard (1), Julie M. McCarthy (4,5), Corinne Cather (1,2,4), Daphne Holt (1-4), Jacqueline A. Clauss (2,3,6,7)
1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
2. Psychosis Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital
3. Resilience and Prevention Program, Department of Psychiatry, Massachusetts General Hospital
4. Department of Psychiatry, Harvard Medical School
5. Division of Psychotic Disorders, McLean Hospital
6. Department of Psychiatry, University of Maryland Medical School
7. Maryland Psychiatric Research Center, University of Maryland

Background: Individuals at clinical high-risk for psychosis (CHR-P) have an elevated risk for developing serious mental illnesses, including psychotic disorders, and severe mood and anxiety disorders. Co-occurring substance use predicts worse symptom and functional outcomes, with cannabis use elevating risk of psychotic disorder conversion. This study examined prevalence of lifetime and recent substance use and treatment engagement around substance use in CHR-P programs in Massachusetts.
Method: Individuals referred to CHR-P programs completed a standardized evaluation battery, including self-report substance use measures. Among CHR-P individuals enrolled in care, providers also reported rates of substance use and whether patients who used substances had treatment goals on reducing substance use, utilized substance use pharmacotherapy, or incorporated adjunctive substance use interventions (e.g., tobacco smoking quitline, recovery coaching, Alcoholics Anonymous). Prevalence rates are reported for the MGH RE-SET program, with data from other programs forthcoming.
Results: Fifty-eight individuals completed evaluation for CHR-P between October 2021 to December 2023 (mean age: 17.8 years old; 57% female; 31% met criteria for CHR-P). Thirty-six (62%) had used substances in their lifetime, with cannabis use being the most frequent (n=13, 36%), followed by alcohol (n=9, 25%). Eleven (31%) used vaping devices. Of those who had tried alcohol or cannabis, more than 75% were current users (used at least once in the past three months). Twelve (33%) screened positive for problematic substance use. Three (38%) current RE-SET patients reported using substances, of whom two were interested in reducing substance use and none utilized substance pharmacotherapy or adjunctive interventions.
Conclusion: Over one-third of help-seeking individuals receiving evaluation for CHR-P have recent and problematic cannabis or alcohol use. As early substance use initiation dramatically increases risk of heavier use and dependence especially for psychiatrically vulnerable populations, interventions for preventing the development and progression of substance use disorders in CHR-P is warranted.

A Machine Learning Approach to Predicting Type 2 Diabetes in Young Adults

Khang Le,(1) Damla Duendar,(1) Amelia Blanton,(2) Temitope Ogundare, (2) Anne Thompson,(2,3) Brittany Gouse,(2,3) Hannah E. Brown, (2,3) Archana Venkataraman (1)
1. Department of Electrical and Computer Engineering, Boston University, USA
2. Wellness & Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA
3. Boston University Avedisian and Chobanian School of Medicine, Boston, MA

Background: Type 2 diabetes mellitus (T2DM) associated with second-generation antipsychotics is a leading driver of premature mortality in schizophrenia. Cardiometabolic risk across the first-episode psychosis (FEP) population is heterogeneous. We developed novel machine learning methods to predict incident T2DM as a first step towards incorporating this information into subsequent studies to reduce mortality in FEP.

Methods: Using data from the 2019–2020 Healthy Minds Study, a traditional machine learning approach was employed to predict T2DM. Samples with missing values were excluded. Feature exclusion for model optimization was performed by calculating the variance of each feature and removing those below the threshold. The dataset was then split into training, validation, and test sets with a 60-20-20 split. To focus on the minority positive class, the training data was under-sampled to achieve a 1:3 class ratio between negative and positive classes. Hyperparameters for various models (XGBoost, Ordinal Logistic Regression, SVM, and Random Forest) were tuned using Latin Hypercube Sampling. Models were trained on the optimized training set and evaluated on the test data to assess predictive performance.

Results: The XGBoost model demonstrated superior performance, achieving a ROC-AUC of 0.7082 (±0.0414), accuracy of 0.6835 (±0.0334), precision of 0.7553 (±0.0584), recall of 0.6425 (±0.0507), specificity of 0.8524 (±0.0479), and an AUC-PR of 0.7432 (±0.0344). XGBoost was further evaluated on a schizophrenia dataset, achieving an ROC-AUC of 0.8729, accuracy of 0.8973, precision of 0.6101, recall of 0.6250, specificity of 0.9544, and an AUC-PR of 0.6183.

Conclusions: Predicting T2DM using machine learning is feasible in a community sample of young adults and could be generalized to a schizophrenia-only sample. External validation in a larger clinical sample of FEP patients is needed to assess clinical utility of our model.

Young adult perspectives on treatment engagement and family communication during psychosis

Bediha Ipekci, PhD (1,2); Heather Thibeau, BA (2); Emily Barnard, BA (2); Jada Gibbs, MPH (2); Emily Kline, PhD (1,2)
1: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
2: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA

Background: Positive clinical outcomes of novel early psychosis interventions has sparked interest among researchers. However, treatment non-adherence among individuals who experience first-episode psychosis (FEP) is highly prevalent. Family involvement is considered the best practice for FEP treatment. A positive patient-MHP relationship plays an important role in early psychosis treatment in regards to enhancing treatment engagement, clinical outcomes, well-being, and global functioning (Berry et al., 2016). Reducing the duration of untreated psychosis and preventing treatment dropout may be achieved by promoting both positive relationships with MHPs and family involvement in psychosis treatment.

Methods: We conducted qualitative interviews with 12 individuals who have been diagnosed with a psychotic disorder within the past 5 years. Participants were asked about current treatment, family involvement, and opinions on communication with their MHPs and family. Study staff analyzed the data using reflexive thematic analysis.

Results: Findings led to the following major themes: (1) Facilitators and barriers to robust treatment engagement, (2) Family involvement with treatment and communication about psychosis, and (3) Determinants of family communication quality. These themes highlight the pivotal role of the therapeutic alliance, measured family involvement, and positive family communication in facilitating treatment engagement.

Conclusions: The findings highlight the crucial role of the therapeutic alliance, measured family involvement, and positive family communication in facilitating treatment engagement for young adults with psychotic disorders. Communication quality is shaped by the individual preferences of young adults in terms of respect, privacy, autonomy, and support.

AI-Driven Detection of Loose Associations in Clinical High-Risk for Psychosis: A Machine Learning Algorithm Using Language Model Metrics

Enrique Gutiérrez, PhD (1,2,*), Carlos Quesada, PhD (1) ,Emily DeFraites, MD, MPH (2,3,4), Danielle J. Harper, PhD (2,5,6) and Amar D. Mandavia, MA, PhD (2,7)
1 Polytechnic University of Madrid
2 MIT linQ
3 Greater Los Angeles VA Healthcare System
4 School of Medicine, University of California Los Angeles
5 Massachusetts General Hospital
6 Harvard Medical School
7 Boston VA Healthcare System

Background: This work introduces a novel approach for the detection of Loose Associations (LA) in psychosis-risk individuals, leveraging the predictive power of surprisal metrics derived from the probability distributions returned by pretrained Large Language Models (LLMs). An instance of LA is characterized by an abrupt change of the topic of conversation to a distant topic without preparing the listener. LA are known to occur consistently in populations at risk for psychosis.

Methods: By utilizing surprisal - a measure of word predictability in context calculated from LLMs such as Llama, GPT or Gemma - we develop an algorithm capable of identifying instances of LA with promising accuracy. Our method involves generating surprisal fingerprints for utterances, which are then used as features in an extreme gradient boosting classifier (XGBoost).

Results: Notably, our approach achieves an accuracy of around 80% in distinguishing between utterances exhibiting LA and not, underscoring its potential as a rapid and scalable diagnostic aid. Moreover, to address the lack of available LA data, we employ LLMs to generate a synthetic database of utterances that simulate speech patterns characteristic of both individuals without LA and those affected by LA. This innovative use of synthetic data not only enriches the training dataset but also highlights the versatility of LLMs in psychiatric research.

Conclusions: Our findings indicate that surprisal metrics, when combined with machine learning techniques, offer a promising avenue for enhancing the specificity of psychosis risk assessment tools, ultimately facilitating timely and personalized intervention strategies.

Peer approaches to implementation science in Massachusetts early psychosis research: Walking a thousand Miles in our shoes

Tyler Gabriel Josma, Lionel Frechette, Antachia Brown, Peter T. Durning, Tay Onyenaka, Sarah “Punky” Dreyfus, Loc Ironwood, & Vera A. Muñiz-Saurré

Background: Peer services are effective in improving the health outcomes of people who experience psychosis (Chinman et al., 2014; Davidson et al., 2012; Kamon & Turner, 2013; Walker & Bryant, 2013; Trachtenberg et al., 2013). This is in spite of research funding structures, policy makers, and researchers being historically resistant to meaningfully incorporating consumer perspectives in the design and implementation of healthcare services (Callejas & Jones, 2022). Growing criticism of elitism in academic knowledge production systems that exclude direct stakeholders presents opportunities to center peer professionals in identifying areas of growth through a framework of meaningful Participatory Design (van der Velden & Mörtberg, 2015) grounded in commitment to community relationships and centering local perspectives. The Massachusetts Psychosis Prevention Partnership (M3P) is a network of programs supported by the Massachusetts Department of Mental Health (DMH) and the Substance Abuse Mental Health Services Administration (SAMHSA). M3P organizes planning committees that inform the Massachusetts Strategic Plan for Early Psychosis (Mass-STEP) and includes people with lived experience serving on one (or more) of five subcommittees including the Lived Experience Expertise and Equity/Access Subcommittees that designed this investigation.
Methods: This housing environmental scan is part of a larger coordinated environmental scan series through the Massachusetts Psychosis Prevention Partnership (M3P) coordinated by M3P’s Lived Experience Expertise and Equity/Access Subcommittees and represents a conscious effort by Massachusetts peer specialist researchers to present the investigational value of peer work in the realm of quality improvement and implementation sciences within clinical research structures. This investigation was built on a framework of Meaningful Participatory Design in collaboration with and led by individuals who experience psychosis in all levels of planning, investigation, and data visualization. The scan methodology is composed of primarily quantitative data collected from literature review of publicly available sources, clinic demographic and fidelity metrics, research data sets, and quantitative survey data distributed to key stakeholders in clinical and housing spaces. Qualitative data from key informant interviews, focus groups, and open response survey data was used to enrich and contextualize findings. Findings were reported using a novel NOISIE Analysis (Needs, Opportunities, Improvements, Strengths, Intersections, Essence) method modified from a traditional NOISE analysis (Needs, Opportunities, Improvements, Strengths, Exceptions) which is used to examine the internal and external complexities of a business or project with a solution-focused lens.

Building Tomorrow's Leaders: Advancing Diversity in Early Psychosis Care through 2B-EPIC

Melanie Maldonado , Joey Rodriguez , Antachia Brown , Bella King-Harvey , Vera Muñiz-Saurré, Olivia Helfrich-Tapia, Kwame Dance, Michelle Friedman-Yakoobian
Interns represented the following schools:
a. Response to Risk Research Program, Beth Israel Deaconess Medical Center, Boston MA,
b. Northeastern University,
c. UMASS Dartmouth,
d.Williams College,
e. William James College

The "Building Bridges toward Equity in Psychosis Intervention and Careers Program" (2B-EPIC) seeks to address the significant underrepresentation of Black, Indigenous, and Latinx professionals in the early psychosis workforce. This initiative is important given the disparities in psychosis diagnosis and treatment outcomes among Black individuals, who are often diagnosed later and misdiagnosed more frequently than their non-Hispanic white counterparts. Early detection of psychosis significantly improves prognosis, but this requires culturally competent care, which is more effective when delivered by providers who share the racial and ethnic backgrounds of their patients. Despite the growing demand for mental health services, particularly in Massachusetts, there is a shortage of providers trained in early psychosis care, with an even more pronounced lack of Black and Latinx professionals in this specialty. The 2B-EPIC program, launched in 2023 with support from the Massachusetts Department of Mental Health, offers paid internships to Black and Latinx high school and college students. The program introduces these students to early psychosis treatment and research, aiming to create a pathway to graduate education and careers in this critical area. Through mentorship from clinicians, researchers, and individuals with lived experience of psychosis, interns gain practical experience and knowledge, which they share with their peers through community presentations and social media campaigns. This poster presentation will provide an overview of the program’s structure, including key components such as workshops, field trips, passion projects, and career networking. It will highlight the program’s impact, including the number of interns, their demographics, satisfaction levels, and future career plans. Challenges faced during the program and the innovative solutions implemented to overcome them will be discussed. Finally, the poster will outline future directions for sustaining and expanding the program, offering recommendations for similar initiatives aimed at diversifying specialized fields

Intersectionality in Early Psychosis: Impact on Mental Health Outcomes, Pathways to Care, and Treatment Engagement

TaKaya McFarland (1,2), James Green (1,2, 5), Kelsey Johnson (1,2), Matcheri Keshavan (1,2) , Margaret Guyer (4), Dost Ongur (5), Michelle Friedman-Yakoobian (1,2,3)
1 Beth Israel Deaconess Medical Center, Boston, MA, USA
2 Harvard Medical School, Boston, MA, USA
3 Brookline Center for Community Mental Health, Brookline, MA, USA
4 Massachusetts Department of Mental Health, 5 McLean Hospital, Belmont, MA, USA
5 University of North Carolina Charlotte, Charlotte NC, USA

Background: Previous literature has suggested that clients with longer duration of untreated psychosis (DUP) have poorer long term outcomes in treatment. Marginalized populations often experience longer DUP, which can impact their treatment outcomes. Research investigating Adverse Childhood Experiences (ACEs) suggests that stressful childhood events are predictive of health outcomes. To measure the risk of marginalization and adversity due to intersectionality, this study developed an additive intersectionality score.
Methods: De-identified quality improvement longitudinal data at baseline, follow-up, and discharge was analyzed from the Massachusetts Psychosis Network for Early Treatment (MAPNET), Self-report and clinical interviews were used to gather participants' demographic data, referral information, clinical and functional outcomes, and client satisfaction. Spearman rank correlations and Dunn Test’s were used to assess baseline correlations and differences while linear mixed effects models were used to examine differences in longitudinal outcomes. False-Discovery rate adjustments were applied to p-values.
Results: Our analysis included 856 clients from various early psychosis clinics Clients were most likely to be white (52.1%), cis-male (58%), straight (80.5%), non-hispanic/latinx (84.5%), English speaking (97.1%), held a high-school diploma or higher (97.2%), had private insurance (13.6%), and were housed (94.9%). Higher intersectionality scores were associated with higher rates of self-referral, lower rates of family referrals, more severe depression, suicidality and self-injurious behavior, and greater occupational functioning at baseline (p < 0.05). Client’s with higher intersectionality scores were more likely to decline in depression and suicidality symptoms over time (p < 0.05) and spend less time in care (p < 0.05).
Conclusion: These results suggest that clients with higher intersectionality scores present to care with more severe depressive symptomatology, potentially due to their pathways to care. Although these clients show improvement in symptom severity overtime, clients with higher intersectionality scores are more likely to drop-out of care.

McLean’s Peer Research Consortium: Accomplishments, Functions, & Analysis

Katerina Konstas (1), Emily E. Carol(1,2), Rahel Bosson (2,3), Nicole Cerundolo (1), Adrienne Gerken (4), Zachary B. Millman (1,2), Nathaniel Van Kirk (2,5), Dost Ongur (1,2), Stephen J. Fedele (1)
1. Division of Psychotic Disorders, McLean Hospital, Belmont, MA
2. Department of Psychiatry, Harvard Medical School, Boston, MA
3. Program of Assertive Community Treatment (PACT), McLean Hospital, Belmont, MA
4. Department of Psychiatry & Human Behavior, Thomas Jefferson University,Philadelphia, PA
5. OCD Institute, McLean Hospital, Belmont, MA

Background: Certified Peer Specialists are becoming better integrated and established as vital team members in interdisciplinary teams across a variety of healthcare settings. However, research on the many roles of Certified Peer Specialists and their impact on recovery is limited. The Peer Research Consortium at McLean Hospital was established with the aim of creating a community of staff across disciplines to research and better understand peer work primarily within psychiatric settings.

Methods: Along with the accomplishments of the consortium, there have been many lessons learned since its establishment in 2019. This poster aims to outline the strengths and solutions to possible barriers when building a research consortium. These recommendations have been compiled in hopes that other clinical and academic centers may establish their own Peer Research Consortiums, expanding the impact of peer research throughout healthcare systems.

Results: Several projects around the roles of peer specialists in psychosis care have been explored, including peers as teachers to families, peers as teachers to staff, and inpatient peer work. Peers often led these projects or were highly involved throughout the entire process. This is a distinct strength of the consortium, as much of the literature on peer work rarely includes peers themselves. The consortium began acting as an educational hub for hospital staff and outside collaborators interested in peer research, growing its impact outside of the hospital. The completion of these projects also provided insight into the procedures and areas of growth for the consortium.

Conclusions: Through support and collaboration, McLean’s Peer Research Consortium has made valuable contributions to understanding the impact of peer work for clients, staff, and community members in a large psychiatric hospital system. By establishing consortiums in other clinics and hospitals, Certified Peer Specialists voices in research can be better implemented while circulating findings to improve overall client care and outcomes.

Examining the Longitudinal Trajectory of Cognition in Individuals Receiving Coordinated Specialty Care Services for Early Psychosis

Ananya Saluja (1), Kelsey A. Johnson (1), Daphne Ying(1), Paulo Lizano (1,2) Raquelle I. Mesholam-Gately (1,2), Matcheri S. Keshavan (1,2)

1. Beth Israel Deaconess Medical Center, Boston, MA
2. Harvard Medical School Department of Psychiatry, Boston, MA

Background Cognitive impairment is a core feature of psychosis-spectrum disorders; however, the course of cognitive functioning, particularly during the first episode of psychosis (FEP), is not well understood. Current research shows that the Coordinated Specialty Care (CSC) model is the best approach to treatment for youth with FEP. The aim of this study was to examine the trajectory of cognition in individuals receiving CSC in the early acute phase of their psychosis, when the maximum clinical improvement is likely to occur.

Method Longitudinal data on cognition were collected from 9/21 to 1/24 in a real-world clinical sample at the ASPIRE Clinic in Boston, Massachusetts. Clients’ scores on the Brief Assessment of Cognition in Schizophrenia (BACS) were assessed at three timepoints: baseline (n = 32), at 6-month follow-up, and at 12-month follow-up (combined n = 17). t-tests were used to compare BACS z-scores across timepoints and test their associations with clinical domains such as hallucinations, functioning, and quality of life.

Results BACS total scores were higher at follow-up; however, differences in individual tasks were not significant. There was a small negative correlation between clinician-rated disorganization & total BACS scores (approaching significance). Other clinical domains were not significantly correlated with BACS scores. Both social and role functioning were significantly correlated with BACS total scores.

Conclusions CSC services are the gold standard treatment for FEP; improved outcomes by 12 months in treatment provide evidence of an effective treatment model. Thus, if cognitive improvement is linked to symptomatic change, we are likely to see higher BACS scores in patients at the ASPIRE Clinic. The link between cognitive performance and positive and negative symptoms should further be explored in future studies by examining correlations between PANSS and BACS scores. Additionally, as CSC services continue to grow nationwide, examining the longitudinal trajectory of cognition in a large

Tailored Literacy Training for Psychosis Patients through Assessment and Adaptable Curricula

Jane Mikkelson, Bridget Dwyer, Harvard Medical School, BIDMC, Abigail Mejia Harvard Medical School, BIDMC, Victoria Lisowski Harvard Medical School, BIDMC

Background: Technology use has evolved from a luxury to a necessity and is now recognized as a social determinant of health (1, 2). While digital tools have the potential to increase access to care, this shift towards technology has excluded individuals in underserved populations who lack the digital literacy skills to engage with technology; This phenomenon is well recognized as The Digital Divide (2, 3, 4, 5, 6). People with serious mental illness (SMI), such as schizophrenia, are particularly affected by this divide and at high risk of digital exclusion (7).

Methods: To help close this divide, it is essential to prioritize digital literacy training for individuals with SMI. Our team has developed a research-backed digital literacy training program called DOORS (8, 9). To streamline training, we have also developed a digital literacy scale that quickly and effectively assesses the baseline knowledge of an individual. Survey results inform digital literacy instructors (digital navigators) on the individualized needs of their client and directly refers them to a corresponding DOORS training module.

Results: At large, the DOORS curriculum teaches essential laptop and smartphone skills through distinct learning modules, powerpoints, and handouts. However, all DOORS materials are designed to be flexibly adapted to meet the unique needs of a specific person, population, or organization. Our digital literacy scale facilitates the adaptation/personalization process and informs the education process.

Discussion: Our DOORS program and actionable assessment provide a feasible method to increase digital literacy among schizophrenia patients at scale. We have implemented the program with success at the largest clubhouse for adults with psychiatric disabilities in Boston (The Center Club) and the inpatient psychiatric unit at BIDMC.

An Exploratory Inductive Thematic Analysis of Focus Groups with Spanish-Speaking Clinicians in Clinical High Risk and Early Psychosis Services in Massachusetts

Melanie Maldonado, Olivia Helfrich-Tapia(a,b), Joey Rodriguez(a,b) Michelle Friedman-Yakoobian(a,b), Bernalyn Ruiz-Yu(a,b,c)
a. Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston MA
b. Department of Psychiatry, Harvard Medical School, Boston MA
c. Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston MA

Background: State-wide initiatives are enhancing the growing recognized need for early intervention for youth at clinical high risk for psychosis (CHR-p) in Massachusetts. If state-wide program development for early psychosis treatment is to be as equitable as it is effective, then it must strategically address the specific needs of non-English-speaking communities. The Spanish Advisory Board for Linguistic Development (SALUD) was established to identify strategies to support the development of specialized early psychosis treatment teams in alignment with state-wide strategic priorities.

Methods: Ten CHRp service providers participated in five biweekly virtual focus groups that were held to conduct a needs assessment for quality of care, satisfaction and engagement, and service delivery for Spanish-speaking youth and families. Participants were all Spanish-speaking staff, 60% (n=6), in clinical and 40% (n=4) in non-clinical roles. From this group, 20% (n=2) identified as Puerto Rican, 10% (n=1) as Cuban, 10% (n=1) Chilean, 10% (n=1) Ecuadorian, 10% (n=1) Haitian, 10% (n=1) Peruvian, 10% (n=1) Mexican, and 30% (n=3) did not specify. Next, transcripts of each focus group were analyzed via an exploratory inductive thematic analysis.

Results: Six main themes were identified. Participants identified (1) time restraints and staff/structural challenges, (2) billing limitations and system limitations (3) need for language diversity, (4) cultural awareness, (e) psychosis education, and (f) outreach.

Conclusion: Services offered for CHRp must be improved to appropriately consider the cultural and language backgrounds of Spanish-speaking clients. As reported by Spanish-speaking clinicians, services should be expanded to include the diverse Spanish languages of communities as well as assessment tools and psychoeducation.

Updated Examination of the Relationship Between Gender, Family Involvement in Treatment, and Functioning in First Episode Psychosis

Jacqueline F. Dow (1), Jamie Fischer (1), Nicole Cerundolo (1), Emily E. Carol (1,2), Dost Öngür, MD( 1,2), Julie M. McCarthy (1,2)
1. Schizophrenia & Bipolar Disorder Program, McLean Hospital, Belmont, MA,
2. Department of Psychiatry, Harvard Medical School, Boston, MA

Background: Involving family can improve client outcomes in coordinated specialty care (CSC) for early psychosis. However, family involvement and functional outcomes can vary by gender, but the relationships between family involvement, client functioning, and gender remains unclear. This secondary data analysis aims to provide an updated examination of family members involvement in treatment among people with early psychosis, as well as the relationship of gender, and social and occupational functioning with such involvement.

Methods: Outpatients in Massachusetts CSC clinics self-reported demographics and family involvement in treatment. Clinicians reported occupational (MIRECC-GAF Occupational) and social functioning scores (GF Social Scale). Individuals without variables of interest were excluded. Non-binary individuals were excluded due to sample size. Chi-square and descriptive analyses evaluated gender differences in client preference for family involvement in care, family involvement and refusal, and occupational and social functioning. T-tests examined gender differences in (1) occupational function, and (2) social functioning. Regression analyses will evaluate the relationship between family involvement, functioning, and gender.

Results: Baseline data (N=122) were included (69.7% men, 30.3% women). Many clients reported a preference for family involvement with some or no restrictions (82.0%). Most clients reported that family had not been involved in their treatment (54.1%), while 8.2% of clients reported family member refusal to participate in their treatment. There were no gender differences in client preference, family involvement, or refusal. Additionally, those with family involvement in care had on average, lower occupational and social functioning scores (p<0.0001 and p<0.05 respectively). Women, on average, had higher social and occupational functioning scores (p<0.0001, p<0.0001). Further analyses will evaluate whether gender and family involvement in treatment predict functioning.

Conclusion: Family involvement in early psychosis treatment may be associated with poor social and occupational functioning but not client gender. Further research is needed to examine who may benefit most from family involvement in care.

Provider Attitudes and Perceptions of Family Interventions for Early Psychosis: Informing Competency-Based Training and Implementation

Cheryl Y. S. Foo (1,2,3), Catherine Leonard (1), Kelsey A. Johnson (3,4), Shirley M. Glynn (5), Lisa Dixon (3,6,7), Dost Ongur (2,3,8), Kim T. Mueser (1,6*), Corinne Cather (1,2*)
1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
2. of Psychiatry, Harvard Medical School
3. Laboratory for Early Psychosis (LEAP) Center
4. Massachusetts Psychosis Network for Early Treatment (MAPNET), Beth Israel Deaconess Medical Center
5. Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
6. Division of Behavioral Health Services and Policy Research, Department of Psychiatry, Columbia University Medical Center
7. Center for Practice Innovations, New York State Psychiatric Institute
8. Schizophrenia and Bipolar Disorder Research Program, McLean Hospital
9. Center for Psychiatric Rehabilitation, Boston University
* Co-senior authors

Background: Family interventions for psychosis (FIP; e.g., psychoeducation, single family, or multifamily group) is a defining element of first-episode psychosis (FEP) coordinated specialty care (CSC) programs, but have low adoption rates and are implemented with variable fidelity. Providers’ lack of buy-in and confidence in providing evidence-based treatments compromise implementation in real world settings. We examined CSC provider attitudes towards and confidence in providing FIP, and their associations with FIP fidelity and training.

Method: Providers from FEP CSC programs in Massachusetts completed an attitude survey comprising three subscales: 1) perceived effectiveness of FIP, 2) perceived impact of family involvement on client’s treatment; 3) stigma related to working with families. Providers also rated their comfort level and skill in working with families. Total and subscale scores on attitudes and confidence scales were correlated with team-level fidelity ratings on type and level of family involvement (i.e., provision and training in evidence-based FIP; most families involved in initial assessment; frequent family contact) (adapted FEP Fidelity Scale 2.0; Addington et al. 2020). We identified provider characteristics (years of experience, role, training received, type of interventions used in practice) associated with provider attitudes towards FIP, and confidence in competently delivering FIP. Providers were asked to identify priority areas for training and challenges to working with families in CSC.

Results: 52 providers from nine programs participated in this study (M= 39 years; 73% female; 56% white; 12% Hispanic/Latine; mean clinical experience: 4 years; 40% providing FIP). More positive FIP attitude was correlated with higher FIP fidelity (r=.29, p=.04). Provider perception of FIP effectiveness (r=.23, p=.10) and perceived positive impact of family involvement on client’s treatment (r=.37, p=.01) was significantly correlated with FIP fidelity. Stigma related to working with families was not associated with FIP fidelity. Compared to other clinical team members, peer specialists had significantly less positive attitudes towards FIP (mean difference range: -0.55 to -0.77; ANOVA effect size: .39; p <.001) and perceived more negative impacts of family involvement on client care (mean difference: -0.96 to -1.1; effect size: .32; p=.007). Among clinicians who do not provide FIP (n=31), those with prior training in evidence-based family interventions (n=6) had greater confidence in collaborating with families than those without FIP training (mean difference (SE): 0.49 (.25); d= .89; p=.06). Over a quarter of providers identified families’ unrealistic expectations about treatment and recovery and balancing client autonomy and confidentiality with family involvement as the most challenging aspects of working with families in CSC. Providers requested additional training on evidence-based FIP and supervision on navigating these challenges.

Conclusions: Providers with more positive attitudes about FIP belonged to programs with higher FIP fidelity. Further work is needed to understand the finding that peer specialists had more negative attitudes towards family involvement than clinical team members. Ongoing training and supervision for the whole team could improve provider attitudes towards FIP and competency in navigating unique challenges of working with families in team-based FEP care.

Beyond Medications: Exploring Referrals to Non-Pharmacologic Coordinated Specialty Care Services at Intake

Jennifer Lancet,(1,2), Brittany Gouse,(1,2) Samantha LaMartine,(1,2) Sarosh Khan,(1,2) Anne Thompson,(1,2) Amelia Blanton,(1,2) Temitope Ogundare,(1,2) Hannah E. Brown(1,2)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian & Avedisian School of Medicine

Background: Coordinated Specialty Care (CSC) offers a comprehensive, recovery-focused, multidisciplinary team-based model designed to treat individuals with first-episode psychosis (FEP). Non-pharmacologic interventions, such as individual therapy and peer support, promote recovery and improve long-term outcomes and quality of life. Here, we describe patterns of patient interest in non-pharmacologic services at intake to an FEP program that uses a shared decision-making approach to offering CSC services to patients rather than requiring uniform participation in the NAVIGATE FEP model.

Methods: We retrospectively examined the electronic health records of all individuals enrolled in Boston Medical Center’s FEP program from 01/01/2020 to 08/21/2022. The primary outcome was a referral to non-pharmacologic CSC outcomes (i.e., peer support, individual therapy, family support, FEP group therapy). All FEP patients are offered the same CSC services at intake. We used independent t-test and chi-squared analysis to explore sociodemographic differences between patients who were and were not interested in non-pharmacologic CSC services. We assessed these associations further with multivariable logistic regression controlling for disease severity (i.e., defined as prior hospitalizations) and telehealth visit modality.

Results: Of the 71 enrolled patients, 62% chose to be referred to at least one non-pharmacologic CSC service. Most opted for individual therapy (52.1%), followed by the FEP group (27.1%), family support (24.3%), and peer support (8.6%). In multivariable logistic regression models, no significant association was found between age, race and ethnicity, gender, insurance status, or prior hospitalization and non-engagement in non-pharmacologic CSC services.

Conclusions: There is significant variability in patients’ preferences for services within a CSC model when they are allowed to choose. These preferences are not influenced by sociodemographic or clinical factors. Future research will explore longitudinal changes in service utilization, examining how patients’ preferences and engagement evolve over time, including the selecti

The experiences of Black emerging adults with psychotic disorders who have community violence exposure: A phenomenological approach

Danielle T. Walker, PhD, PMHNP-BC (1, 2), Jane Flanagan, PhD, FAAN (2), Robert O. Motley, PHD (3), Gary Brucato, PhD (4), Ann W. Burgess, DNSc, FAAN (2)
1: Department of Psychiatry, Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA
2. Boston College, Connell School of Nursing, Chestnut Hill, MA
3. Boston College, School of Social Work, Chestnut Hill, MA
4. Columbia University, Department of Psychiatry, New York, NY

Purpose: This descriptive phenomenological study aims to understand the lived experiences of Black emerging adults with psychotic disorders who have been exposed to community violence (CVE).

Background: CVE is recognized as a public health crisis, with Black emerging adults at higher risk for both CVE and psychotic disorders. The combination of CVE and psychotic disorders poses a significant burden on individuals' lives. Despite this, limited qualitative research focuses on Black emerging adults facing these challenges. Method: The study is rooted in Husserl's descriptive phenomenology philosophy, with data collection and analysis guided by Giorgi's descriptive psychological phenomenological approach. Participants were recruited through purposive sampling and had to meet specific criteria: having a psychotic disorder, experiencing CVE, identifying as Black or African-American, and being aged 18 to 29. Individual interviews were conducted to explore their experiences of CVE. Data was coded and analyzed using bracketing to mitigate researcher bias.

Results: The study sample consisted of eleven participants aged 21 to 28, with an average age of 24.6. Six participants identified as male, four as female, and one as transgender and non-binary/non-conforming. All identified as non-Hispanic Black/African-American and had a primary psychotic disorder. Four key themes emerged: (1) CVE results in a range of emotional responses, (2) CVE results in a range of behavioral responses, (3) CVE causes disruptions in life and relationships, and (4) participants aspire for a better life without a clear pathway. These themes highlight the lived experiences of CVE among these individuals in Boston, MA, and the significant impact on their lives.

Conclusion: Descriptive phenomenology provided a comprehensive understanding of the impact of CVE on Black emerging adults with psychotic disorders. The study illuminates the complex effects of CVE on their mental health and lives. Future research should focus on quantitative studies to further explore CVE's impact on health, social, and psychological outcomes.

Protocol for Improving Smartphone Data Quality in Accelerated Medicines Partnership (AMP) Schizophrenia (SCZ)

Erlend Lane, Harvard Medical School/ BIDMC Matt Flathers, Harvard Medical School/ BIDMC John Torous, Harvard Medical School/ BIDMC Scott Woods, Yale

Background: Digital Phenotyping data, particularly data gathered from smartphones, has become increasingly utilized in psychiatric research for its capacity to collect high volume, ecological data that is low participant burden and sensitive to change. Digital phenotyping data collection brings a variety of challenges distinct from cross sectional research, including specific smartphone configurations subject to change and ongoing engagement from participants, something difficult to sustain over the course of 12 months. Accelerated Medicines Partnership (AMP) Schizophrenia (SCZ) represents one of the largest studies currently collecting smartphone data, gathered across more than 40 sites, in eight different languages for up to one year.

Methods: Our team aims to outline and implement a protocol for support staff to improve digital phenotyping data quality across sites, based on evidence of data quality improvement efforts initiated within the project. Measurements will be comparisons of pre and post intervention data quality, measured in the volume of passive data points across participants across sites. This will help assess and establish best practices for the collection of smartphone data in psychiatric samples, particularly for large, multi-month studies.

Results: The results of our QI efforts will be utilizable and distributed as a model of data quality management for digital data in multisite, longitudinal studies of participants with psychosis. We have achieved prior results in this domain, in which our team produced an average data quality of .82 for 33 participants across 6 weeks in a digitally supported clinical program, and we seek to replicate this output in a much larger, longitudinal research environment.

Conclusion: This work integrates prior experience in improving data quality in single-site short term collection of digital phenotyping data to larger scale efforts. Understanding best practices for data quality maintenance in digital phenotyping study design is critical for this burgeoning field.

The Intersection of Community Violence and First Episode Psychosis: An Exploratory Analysis in the Metro Boston Area

Anne Thompson, (1,2) Brittany Gouse, (1,2) Danielle Walker, (1,2) Cindy Xu, Samantha LaMartine, (1,2) Ellie Reagan, (1,2) Amelia Blanton, (1,2)Hannah E. Brown (1,2)
1: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
2: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA

Background: Witnessed and experienced trauma increase the risk of the development of a schizophrenia spectrum disorder (SSD) and increase the severity of psychotic symptoms. Post traumatic stress disorder (PTSD) is commonly underrecognized in SSDs and when untreated carries adverse prognostic outcomes. Here, we explore potential exposure to community violence among individuals with first episode psychosis (FEP) on a neighborhood level at an urban safety net hospital.

Methods: We performed a cross sectional analysis of clinic census data for individuals who enrolled in Boston Medical Center’s FEP program between 2019-2022. Only patients living in the metro boston area policed by Boston Police Department were included. Patient addresses were used to crosswalk patient-level data to Boston Police Department Bureau of Intelligence and Analysis data on fatal and non-fatal shootings in 2022. We used descriptive statistics as well as independent t-tests and chi squared tests to explore the relationship between sociodemographic factors and shooting rates on both a neighborhood and individual level. We also performed a mixed effects model to control for neighborhood-level clustering.

Results: There was complete geocoding data for 136 FEP patients. The number of yearly shootings in Boston varied widely on a neighborhood level, from 2 in West Roxbury to 47 in Mattapan in 2022. The majority of our clinic (72.8%) lived in the top quartile for gun violence in Boston. We did not find statistically significant associations between age, race, gender, or primary language, insurance, and neighborhood-level gun violence in bivariate or multivariate analyses.

Conclusions: At our safety-net hospital, the vast majority of of patients in our FEP program live in communities with relatively high rates of gun violence. Our next step is to examine the impact of neighborhood-level gun violence on outcomes such as the duration of untreated psychosis and comorbid PTSD.

Antipsychotic Prescribing Patterns Upon Entering First Episode Psychosis Care: Investigating Concordance to NAVIGATE Guidelines

Sarosh Khan DO (1,2,3) Julie Ngo BA (2) Anne Thompson, MPH (1,2,3) Amelia Blanton BA (1,3) Brittany Gouse MD, MPH (1,2,3) Hannah Brown MD (1,2,3)
1. WRAP Research Program, Department of Psychiatry, Boston Medical Center
2. Boston University Chobanian & Avedisian School of Medicine
3. Department of Psychiatry, Boston University School of Medicine

Background: Antipsychotic medications are an integral part of recovery in early intervention (EI) for psychosis and vary greatly by formulation and side effect profile. EI programs emphasize the need for shared decision making between patients and providers to ensure initial antipsychotic choice considers patient preference, side effect profile, relevant medical history, risk factors, and long-term treatment planning. Since many patients are started on antipsychotics in acute care settings, further research is needed to evaluate if prescribing patterns follow practice guidelines.

Method: We conducted a retrospective chart review of initial intake appointments at our specialty psychosis program, the Wellness and Recovery After Psychosis (WRAP) program at Boston Medical Center between January 2020 to August 2022. We used descriptive statistics to report cohort characteristics and clinical factors. The primary outcome was antipsychotic prescribed upon entering the program.

Results: We analyzed 197 initial intake appointments with ICD-10 codes for schizophrenia spectrum psychotic disorders (Mean age: 39 years, SD: 4.2 years, 62% Black or African American, Insurance type: 80% Medicare or Medicaid). 81% of patients reported one or more psychiatric hospitalizations prior to intake appointment. 85% of patients were prescribed an antipsychotic medication prior to intake appointment. The three most common antipsychotic medications were: 1. Olanzapine (N = 40, 20%), 2. Risperidone (N = 34, 17%), 3. Aripiprazole (N = 22, 11%). Thirty-six (18%) patients presented to their intake appointments while taking a long acting injectable (LAI) antipsychotic. The most common LAIs were Paliperidone (N= 17, 9%) and Aripiprazole (N= 10, 5%). A minority of patients were prescribed clozapine (N =5, 2%).

Conclusion: Consistent with prior research, our findings show olanzapine was the most commonly prescribed antipsychotic among individuals entering WRAP. Given olanzapine’s significant cardiometabolic risk, in future work we will explore sociodemographic and clinical factors associated with olanzapine prescription upon entering EI care.

Sociodemographic Differences and Engagement in Care among Hispanic Patients Receiving Care for First Episode Psychosis

Alexa M. Rivas (1), Jacqueline Dow (1), Ismael Maganga-Bakita (1), Katerina Konstas (1), Nicole Cerundolo (1), Emily E. Carol (1,2), Dost Öngür (1,2)
Psychotic Disorders Division, McLean Hospital (1), ; Department of Psychiatry, Harvard Medical School (2)

Background: Hispanic individuals experience societal factors that may impact their experiences within the healthcare system, particularly when navigating psychiatric care. These social determinants may interact with the experience of first episode psychosis (FEP) to impact subsequent health outcomes. While existing literature points to decreased health literacy among Hispanics in topics related to psychotic disorders, there is also evidence that Hispanic individuals within the US report higher prevalence of psychotic symptoms than non-Hispanic individuals. Given these intricacies, it is important that ethnic differences in access and outcomes are understood and considered across the psychosis care continuum.

Methods: The present baseline standardized MAPNET/EPINET assessments were collected from N=865 (mean age = 26.78 years) individuals receiving treatment for early psychosis in coordinated specialty care clinics in Massachusetts. Descriptive statistics assess self-reported client ethnicity and its relation to several other variables of interest. Ethnicity was collected as a binary categorical variable coded as Hispanic or Non-Hispanic.

Results: Sociodemographic differences between Hispanic (n=114) and non-Hispanic (n=620) individuals seeking FEP care were present across a number of the variables of interest including insurance, SSI, legal involvement, and housing. Among the sample, 15.53% individuals endorsed Hispanic ethnicity; the 2020 census indicates that Hispanics make up about 18.7% of the Massachusetts population, proposing potentially lower rates of engagement in care among Hispanic individuals. Differences surrounding contact with family and family involvement in care were also present, with 13.3% of Hispanics having reported that their family refused to participate in their treatment, compared to 5.34% of non-Hispanics.

Conclusions: Opportunities exist to increase understanding of differences in social determinants among Hispanic individuals seeking mental health treatment. An improved understanding of the ethnic differences experienced by Hispanics seeking FEP treatment could ultimately enhance care among this population.

Cognitive Subtypes In The Clinical High Risk For Psychosis Population

Walid Yassin (1), James Green (2), Matcheri Keshavan (1), Elisabetta Del Re (1), Daniel H Mathalon (3), Tyrone D Cannon (4), Jean Addington (5), Carrie EBearden (6), Kristin S Cadenhead (7), Barbara A Cornblatt (8), Diana O Perkins (9), Elaine F Walker (10), Scott W Woods (4), William S. Stone (1)
1 Harvard Medical School
2 Beth Israel Deaconess Medical Center
3 Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco CA
4 Department of Psychology, Yale University, New Haven CT
5 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
6 Departments of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles CA
7 Department of Psychiatry, UCSD, La Jolla CA
8 Department of Psychiatry, Zucker Hillside Hospital, Long Island NY
9 Department of Psychiatry, University of North Carolina, Chapel Hill NC
10 Departments of Psychology and Psychiatry, Emory University, Atlanta GA

Schizophrenia is a chronic mental health condition that severely impacts well-being, with cognitive impairment being a core feature. Identifying cognitive impairment early, particularly in individuals at clinical high risk (CHR) for psychosis, is crucial for maximizing intervention benefits and improving outcomes. Due to the heterogeneity of cognitive impairment in this population, a one-size-fits-all approach to therapeutic interventions is insufficient. Therefore, identifying cognitive subtypes within the CHR population is essential for tailored and effective interventions. This study aims to identify, validate, and characterize cognitive subtypes in large CHR samples and delineate their baseline and longitudinal cognitive and functional trajectories. Utilizing machine learning, we performed cluster analysis on cognitive measures in a large CHR sample from the North American Prodrome Longitudinal Study (NAPLS) 2, and validated our findings with an independent sample from NAPLS 3. We evaluated the resulting clusters on cognition and functioning at baseline and longitudinally, and further assessed the conversion status within these clusters. Our analysis identified two main cognitive clusters: “impaired” and “intact” across all cognitive domains compared to controls. At baseline, differences between the cognitively intact cluster and controls were observed only in verbal abilities and attention and working memory domains. Longitudinally, the cognitively impaired group showed a "catch-up" trajectory in attention and working memory and did not deteriorate further. This group also had higher instances of conversion than the intact group. In the cognitively intact group, those who later converted showed a sharp decline in attention. Global functioning roles and social scales were significantly better in the cognitively intact group at baseline, although global assessment of functioning did not differ. Most cognitive measures showed a meaningful positive relationship with functional measures. Our findings provide evidence for distinct intact and impaired cognitive subtypes in CHR youth, independent of conversion status. Attention and working memory are critical in distinguishing CHR individuals with intact cognition from controls. Early assessment of multiple cognitive domains is vital for identifying trajectories of improvement and deterioration, allowing for tailored interventions to improve outcomes for individuals at high risk for psychosis.

Program-level Factors Associated with Patient Retention and Family Engagement in First-Episode Psychosis Coordinated Specialty Care Programs in Massachusetts

Cheryl Y. S. Foo (1,2,3), Catherine Leonard (1), Kelsey A. Johnson (3,4), Dost Ongur (2,3,5), Corinne Cather (1,2*), Kim T. Mueser (1,6*)
1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital
2. Department of Psychiatry, Harvard Medical School
3. Laboratory for Early Psychosis (LEAP) Center
4. Massachusetts PsychosisNetwork for Early Treatment (MAPNET), Beth Israel Deaconess Medical Center
5. Schizophrenia and Bipolar Disorder Research Program, McLean Hospital
6. Center for Psychiatric Rehabilitation, Boston University
*Co-senior authors

Background: Poor treatment engagement of individuals with first-episode psychosis (FEP) and their families adversely impacts the effectiveness of early intervention services and increases patients’ risk of relapse. This study examined modifiable program-level determinants of patient retention and family engagement rates across FEP coordinated specialty care (CSC) programs in Massachusetts.

Method: Out of the total number of active patients in their program from October 2022 to September 2023, program leaders reported the number of patients who prematurely discontinued services (for reasons other than successful completion, attainment of recovery/treatment goals, or no longer meeting program eligibility) and number of families who participated in at least one session of any type of family intervention (e.g., family psychoeducation, multifamily group, family peer support). Program characteristics (EPINET Program-Level Battery) and MAPNET Fidelity Scale (adapted FEP Services Fidelity Scale 2.0) ratings on level/type of family involvement and outreach and engagement practices (e.g., proactive outreach, flexible hours and location, shared decision making documentation) were explored as predictors of patient retention and family engagement using independent t-tests or univariate linear regressions.

Results: Across the nine participating sites, mean patient retention rate was 86% (SD: 13) and family engagement rate was 40% (SD: 27). Higher overall fidelity in providing evidence-based family interventions had a significant, large, positive effect on patient retention (B (SE)=11.5 (2.7); AR2=.68, p=.004). Fidelity to family interventions was not associated with family engagement rates. Higher overall fidelity to recommended outreach and engagement practices had marginally significant positive effects on family engagement rates (B (SE)=19.8 (10.5); AR2=.24; p=.10), but not on patient retention rates. Programs that offered home/in-community visits for family interventions (B (SE)=29.4 (15.6); g [95% CI]=1.12 [-0.21, 2.40]) and family partner/peer support services (B (SE)=30.9 (16.5); g [95% CI]=1.17 [-0.23, 2.51]) had higher family engagement rates (p=.10).

Conclusion: Among Massachusetts FEP CSC programs, those that offer high-fidelity family services delivered by clinicians trained in evidence-based family interventions for psychosis had better patient retention than those who did not. While flexible and varied approaches of engaging families were helpful, patient factors (e.g., age, living at home, consent) may be more important determinants of the family engagement rates in FEP CSC services. Our findings are consistent with studies showing effects of family psychoeducation on treatment adherence in early psychosis.

Factors Associated with Resisting Stigma in Clients with First-Episode Psychosis: Demographic, Clinical, and Functional Correlates and Comparisons

*Katerina Konstas (1),*Nicole Cerundolo (1), Jacqueline F. Dow (1), Dost Öngür (1,2),Emily Carol (1,2), Ruth Firmin (3)
1. The LEAP Center, Division of Psychotic Disorders, McLean Hospital
2. Department of Psychiatry, Harvard Medical School
3. Department of Psychology, Gordon College,

Background: Although stigma is linked to a wide range of negative outcomes for individuals with psychosis, little is known about the process of resisting stigma. Stigma resistance (SR) was measured among individuals in their first year of experiencing psychosis in order to understand (a) the degree to which SR occurs early on, (b) relationships between SR and clinical and functional outcomes, and (c) if individuals experiencing multiple stigmas may be in need of greater support.

Methods: We examined baseline levels of SR and the relationship between SR and demographic, clinical, and functional assessments using the Stigma Resistance Scale (SRS) in an outpatient first- episode psychosis clinic. The SRS is a 20-question self-report survey assessing five domains of SR. Higher scores reflect greater SR. The SRS was assessed at baseline and follow-up alongside the EPINET battery. The assessment collection period was from November 2023 to July 2024 totaling 55 total records (50 unique individuals).

Results: This poster will present data on baseline SR across the five subscales and its associations with other EPINET variables. Since this may be a client’s first experiences with mental health care, they will likely demonstrate greater self-stigma resistance than public and peer stigma resistance. We will run descriptive analyses on the associations between SR and demographic, clinical, and functional measures.

Conclusions: These findings can illuminate how individuals with first episode psychosis experience and respond to stigma. Results will have implications for how SR may intersect with early intervention services, potentially identifying areas for further work if some individuals are at greater risk for the negative impacts of stigma.

Biomarkers/Biotypes, Course of Early Psychosis and Specialty Services (BICEPS)

Kareem Hamada (1,5), Ananya Saluja (1), Pegah Seif (1), Gautami Shashidhar (1), Walid Yassine (1), Victor Zeng (1), Paulo Lizano (1), Rosco Brady (1),Brett Clementz (2,) Elliot Gershon (3), Sarah Keedy (3), Godfrey Pearlson (4), Dost Ongur (5), Eve Lewandowsky (5), Carol Tamminga (6), Matcheri Keshavan (1)
(1) Beth Israel Deaconess Medical Center, Boston, MA
(2) University of Georgia, Athens, GA
(3) University of Chicago, Chicago, IL
(4) Yale University, New Haven, CT
(5) McLean Hospital, Boston MA
(6) University of Texas Southwestern Medical Center, Dallas, TX

Background: Psychotic disorders are highly heterogeneous in the early stages, ranging from early full recovery to treatment resistance and functional decline from onset. This heterogeneity limits accurate and effective prediction of remission and recovery. The ability to predict outcomes on an individual level for those with Early Psychosis (EP) would be valuable for treatment planning and for tailoring psychosocial and pharmacological interventions.

Methods: We leverage the biomarker-based categorization (EEG, eye tracking, neurocognition, blood/DNA collection, digital phenotyping) of a cross-diagnostic sample of psychosis (Biotypes) developed, replicated and validated by our Bipolar-Schizophrenia Network for Intermediate Phenotypes consortium (BSNIP). We have 5 active EP sites, each enrolling ~16 patients/year (total 80/year), aiming for 320 EP patients (< 3 years from onset: schizophrenia, schizoaffective disorder, bipolar disorder, schizophreniform disorder, delusional disorder, major depressive disorder with psychosis, and psychosis NOS) over the first 4 years of funding. With 25% attrition, we expect 240 completers. Current enrollments: Boston: 18; Hartford: 14; Chicago: 13; Dallas: 11; Georgia: 5. All EP cases are tested with BSNIP biomarker assessments at baseline, with clinical and cognition assessments are repeated at 1, 6 and 12 months.

Results: We are still collecting data from the BICEPS study. However, we will briefly present data from our previous studies that support the rationale for this study; a) our data from Pittsburgh show that distinct trajectories of psychosis outcomes can be identified during 1 year follow-up in EP patients; and b) data from the BSNIP study show that biotypes 1, 2 and 3, characterized in mid-late course psychosis patients can be identified in EP patients as well.

Conclusions: Our goal is to identify multivariate biomarkers/Biotypes predictors of clinical and functional outcomes in EP patients treated in coordinated specialty care clinics. Such data could help develop a predictive algorithm and calculator for clinical use in EP.

“I Don’t Want a ‘Program’” A Case-Based Approach to Ethical Issues in First-Episode Psychosis Services

Syd Russell Leed, Yveton Isnor, Saipriya Iyer, Michael Ryan, Drew Madore
Cambridge Health Alliance, Recovery in Shared Experiences (RISE) First Episode Psychosis Program, Cambridge, MA

Background: People experiencing a first episode of psychosis (FEP) are vulnerable to ethical issues in clinical care and research, but FEP is an under-researched area of bioethics with significant implications for patients’ rights.

Methods: The authors draw on existing ethics literature, clinical experience in a coordinated specialty care program within a safety net hospital, and their diverse professional backgrounds. They describe four categories of ethical issues in FEP care using anonymized scenarios.

Areas of exploration: Noncoercive methods in treatment. Systems of psychosis treatments often include some degree of coercion, from involuntary hospitalization to lack of access to psychosocial interventions chosen freely by the patient. Example scenario: a patient’s psychiatric advance directive is not recognized by his treaters. Cultural responsiveness. Biomedical models localize psychosis to the individual. Insistence on a single explanatory frame can alienate patients, delay appropriate care, and weaken team engagement with patients’ community members. Example scenario: a recent immigrant is misdiagnosed with schizophrenia after expressing culturally-normative beliefs. Patient privacy and family involvement. Family engagement is important to FEP programming and, ideally, can be a healing experience for families and communities. However, it also raises issues of patient autonomy and provider nonmaleficence. Example scenario: a patient discloses their parents are physically abusive. Patient-centered outcomes measurement. FEP program evaluation typically prioritizes standardized measurements of individual symptom burden. There is limited research on qualitative outcomes that may be important to affected communities, such as post-traumatic growth and self-determination. Example scenario: a study on the prevalence of disruptive behaviors in an FEP population does not evaluate participants’ perspectives on conflict.

Conclusions: The authors identify four core areas of potential future bioethics research and evaluation: coercive methods in treatment, cultural responsiveness, patient privacy and family involvement, and outcomes measurement. These areas are guided by professional values of autonomy, nonmaleficence, beneficence, and justice.

Recent Stress Exposure’s influence on Executive and Psychosocial Functioning in Youth at High Risk of Psychosis or Depression

Jonah Loshin (1), Katerina Konstas (1), Zachary B. Millman (1,2)
1. Division of Psychotic Disorders, McLean Hospital
2. Department of Psychiatry, Harvard Medical School

Background The early and high-risk stages of psychosis and depression share clinical features and risk factors, suggesting that comparative studies of these populations may inform treatment. Psychosocial functioning is a key treatment target but the contributing factors are complex. External considerations such as stressful life events can impact on more internal ones such as executive functioning and shape functioning as well as clinical symptoms. Here we will study the interrelations between external measures of stress exposure, executive function, and clinical presentation in a sample of youth in the early and high-risk stages of psychosis or depression.

Methods A small ongoing pilot study is enrolling participants ages 14-30 with clinical psychosis-risk, depressive syndromes, or no psychopathology. Participants complete clinical interviews, a recent life stress questionnaire, and an executive functioning task. We will compare groups on the measures of interest and examine correlations between these measures across groups to determine similarities and differences in the relation between stress, executive function, and clinical presentation. We expect that greater recent life stress is associated with lower executive performance which in turn is associated with lower psychosocial functioning transdiagnostically.

Results Preliminary results from 22 individuals (mean age 21.3 +/- 3.12) suggest that psychosocial impairment appears greatest in psychosis-risk youth with a similar pattern suggested for stress exposure, but executive performance appears lowest in depression. Executive functioning shows a preliminary positive relation to psychosocial functioning in the combined sample. We will present these results with an updated dataset in addition to correlations between measures across clinical groups.

Conclusions Stress and executive functioning have previously been shown to be interrelated contributors to clinical concerns in young people. The study of these relations in a transdiagnostic risk/early-stage population will contribute important information to our understanding of clinical presentation at a critical developmental stage.

Does Insight Improve during the Course of Psychosis?

P Seif (1), K Hamada (1), R Trotti (1), C Tamminga (2), G Pearlson (3), B Clementz (4),S Keedy (5), E Gershon (5), EC DelRe (1), MS Keshavan (1)

Introduction: Insight and cognition are critical aspects of psychiatric disorders. We assessed the course of insight and cognition over the duration of psychosis and examined the correlation between insight and cognition in psychosis.

Methods: We screened patients using the Structured Clinical Interview for DSM-5 (SCID-5) to determine various DSM diagnoses. Cognitive performance was evaluated using the Brief Assessment of Cognition in Schizophrenia (BACS). Insight was measured using item G12 of the Positive and Negative Syndrome Scale (PANSS).

Results: The study found that insight, as measured by PANSS G12 scores, was significantly correlated with the duration of illness (r = -0.083, p = 0.005). In the schizophrenia (SZ) group, illness duration significantly influenced insight (F(12, 430) = 2.205, p = 0.011, η² = 0.058) and was also a significant predictor of poorer cognitive performance (F(12, 428) = 2.305, p = 0.007, η² = 0.061). However, no significant impact of illness duration on insight or cognitive performance was observed in the bipolar disorder with psychosis (BP) or schizoaffective disorder (SAD) groups. Additionally, poorer insight was associated with lower cognitive performance (r = -0.089, p = 0.003) and more severe negative (r = 0.280, p < 0.001) and positive symptoms (r = 0.385, p < 0.001). Despite significant models for predicting symptom severity in SZ, the duration of illness was not a significant predictor of either positive or negative symptoms. Finally, BT2 showed significant improvement in insight from a mean PANSS G12 score of 4.00 to 2.59 over the first three years of illness (F(1, 19) = 5.382, p = .032), while BT1 and BT3 showed no significant improvement.

Conclusion: The study concludes that in schizophrenia, the duration of illness significantly influences both insight and cognitive performance, highlighting the importance of early intervention in this population. Poorer insight is associated with lower cognitive performance and more severe symptoms, yet the duration of illness does not significantly predict changes in positive or negative symptoms over time. The improvement observed in insight within the first three years for the BT2 group underscores the potential for targeted therapeutic strategies to enhance insight early in the course of illness. Conversely, the lack of significant improvement in BT1 and BT3 suggests the need for further research into the factors that contribute to sustained deficits in insight across different biotypes.

Pathways to Specialty Psychosis Care: Referral Outcomes to Massachusetts Largest Safety Net Hospital

BreeOna C. Namukowa, MD, MSPH 1,2, Ellie Reagan 1, Rayah Touma Sawaya 1, Amelia Blanton 1, Temitope Ogundare 1, Brittany Gouse, MD, MPH 1,2, Hannah E. Brown, MD 1,2
1: Wellness & Recovery After Psychosis Program, Boston Medical Center, Boston, MA
2: Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA

Background: Individuals with schizophrenia have a 13-15 year reduction in life expectancy compared to the general population; much of this premature mortality is due to preventable cardiovascular risk and other unmet physical health needs. “Reverse integration” of primary care into specialty care has the potential to reduce disparities in physical health outcomes in patients with schizophrenia. Here, we describe the first year of a pilot of the Psychiatric Reverse Integration for Medical Expertise (PRIME) clinic run by Family Medicine and Psychiatry combined residents embedded within the specialty outpatient psychiatry setting at Boston Medical Center.

Methods: We retrospectively analyzed the utilization of PRIME clinic services between July 2023-August 2024. We used descriptive statistics to describe visit utilization as well as common conditions diagnosed and treated.

Results: There were 238 patient visits in PRIME between July 2023 to August 2024. There was a show rate of 81% of scheduled visits. Patients are referred from several sources including the general outpatient psychiatry department, the Wellness and Recovery After Psychosis (WRAP) program, addiction psychiatry, consult-liaison psychiatry, and the Boston Outpatient Assisted Treatment (BOAT) program. Examples of conditions diagnosed and treated included management of hypertension, diabetes, memory evaluations, anemia, asthma/COPD, pregnancy, cellulitis, erectile dysfunction, GERD, and Hepatitis C.

Conclusions: The relatively high show rate for PRIME clinic suggests that reverse integration is feasible and desired by patients receiving outpatient psychiatric care at a safety net hospital. Next steps include examining effectiveness outcomes, such as the longitudinal impact of PRIME on objective measures of healthcare maintenance.

Leveraging Machine Learning Methods to Predict Active Suicidal Thinking in Young Adults with Schizophrenia

Damla Duendar,(1) Khang Le,(1) Amelia Blanton,(2) Anne Thompson,(2,3) Brittany Gouse, (2,3) Hannah Brown, (2,3) Archana Venkataraman (1)
1: Department of Electrical and Computer Engineering, Boston University, USA
2: WRAP Research Program, Boston Medical Center, Boston, MA
3: Boston University Avedisian and Chobanian School of Medicine, Boston, MA

Background: Suicide is a leading cause of preventable death following the first episode of psychosis. This study aims to develop a predictive machine learning model to identify college students with psychosis who are at heightened risk of depressive symptoms and suicidal thinking.

Methods: We leveraged sociodemographic data and psychological assessments of N = 227 college students with lifetime history of psychosis using the 2019-2020 Healthy Minds Study Data Set. Our model classifies individuals into three categories: no or mild depression without suicidal ideation (SI), moderate or severe depression without SI, and patient with active SI. Depression severity was assessed using the Patient Health Questionnaire-9. The study evaluated the performance of XGBoost and Random Forest models, using Recursive Feature Elimination (RFE) to select the top 30, 40, and 50 features. Additionally, a hierarchical classifier employing Random Forest as the local classifier was developed using the local classifier per parent node approach. In this approach, individuals were first classified by depression severity, followed by a local classifier to assess the risk of suicidal ideation.

Results: The performance of the Random Forest and XGBoost models was compared using the macro recall score across the outer folds of the nested cross-validation. The best macro recall score of 0.5720 ± 0.0511 was achieved using XGBoost with the top 50 features. The hierarchical classifier demonstrated superior performance, achieving an average recall score of 0.9286 ± 0.0426 on the training and validation set and a recall score of 0.8824 on the held-out test set.

Conclusions: The results of this study could help identify college students at a higher risk of suicidal thinking, allowing for timely support. Future work will apply this framework to the study of first-episode psychosis in order to identify patients in urgent need for intervention.

Initial Outcomes in a Coordinated Specialty Care Program for an Underserved Population in Fall River

Amy Paris, PhD, Jacqueline Schofield, LICSW; Kendra Mello, LICSW; Waffa Freij, LCSW; Iesha Niles; Nilka Benitez; Vanessa Belisle; Maxwell Mayer, MD; Margaret Guyer, PhD

Background: Based on epidemiological studies, each year in Massachusetts roughly 2,000 people will experience a first episode of a psychotic disorder. In line with the Massachusetts strategic plan to extend access and equity for the treatment of psychosis in its earlier stages, the DMH-funded Coordinated Specialty Care Team at Corrigan Mental Health Center began in October 2022 in Fall River. Now, more than 18 months into operations, we can begin to examine outcomes and areas to improve our client care. This examination allows us to spotlight our program successes at treating an under-served population while also allowing the potential to learn from other programs’ successes for our further implementation.

Methods: Data previously collected in the process of treatment were utilized to assess client engagement with a new CSC program, highlight initial outcomes for the first cohort of clients treated, and examine both client self-report and clinician ratings to observe progress. Assessments included self-reports from clients on their process of recovery, overall satisfaction, and symptomatology as well as clinician ratings on client symptom severity and service utilization. Tallying types of encounters with the clients allowed us to highlight the outreach and engagement the program has with clients in comparison with what is expected from a typical, non-specialized treatment.

Results: These data provide insight into the clients the Corrigan CSC program has been able to engage, strengths of the CSC program early in implementation including the benefit of maintaining a low-barrier to treatment, and some areas we may be able to increase gains moving forward.

Conclusions: During the initial months of the CSC program in Fall River we demonstrated positive outcomes through our low-barrier to treatment approach and utilization of all components of CSC roles. Further work in this community with the CSC team will include focusing on identified deficits and strengthening alignment in the community.