Introduction:
Up to five years before an acute psychosis manifests, initial prodromal symptoms may appear. Professionals refer to these as high-risk symptoms. Often, these symptoms are experienced as distressing and can significantly impede daily functioning. Early warning signs are frequently nonspecific, making them difficult to recognize both by the affected individual and their environment.
Especially in adolescents, early stages of psychosis are often overlooked for longer periods compared to when they occur in young adults. On one hand, children and adolescents during this phase of life exhibit altered behavior as part of "normal" adolescence; on the other hand, the signs are often subtle and frequently insidious. Therefore, it is crucial to conduct a careful risk assessment early on and, if necessary, closely monitor and advise those affected.
In recent years, early detection centers for psychosis have emerged worldwide, providing careful risk assessment, counseling, and potentially close monitoring for those affected. The Early Detection Clinic Zurich at the Clinic for Child and Adolescent Psychiatry and Psychotherapy is one of these early detection centers.

Methods and Results:
The presentation will showcase and discuss the clinical data of a total of 342 adolescents who presented at the Early Detection Clinic Zurich between 2017 and 2023.

Discussion:
This presentation introduces the clinical work of the Early Detection Clinic Zurich. Alongside results from psychosis risk assessment, comorbidities, clinical diagnoses, and subsequent psychiatric support will be presented.

The incidence of schizophrenia peaks between 20 and 24 years of age, but, approximately, one third of individuals develop this disorder before the age of 18 (Early Onset Psychosis, EOP) with an even worse outcome than in adults. Indeed, psychoses are one of the most severe disorders in children and adolescents (CAD) representing the second cause of years lost because of disability (YLDs) worldwide.
Thus, over the last decade, valid and reliable criteria have been introduced for the prospective identification of individuals at heightened risk of developing psychosis.
In the meantime, clinicians and researchers have tested several psychosocial interventions aimed at ameliorate, delay, or even prevent onset of psychosis. Nevertheless, there is still a lack of evidence for the efficacy of specific therapeutic interventions. This is even more evident for interventions targeted on pre-adolescents and adolescents.
With the present talk, we aim to provide rationale to focus on psychosocial interventions targeted on social cognition. Indeed, recent psychological, clinical and neuroscientific studies demonstrate that socio emotional difficulties are fundamental in determining clinical and functional outcomes in CHR-P patients.
We will review the evidence suggesting that both during the premorbid phase and clinical high-risk phase, attenuated psychotic symptoms may impede the maturation of key social cognitive processes, particularly the suite of reflective thinking processes coming under the term of mentalization. From this evidence base, we will describe our staging model of psychosis progression in function of our mentalization-informed model, tailored to provide a coherent framework of care addressing the key clinical needs at every stage of psychosis progression.

Background: Researchers aim to prevent psychotic disorders by identifying and treating individuals at clinical high risk (CHR) for psychosis, typically during adolescence and young adulthood. CHR symptoms emerge during this sensitive period, leading to functional impairment. Addressing this gap, the "Robin" combined treatment program and smartphone app ("Robin Z") target CHR symptoms, comorbidities, and daily functioning, aiming to improve quality of life. While smartphone interventions show promise in adult psychosis patients, "Robin Z" is among the first designed for adolescent CHR patients.

Methods: The ETRo study is a prospective, naturalistic follow-up with 40 CHR adolescents receiving the "Robin" intervention (16 sessions + 4 family sessions) compared to 72 receiving treatment as usual (TAU). CHR symptoms, comorbidities, functioning, self-efficacy, and quality of life were monitored at six time points.

Results: Fewer transitions to psychosis occurred in the intervention group (2.5%) compared to the control group (16.9%). The control group showed improved global functionality (F=11.88, p=0.001) and a trend towards self-efficacy improvement (F=4.02, p=0.053) at one-year follow-up, with no significant change in quality of life.

Discussion: This trial is the first to evaluate a treatment manual with a smartphone app for CHR adolescents, crucial for early intervention research. Initial data analysis suggests treatment effects, with expectations of further disparities favoring the intervention group, as indicated by reduced transition rates to psychosis.

Background: Cognitive-behavioural therapy (CBT) is the well-established gold standard treatment for young people with a clinical high-risk (CHR) state for psychosis. While CBT has been shown to reduce the risk of transition to psychosis by up to 40%, difficulties in engagement and high rates of early treatment discontinuation are highly prevalent in people with CHR. Potential contributing factors include social isolation and the impact of attenuated psychotic symptoms on the therapeutic alliance (TA). Therefore, we aimed to examine TA and other clinical features in relation to (dis)continuation in CBT for young people with CHR.
Methods: We analysed data from 65 young people who received a specialized CBT intervention for CHR at the Bern Early Recognition and Intervention Centre (FETZ Bern), between 2018 and 2023. Demographic information, pre- and post-therapy measures of psychopathology (including Structured Interview for Psychosis-Risk Syndromes (SIPS), Prodromal Questionnaire Brief (PQ-B), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Social and Occupational Functioning Assessment Scale (SOFAS), Brief Multidimensional Life Satisfaction Scale (BMLSS)) and regular assessments of TA (Scale for the Multi-perspective Assessment of General Change Mechanisms in Psychotherapy - SACiP) were included.
Results: Of the 65 participants (71% female, Mage 18 years), 36 (55%) completed the regular 12 sessions of CBT. CBT led to improvements in psychotic, depressive and anxiety symptoms, and health related quality of life. The presentation will focus on the interaction between overall symptom severity, specific symptoms (including suspiciousness and negative symptoms) and TA, as well as the role of TA as a moderating factor of clinical results and therapy attendance.
Conclusion: CBT is an effective intervention for young people at risk of psychosis. Nevertheless, even in specialized early intervention services, a substantial number of young people discontinue treatment early. TA is an important factor to consider in order to improve engagement in therapy, and ultimately the clinical outcomes of young people at risk of psychosis.

Obesity is strongly associated to multiple adverse mental health outcomes including schizophrenia. However, the causal directionality of underlying genetic, clinical, and neurodevelopmental pathways remains unclear. Here we investigate bidirectional pathways linking metabolic, behavioral and neurodevelopment trajectories in a unique longitudinal cohort at high genetic risk for psychosis, due to 22q11.2 Deletion Syndrome.
Childhood BMI-Increase predicted the subsequent emergence of psychosis, while BMI-Increase during adolescence was associated to depression, tightly replicating previous epidemiological findings. The emergence of motor, cognitive and behavioral disorganization, was more strongly predicted by duration of increased BMI-status, than by other age-related factors, and was linked to progressive gray-matter-volume reductions in posterior-inferior cerebellum. Behavioral impulsivity predicted Childhood BMI-increase and was linked to atypical maturation of NAc-Shell connectivity, reflecting insufficient top-down control of goal-directed and feeding behavior. Metabolic dysregulation could link childhood behavioral impulsivity to psychosis vulnerability, by influencing cerebellar maturation, mediating the effects of shared genetic vulnerability.