Abstract: Abstract xD;Background:Adolescents and young adults have a high incidence and prevalence of mental disorders, which can be disabling, chronic and lead to the development of further mental health problems. Yet their needs are not being adequately met by existing health structures. We set out to examine the extent of met and unmet need in young people by assessing referrals to a public mental health service for 15 - 24 year olds. We sought to identify differences between young people who were accepted into the service and those who were not with respect to psychiatric diagnosis, subthreshold symptoms, and psychosocial functioning. xD; xD;Method:All young people aged 15 - 24 years who were referred to the service from April to September 2003 for assistance with non-psychotic disorders were approached for assessment. xD; xD;Results:204 individuals were referred to the service with non-psychotic problems over the data collection period, and 150 consented to participate in the study. Fifty nine percent of participants (n = 88) were accepted into the service (the RA group). They were more likely to have a current diagnosis than those not accepted into the service (the RNA group; n = 62). The RA group had higher levels of depression and anxiety, and lower psychosocial functioning, compared to the RNA group. The RNA group group were also unwell: nearly 63% had at least one diagnosis at the time of referral. Both the RA and RNA groups showed functional impairment. xD; xD;Conclusions:Limited services are denying assistance to young people with significant morbidity and associated functional impairment. We suggest a range of reforms that would benefit the mental health of society by focussing on those most in need and those most likely to respond to early intervention: our young people.

Abstract: While the prevalence, correlates and mental health impacts of intimate partner violence are well documented in adolescents and young adults, fewer studies have considered physical dating violence among clinical samples of help-seeking young people. In a sample of 98 young people aged 15-24 years (54% females) referred to a specialist public youth mental health service, we examined the 12- month prevalence of physical violence inflicted by an intimate partner and its relationship with psychiatric disorders and psychosocial functioning. Data were collected at referral (baseline) and six months following referral. The reported prevalence of dating violence in the 12 months prior to referral was 13%, with similar rates reported by males and females. Analyses indicated that physical dating violence reported at baseline was associated with poorer psychosocial functioning, substance dependence and a greater number of Axis I diagnoses at six month follow-up. These findings suggest that youth mental health services are well positioned not only to screen for dating violence, but to intervene to ameliorate the mental health consequences of such abuse and to prevent further violence.

Abstract: OBJECTIVE: Studies conducted in community samples suggest that psychotic-like experiences are common in the general population, leading to suggestions that they are either variations of normal personality or are different expressions of underlying vulnerability to psychotic disorder. Different types of psychotic symptoms may exist, some being normal variants and some having implications for mental health and functioning. The aim of the present study was to determine if different subtypes of psychotic-like experiences could be identified in a community sample of adolescents and to investigate if particular subtypes were more likely to be associated with psychosocial difficulties, that is, distress, depression and poor functioning, than other subtypes. METHOD: Eight hundred and seventy-five Year 10 students from 34 schools participated in a cross-sectional survey that measured psychotic-like experiences using the Community Assessment of Psychic Experiences; depression using the Centre for Epidemiologic Studies Depression Scale; and psychosocial functioning using the Revised Multidimensional Assessment of Functioning Scale. Factor analysis was conducted to identify any subtypes of psychotic experiences. RESULTS: Four subtypes of psychotic-like experiences were identified: Bizarre Experiences, Perceptual Abnormalities, Persecutory Ideas, and Magical Thinking. Intermittent, infrequent psychotic experiences were common, but frequent experiences were not. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas were strongly associated with distress, depression and poor functioning. Magical Thinking was only weakly associated with these variables. Overall these findings may suggest that infrequent psychotic-like experiences are unlikely to be a specific risk factor for onset of a psychotic disorder in community samples. CONCLUSIONS: Given that the different subtypes had varying associations with current difficulties it is suggested that not all subtypes confer the same risk for onset of psychotic disorder and poor outcome. Bizarre Experiences, Perceptual Abnormalities and Persecutory Ideas may represent expressions of underlying vulnerability to psychotic disorder, but Magical Thinking may be a normal personality variant.

Abstract: Cannabis use has been associated with greater risk of developing psychotic-like experiences (PLEs) and psychosis. This paper aims to determine if different levels of cannabis (lifetime, regular, recent) exposure are associated with PLEs and specific PLE subscales among adolescents. Participants consisted of a community sample of 880 adolescents in Melbourne, Australia. Adolescents were administered the positive symptom scale of the Community Assessment of Psychic Experiences (CAPE) and measures of substance use and depression. Lifetime cannabis use and the frequency of cannabis use in the last year (recent use) were associated with PLEs, primarily the experience of auditory and visual hallucinations (perceptual abnormalities). Low levels of recent cannabis use were more strongly associated with PLEs than more frequent use. These findings indicate that different levels of cannabis exposure were differentially associated with PLEs and highlight the need for early detection and treatment strategies for PLEs and cannabis use in adolescents.

Abstract: Objective: Recent years have witnessed widespread interest in the early phase of xD;psychotic disorders. The most widely used approach to identify individuals in the xD;prodromal phase is the ultra-high risk (UHR) approach, which combines known trait xD;and state risk factors for psychotic disorder. The PACE Clinic introduced the xD;Comprehensive Assessment of At Risk Mental States (CAARMS) in order to assess xD;UHR status. A training DVD and manual in the use of the CAARMS was recently xD;developed in order to assist with UHR identification. The current paper reports the xD;outcome of a series of training workshops with mental health professionals based xD;around this DVD. The research aim was to investigate whether the training workshops xD;assisted mental health professionals in their confidence and ability to accurately identify xD;UHR cases and distinguish these from non-UHR and FEP cases. Method: 137 mental xD;health workers participated in the training sessions across 8 training sites. The training xD;sessions consisted of four modules: theoretical background; rating written vignettes for xD;UHR, non-UHR or FEP status; viewing and discussing the CAARMS Training DVD; xD;and re-rating matched written vignettes for UHR, non-UHR or FEP status. xD;Results: Participants� confidence in identifying UHR cases and in using the CAARMS xD;increased as a result of the workshop. Participants� ability to correctly identify UHRpositive xD;cases did not improve as a result of the workshop. This may have been the xD;result of a ceiling effect due to baseline ability to identify UHR-positive cases being xD;high. However, there was a trend for participants� ability to correctly identify UHRnegative xD;cases to improve as a result of the workshop. xD;Conclusions: UHR training workshops are a valuable means of increasing mental health xD;workers� confidence in identifying UHR patients. Future UHR training programmes xD;Australian and New Zealand Journal of Psychiatry with experienced mental health professionals should pay particular attention to the xD;correct identification of UHR-negative cases.

Abstract: Abstract Aims: To explore substance use motives among young people seeking mental health treatment. Methods: Participants consisted of 103 young people seeking mental health treatment, who had used drugs or alcohol in the past year. The young people completed a 42-item substance use motives measure based on the Drinking Motives Measure for their most frequently used substance in the past year. Results: Exploratory factor analysis of the substance use motives scale indicated the young people reported using substances for positive and negative drug effects, to socialize with their peers, and to cope with a negative affect. They did not report using substances for enhancement or conformity motives. Coping motives predicted the presence of a current substance use disorder. Conclusions: The findings support the need for integrated treatment approaches within mental health settings, particularly targeted at young people with co-occurring mental health and substance use problems.

Abstract: Background: The Mood and Anxiety Symptom Questionnaire (MASQ) was designed to specifically measure the Tripartite model of affect and is proposed to offer a delineation between the core components of anxiety and depression. Factor analytic data from adult clinical samples has shown mixed results; however no studies employing confirmatory factor analysis (CFA) have supported the predicted structure of distinct Depression, Anxiety and General Distress factors. The Tripartite model has not been validated in a clinical sample of older adolescents and young adults. The aim of the present study was to examine the validity of the Tripartite model using scalelevel data from the MASQ and correlational and confirmatory factor analysis techniques. Method: 137 young people (M = 17.78, SD = 2.63) referred to a specialist mental health service for adolescents and young adults completed the MASQ and diagnostic interview. Results: All MASQ scales were highly inter-correlated, with the lowest correlation between the depression- and anxiety-specific scales (r = .59). This pattern of correlations was observed for all participants rating for an Axis-I disorder but not for participants without a current disorder (r = .18). Confirmatory factor analyses were conducted to evaluate the model fit of a number of solutions. The predicted Tripartite structure was not supported. A 2-factor model demonstrated superior model fit and parsimony compared to1- or 3-factor models. These broad factors represented Depression and Anxiety and were highly correlated (r = .88). Conclusions: The present data lend support to the notion that the Tripartite model does not adequately explain the relationship between anxiety and depression in all clinical populations. Indeed, in the present study this model was found to be inappropriate for a help-seeking community sample of older adolescents and young adults.

Abstract: Background: Identification of individuals �prodromal� for schizophrenia and other psychotic disorders relies on criteria that predict onset within a brief period. Previous trials and biological research have been predicated on the view that certain �ultra high risk� (UHR) criteria detect �the prodrome�, but there is a need to test the validity of these criteria. Aim: To assess the predictive validity of the UHR criteria in a clinical population. Method: Presence of UHR criteria was determined in 292 help-seeking individuals. At 2 year follow up the number of new cases of psychotic disorder was assessed. Results: The criteria significantly predicted onset of psychotic disorder within 2 years. The transition rate of 16% was much lower than in initial cohorts (over 40%). Conclusions: The predictive validity of UHR criteria depends on the sample to which they are applied. Although young help-seekers meeting these criteria are at greater risk of psychotic disorder than those who do not meet them, caution is needed in their management, since a high transition rate can no longer be assumed.

Abstract: Psychotic-like experiences (PLEs) are used to identify individuals considered to be at Ultra High Risk (UHR) of, or prodromal for, psychotic disorder. They are also common in the general population and in clinical samples of non-psychotic individuals. Depression has been found to be an important factor in mediating outcome in those with PLEs in both community and UHR populations. It is associated with increased risk of transition to psychotic disorder in the UHR group, and with need for care in relation to PLEs in community samples. In this study we aimed to examine the 6 month outcome of PLEs in a sample of help-seeking young people aged 15 to 24 years in relation to their level of depression. Subjects (n = 140) were assessed at baseline and 6-months for PLEs and depression. PLEs were measured by the Community Assessment of Psychic Experiences (CAPE). Depression was assessed as a continuous measure using the Mood and Anxiety Symptom Questionnaire (MASQ) and categorically according to DSM-IV diagnosis of mood disorder. PLEs reduced in conjunction with an improvement in depression level and with remission of diagnosis of mood disorder. It is important to assess depression in those with PLEs and consider the need for treatment of the comorbid depressive syndrome. This may reduce the risk of worsening of PLEs and transition to psychotic disorder

Abstract: Suicidal behvior is associated with negative outcomes, including completed suidice. This study examined the prevalence of suicidal behavior in a sample of referrals to a youth psychiatric service and investiaged the stability of suicidality over 2 years. Of the 140 people (mean age 17.8) who were referred to a youth psychiatric service, 82 who were accepted for treatment (RA group) and 58 who were not accepted (RNA group) were assessed: 57% reported considering suicide and 39% reported attempting suicide in the 12 months prior to referral. Participants who reported suicidal ideation were significantly more likely than nonsuicidal participants to have multiple Axis I diagnoses and lower levels of functioning. At the 2-year follow-up there was a significant reduction in suicidality in the RA group, but not inthe RNA group. In conclusion, suicidality is prevalent among young people referred to psychiatric services. Even brief contact with services resultsi in a reduction in suicidality over 2 years.

Abstract: Objective: To examine the discriminant validity of the Mood and xD;Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers. xD;Method: 136 young people referred to a psychiatric service completed a xD;diagnostic interview and the MASQ. xD;Results: Participants were classified according to diagnostic status: Mood Only; xD;Anxiety Only; Mixed Anxiety-Depression; Other DSM-IV Disorder; and No Axis-I xD;Disorder. Participants in the Mood Only and Mixed groups scored significantly xD;higher than the remaining groups on all MASQ scales. Participants in the Anxiety xD;Only group did not score significantly higher than participants in the Other xD;DSM-IV or No Diagnosis groups for any scale. xD;Conclusion: Our findings supported the specificity of the depression-specific xD;scale, however the purported anxiety-specific scale did not distinguish between xD;those with and those without Anxiety disorders. It was hypothesised that in xD;clinical samples, the MASQ may measure general psychological distress.

Abstract: Objective: Co-occurring substance use and mental health disorders are highly prevalent xD;among young people attending services, yet few studies have examined the effect of such xD;comorbidity among those referred for treatment. The aim of the current study was to xD;examine the impact of co-occurring substance use disorders (SUDs) on 6 month outcomes xD;for young people seeking mental health treatment. xD;Method: One hundred and six young people (aged 15 24 years) with a non-psychotic xD;DSM-IV Axis I disorder were assessed following referral to a specialist youth public mental xD;health service. Participants were given a structured interview, as well as questionnaires xD;assessing drug use, psychopathology, psychosocial functioning and self-esteem at xD;baseline and 6 month follow up. xD;Results: At baseline, 23 participants met criteria for a co-occurring SUD and 83 had a nonpsychotic xD;Axis I disorder. Both the non-SUD and the co-occurring SUD groups had high xD;levels of psychopathology, serious impairments in functioning and moderate levels of xD;suicidal ideation, although those with co-occurring SUD had significantly poorer levels of xD;functioning. At 6 month follow up the co-occurring SUD group continued to experience xD;substantial problems with symptoms and functioning whereas the non-SUD group had xD;significant improvement in both of these domains. xD;Conclusions: The present findings are consistent with studies examining the impact of cooccurring xD;substance use and mental health issues across different treatment settings, and xD;reinforce recommendations that young people with co-occurring disorders require more xD;intensive and integrated interventions. The present findings also highlight the need for xD;routine assessment and management of substance use issues within youth mental health xD;settings.

Abstract: Background xD; xD;The overlap between Depression and Anxiety has led some researchers to conclude that they are manifestations of a broad, non-specific neurotic disorder. However, others believe that they can be distinguished despite sharing symptoms of general distress. The Tripartite Model of Affect proposes an anxiety-specific, a depression-specific and a shared symptoms factor. Watson and Clark developed the Mood and Anxiety Symptom Questionnaire (MASQ) to specifically measure these Tripartite constructs. Early research showed that the MASQ distinguished between dimensions of Depression and Anxiety in non-clinical samples. However, two recent studies have cautioned that the MASQ may show limited validity in clinical populations. The present study investigated the clinical utility of the MASQ in a clinical sample of adolescents and young adults. xD; xD;Method xD; xD;A total of 204 Young people consecutively referred to a specialist public mental health service in Melbourne, Australia were approached and 150 consented to participate. From this, 136 participants completed both a diagnostic interview and the MASQ. xD; xD;Results xD; xD;The majority of the sample rated for an Axis-I disorder, with Mood and Anxiety disorders most prevalent. The disorder-specific scales of the MASQ significantly discriminated Anxiety (61.0%) and Mood Disorders (72.8%), however the predictive accuracy for presence of Anxiety Disorders was very low (29.8%). From ROC analyses, a proposed cut-off of 76 was proposed for the depression scale to indicate 'caseness' for Mood Disorders. The resulting sensitivity/specificity was superior to that of the CES-D. xD; xD;Conclusions xD; xD;It was concluded that the depression-specific scale of the MASQ showed good clinical utility, but that the anxiety-specific scale showed poor discriminant validity. xD;

Abstract: Objectives: Young people may place themselves and others at risk of sexually transmitted infections (STI) and /or the human immunodeficiency virus (HIV) through engaging in unprotected sex. Mental health problems may play an important role in sex-related risk behaviour. The current research was an investigation of depressed mood and condom use in a help-seeking sample of young people in Melbourne, Australia. xD; xD;Method: The sample comprised 76 sexually active young people aged 15-24 years who were referred to ORYGEN Youth Health, a public mental health service in Melbourne, Australia. Controlling for demographic characteristics and substance use, mulitvariae logistic regression examined depressed mood as a predictor of condom use at last sexual intercourse. xD; xD;Results: Half of the sample reported condom use the last time they had sexual intercourse. Depressed mood, female gender and unemployment increased the liklihood that participants engaged in unprotected sex. xD; xD;Conclusion: A high proportion of young people, particularly those who are depressed, are failing to protect themselves from STI/HIV. Mental health services working with young people have the opportunity to implement initiatives aimed at reducing risk of STI/HIV infection.

Abstract: Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders yet are common in the community. Some PLEs, such as those associated with depression, distress, and poor functioning, may confer increased risk. The aim of this study is to determine the prevalence of PLEs in a nonpsychotic clinical sample and to investigate whether any subtypes of PLEs are associated with the above factors. Consecutive referrals to a youth psychiatric service (N = 140) were assessed to measure PLEs, depression, and functioning. PLE data were factor analyzed, and the associations of psychotic subtypes and distress, depression, and disability were analyzed. Three subtypes of PLEs were identified: Bizarre Experiences, Persecutory Ideas, and Magical Thinking. Bizarre Experiences and Persecutory Ideas were associated with distress, depression, and poor functioning. Magical Thinking was not, unless accompanied by distress. Bizarre Experiences and Persecutory Ideas may be more malignant forms of psychotic symptoms, as they are associated with current disability, and may confer increased risk of development of full-blown psychotic disorder.

Abstract: Objective: To identify the pattern of current comorbidity in young help-seekers referred to a specialist mental health service. Method: One hundred and forty-nine participants were assessed for current psychiatric diagnoses following their referral to ORYGEN Youth Health. Results: Seventy-eight per cent of the sample rated for at least one diagnosis with almost half the sample presenting with two or more disorders. Next to comorbid depression and anxiety, comorbidity between substance use disorders and mood and anxiety disorders was the most prominent pattern of comorbidity in the sample. Conclusions: The present findings suggest that integration between mental health and substance abuse services is well overdue and must be addressed at policy, service system and clinical levels.

Abstract: Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI=1.5�103.41, p=0.0025)). The CAARMS had good to excellent reliability. Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder.

Abstract: Mental health problems affect a sizeable minority of Australian adolescents. xD;Depression and substance use disorders are common mental disorders xD;reported in this age group. Difficulties of this nature that manifest xD;in adolescence will often continue into adulthood. This report xD;describes a sample of adolescents referred to a public mental health xD;service with respect to their psychiatric diagnoses, depressive symptoms, xD;patterns of substance use and level of suicidality. Mood disorders xD;and substance-use disorders were both prevalent in the sample of xD;participants, with sizeable comorbidity reflected in the number of participants xD;meeting criteria for both of these diagnoses. Data revealed xD;participants with a psychiatric diagnosis were significantly more likely xD;to have made a suicide attempt than those with no diagnosis. High xD;levels of depressive symptoms were associated with suicidality, illicit xD;substance use, and the likelihood of having a psychiatric diagnosis. xD;Heavy use of alcohol was prevalent in this group, but unrelated to the xD;other variables of interest to the study. These results are discussed xD;with respect to the importance of early detection of vulnerable students xD;in a school setting.