Faces, Virtual Spaces, and Social Functioning: Early Markers of Impairment in Psychosis Risk Syndrome

Tisha Chatterjea, Lauren Utter, MGB, Sajel Shah, MGH, Megan Good, BIDMC, Nicole Detore, MGH, Daphne Holt, MGH, Jacqueline Clauss, MGH

Background: Individuals who meet criteria for clinical high-risk for psychosis (CHR-P) have 20-fold increased risk for psychotic disorders. CHR-P is also associated with negative symptoms of psychosis, including social anhedonia and withdrawal. Understanding the underlying abnormalities contributing to social impairment in CHR-P may provide novel opportunities for treatment and intervention.

Methods: Participants ages 14-30 (CHR-P, psychosis-spectrum illness, and controls) were recruited via clinical services and online advertisements. They completed a battery of self-report clinical measures, an online behavioral task to assess emotion recognition accuracy, an open-ended interview task to quantify facial affect and linguistic complexity, a virtual-reality based personal space task, and clinician-rated interviews social and role function. As a preliminary analysis, Pearson correlations between self-report of social functioning, emotion recognition accuracy, and personal space measures were calculated. Accuracy of emotion recognition was calculated using the Penn ER40 (emotion recognition 40).

Results: Data collection is ongoing, with 12 participants enrolled to date (4 CHR, 4 POPS, 4 help-seeking). Preliminary analysis showed that across all three groups, individuals who self-reported more loneliness were less accurate in discriminating between different emotions and ages of faces (p < 0.05). More self-reported childhood trauma was related to less accuracy in identifying neutral faces (p=0.003).

Conclusion: This study leverages modern, cutting-edge methodologies to characterize social dysfunction in CHR-P. By coupling traditional self-report and clinician-rated measures with innovative technology to quantify behavior, we aim to illuminate mechanisms driving persistent social impairment in psychosis risk syndromes.

Relationships Between Employment and Loneliness in Psychosis

Francesca de Marneffe (1), Robert Sawdey (2), Nicole DeTore (2,3), Kim T Mueser (4)
1. Department of Psychiatry, Massachusetts General Hospital
2. Department of Occupational Therapy, Boston University
3. Department of Psychiatry, Harvard Medical School
4. Center for Psychiatric Rehabilitation, Boston University

Background: Loneliness is highly prevalent in people with psychotic disorders, but few interventions have been found to decrease loneliness in this population. While employment is generally associated with improvements in self-esteem and quality of life, the impact of employment on loneliness in those with psychosis has not been thoroughly investigated. Therefore, we evaluated whether obtaining competitive work is associated with reduced loneliness over time in people with psychotic disorders.

Methods: In 152 adults with a primary psychotic disorder, we assessed loneliness (single item from the Social Adjustment Scale-II), work functioning (employment status), psychotic symptoms (Positive and Negative Syndrome Scale), self-esteem (Rosenberg Self-Esteem Scale), social network (Social Support Network Inventory), and life satisfaction (Abbreviated Quality of Life Interview). We collected these measures at baseline, 6-, 12-, 18-, and 24-months.

Results: Baseline loneliness was significantly correlated with more severe positive (r=.38, p<.001) and depressive symptoms (r=.47, p<.001). Loneliness was also negatively correlated with overall quality of life (r=-.33, p<.001), self-esteem (r=-.37, p<.001), and number of social contacts (r=-.17, p=.037). Furthermore, loneliness at 24 months was associated with employment status at 24 months (X2=3.86, p=.049). To better understand the causal relationship between loneliness and employment, we plan to conduct two mixed effects linear regression models predicting loneliness at 6-, 12-, 18-, and 24-months, including baseline loneliness as a covariate and competitive work status (binary work status of yes/no at each follow-up assessment) as a time-varying covariate.

Conclusions: These results confirm associations between loneliness and other correlates of psychotic disorders previously reported in the literature, including more severe symptoms, lower quality of life and self-esteem, and more social dysfunction. While preliminary results show a possible relationship between work functioning and reduced loneliness at two years, the planned analyses will help us better understand the causal effects of employment on loneliness.

Socioeconomic Influences on Engagement in Coordinated Specialty Care: Perspectives from Publicly Insured Patients on Disengagement and Re-Engagement

Brittany M Gouse MD MPH (1), Samantha LaMartine PsyD, BreeOna Namukowa MD MPH, Amelia Blanton BS, Haniya Rizwan, Sonya Abdalla, Peggy Williams, Julia Browne PhD, Hannah E. Brown MD
WRAP Program, Boston Medical Center

Background: Despite the benefits of coordinated specialty care (CSC), 30-50% of patients drop out within two years, leading to adverse outcomes, such as unemployment, impaired functioning, and reduced quality of life. Socioenvironmental factors (e.g., urbanicity and poverty) are linked to risk for psychotic illness, and socioeconomic (SES) drift often follows illness onset. However, less is known about how patient-level SES and systems-level structural factors interact to influence CSC dropout. Further, the factors related to re-engagement in care after treatment dropout is not well understood.

Methods: We conducted 18 semi-structured interviews of publicly insured patients who engaged in CSC between 2019-2024 who had at least one 90 day gap in treatment and re-engaged in care. Semi-structured interviews explored treatment disengagement factors, with specific prompts. Analysis used an inductive thematic approach with a codebook iteratively refined from the first three transcripts. Coding was triple-checked, with discrepancies resolved by consensus. We examined themes across three phases of care: initial engagement, disengagement, and re-engagement.

Results: Seventeen initial themes were refined to 13, validated by an independent auditor. Themes varied across phases of treatment engagement. Participants often described early care as disempowering, with several feeling distrustful of providers due to “feeling like a guinea pig.” Lack of perceived need for treatment and structural barriers (e.g., transportation) were common factors related to CSC disengagement. Family, social supports, and provider rapport were pivotal for re-engagement in care. Patients suggested community-building (e.g., social gatherings), integration of spiritual leaders into care, enhanced transparency in clinical decision making as strategies to promote sustained engagement in care for their peers.

Conclusion: For individuals with psychosis, early mistrust, =dehumanizing treatment experiences, and structural barriers contribute to disengagement from care. Programs can reduce dropout by improving access, embedding trauma-informed, recovery-oriented care, and fostering consistent, supportive provider relationships to rebuild trust and sustain engagement.

Addressing risk factors for criminal legal involvement in treatment: The effects of training on state hospital clinicians’ knowledge and attitudes

Faith Scanlon PhD (1,2), Quinn Lewis BA (1,2,3), Isabella Monroe BS (1,2), Corinne Cather, PhD (1,2)
1. Massachusetts General Hospital
2. Harvard Medical School
3. Tufts University

Background: Estimates suggest that 9 to 25% of people experiencing early psychosis in the U.S. are involved in the criminal legal system (Rolin et al., 2019; Webster et al., 2024). For people with first episode psychosis (FEP), past criminal legal involvement (CLI) is predictive of future CLI (e.g., Scanlon et al., 2025) which is associated with a range of poorer outcomes including unstable housing and employment, mental illness, substance use, and suicide. It is therefore critical for clinicians working with the FEP population to have the knowledge and skills necessary to provide interventions targeting risk factors for CLI.
Methods: We delivered an 8-hour, one-day live training to 23 clinicians at Worcester Recovery Center and Hospital on a 9-session cognitive behavioral therapy-based intervention (Changing Lives and Changing Outcomes-9; CLCO-9). CLCO-9 was created for people with serious mental illness and CLI with the goal of improving illness self-management and risk factors for CLI (e.g., substance use, thoughts conducive to crime). Before and after the training, we administered self-report measures on clinicians’ knowledge of risk factors and best practices for treatment, as well as attitudes on the importance of addressing patients’ risk factors for CLI (N = 15).
Results: Paired samples t-tests showed clinicians’ knowledge of risk factors significantly increased from before to after completing the training, with a medium to large effect size (t[14] = 2.98, p = .01, d = 0.77). Similarly, clinicians’ ratings of the importance of addressing risk factors for legal involvement also significantly increased from pre- to post-training with a large effect (t[14] = 4.94, p < .001, d = 1.28).
Conclusions: Findings provide preliminary evidence that completing a training on a treatment program that targets risk factors for CLI helps clinicians develop skills to decrease the likelihood of future legal involvement and hospitalization for their patients.

Promoting Early Psychosis Identification and Psychosis-Informed Care: Characterizing the Statewide Impact of M-PATH in Massachusetts

Heather Muir, PhD (1), Emily Gagen, PhD (1,2), Rebecca Wleck, BA (1), Charlene Flynn, LMHC (1), Natalia Nodiff (1), Amanda Weber, PhD (1,2), Henry White, MD (1)
1. Brookline Center for Community Mental Health, Brookline, MA
2. Harvard Medical School Department of Psychiatry, Boston, MA

Background: The Massachusetts Strategic Plan for Early Psychosis (Mass-STEP) outlines priorities to build a high-quality system of care for people with psychosis. A key goal is to promote early identification and intervention through support for community members likely to encounter those experiencing psychosis. In alignment with this goal, the Massachusetts Psychosis Access and Triage Hub (M-PATH) was created to provide centralized triage and navigation, offering rapid consultation and support for early psychosis.

Methods: Since launching in late 2022, M-PATH has engaged almost 700 young people, families, and providers with support, education, resources, and referrals to specialized early psychosis programs. Its family partner and young adult peer mentor have drawn on lived experience to support families and youth through more than 50 sessions. M-PATH has also delivered over 100 presentations and trainings statewide to almost 3900 individuals, including to primary care and pediatric practices (with an emphasis on community health centers) and to non-behavioral health youth-facing state agencies (e.g., DCF, DYS). These efforts disseminate the principles of psychosis-informed care, which, similar to trauma-informed care, equips providers with skills, information, and confidence to discuss psychosis without requiring specialized expertise.

Results: We will present quantitative and qualitative data on M-PATH’s statewide impact since 2022. Findings include referral patterns (e.g., provider consultations, family consultations, peer mentorship, family partnership), referral sources, ages of youth served, sessions completed, response times, and organizational presentations delivered. Additionally, we will report qualitative themes of feedback from young people, families, and organizations on their experiences working with M-PATH. Finally, we will describe the principles of psychosis-informed care as well as future directions for M-PATH.

Conclusion: In under three years, M-PATH has significantly expanded access to early psychosis support by centralizing triage and navigation while promoting psychosis-informed care across diverse systems. Despite rapid growth and impact, opportunities remain for further expansion.