Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness.

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Out of fright, out of mind: impaired memory for information negated during looming threat.

People often need to update representations of information upon discovering them to be incorrect, a process that can be interrupted by competing cognitive demands. Because anxiety and stress can impair cognitive performance, we tested whether looming threat can similarly interfere with the process of updating representations of a statement's truthfulness. On each trial, participants saw a face paired with a personality descriptor. Each pairing was followed by a signal indicating whether the pairing was "true", or "false" (a negation of the truth of the statement), and this signal could be followed by a warning of imminent electric shock (i.e., the looming threat). As predicted, threat of shock left memory for "true" pairings intact, while impairing people's ability to label negated pairings as untrue. Contrary to our predictions, the pattern of errors for pairings that were negated under threat suggested that these mistakes were at least partly attributable to participants forgetting that they saw the negated information at all (rather than being driven by miscategorization of the pairings as true). Consistent with this, linear ballistic accumulator modelling suggested that this impaired recognition stemmed from weaker memory traces rather than decisional processes. We suggest that arousal due to looming threat may interfere with executive processes important for resolving competition between mutually suppressive tags of whether representations in memory are "true" or "false".