The Journal of clinical psychiatry
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Review
Intervention in individuals at ultra-high risk for psychosis: a review and future directions.
Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initially, the early psychosis movement focused on timely recognition and phase-specific treatment of first-episode psychosis. However, early psychosis researchers suspected that pushing the point of intervention even further back to the prodromal phase of psychotic disorders may result in even better outcomes. This article reviews intervention research in the ultra-high-risk phase of psychotic disorders. ⋯ Further controlled intervention trials with larger sample sizes are required in order to confirm and extend these findings. We argue that the clinical staging model provides a framework for the rationale and design of such studies, with simpler, safer, and more benign interventions being better candidates for first-line treatment, while more complex and potentially harmful treatments should be reserved for those cases in which response has failed to occur. Recent evidence indicates that neuroprotective agents, such as essential fatty acids, may be a suitable form of intervention for the ultra-high-risk phase of psychotic disorders, with a positive risk-benefit balance. Ethical aspects have become more salient given the recently observed declining transition rate in ultra-high-risk samples. We outline the key questions for the next generation of ultra-high-risk intervention trials.
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Comparative Study
Relations among psychopathology, substance use, and physical pain experiences in methadone-maintained patients.
Differences in psychiatric distress and substance use (licit and illicit) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. ⋯ Pain-related differences in psychiatric problems exist in MMT patients and may have implications for program planning and outreach efforts.
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Comparative Study
Association between number of deployments to Iraq and mental health screening outcomes in US Army soldiers.
High rates of mental health concerns have been documented in US Army soldiers deployed in support of Operation Iraqi Freedom. The goal of this study was to compare the postdeployment mental health screening results of US Army soldiers with 1 or 2 deployments to Iraq. ⋯ These results provide preliminary evidence that multiple deployments to Iraq may be a risk factor for PTSD. However, these cross-sectional data require replication in a longitudinal study.