The Journal of clinical psychiatry
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The US Food and Drug Administration warnings that psychotropic medications may increase the risk of suicidality have generated concern about prescribing these agents to patients with psychiatric disorders, many of whom are already at increased risk for suicide. To effectively prevent suicidal behaviors and suicide in clinical practice, clinicians must understand the dangers and benefits associated with psychotropic medications. In addition, they must learn how to identify and manage suicidal risk during treatment.
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To investigate the outcome of subjects with major depressive disorder after serious suicide attempt and to examine the effect of psychotic symptoms on their outcome. ⋯ Psychotic symptoms during major depressive episode increase the risk of completed suicide after serious suicide attempt. The quality of treatment for major depression with psychotic features after attempted suicide should be improved to prevent suicide.
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The American Board of Medical Specialties (ABMS) developed 6 core competencies for physicians of all specialties and a maintenance of certification (MOC) program for board-certified physicians. The MOC program incorporates the 6 competencies into 4 component areas: professional standing, self-assessment and lifelong learning, cognitive expertise, and performance in practice. These 4 components are designed to promote a cycle of lifelong learning, self-assessment and peer review, and incorporation of best practices in order to improve the quality of health care in clinical practice. The American Board of Psychiatry and Neurology is a member board of the ABMS and has adapted the competencies and MOC requirements for psychiatrists and neurologists.
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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.