Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes.

OBJECTIVE: The purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. METHODS: This study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. RESULTS: There was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. CONCLUSION: This sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.

A Pilot Randomised Control Trial Exploring the Feasibility and Acceptability of Delivering a Personalised Modular Psychological Intervention for Anxiety Experienced by Autistic Adults: Personalised Anxiety Treatment-Autism (PAT-A).

Anxiety is commonly experienced by autistic people and impacts on quality of life and social participation. New anxiety interventions are required to effectively meet the needs of autistic people. Personalised Anxiety Treatment-Autism (PAT-A©) is a bespoke, modular approach to treating anxiety in up to 12 sessions. This study explored the feasibility and acceptability of delivering PAT-A© in the UK National Health Service (NHS). A single-blind randomised controlled trial design. Thirty-four autistic adults were recruited via clinical services and randomised to receive either PAT-A© or enhanced treatment as usual (CCSP). Outcome assessments relating to anxiety, quality of life and related constructs were completed at baseline, immediately post intervention; and at 3 and 12 months. Seventy-one percent of the PAT-A© group and 65% of the CCSP met diagnostic threshold for at least three anxiety disorders. Retention was good across both groups, with 82% (N = 14/17) completing the full course of PAT-A© and 71% (N = 12/17) attending both psychoeducational sessions in CCSP. 94% in PAT-A© and 82% in CCSP completed some follow up assessment 3 months post-intervention. Thematic analysis of interview data revealed that many participants valued the personalised approach, developed transferable skills and experienced positive changes to their anxiety. Participants were willing to be recruited and randomised, PAT-A© was feasible to deliver in the NHS and the trial methods and materials were acceptable. Our findings indicate that a fully powered clinical and cost-effectiveness trial of PAT-A© is warranted.

Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment-Autism (PAT-A©) pilot randomised controlled feasibility trial.

BACKGROUND: Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. METHODS/DESIGN: This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. DISCUSSION: This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people. TRIAL REGISTRATION: ISRCTN, ID: 15881562. Retrospectively registered on 9 August 2019.

THE INFLUENCE OF HIP JOINT ANGLE ON THE RATIO BETWEEN ADDUCTION AND ABDUCTION TORQUE IN EXPERIENCED, RECREATIONAL MALE ICE HOCKEY PLAYERS.

BACKGROUND: Strains of the adductor muscle group of the hip are common amongst ice hockey players. The ratio of isometric strengths between the hip adductors and abductors has been offered as a risk factor for hip adductor strain; however, there is no description for how the ratio between hip adductor and abductor strength varies as a function of hip abduction angle. HYPOTHESIS/PURPOSE: The aim of this study was to determine the influence of hip joint abduction angle on measured ratios of hip adduction to abduction torque in experienced, recreational, male hockey players. The primary null hypothesis for this study was that hip joint abduction angle would not influence hip adduction-to-abduction torque ratios in male hockey players. STUDY DESIGN: Counterbalanced observational cohort. METHODS: Twelve uninjured, male, recreational hockey players, with a minimum experience level of midget AAA/minor competitive or equivalent. Participants performed maximal isometric side-lying hip adduction and abduction exertions against a rigidly constrained load cell at 0, 10, and 20 degrees of hip abduction. Measured peak torques from each exertion were used to derive the hip adductor-to-abductor torque ratio. Kinematics of the trunk, pelvis, and lower limbs were monitored using an optoelectronic motion capture system. RESULTS: Adductor-to-abductor torque ratio increased from 1.49 (SD = 0.20), to 1.92 (SD = 0.20) and to 2.30 (SD = 0.54) with successively increasing hip abduction angle (p < 0.001). Peak torque was significantly different between all angles (p ≤ 0.016) except between adduction exertions performed at 10 and 20 degrees of abduction (p = 0.895). Small changes in hip angle during the exertion were coincident with exertion direction, which confirmed the isometric nature of the task. CONCLUSION: Hip abduction angle has a significant impact on the measured adductor-to-abductor torque ratio. The ratio increased due to a combination of increased adductor torque and decreased abductor torque as the hip abduction angle increased. LEVEL OF EVIDENCE: 2b.

What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study.

OBJECTIVES: To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service. SETTING: Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD). PARTICIPANTS: Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD. PRIMARY OUTCOME MEASURE: Antidepressant prescription rates per month per 100 000 depressed 4-17 year olds. RESULTS: Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (ß for change in trend -12.34 (95% CI -18.67 to -6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (ß for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low. CONCLUSIONS: Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.

T vector velocity: A new ECG biomarker for identifying drug effects on cardiac ventricular repolarization.

BACKGROUND: We present a new family of ECG biomarkers for assessing drug effects on ventricular repolarization. We show that drugs blocking inward (depolarizing) ion currents cause a relative increase of the T vector velocity (TVV) and accelerate repolarization, while drugs blocking outward ion currents cause a relative decrease of the TVV and delay repolarization. The results suggest a link between the TVV and the instantaneous change of the cellular action potentials that may contribute to bridge the gap between the surface ECG and myocardial cellular processes. METHODS: We measure TVV as the time required to reach X% of the total Trajectory length of the T vector loop, denoted as TrX. Applied to data from two FDA funded studies (22+22 subjects, 5232+4208 ECGs) which target ECG effects of various ion-channel blocking drugs, the TrX effect profiles indicate increasingly delayed electrical activity over the entire repolarization process for drugs solely reducing outward potassium current (dofetilide, moxifloxacin). For drugs eliciting block of the inward sodium or calcium currents (mexiletine, lidocaine), the TrX effect profiles were consistent with accelerated electrical activity in the initial repolarization phase. For multichannel blocking drugs (ranolazine) or drug combinations blocking multiple ion currents (dofetilide + mexiletine, dofetilide + lidocaine), the overall TrX effect profiles indicate a superposition of the individual TrX effect profiles. RESULTS: The parameter Tr40c differentiates pure potassium channel blocking drugs from multichannel blocking drugs with an area under the ROC curve (AUC) of 0.90, CI = [0.88 to 0.92]. This is significantly better than the performance of J-Tpeakc (0.81, CI = [0.78 to 0.84]) identified as the best parameter in the second FDA study. Combining the ten parameters Tr10c to Tr100c in a logistic regression model further improved the AUC to 0.94, CI = [0.92 to 0.96]. CONCLUSIONS: TVV analysis substantially improves assessment of drug effects on cardiac repolarization, providing a plausible and improved mechanistic link between drug effects on ionic currents and overall ventricular repolarization reflected in the body surface ECG. TVV contributes to an enhanced appraisal of the proarrhythmic risk of drugs beyond QTc prolongation and J-Tpeakc.

Teachers' perceptions of Restricted and Repetitive Behaviours (RRBs) in children with ASD: Attributions, confidence and emotional response.

BACKGROUND: Restricted and Repetitive Behaviours (RRBs) are some of the most difficult behaviours to manage in children with Autism Spectrum Disorders (ASD). Although RRBs frequently occur in educational settings, we know little about the way in which teachers understand these behaviours. AIMS: The study aimed to explore the attributions, emotional response and feelings of confidence held by teachers working in different educational settings when faced with RRBs. METHODS AND PROCEDURES: A single group survey design using behavioural vignettes was adopted in order to elicit teacher beliefs and ratings. OUTCOMES AND RESULTS: Analysis indicated that there were differences in the attributions and confidence ratings held for different types of RRBs. Significant differences were also observed between teachers working in mainstream and specialist educational settings. Emotional response and confidence scores were often predictive of one another alongside factors related to teaching experience. CONCLUSION AND IMPLICATIONS: The findings indicate that teachers from mainstream schools potentially hold less helpful beliefs in response to RRBs and therefore are a professional group who may benefit the most from additional support and training. Further research could consider conducting a qualitative exploration of why teachers hold certain beliefs about RRBs and/or sampling those who are less experienced in working with children with ASD.

Tendon neuroplastic training for lateral elbow tendinopathy: 2 case reports.

OBJECTIVE: To report 2 cases of lateral elbow tendinopathy treated with a novel adaptation of tendon neuroplastic training (TNT). CLINICAL FEATURES: Patient 1: A 61-year-old male machine operator presented with one year of bilateral lateral elbow pain related to his occupation of using torque wrenches.Patient 2: A 37-year-old male electrician presented with two months of recurrent left lateral elbow pain related to repetitive motions of gripping and pulling at work. INTERVENTION AND OUTCOME: Both patients underwent 8 weeks of a novel rehabilitation program, including TNT, which involved pacing their resistance exercises to a metronome. Both patients experienced clinically meaningful improvements in pain and functional outcome scores that were sustained at the 3-month follow-up. SUMMARY: Recent evidence suggests that the central nervous system may play a role in chronic tendinopathies. It is possible that TNT may address the central nervous system component of chronic/recurrent tendinopathy that is not addressed by traditional passive therapies. However, further research is needed.

OBJECTIF: Présenter 2 cas de tendinopathie latérale du coude traitée par un nouveau type d'entraînement neuroplastique tendineux (ENT). CARACTÉRISTIQUES CLINIQUES: Patient 1: Un opérateur de machines de 61 ans se plaignait d'une douleur latérale aux deux coudes, apparue il y a un an, et qui était liée à l'utilisation de clés dynamométriques sur les lieux de travail.Patient 2: Un électricien de 37 ans se plaignait d'une douleur latérale récurrente au coude gauche, qui était apparue il y a deux mois et qui était reliée à des mouvements répétitifs de serrage et de traction effectués au travail. INTERVENTION ET RÉSULTAT: Les deux patients ont suivi un nouveau type de programme de rééducation, d'une durée de 8 semaines, y compris un ENT, qui consistait à exécuter des exercices de résistance avec un métronome. Les deux patients ont éprouvé un soulagement cliniquement significatif de la douleur et les scores obtenus sur l'échelle d'évaluation des capacités fonctionnelles se sont maintenus durant le suivi de 3 mois. RÉSUMÉ: Des preuves récentes semblent indiquer que le système nerveux central pourrait jouer un rôle dans les tendinopathies chroniques. L'ENT pourrait permettre d'intervenir sur la composante neurologique des tendinopathies chroniques ou récurrentes associée au système nerveux central, alors que les traitements passifs classiques ne le permettent pas. Mais d'autres travaux de recherche pourraient s'avérer nécessaires.

Personalized Medication Response Prediction for Attention-Deficit Hyperactivity Disorder: Learning in the Model Space vs. Learning in the Data Space.

Attention-Deficit Hyperactive Disorder (ADHD) is one of the most common mental health disorders amongst school-aged children with an estimated prevalence of 5% in the global population (American Psychiatric Association, 2013). Stimulants, particularly methylphenidate (MPH), are the first-line option in the treatment of ADHD (Reeves and Schweitzer, 2004; Dopheide and Pliszka, 2009) and are prescribed to an increasing number of children and adolescents in the US and the UK every year (Safer et al., 1996; McCarthy et al., 2009), though recent studies suggest that this is tailing off, e.g., Holden et al. (2013). Around 70% of children demonstrate a clinically significant treatment response to stimulant medication (Spencer et al., 1996; Schachter et al., 2001; Swanson et al., 2001; Barbaresi et al., 2006). However, it is unclear which patient characteristics may moderate treatment effectiveness. As such, most existing research has focused on investigating univariate or multivariate correlations between a set of patient characteristics and the treatment outcome, with respect to dosage of one or several types of medication. The results of such studies are often contradictory and inconclusive due to a combination of small sample sizes, low-quality data, or a lack of available information on covariates. In this paper, feature extraction techniques such as latent trait analysis were applied to reduce the dimension of on a large dataset of patient characteristics, including the responses to symptom-based questionnaires, developmental health factors, demographic variables such as age and gender, and socioeconomic factors such as parental income. We introduce a Bayesian modeling approach in a "learning in the model space" framework that combines existing knowledge in the literature on factors that may potentially affect treatment response, with constraints imposed by a treatment response model. The model is personalized such that the variability among subjects is accounted for by a set of subject-specific parameters. For remission classification, this approach compares favorably with conventional methods such as support vector machines and mixed effect models on a range of performance measures. For instance, the proposed approach achieved an area under receiver operator characteristic curve of 82-84%, compared to 75-77% obtained from conventional regression or machine learning ("learning in the data space") methods.

Mallards (Anas platyrhynchos) and wastewater ponds, Part I: Mallard ducks overwintering at a northern wastewater treatment pond.

In northern urban areas, wastewater treatment ponds (WWTPs) may provide a thermal refuge during winter (~10°C) that is used by normally migratory mallards (Anas platyrhynchos). On the ponds, mallards may experience stress due to crowding, or through the ingestion of WWTP water, be exposed to a diverse array of synthetic chemicals, which may have adverse health effects. Photographic sampling was used to assess mallard sex ratios and behavioural patterns throughout the late winter on wastewater ponds in Edmonton, Canada. The WWTP mallard population was large (>1000 birds), but temporally variable and consistently male-dominated. Locomotion and dabbling were the primary behaviors observed; aggression was rarely observed, which suggests crowding stress was low or absent. Mallard abundance tended to be higher at lower air temperatures, suggesting that WWTP ponds acted as a thermal refuge. Stable isotope analysis of carbon and nitrogen from duck feces and potential food sources indicated that mallards were not feeding at the site, or on invertebrates or select waste grain from offsite. Rather, ducks either consumed an undetermined food source or were feeding very little. Taken together, the data suggest that winter use of northern WWTP ponds may serve as an alternative to migration, whether this strategy benefits or harms mallards likely depends on winter severity, and not on WWTP pond characteristics or water quality.

Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report.

Axillary Web Syndrome (AWS), also known as lymphatic cording, refers to a condition in which a rope-like soft-tissue density develops in the axilla. It usually appears in the 5 to 8 week period following breast cancer surgery and can lead to shoulder pain and restricted motion. We present a case of AWS in a male squash player with no history of breast cancer or surgery following a period of intense exercise. This case highlights the rare presentation of AWS in a male patient and raises awareness for the health care practitioner who may not suspect this condition in this population.

Le syndrome des cordelettes axillaires (AWS), également connu sous le nom de thromboses lymphatiques, se réfère à une condition dans laquelle des tissus mous denses comme une corde se forment dans la région de l'aisselle. Ceci apparaît généralement dans 5 à 8 semaines après une chirurgie du cancer du sein et peut entraîner des douleurs à l'épaule et limiter les mouvements. Nous présentons un cas d'AWS chez un joueur masculin de squash, sans antécédents de cancer du sein ou de chirurgie du sein, après une période intense d'exercice. Ce cas met en évidence la rare présentation de l'AWS chez un patient masculin et sert à sensibiliser le professionnel de la santé qui ne pourrait pas soupçonner cette condition chez cette population.

Delayed diagnosis of an isolated posterolateral corner injury: a case report.

INTRODUCTION: Isolated injuries to the posterolateral corner of the knee are a rare and commonly missed injury associated with athletic trauma, motor vehicle accidents, and falls. Delayed or missed diagnoses can negatively impact patient prognosis, contributing to residual instability, chronic pain, and failure of surgical repair to other ligaments. CASE PRESENTATION: A 44-year-old male CrossFit athlete presented with a history of two non-contact hyperextension injuries to his left knee while walking on ice. The only positive finding was the Dial Test at 30 degrees of knee flexion, indicative of an isolated posterolateral corner injury. After a delay in diagnosis, the patient underwent a reconstruction of the posterolateral corner and subsequent rehabilitation. Early recognition of this injury is important as this can affect the prognosis and activities of daily living of the patient. SUMMARY: This case will discuss the clinical presentation, diagnostic procedures, and management of an isolated posterolateral corner injury and highlight the importance of early recognition and referrals from primary contact healthcare practitioners.

INTRODUCTION: Les lésions isolées du point d'angle postéro-externe du genou sont une blessure rare et fréquemment manquée associée à un traumatisme sportif, à des accidents de véhicule automobile et à des chutes. Les diagnostics tardifs ou ambigus peuvent avoir un impact négatif sur le pronostic du patient, ce qui contribue à l'instabilité résiduelle, à la douleur chronique et à l'échec de la réparation chirurgicale à d'autres ligaments. EXPOSÉ DE CAS: Un athlète CrossFit masculin de 44 ans s'est présenté avec deux lésions d'hyperextension sans contact de son genou gauche qui se sont produites alors qu'il marchait sur la glace. Le seul résultat positif a été le test d'hypermobilité externe (Dial test) à 30 degrés de flexion du genou, indiquant une lésion isolée du point d'angle postéro-externe. Après un retard dans le diagnostic, le patient a subi une reconstruction du point d'angle postéro-externe et une réadaptation subséquente. Le diagnostic précoce de cette lésion est important, car cela peut affecter le pronostic et les activités de la vie quotidienne du patient. RÉSUMÉ: Ce cas traitera du tableau clinique, des procédures diagnostiques et de la prise en charge d'une lésion isolée du point d'angle postéro-externe et soulignera l'importance du diagnostic précoce et des références des professionnels de soins de santé primaires.

Behavioural activation therapy for adolescents 'at risk' for psychosis?

The following hypothesis explores the possibility of using behavioural activation therapy for adolescents with an at-risk mental state for psychosis. Support is drawn from psychosis-related survey and pilot data as well as a robust evidence base for adult depression. However, we acknowledge that extensive feasibility work is required before exploring this hypothesis further.

Getting it right! Enhancing youth involvement in mental health research.

BACKGROUND: Few studies relating to youth mental health have actively involved young people in the design and conduct of research. AIMS: This qualitative study explores the perceptions of young people about involving them in mental health research. METHOD: An opportunistic sample of eight young people (aged 14-24 years) from non-statutory mental health organizations was interviewed. Interviews were transcribed verbatim, and inductive thematic analysis was conducted. RESULTS: Six key themes emerged reflecting a desire for young people to have the opportunity to actively contribute to every stage of the research process. Meaningful research involvement was perceived as offering opportunities to develop personal skills, contribute to making a difference and ensuring research projects were more relevant. CONCLUSIONS: Young people with an active interest in mental health promotion demonstrate a desire to be involved in research with training in research methods likely to facilitate this process. Researchers need training on how best to actively and meaningfully involve young people in mental health research.

The simultaneous presence of a bicarotid trunk and a retroesophageal right subclavian artery: a case report with clinical impact

Many variations exist in the branching pattern of the aortic arch. One variation exists in which there is a common origin of the carotid arteries, known as a bicarotid trunk, coexisting with a retroesophageal right subclavian artery. This anomaly is associated with a right non-recurrent laryngeal nerve. Aortic arch anomalies are clinically applicable to the fields of anatomy, radiology, general medical practice, as well as thoracic and cardiovascular surgery. Here, we report a case of an uncommon branching pattern of the aortic arch identified during anatomical dissection and supported by ante-mortem diagnostic imaging. The anatomical variant was discovered in an 89-year-old Caucasian male during a routine anatomical dissection and was characterized by a bicarotid arterial trunk, left subclavian artery, followed by a retroesophageal right subclavian artery. Additionally, a right non-recurrent inferior laryngeal nerve was present. In the absence of clinical symptoms, the relevance of this variant is most evident in the case of cardiovascular or laryngeal surgeries. With advanced imaging such as CT and MRI, this type of vascular anomaly should be properly identified and described. The variation presented has particular interest to general practitioners, radiologists, and cardiovascular and thoracic surgeons

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Youth Speak: increasing engagement of young people in mental health research.

BACKGROUND: Patient and Public Involvement is now an essential part of health-related research. Evidence suggests that research that involves patients and members of the public can enhance methodological rigor and facilitate the implementation of research findings. AIMS: Our paper describes the development of a youth research group (Youth Speak) aimed at increasing youth engagement in mental health research. METHOD: We provide a selective review of the literature and outline the challenges and benefits of involving young people in research. Examples of how our group has facilitated involvement and the challenges we have encountered are also discussed. RESULTS: Meaningful involvement of young people in mental health research is poorly documented or significantly lacking given the dearth of published literature. This may reflect the difficulty of obtaining sustained funding which is required to facilitate non-tokenistic involvement or a perception that young people are unable to provide meaningful contributions in this area. CONCLUSIONS: By establishing groups such as Youth Speak, which focus on the long-term involvement and development of young people in all stages of the research process, we hope to empower young people so that they can reshape youth mental health services.

Adolescent family perceptions in the At-Risk Mental State for psychosis.

AIM: There is a long-standing interest in the relationship between patients affected by psychosis and their families. Previous research also suggests that perceived family dysfunction is a factor commonly associated with psychological problems in adolescence. The current study examined the role of self-reported family perceptions in the context of adolescents with an At-Risk Mental State (ARMS) for psychosis. METHODS: Family perceptions were obtained using the Family Perceptions Scale (FPS) and compared across three groups; an ARMS for psychosis group (n = 44), a first-episode affective/non-affective psychosis group (n = 26) and a control group (n = 140) drawn from a community population. RESULTS: Scores on the FPS Expressed Emotion subscale were significantly higher in the psychosis and ARMS groups, compared to controls (P = 0.039 and P = 0.041, respectively). In contrast, participants in the ARMS group reported poorer perceived problem solving and lower levels of nurturing behaviour in their families compared to controls (P = 0.032 and P = 0.027). Overall, family perceptions were not related to symptom severity in both the ARMS and psychosis groups (except for manic symptomatology and Expressed Emotion). CONCLUSIONS: These findings highlight that ARMS patients are likely to report higher levels of perceived family dysfunction compared to a community sample of young people. However, the mechanisms by which family perceptions may contribute to the development of distressing psychotic symptoms remain unclear and require further study. Family work, with a focus upon improving perceived expressed emotion, nurturing behaviours and hostility may at this stage represent a feasible adjunct therapy for those with ARMS.

The 'at-risk mental state' for psychosis in adolescents: clinical presentation, transition and remission.

Despite increased efforts over the last decade to prospectively identify individuals at ultra-high risk of developing a psychotic illness, limited attention has been specifically directed towards adolescent populations (<18 years). In order to evaluate how those under 18 fulfilling the operationalised criteria for an At-Risk Mental State (ARMS) present and fare over time, we conducted an observational study. Participants (N = 30) generally reported a high degree of functional disability and frequent and distressing perceptual disturbance, mainly in the form of auditory hallucinations. Seventy percent (21/30) were found to fulfil the criteria for a co-morbid ICD-10 listed mental health disorder, with mood (affective; 13/30) disorders being most prevalent. Overall transition rates to psychosis were low at 24 months follow-up (2/28; 7.1 %) whilst many participants demonstrated a significant reduction in psychotic-like symptoms. The generalisation of these findings may be limited due to the small sample size and require replication in a larger sample.

Assessing adolescent preference in the treatment of first-episode psychosis and psychosis risk.

AIM: The objective of this study was to investigate the treatment preferences of adolescents with a first-episode psychosis (FEP) or at-risk mental state (ARMS) for psychosis. METHODS: A questionnaire was distributed to all adolescents (12-18 years) within an early intervention in psychosis service based in North-East England, during a 3-month period. RESULTS: Forty eligible young people responded (53% response rate). The majority of FEP and ARMS participants endorsed psychoeducational material as the most popular treatment choice (36/40; 90%) from the interventions described. Participants with FEP indicated a significant preference for using antipsychotic medications over their ARMS counterparts (75% vs. 25%). CONCLUSIONS: These findings support the use of psychoeducational interventions (both groups) and antipsychotic medication in adolescent FEP (as opposed to ARMS) patient groups, albeit in a small sample requiring replication. This study indicates that the generation of future treatment guidelines and the allocation of clinical resources should be informed by patient preference where possible.