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ImportanceClinical trials have not established the optimal type, sequence, and duration of interventions for people at ultrahigh risk of psychosis.ObjectiveTo determine the effectiveness of a sequential and adaptive intervention strategy for individuals at ultrahigh risk of psychosis.Design, setting, and participantsThe Staged Treatment in Early Psychosis (STEP) sequential multiple assignment randomized trial took place within the clinical program at Orygen, Melbourne, Australia. Individuals aged 12 to 25 years who were seeking treatment and met criteria for ultrahigh risk of psychosis according to the Comprehensive Assessment of At-Risk Mental States were recruited between April 2016 and January 2019. Of 1343 individuals considered, 342 were recruited.InterventionsStep 1: 6 weeks of support and problem solving (SPS); step 2: 20 weeks of cognitive-behavioral case management (CBCM) vs SPS; and step 3: 26 weeks of CBCM with fluoxetine vs CBCM with placebo with an embedded fast-fail option of ω-3 fatty acids or low-dose antipsychotic medication. Individuals who did not remit progressed through these steps; those who remitted received SPS or monitoring for up to 12 months.Main outcomes and measuresGlobal Functioning: Social and Role scales (primary outcome), Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Montgomery-Åsberg Depression Rating Scale, quality of life, transition to psychosis, and remission and relapse rates.ResultsThe sample comprised 342 participants (198 female; mean [SD] age, 17.7 [3.1] years). Remission rates, reflecting sustained symptomatic and functional improvement, were 8.5%, 10.3%, and 11.4% at steps 1, 2, and 3, respectively. A total of 27.2% met remission criteria at any step. Relapse rates among those who remitted did not significantly differ between SPS and monitoring (step 1: 65.1% vs 58.3%; step 2: 37.7% vs 47.5%). There was no significant difference in functioning, symptoms, and transition rates between SPS and CBCM and between CBCM with fluoxetine and CBCM with placebo. Twelve-month transition rates to psychosis were 13.5% (entire sample), 3.3% (those who ever remitted), and 17.4% (those with no remission).Conclusions and relevanceIn this sequential multiple assignment randomized trial, transition rates to psychosis were moderate, and remission rates were lower than expected, partly reflecting the ambitious criteria set and challenges with real-world treatment fidelity and adherence. While all groups showed mild to moderate functional and symptomatic improvement, this was typically short of remission. While further adaptive trials that address these challenges are needed, findings confirm substantial and sustained morbidity and reveal relatively poor responsiveness to existing treatments.Trial registrationClinicalTrials.gov Identifier: NCT02751632.

AimResearch has shown that preventative intervention in individuals at ultra-high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive-behavioural case management and (3) antidepressant medication with an embedded fast-fail option of (4) omega-3 fatty acids or low-dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample.MethodsSTEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019.ResultsOf 1343, help-seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty-five percent of the enrolled sample had a non-psychotic DSM-5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment.DiscussionThe present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate.

AimPrevious research indicates that preventive intervention is likely to benefit patients "at risk" of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive-behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy.MethodsThis is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline.ConclusionThis paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population.

Aim: To harmonize two ascertainment and severity rating instruments commonly used for the clinical high risk syndrome for psychosis (CHR‐P): the Structured Interview for Psychosis‐risk Syndromes (SIPS) and the Comprehensive Assessment of At‐Risk Mental States (CAARMS). Methods: The initial workshop is described in the companion report from Addington et al. After the workshop, lead experts for each instrument continued harmonizing attenuated positive symptoms and criteria for psychosis and CHR‐P through an intensive series of joint videoconferences. Results: Full harmonization was achieved for attenuated positive symptom ratings and psychosis criteria, and modest harmonization for CHR‐P criteria. The semi‐structured interview, named Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS (PSYCHS), generates CHR‐P criteria and severity scores for both CAARMS and SIPS. Conclusions: Using the PSYCHS for CHR‐P ascertainment, conversion determination, and attenuated positive symptom severity rating will help in comparing findings across studies and in meta‐analyses. [ABSTRACT FROM AUTHOR]

A continuous effort within an undergraduate university setting is to improve students' learning outcomes and thus improve students' attitudes about a particular field of study. This is undoubtedly relevant within a chemistry laboratory. This paper reports the results of an effort to introduce a problem-based learning strategy into the analytical chemistry laboratory curricula at North Carolina Central University. This study involved a total of 48 science major students who were taking two analytical chemistry courses, namely Quantitative Chemical Analysis and Instrumental Analysis, spanning Fall 2011 to Spring 2015. Course-based undergraduate research experiences or CUREs have been systematically incorporated into the laboratory components of these two consecutive analytical courses in Fall 2014 and Spring 2015 semesters. Each CUREs project involved identifying a problem, locating an appropriate method via literature search, designing a study, collecting samples, measuring variables, analyzing data, and presenting the results in a formal report and an oral presentation. Our evaluation of the preliminary impacts of CUREs integration shows that the majority of students became more excited about careers in chemistry, and science in general, as an outcome of this exercise. This is evidenced by overwhelmingly positive feedback received from the student participants, as well as increased retention of upper-level science major students.

As 3D total‐body photography for the early detection of melanoma is not yet widely used in clinical practice, we do not have a full understanding of patient's concerns about use, privacy and confidentiality, and if their concerns differ depending on the use‐case. We conducted a virtual consumer forum to assess patients concerns about privacy and confidentiality in dermatology imaging for research, artificial intelligence development and for their own clinical care. [ABSTRACT FROM AUTHOR]

This study examined the association between dating violence victimization and psychosocial risk and protective factors among Latino early adolescents. An anonymous, cross-sectional, self-reported survey was administered to a convenience sample of Latino youth (n = 322) aged 11 to 13 residing in suburban Washington, D.C. The dependent variable was physical dating violence; the independent variables included violence, substance use, emotional well-being, prosocial behaviors, and parenting practices. Multivariate logistic regression models were constructed and adjusted odds ratio and 95% confidence interval were examined. Overall, 13.5% (n = 43) of Latino early adolescents reported being a victim of physical dating violence within the past year. The prevalence was 14.4% for girls and 12.9% for boys. Among the girls, binge drinking was the sole risk behavior associated with dating violence. Gun carrying, alcohol consumption, and having considered suicide were associated with dating violence among the boys. Physical dating violence appears to affect a small but significant proportion of Latino early adolescents and is associated with other risk behaviors. Healthy dating relationship programs are warranted for middle school youth with some tailoring to reflect gender differences in risk profiles. (Contains 3 tables.)

To examine the association between physical dating violence victimization and risk and protective factors, an anonymous, cross-sectional, self-reported survey was administered to Latino youth (n = 446) residing in suburban Washington, DC. Multivariate logistic regression models were constructed, and adjusted OR and 95% CI were examined. Approximately 9% of Latino adolescents reported physical dating violence victimization. Overall, youth who reported carrying a gun, involvement in physical fights and suicidal thoughts were at greater odds of reporting dating violence. Among females, fighting was the sole risk behavior associated with dating violence. Girls who reported a stronger sense of self were less likely to report dating violence. Among males, gun carrying, but not physical fighting, and having considered suicide were associated with dating violence. Spending time each week with a mentor was also positively associated with male dating violence victimization. Dating violence appeared to cluster with other risk behavior engagement. Important gender differences in associated risk and protective behaviors were identified and should be incorporated into primary and secondary prevention activities.

Explored the relationship between familial factors and behavior outcomes in Latino adolescents using a youth development framework. Surveys of 446 youth within an urban community indicated that higher levels of parental monitoring and familial connectedness consistently related to less problem behavior involvement. Sociocultural encouragement consistently associated with more prosocial behavior involvement. (SM)

Aim: Prevention and early intervention efforts of serious mental illnesses has yielded promising results. However, alongside benefits, several ethical concerns have been raised, including the effects of being identified as being at‐risk. In these debates, the voice of parents or carers is conspicuously absent. This is especially concerning as several at‐risk interventions are trialled in under‐age youth where parents consent on behalf of young people. Therefore, this study aimed to understand carer's experiences of their teenager being identified as at risk for psychosis. Methods: Semi‐structured interviews were conducted with seven carers who had provided consent for their teenager to participate in a stepped intervention study for youth at‐risk for psychosis. Questions explored their experiences regarding having their teenager being identified as at‐risk. Transcripts were analysed using thematic analysis. Results: We identified five main themes from seven female carers' experiences of risk identification including: (a) recall of risk information was limited, or variable, (b) goal of risk disclosure was perceived to be positive, (c) negative emotions were associated with knowledge of risk, (d) relief from uncertainty and helplessness and (e) effects of risk disclosure were mediated by individual circumstance. Conclusion: Overall, the results demonstrate that carers' experience of risk disclosure varied with factors surrounding their individual circumstances, and the process of disclosure. Whilst participants acknowledged potential adverse effects associated with risk disclosure, many still adopted a positive outlook. Tailoring safe and effective disclosure of risk to suit the needs of youth and carers could outweigh the potential risks. [ABSTRACT FROM AUTHOR]

Background: No biological treatment has been firmly established for the at‐risk stage of psychotic disorder. In this study we aim to test if subthreshold psychotic symptoms can be effectively treated with cannabidiol (CBD), a non‐psychoactive compound of the plant Cannabis sativa. The question has taken on increased importance in the wake of evidence questioning both the need and efficacy of specific pharmacological interventions in the ultra‐high risk (UHR) for psychosis group. Methods: Three‐arm randomized controlled trial of 405 patients (135 per arm) aged 12–25 years who meet UHR for psychosis criteria. The study includes a 6‐week lead‐in phase during which 10% of UHR individuals are expected to experience symptom remission. Participants will receive CBD (per oral) at doses 600 or 1000 mg per day (fixed schedule) for 12 weeks. Participants in the third arm of the trial will receive matching placebo capsules. Primary outcome is severity of positive psychotic symptoms as measured by the Comprehensive Assessment of At‐Risk Mental States at 12 weeks. We hypothesize that CBD will be significantly more effective than placebo in improving positive psychotic symptoms in UHR patients. All participants will also be followed up 6 months post baseline to evaluate if treatment effects are sustained. Conclusion: This paper reports on the rationale and protocol of the Cannabidiol for At Risk for psychosis Youth (CanARY) study. This study will test CBD for the first time in the UHR phase of psychotic disorder. [ABSTRACT FROM AUTHOR]

To examine the association between physical dating violence victimization and risk and protective factors, an anonymous, cross-sectional, self-reported survey was administered to Latino youth (n = 446) residing in suburban Washington, DC. Multivariate logistic regression models were constructed, and adjusted OR and 95% CI were examined. Approximately 9% of Latino adolescents reported physical dating violence victimization. Overall, youth who reported carrying a gun, involvement in physical fights and suicidal thoughts were at greater odds of reporting dating violence. Among females, fighting was the sole risk behavior associated with dating violence. Girls who reported a stronger sense of self were less likely to report dating violence. Among males, gun carrying, but not physical fighting, and having considered suicide were associated with dating violence. Spending time each week with a mentor was also positively associated with male dating violence victimization. Dating violence appeared to cluster with other risk behavior engagement. Important gender differences in associated risk and protective behaviors were identified and should be incorporated into primary and secondary prevention activities., A growing literature attests to the fact that dating violence is an important public health problem (Howard & Wang, 2003a,b; Silverman, Raj, Mucci, & Hathaway, 2001; U.S. Department of Health [...]