Family-Focused Treatment for Adolescents and Young Adults at High Risk for Psychosis: Results of a Randomized Trial

Objective: Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk. Method: Adolescents and young adults (mean age 17.4 +/- 4.1 years) with attenuated positive psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]. FFT-CHR included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning. Results: Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC (F-1,F-97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR, whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy. Conclusion: Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis. Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency. Clinical trial registration information-Prevention Trial of Family Focused Treatment in Youth at Risk for Psychosis

The scientific foundations and associated injury risks of early soccer specialisation

Early specialisation is characterised by formal participation in a single sport at the exclusion of others. Limited data are available to support this approach in the development of soccer players who attain elite status later in life. Of growing concern is the associated increased risk of injury and suggestions that single sport specialisation is a risk factor independent of age, growth, biological maturation and training volumes In the United Kingdom, elite soccer organisations have recently adopted an early sport specialisation approach following the introduction of the Elite Player Performance Plan. A key tenet of this programme is increased opportunities for training through a marked rise in the specified on-pitch hours per week. The accumulation of high training hours may be less of a relevant marker for success, and the impact of such a significant increase in training volume for young athletes who are experiencing a range of growth and maturational processes is currently unknown. This critical commentary includes an evidence based discussion of the effectiveness of early sport specialisation and the potential injury risks associated with such programmes placing a specific focus on elite male youth soccer players. Available data indicate that modifications to the existing EPPP framework could enhance player development and reduce injury risk. Proposed alterations include reduced volume of soccer specific training at key stages of growth and maturation and guidelines for the provision of a greater variety of physical activities that are integrated within other programme components

A Thousand Contradictory Ways: Addiction, Neuroscience, and Expert Autobiography

Neuroscientific accounts of addiction are increasingly influential in health and medical circles. At the same time a diverse, if equally scientifically focused, opposition to addiction neuroscience is emerging. In this struggle over the merits of addiction neuroscience are elements of a uniquely 21st-century public engagement with science. No longer trusted by the public as the unerring source of objective knowledge about the world, science is, at least in some contexts, increasingly treated as just one voice among many. Observing the difficulties this loss of faith in science poses for effective action on pressing issues such as climate change, philosopher Bruno Latour develops a different (ecological) approach to scientific knowledge, one that for the first time allows scientists (and other “moderns”) to understand it for what it really is and locate it “diplomatically” alongside other modes of knowing. In this article, I ask whether a similar innovation is needed to allow more effective understanding of addiction. I explore this question by analyzing two recent, widely discussed, popular books (Marc Lewis’s Memoirs of an Addicted Brain: A Neuroscientist Examines His Former Life on Drugs, 2011 and Carl Hart’s High Price: A Neuroscientist’s Journey of Self-discovery that Challenges Everything You Think You Know About Drugs and Society, 2013) as well as reviews of these books. Written by neuroscientists, and drawing heavily on personal memoir to illustrate and ratify their competing views on drugs and addiction, both books crystallize contemporary dilemmas about science, empiricism, and the nature of evidence and truth. How are we to understand their mix of “scientific fact” and individual self-observation, what does this mix suggest about scientific knowledge, and what are its implications for dominant notions of “evidence-based” drug policy and treatment? I argue that these books both trouble and reinforce our taken-for-granted distinctions between science and personal stories, between objectivity and subjectivity, and note the lost opportunities the books represent for a more searching and productive (Latour might say “ecological”) engagement with science

Sourcing illegal drugs as a hidden older user: the ideal of ‘social supply’

Aims: At a time of growing awareness regarding the non-commercial supply of illegal drugs between friends, this article explores the significance of so-called ‘social supply’ for a group of ‘hidden’ users of illegal drugs aged 40 and over. Methodology: Semi-structured interviews were conducted with 30 users of illegal drugs aged 40 and over who were not in contact with the criminal justice system or treatment agencies regarding their use. Participants were recruited using snowball sampling. Findings: Accessing drugs through the commercial market was considered as a less attractive proposition than social supply by the participants. The majority used only socially supplied drugs, with some engaging commercial dealers when socially supplied product was unavailable. A handful sourced drugs exclusively through the commercial market. Some were home growers of cannabis, and a small number had drifted into social supply themselves. Conclusions: Social supply was seen in a far more favourable light than commercial transactions by our participants, and acted as an ideal against which all other acts of sourcing were compared. Moreover, social supply was often an integral facet of the drug using experience and served to validate and enhance that experience. The relatively benign, non-predatory nature of the social supply engaged in by the participants lends support to calls for some reform of the offence of supply in UK law

Childhood trauma and cognitive functioning in individuals at clinical high risk (CHR) for psychosis

Evidence suggests that early trauma may have a negative effect on cognitive functioning in individuals with psychosis, yet the relationship between childhood trauma and cognition among those at clinical high risk (CHR) for psychosis remains unexplored. Our sample consisted of 626 CHR children and 279 healthy controls who were recruited as part of the North American Prodrome Longitudinal Study 2. Childhood trauma up to the age of 16 (psychological, physical, and sexual abuse, emotional neglect, and bullying) was assessed by using the Childhood Trauma and Abuse Scale. Multiple domains of cognition were measured at baseline and at the time of psychosis conversion, using standardized assessments. In the CHR group, there was a trend for better performance in individuals who reported a history of multiple types of childhood trauma compared with those with no/one type of trauma (Cohen d = 0.16). A history of multiple trauma types was not associated with greater cognitive change in CHR converters over time. Our findings tentatively suggest there may be different mechanisms that lead to CHR states. Individuals who are at clinical high risk who have experienced multiple types of childhood trauma may have more typically developing premorbid cognitive functioning than those who reported minimal trauma do. Further research is needed to unravel the complexity of factors underlying the development of at-risk states

Potentially important periods of change in the development of social and role functioning in youth at clinical high risk for psychosis

The developmental course of daily functioning prior to first psychosis-onset remains poorly understood. This study explored age-related periods of change in social and role functioning. The longitudinal study included youth (aged 12-23, mean follow-up years = 1.19) at clinical high risk (CHR) for psychosis (converters [CHR-C], n = 83; nonconverters [CHR-NC], n = 275) and a healthy control group (n = 164). Mixed-model analyses were performed to determine age-related differences in social and role functioning. We limited our analyses to functioning before psychosis conversion; thus, data of CHR-C participants gathered after psychosis onset were excluded. In controls, social and role functioning improved over time. From at least age 12, functioning in CHR was poorer than in controls, and this lag persisted over time. Between ages 15 and 18, social functioning in CHR-C stagnated and diverged from that of CHR-NC, who continued to improve (p =.001). Subsequently, CHR-C lagged behind in improvement between ages 21 and 23, further distinguishing them from CHR-NC (p <.001). A similar period of stagnation was apparent for role functioning, but to a lesser extent (p =.007). The results remained consistent when we accounted for the time to conversion. Our findings suggest that CHR-C start lagging behind CHR-NC in social and role functioning in adolescence, followed by a period of further stagnation in adulthood

Heroin versus cocaine: opposite choice as a function of context but not of drug history in the rat

Rationale Previous studies have shown that rats trained to self-administer heroin and cocaine exhibit opposite preferences, as a function of setting, when tested in a choice paradigm. Rats tested at home prefer heroin to cocaine whereas rats tested outside the home prefer cocaine to heroin. Here we investigated whether drug history would influence subsequent drug preference in distinct settings. Based on a theoretical model of drug-setting interaction, we predicted that regardless of drug history rats would prefer heroin at home and cocaine outside the home. Methods Rats with double-lumen catheters were first trained to self-administer either heroin (25 μg/kg) or cocaine (400 μg/kg) for 12 consecutive sessions. Twenty-six rats were housed in the self-administration chambers (thus, they were tested at home) whereas 30 rats lived in distinct home cages and were transferred to self-administration chambers only for the self-administration session (thus, they were tested outside the home). The rats were then allowed to choose repeatedly between heroin and cocaine within the same session for 7 sessions. Results Regardless of the training drug, the rats tested outside the home preferred cocaine to heroin whereas the rats tested at home preferred heroin to cocaine. There was no correlation between drug preference and drug intake during the training phase. Conclusion Drug preferences were powerfully influenced by the setting but, quite surprisingly, not by drug history. This suggests that, under certain conditions, associative learning processes and drug-induced neuroplastic adaptations play a minor role in shaping individual preferences for one drug or the other