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Aim We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre–post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. Methods The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15–25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer-to-carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow-up. Multiple indicators of acceptability, usability and safety were utilized. Results Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow-up. Sixty-six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. Conclusion Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.

The global pandemic and the uncertainty if and when life will return to normality have motivated a series of studies on human mental health. This research has elicited evidence for increasing numbers of anxiety, depression, and overall impaired mental well-being. But, the global COVID-19 pandemic has also created new opportunities for research into quantifying human emotions: remotely, contactless, in everyday life. The ubiquitous computing community has long been at the forefront of developing, testing, and building user-facing systems that aim at quantifying human emotion. However, rather than aiming at more accurate sensing algorithms, it is time to critically evaluate whether it is actually possible and in what ways it could be beneficial for technologies to be able to detect user emotions. In this workshop, we bring together experts from the fields of Ubiquitous Computing, Human-Computer Interaction, and Psychology to - long-overdue - merge their expertise and ask the fundamental questions: how do we make sense of emotion-sensing, can and should we quantify human emotions?

This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-episode psychosis (N=170), aged 16-27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09-28.23, p=0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11-0.86, p=0.03, number needed to treat, NNT=5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11-1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.

Introduction: Interactive audience response during continuing education (CE) in pharmacy practice increases audience involvement. However, remote-site participants may not have access to interactive technology. This study explores the perceptions of a mobile application audience response system (ARS) by remote pharmacy CE participants. Secondarily, we evaluatedinterest in continued use of ARS, as well as willingness to use as an assessment tool for CE effectiveness. Methods: Pharmacists participating in CE sessions remotely within a health system were provided a unique ARS session code to enter into a free mobile application. Participants then responded to ARS presentation questions. An online survey link was e-mailed to all potential remote participants inquiring about perceptions of ARS use. Results: Of the 52 potential remote users, 28 (53.8%) responded to the survey. The top 3 positive responses included the availability of free software (71.4%), anonymity (57.1%), and ease of use (53.6%). Top 2 barriers included slowing the process down (14.3%) and requiring the use of application software (14.3%). Discussion: Interactive software during pharmacy CE lectures for participants at remote locations within a health system was well accepted. ARS should be considered and further studied for CE lectures at institutions with remote participants.

IntroductionSpecialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care.Methods and analysisThis study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16–27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool.Ethics and disseminationMelbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website.Trial registration numberACTRN12614000009617; Pre-results.

Affective instability, conceptualized as fluctuations in mood over time, has been related to ill-health and psychopathology. In this study, we examined the role of affective instability on daily pain outcomes in 70 patients with chronic pain (M-age = 49.7 years; 46 females) using an end-of-day diary. During a baseline phase, patients completed self-reported questionnaires of pain severity, pain duration, disability, depression, and anxiety. During a subsequent diary phase, patients filled out an electronic end-of-day diary over 14 consecutive days assessing daily levels of pain severity, disability, cognitive complaints, negative affect (NA) and positive affect. Affective instability was operationalized as the mean square of successive differences in daily mood (separately for NA and positive affect), which takes into account the size of affective changes over consecutive days. Results indicated that NA instability was positively associated with daily disability, beyond the effects of daily pain severity. Furthermore, NA instability moderated the relationship between daily pain severity and daily disability and the relationship between daily pain severity and daily cognitive complaints. Positive affect instability, however, showed to be unrelated to all outcomes. Current findings extend previous results and reveal the putative role of affective instability on pain-related outcomes and may yield important clinical implications. Indeed, they suggest that targeting NA instability by improving emotion regulation skills may be a strategy to diminish disability and cognitive complaints in patients with chronic pain.

Antipsychotic medication has been the mainstay of treatment for psychotic illnesses for over 60 years. This has been associated with improvements in positive psychotic symptoms and a reduction in relapse rates. However, there has been little improvement in functional outcomes for people with psychosis. At the same time there is increasing evidence that medications contribute to life shortening metabolic and cardiovascular illnesses. There is also uncertainty as to the role played by antipsychotic medication in brain volume changes. Aim The primary aim of the study is, in a population of young people with first-episode psychosis, to compare functional outcomes between an antipsychotic dose reduction strategy with evidence-based intensive recovery treatment (EBIRT) group (DRS+) and an antipsychotic maintenance treatment with EBIRT group (AMTx+) at 24-months follow-up. Methods Our single-blind randomized controlled trial, within a specialist early psychosis treatment setting, will test the whether the DRS+ group leads to better vocational and social recovery than, the AMTx+ group over a 2-year period in 180 remitted first-episode psychosis patients. Additionally, we will examine the effect of DRS+ vs AMTx+ on physical health, brain volume and cognitive functioning. This study will also determine whether the group receiving DRS+ will be no worse off in terms of psychotic relapses over 2 years follow-up. Results This paper presents the protocol, rationale and hypotheses for this study which commenced recruitment in July 2017. Conclusion This study will provide evidence as to whether an antipsychotic dose-reduction recovery treatment leads to improved functioning and safer outcomes in first-episode psychosis patients. In addition, it will be the first-controlled experiment of the effect of exposure to antipsychotic maintenance treatment on brain volume changes in this population.

Naturalistic studies of emotional reactivity in depression have repeatedly found larger decreases in negative affect (NA) among depressed individuals in response to daily positive events. This so-called mood-brightening (MB) effect represents a theoretical and empirical oddity. The current study is a secondary analysis investigating whether the MB effect is moderated by spontaneous use of emotion regulation strategies, which have been implicated in the maintenance and modulation of NA in prior work. Participants (N = 95) representing a large spectrum of depressive symptom severity reported their experiences of NA and the occurrence of positive events in daily life over the course of seven days using the experience sampling method. Our findings replicate and build upon those of prior studies relating to the MB effect in the following ways: (1) we observed the MB effect for specific negative emotions of sadness, anger, anxiety; and (2) we found evidence that the MB effect is moderated by spontaneous use of rumination, distraction, and expressive suppression, which have been shown to enhance or dampen NA. The role of emotion regulation strategies in daily emotional reactivity to pleasant events is discussed. ispartof: Cognition and Emotion vol:33 issue:6 pages:1291-1301 ispartof: location:England status: published

People differ in the extent to which they experience positive (PA) and negative affect (NA) rather independently or as bipolar opposites. Here, we examine the proposition that the nature of the relation between positive and negative affect in a person's emotional experience is indicative of psychological well-being, in particular the experience of depressive symptoms, typically characterized by diminished positive affect (anhedonia) and increased negative affect (depressed mood). In three experience sampling studies, we examine how positive and negative affective states are related within people's emotional experience in daily life and how the degree of bipolarity of this relation is associated with depressive symptom severity. In Study 1 and 2, we show both concurrently and longitudinally that a stronger bipolar PA-NA relationship is associated with, and in fact is predicted by, higher depressive symptom severity, even after controlling for mean levels of positive and negative affect. In Study 3, we replicate these findings in a daily diary design, with the two conceptually related main symptoms of depression, sadness, and anhedonia, as specific manifestations of high NA and low PA, respectively. Across studies, additional analyses indicate these results are robust across different time scales and various PA and NA operationalizations and that affective bipolarity shows particular specificity toward depressive symptomatology, in comparison with anxiety symptoms. Together, these findings demonstrate that depressive symptoms involve stronger bipolarity between positive and negative affect, reflecting reduced emotional complexity and flexibility. (PsycINFO Database Record

We discuss three varieties of affective dynamics (affective instability, emotional inertia, and emotional differentiation). In each case, we suggest how these affective dynamics should be operationalized and measured in daily life using time-intensive methods, like ecological momentary assessment or ambulatory assessment, and recommend time-sensitive analyses that take into account not only the variability but also the temporal dependency of reports. Studies that explore how these affective dynamics are associated with psychological disorders and symptoms are reviewed, and we emphasize that these affective processes are within a nexus of other components of emotion regulation. ispartof: Emotion Review vol:7 issue:4 pages:355-361 ispartof: location:England status: published

Introduction: As we move from a fee-for-service system to a value-based payment system, ongoing quality improvement projects have become the norm. We chose to evaluate whether academic detailing by a pharmacist is an effective means of increasing knowledge among family medicine residents of the need to monitor for iron deficiency in chronic heart failure (CHF) patients. Methods: We identified the baseline number of iron levels obtained for CHF patients and surveyed all 24 residents to evaluate baseline knowledge of the association between iron deficiency and CHF. Residents met with a pharmacist on clinic days to discuss iron deficiency and CHF and received an educational handout and a list of their CHF patients. Periodic reminders were first sent electronically to residents followed by in-person reminders from the pharmacist for patients seen that day in clinic. Results: At baseline, 16 (3%) of 488 CHF patients had an iron level collected within the past year. Initial survey results showed only one resident (4.2%) reported knowledge of monitoring iron in CHF patients. After academic detailing, residents ordered iron panels on 234 patients. Of these, 98 patients (42%) were found to be iron deficient. On postintervention analysis, all residents surveyed (20) reported that they would monitor iron in CHF patients (P

Purpose American Society of Health-System Pharmacists (ASHP) defines pharmacy resident growth as preceptors as an objective for ASHP-accredited pharmacy residencies. ASHP recognizes instructing, modeling, coaching, and facilitating as precepting roles necessary for effective teaching. Currently, there is no standard, validated tool for pharmacy resident–preceptor evaluations. Student evaluations meet ASHP requirements for evaluating preceptor effectiveness. The purpose of this pilot study was to implement a process for utilizing student evaluations in developing and evaluating pharmacy residents as preceptors. Methods Pharmacy students that completed advanced pharmacy practice experiences (APPE) during 2010–2011 with pharmacy resident co-preceptors were included. SurveyMonkey™ links were provided to evaluate residents as co-preceptors for the APPE. Residents’ evaluations were summarized and reviewed with them; residents were asked to complete resident response surveys and develop precepting strategies from the feedback. Results A total of 23 pharmacy student evaluations were completed for eight pharmacy residents, and eight residents completed the response survey. No residents received negative evaluations. All residents were recommended by the students to be future preceptors. Overall, 86% of the residents indicated the feedback was useful for preceptor growth and development. The students and residents mostly agreed on their abilities regarding modeling and coaching; their responses differed slightly regarding instructing and facilitating. Residents developed several tools to utilize for future precepting responsibilities and development based on their feedback. Preceptor training is noted as a desirable option. Conclusion Pharmacy student evaluation of pharmacy residents may be an effective method for obtaining feedback for residents on their precepting skills to foster preceptor development.

Family members caring for a young person diagnosed with the onset of mental health problems face heightened stress, depression, and social isolation. Despite evidence for the effectiveness of family based interventions, sustaining access to specialist family interventions is a major challenge. The availability of the Internet provides possibilities to expand and sustain access to evidence-based psychoeducation and personal support for family members. In this paper we describe the therapeutic model and the components of our purpose-built moderated online social therapy (MOST) program for families. We outline the background to its development, beginning with our face-to-face EPISODE II family intervention, which informed our selection of therapeutic content, and the integration of recent developments in positive psychology. Our online interventions for carers integrate online therapy, online social networking, peer and expert support, and online social problem solving which has been designed to reduce stress in carers. The initial version of our application entitled Meridian was shown to be safe, acceptable, and feasible in a feasibility study of carers of youth diagnosed with depression and anxiety. There was a significant reduction in self-reported levels of stress in caregivers and change in stress was significantly correlated with use of the system. We have subsequently launched a cluster RCT for caregivers with a relative diagnosed with first-episode psychosis. Our intervention has the potential to improve access to effective specialist support for families facing the onset of serious mental health problems in their young relative.

The ability to regulate emotions is central to well-being, but healthy emotion regulation may not merely be about using the "right" strategies. According to the strategy-situation-fit hypothesis, emotion-regulation strategies are conducive to well-being only when used in appropriate contexts. This study is the first to test the strategy-situation-fit hypothesis using ecological momentary assessment of cognitive reappraisal-a putatively adaptive strategy. We expected people who used reappraisal more in uncontrollable situations and less in controllable situations to have greater well-being than people with the opposite pattern of reappraisal use. Healthy participants ( n = 74) completed measures of well-being in the lab and used a smartphone app to report their use of reappraisal and perceived controllability of their environment 10 times a day for 1 week. Results supported the strategy-situation-fit hypothesis. Participants with relatively high well-being used reappraisal more in situations they perceived as lower in controllability and less in situations they perceived as higher in controllability. In contrast, we found little evidence for an association between greater well-being and greater mean use of reappraisal across situations. ispartof: Psychological Science vol:27 issue:12 pages:1651-1659 ispartof: location:United States status: published

Hospitals across the United States develop treatment algorithms for acute bronchospasm, asthma, and chronic obstructive pulmonary disease by following several different pathways. Some institutions use established national guidelines and protocols, some revise national guidelines to apply to their particular environment, and others create specific institution-related treatment algorithms with input from various departments, such as emergency medicine, respiratory therapy, and pharmacy. Although some institutions track outcomes on either a formal or an informal basis, others have not yet implemented outcomes-based programs.

Parathyroid hormone (PTH) is the most recently approved agent for osteoposis treatment. It differs from other therapies that act by inhibiting bone resorption, because it stimulates bone formation. The resultant increases in bone mineral density are therefore greater than those associated with therapy with bisphosphonates (BPs), selective estrogen receptor modulators, or calcitonin. Despite being available for at least 2 yr. PTH has not been exten sively studied. Although some existing data support its use for reducing the risk of vertebral fractures in women. data are still limited with regard to nonvertebral fracture prevention in women and fracture prevention in men. Preliminary studies have demonstrated a potential role in the management of patients with glucocorticoid-induced osteoporosis, but more data are needed. PTH is administered daily by subcutaneous injection for a maximum of 24 mo. Common adverse effects include pain with injection, arthralgia, and nausea. PTH caused an increase in osteosarcoma in rats and therefore, its use should be avoided in patients at increased risk of osteosarcoma, such as those with Paget's disease, unexplained baseline elevations of alkaline phosphatase, open epiphyses, or previous skeletal radiation exposure. At this time. PTH should not be combined with other agents, but a 2-yr treatment period may be sequentially followed by a BP. Because of high cost, the need for parenteral administration and potential for adverse effects, PTH use should be reserved for patients with severe osteoporosis who fail BP therapy.

Rumination--repetitively thinking about one's emotional state, its causes and consequences--exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person's negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students' (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.

Western culture has become obsessed with happiness, while treating negative emotions like sadness, depression, or anxiety as pathological and nonnormative. These salient cultural norms communicate social expectations that people should feel “happy” and not “sad.” Previous research has shown that these “social expectancies” can increase feelings of sadness and reduce well-being. In this study, we examined whether these perceived social pressures might also lead people to feel socially disconnected—lonely—when they do experience negative emotions? Drawing on a large stratified sample prescreened for depressive symptoms and utilizing both trait measures and moment-to-moment “experience sampling” over a 7-day period, we found that people who felt more negative emotions and also believe that others in society disapprove of these emotions reported more loneliness. Our data suggest that social pressures to be happy and not sad can make people feel more socially isolated when they do feel sad.

The autocorrelation or inertia of negative affect reflects how much negative emotions carry over from moment to moment and has been associated with increased depressive symptoms. In this study, we posed three challenges to this association by examining: (1) whether emotional inertia is relevant for depressive symptoms when assessed on a longer timescale than usual; (2) whether inertia is uniquely related to depressive symptoms after controlling for perseverative thoughts; and (3) whether inertia is related to depressive symptoms over and above the within-person association between affect and perseverative thoughts. Participants (N = 101) provided ratings of affect and perseverative thoughts for 100 days; depressive symptoms were reported before and after the study, and again after 2.5 years. Day-to-day emotional inertia was related to depressive symptoms over and above trait and state perseverative thoughts. Moreover, inertia predicted depressive symptoms when adjusting for its association with perseverative thoughts. These findings establish the relevance of emotional inertia in depressive symptoms independent of perseverative thoughts. peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=pcem20 ispartof: Cognition & Emotion vol:29 issue:3 pages:527-538 ispartof: location:England status: published

Previous research has shown that being affectively unstable is an indicator of several forms of psychological maladjustment. However, little is known about the mechanisms underlying affective instability. Our research aims to examine the possibility that being prone to extreme fluctuations in one’s feelings is related to maladaptive emotion regulation. We investigated this hypothesis by relating affective instability, assessed in daily life using the experience sampling method, to self-reported emotion regulation strategies and to parasympathetically mediated heart rate variability (HRV), a physiological indicator of emotion regulation capacity. Results showed that HRV was negatively related to instability of positive affect (as measured by mean square successive differences), indicating that individuals with lower parasympathetic tone are emotionally less stable, particularly for positive affect. ispartof: PLoS One vol:8 issue:11 pages:1-10 ispartof: location:United States status: published

Emotion regulation has primarily been studied either experimentally or by using retrospective trait questionnaires. Very few studies have investigated emotion regulation in the context in which it is usually deployed, namely, the complexity of everyday life. We address this in the current paper by reporting findings of two experience-sampling studies (Ns = 46 and 95) investigating the use of six emotion-regulation strategies (reflection, reappraisal, rumination, distraction, expressive suppression, and social sharing) and their associations with changes in positive affect (PA) and negative affect (NA) in daily life. Regarding the relative use of emotion-regulation strategies, a highly similar ordering was found across both studies with distraction being used more than sharing and reappraisal. While the use of all six strategies was positively correlated both within- and between-persons, different strategies were associated with distinct affective consequences: Suppression and rumination were associated with increases in NA and decreases in PA, whereas reflection was associated with increases in PA across both studies. Additionally, reappraisal, distraction, and social sharing were related to increases in PA in Study 2. Discussion focuses on how the current findings fit with theoretical models of emotion regulation and with previous evidence from experimental and retrospective studies.

Research has shown that cognitive control processes play a central role in emotion regulation. While most research has examined whether individual differences in such processes are related to the use of these strategies, a crucial next step involves examining whether such differences influence their impact on people's feelings, especially in normal daily life. The present study examined whether impairments in cognitive control (measured using an affective interference resolution task) moderate the impact of using rumination and reappraisal on affective experiences in everyday life (assessed using experience sampling methods). Multilevel analyses revealed that difficulties removing previously relevant negative information from working memory were associated with a larger increase in negative affect following rumination, and smaller increase and decrease in positive and negative affect, respectively, following reappraisal. These findings show that impaired interference resolution for negative information aggravates the deleterious effects of rumination and curbs the benefits of reappraisal in daily life. ispartof: Cognition & Emotion vol:27 issue:3 pages:492-501 ispartof: location:England status: published

Like many other mental disorders, depression is characterised by psychological inflexibility. Two instances of such inflexibility are rumination: repetitive cognitions focusing on the causes and consequences of depressive symptoms; and emotional inertia: the tendency for affective states to be resistant to change. In two studies, we tested the predictions that: (1) rumination and emotional inertia are related; and (2) both independently contribute to depressive symptoms. We examined emotional inertia of subjective affective experiences in daily life among a sample of non-clinical undergraduates (Study 1), and of affective behaviours during a family interaction task in a sample of clinically depressed and non-depressed adolescents (Study 2), and related it to self-reported rumination and depression severity. In both studies, rumination (particularly the brooding facet) and emotional inertia (particularly of sad/dysphoric affect) were positively associated, and both independently predicted depression severity. These findings demonstrate the importance of studying both cognitive and affective inflexibility in depression.

The aim of the study was to investigate trajectories of social functioning in young people with first-episode psychosis (FEP) with and without cannabis misuse using a secondary analysis of data from the Episode-II trial. Forty-two young people with FEP and comorbid cannabis use disorder were compared with 39 young people with FEP but without a cannabis use disorder. Social functioning was assessed every 6 months during a 30-month follow-up. Multilevel linear growth curve modeling was used to compare the social functioning trajectories over time for those with and without cannabis misuse. Cannabis misuse was not associated with social functioning at baseline assessment. Over a 30-month follow-up, FEP patients without cannabis disorder showed significant improvements in their social functioning, whereas patients with cannabis misuse at baseline displayed no such improvement. Patients with and without cannabis misuse differed significantly in their levels of social functioning after 24 months. Similar results were obtained after adjusting for potential confounders (i.e., age, gender, negative symptoms, premorbid functioning, DSM-IV diagnoses, baseline social functioning and other substance use). In the context of a specialized early intervention service, patients with cannabis misuse at baseline did not attain the improvements in social outcomes observed in their counterparts without cannabis misuse. There is a need to develop effective interventions to reduce cannabis misuse to ultimately improve social outcomes in young people with psychosis. ispartof: PLoS One vol:10 issue:4 pages:1-14 ispartof: location:United States status: published

To determine acceptance rates to postgraduate year 1 (PGY1) pharmacy residencies and examine the impact of several variables on acceptance rate.Residency match data for every US college and school of pharmacy with a graduating class between 2008 and 2011 were sorted by graduating class and applicant match rates into PGY1 residency programs. Data were analyzed to determine factors influencing PGY1 match rates.The graduating class match rate to PGY1 residencies was 14.2% for all colleges and schools, 16.0% for public colleges and schools, and 12.6% for private colleges and schools. Colleges and schools with a first graduating class greater than 20 years ago matched 16.7% of students to residency programs.Whether the college or school was public rather than private was an influencing factor on both graduating class and applicant match rates. Years since first graduating class influenced applicant match rate only.

Background First-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled ‘Altitudes’ that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period. Methods/design We describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15–27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers’ perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool. Discussion This is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis. Trial registration Australian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471. Retrospectively registered on 22 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1775-5) contains supplementary material, which is available to authorized users.