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Introduction: Ketamine has emerged as a promising treatment alternative for the management of chronic pain. Despite encouraging findings in civilian populations, and favourable results from trials examining its efficacy in military populations, there is still a dearth of information pointing to optimal specifications related to ketamine administration for pain, depression, and posttraumatic stress disorder (PTSD) in military populations. This meta-analysis and systematic review synthesised available evidence on the effectiveness, tolerability, and feasibility of ketamine in the management of chronic pain and mental health conditions in military populations. Methods: This review followed the Cochrane's Guide for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as frameworks for data collection and synthesis. Results: A total of 11 studies and 22 independent samples were retained for data analyses. Across samples, improvements in pain, depression, and PTSD outcomes were evident, with the use of ketamine leading to significant reductions, g = 1.76, SE = 0.19, 95% CI (1.39, 2.13), Z = 9.26, p <.001. These effect sizes were robust with moderate-to-large effects. In addition, the reductions in symptoms were observed in both active-duty and Veteran groups, and for different routes of ketamine administration, frequencies of ketamine administration, duration of ketamine treatments, dosage, study design, and allowance for concurrent treatments. Discussion: This review provides a preliminary synthesis of available evidence which suggests that ketamine may be a potential option for the treatment of depression, PTSD, and chronic pain in military populations. The viability of ketamine as an alternative treatment may be particularly impactful for those who are treatment resistant, experience chronic symptoms, and/or have exhausted conventional treatments. More research is warranted in order verify the findings presented in this review. [ABSTRACT FROM AUTHOR]

Delay discounting—the extent to which individuals show a preference for smaller immediate rewards over larger delayed rewards—has been proposed as a transdiagnostic neurocognitive process across mental health conditions, but its examination in relation to posttraumatic stress disorder (PTSD) is comparatively recent. To assess the aggregated evidence for elevated delay discounting in relation to posttraumatic stress, we conducted a meta-analysis on existing empirical literature. Bibliographic searches identified 209 candidate articles, of which 13 articles with 14 independent effect sizes were eligible for meta-analysis, reflecting a combined sample size of N = 6897. Individual study designs included case-control (e.g. examination of differences in delay discounting between individuals with and without PTSD) and continuous association studies (e.g. relationship between posttraumatic stress symptom severity and delay discounting). In a combined analysis of all studies, the overall relationship was a small but statistically significant positive association between posttraumatic stress and delay discounting (r =.135, p <.0001). The same relationship was statistically significant for continuous association studies (r =.092, p =.027) and case-control designs (r =.179, p <.001). Evidence of publication bias was minimal. The included studies were limited in that many did not concurrently incorporate other psychiatric conditions in the analyses, leaving the specificity of the relationship to posttraumatic stress less clear. Nonetheless, these findings are broadly consistent with previous meta-analyses of delayed reward discounting in relation to other mental health conditions and provide further evidence for the transdiagnostic utility of this construct. [ABSTRACT FROM AUTHOR]

Background: The study of risk factors for antisocial and delinquent behavior has flourished in the past 20 years, as great strides have been made in understanding the developmental pathways that give rise to the onset, course, and desistance of the behavior. However, as a body of literature, risk factor research (RFR) is characterized by heterogeneity in definitions, conceptualization, and measurement of key constructs that can make it difficult to discern robust from spurious findings. This may pose challenges to child-serving agencies invested in developing crime reduction policies and programs but lack the resources to carefully comb through and make sense of the literature. Objective: This article reviews the terminological, conceptual, and methodological issues in the RFR literature with an aim towards clarifying some of the inconsistencies that limit interpretation and application of findings. Risk factors related to antisocial and delinquent behavior are used to illustrate the concepts discussed. Method: We reviewed the RFR literature pertaining to antisocial and delinquent behavior in children and youth to identify key concepts and discrepancies in this area. Conclusions: The literature would be well served if researchers were consistent in their use of terminology to describe the effects of risk factors on antisocial and delinquent behavior. There is also a need to study the processes and causal mechanisms that link past events to future outcomes.

Understanding the developmental precursors of juvenile violent sex offending can contribute to the promotion of effective early intervention and prevention programs for high-risk children and youth. However, there is currently a lack of research on the early characteristics of adolescents who commit violent sex offenses. Drawing on the literature regarding the generalist and specialist positions of criminal behavior, the aim of the present study was to compare childhood risk factors for three groups of juvenile offenders: (a) pure sex offenders (PSO; n = 28); (b) violent non-sex offenders (VNSO; n = 172); and (c) versatile violent sex offenders (VVSO; n = 24). Nineteen risk factors comprising four life domains (individual, family, peer, and school) were identified from a file review. Three hierarchical logistic regression analyses examined associations between risk factors and offender groups. The results reflected the underlying heterogeneity of the sample, offering support for both the specialist and generalist positions of criminal behavior. PSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior. Second, VVSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior, criminal family members, and an adolescent mother, as well as lower odds for poor school behavior. Third, PSOs were marginally more likely to have engaged in early overt antisocial behavior compared with VVSOs. Fourth, many of the childhood risk factors examined were not associated with any offender group. In conclusion, VVSOs appeared to differ on the greatest number of risk factors from VNSOs, suggesting that VVSOs share a more similar developmental pathway with PSOs. The prevention and future research implications of these findings are discussed. (Contains 5 tables.)

Background: The role of interpersonal relationship functioning in trauma recovery is well-established. However, much of this research has been done with cross-sectional samples, often years after trauma exposure, using self-report methodology only, and is focused on intimate relationship adjustment. Methods: The current study investigated the longitudinal associations between interpersonal (intimate and non-intimate) relationship functioning and clinician- and self-reported posttraumatic stress disorder (PTSD) symptoms in 151 recently (within the past 6 months) traumatized individuals. Participants were assessed at four time points over 1 year. Results: Approximately 53% of the sample was diagnosed with PTSD at initial assessment, with declining rates of diagnostic status over time to 16%. Latent difference score (LDS) modeling revealed nonlinear declines in both clinician-assessed and self-reported PTSD symptom severity, with faster declines in earlier periods. Likewise, LDS models revealed nonlinear declines in negative (conflict) aspects of interpersonal relationship functioning, but linear declines in positive (support, depth) aspects. The relationship between PTSD and relationship functioning differed for clinician- and self-reported PTSD. Bivariate LDS modeling revealed significant cross-lagged effects from relationship conflict to clinician-assessed PTSD, and significant cross-lagged effects from self-reported PTSD to relationship conflict over time. Conclusions: These results highlight that the variability in prior results may be related to the method of assessing PTSD symptomatology and different relational constructs. Implications for theory and early intervention are discussed. [ABSTRACT FROM AUTHOR]

The continuity of developmental risk factors from childhood into adolescence to predict criminal adult offending has not been investigated. From a developmental and life-course perspective, the issue is of both theoretical and practical importance, as understanding the long-term impact of early life experiences on adult outcomes that carry forward across major developmental periods can assist clinicians with the identification of targets for early intervention and prevention. The aim of the present study was to examine the extent to which childhood and adolescent risk factors distinguish among three offender subgroups in a sample of adult male offenders. The results indicated that the groups were more clearly distinguished on adolescent risk factors, giving greater prominence to proximal than distal predictors. As well, from a dose-response perspective, the pure sex offenders showed the most adverse developmental history and were differentiated from both the versatile violent sex offenders and the violent non-sex offenders. [ABSTRACT FROM AUTHOR]