American Journal Of Psychiatry Research Articles

The Affect-Hungry Child: Friendliness and Amygdala Are Indiscriminate

In 1937, David Levy described the “affect hunger” of deprived children (Am J Psychiatry 1937; 94:643), which is often manifested by the child's

Recent Med School Grad Envisions Career as Psychiatric 'Cultural Broker'

A graduating medical student planning a career in psychiatry turns a background of relinquishment and rescue, poverty and privilege into the goal of treating underserved Americans.

The 100 Top-Cited Articles Published in Psychiatric Journals

An examination of top-cited articles is a tool that can be used to identify and monitor outstanding scientific research. The goal of this study was to identify and analyze the characteristics of the 100 top-cited articles published in international journals dedicated to psychiatry. The Science Citation Index Expanded provided by the Thomson Reuters Institute for Scientific Information Web of Knowledge was searched in December, 2011, and 128 journals were identified in the subject category "Psychiatry." Each journal was searched on the Web of Science under "Publication Name" and the results were sorted by category "Times Cited." The 100 top-cited articles were recorded, and the list was analyzed with regard to journals, number of citations, authors, year, institution, and country of origin. The original research articles of the 100 top-cited articles were classified into one of five categories: scale/measurement, descriptive/epidemiology, mechanism, management, and imaging. The 100 top-cited articles were cited between 26,578 and 781 times; they were published between 1957 and 2005, with the largest number (35) published in the 1990s. The articles appeared in 24 journals, with more than half published in the Archives of General Psychiatry (56), followed by the American Journal of Psychiatry (6), and Psychological Medicine (6). Articles that dealt with the development, application, or validity of measurements led the list of top-cited psychiatric publications (43) and had a significantly higher number of citations compared with the rest of the articles. The time and language of publication, field of study, country of origin, and journal in which the paper appeared are possible determinants of the likelihood of citation and impact.

Do I smell pot? A trial of an alternative paradigm of olfactory cue-reactance to marijuana

Marijuana, the most commonly used illicit drug among college students, remains the most cited reason for entering treatment for substance abuse and dependency (Johnston, L.D., O’Malley, P.M., Bachman, J.G., & Schulenberg, J.E. (2009). Monitoring the future: National survey results on drug use, 1975–2008. Volume II: College students and adults aged 19–50. Bethesda, MD: National Institute on Drug Abuse). Current models now include craving as a potential indicator of drug problems (Goldstein, R.Z., & Volkow, N.D. (2002). Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry, 159, 1642–1652). Memory-expectancy and cue-reactance manipulations are increasingly common in the study of craving. Such manipulations rely on the use of relevant cues to prime thoughts associated with the substance of interest. Nevertheless, manipulations involving marijuana primes remain limited; most only using visual and over-stereotyped cues and are tested using samples that already meet criteria for problematic use. The current experiment tested an olfactory manipulation for priming thoughts of marijuana using a sample of 85 college students that represent an array of past marijuana use. Two 2 × 3 χ2 tests revealed that participants who smelled cannabis reported a higher proportion of primed words associated with marijuana than those who smelled a control scent. Logistic regression revealed that history of cannabis use did not alter the magnitude of this priming effect. Results support the use of this study's novel olfactory cue as an appropriate manipulation for the study of marijuana priming effects within college-aged samples.

Prolonged Fatigue in Teens Is Disabling, Undertreated

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessProlonged Fatigue in Teens Is Disabling, UndertreatedMark MoranMark MoranSearch for more papers by this authorPublished Online:17 May 2013https://doi.org/10.1176/appi.pn.2013.5b9AbstractPersistent fatigue in adolescents with anxiety or depression results in a clinical presentation with more comorbidity and more disability than anxiety or depression without fatigue.Prolonged fatigue is associated with disability and may be an important clinical entity independent of mood and anxiety disorders in adolescents. Moreover, persistent fatigue with a comorbid mood or anxiety state is related to even more functional impairment, suggesting that prolonged fatigue may reflect greater severity of mood and anxiety disorders in adolescents, according to a study reported in the May American Journal of Psychiatry. fotofreak/Shutterstock.comThe study found additionally that only 13.7 percent of the adolescents with prolonged fatigue alone had received any type of services for emotional or behavioral symptoms in the preceding year. “Our findings suggest that fatigue should be comprehensively evaluated in youth,” lead author Kathleen Merikangas, Ph.D., told Psychiatric News. “Fatigue may not simply be ‘laziness’ but rather either an index of a medical condition or of clinical anxiety or depression. Sleep patterns and activity patterns should be evaluated to determine whether behavioral changes might relieve the tiredness. Adolescents with fatigue along with mood or anxiety disorders should also be monitored because our research indicates that fatigue may be an index of greater severity and impairment of these disorders.” She is with the Genetic Epidemiology Research Branch of the Intramural Research Program at the National Institute of Mental Health (NIMH). Merikangas and colleagues analyzed data from the National Comorbidity Survey Adolescent Supplement. Participants were 10,123 adolescents aged 13 to 18 years who were interviewed about prolonged fatigue, defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least three months.They found that the prevalence of prolonged fatigue was 3.0 percent, with 1.4 percent for prolonged fatigue only and 1.6 percent for prolonged fatigue concomitant with a depressive or anxiety disorder. Nearly 60 percent of the adolescents with prolonged fatigue only had severe or very severe disability, and their rates of poor physical and mental health were comparable to those of adolescents with mood or anxiety disorders only. “The cross-sectional nature of our study prevents us from addressing causation,” Merikangas said. “However, previous studies of both adults and adolescents have shown a bidirectional association between anxiety/depression and fatigue states, with each of these sets of disorders predicting new incidence of the other. So those with fatigue have elevated incidence of mood and anxiety disorders at follow-up, as well as the converse.”The study was upported by an NIMH Intramural Research Program grant. ■ “Prevalence and Correlates of Prolonged Fatigue in a U.S. Sample of Adolescents” is posted at http://ajp.psychiatryonline.org/article.aspx?articleID=1683312. Key Points Bottom line: The presence of fatigue may be an indicator of a more severe depressive or anxiety disorder. Extreme fatigue in adolescents that continues even after rest and interferes with the ability to participate academically, socially, or at home appears to be a pathological condition, independent of depression or anxiety.Persistent fatigue with a comorbid mood or anxiety state is related to even more functional impairment, suggesting that prolonged fatigue may reflect greater severity of mood and anxiety disorders in adolescents.A small percentage of adolescents with prolonged fatigue alone receive any type of services for emotional or behavioral symptoms. ISSUES NewArchived

Social Psychology in Classic Counterinsurgency Writing

Social Psychology in Classic Counterinsurgency Writing

Psychiatric Care During Pregnancy To Be Focus of Forum

Back to table of contents Previous article Next article Annual Meeting HighlightsFull AccessPsychiatric Care During Pregnancy To Be Focus of ForumLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:15 Feb 2013https://doi.org/10.1176/appi.pn.2013.2b7AbstractClinical treatment decisions during pregnancy mandate careful balancing of risk and benefit. Authors of studies recently published in AJP will give clinical guidance for such decisions.The American Journal of Psychiatry (AJP) will host a forum titled “Treatment of the Pregnant Woman and Her Child,” chaired by Robert Freedman, M.D., editor in chief of AJP, at APA’s annual meeting in San Francisco. The session will be held Monday, May 20, at 11 a.m. Researchers say careful balancing of the risks and benefits to both mother and baby of treatment for maternal mental illness is needed.MitarArt/Shutterstock.com“We strive to make the journal’s cutting-edge research germane to today’s practicing clinician,” Freedman told Psychiatric News, “and we particularly target clinical situations in which even the most experienced psychiatrists are the most careful in their approach. The care of the psychiatrically ill pregnant woman and her fetus is an area in which all clinicians want to be informed about the latest research that investigates the risk and benefit of treatment.” He added that the forum “will bring together authors of four recently published articles to discuss their research, all of which informs current care and will affect future treatment development.”But first, Harita Raja, M.D., a psychiatry resident at Medstar Georgetown University Hospital in Washington, D.C., will begin the symposium with a case presentation. She is the author of a recent review article on treatment of maternal depression in the Residents’ Journal, an online publication of the American Journal of Psychiatry.The first speaker will be Katherine Wisner, M.D., a professor of psychiatry; obstetrics; gynecology; and reproductive sciences and epidemiology at the University of Pittsburgh School of Medicine. Wisner has meticulously characterized the effects of depression and medication treatment for it on the growth and development of the fetus and found independent effects of each, but little evidence that antidepressants cause additional harm to the fetus.Mallay Occhiogrosso, M.D., an assistant professor of psychiatry at Weill Cornell Medical College, and her colleagues made similar findings about newborn pulmonary hypertension, once thought to be an adverse effect of SSRI treatment during pregnancy (Psychiatric News, May 4, 2012). Their extensive epidemiologic investigations revealed that the effect is small and as likely to be caused by depression itself as by the medications. Veerle Bergink, M.D., a psychiatrist at the Erasmus Medical Center in Rotterdam, the Netherlands, will present a study of the approach preferred by her clinic for pregnant women with a history of bipolar disorder or postpartum psychosis (Psychiatric News, May 4, 2012). Her clinic’s prophylactic treatment diminishes some but not all risk for subsequent illness during or after pregnancy. The final speaker, Randal Ross, M.D., a professor in the Department of Psychiatry at the University of Colorado School of Medicine, has developed a physiological indicator of the newborn’s brain development. With this technique, he finds that antidepressant treatment frequently prevents the otherwise deleterious effect of a maternal anxiety disorder and that the nutrient choline may prevent the development of pathological brain dysfunction associated with later mental disorders in the child. ■ ISSUES NewArchived

All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties Into Mental Disordersby HorwitzAllan V. Ph.D., and WakefieldJerome C. D.S.W., Ph.D. New York, Oxford University Press, 2012, 320 pp., $29.95.

All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties Into Mental Disordersby HorwitzAllan V. Ph.D., and WakefieldJerome C. D.S.W., Ph.D. New York, Oxford University Press, 2012, 320 pp., $29.95.

Interventions to Reduce Distress in Adult Victims of Sexual Violence and Rape: A Systematic Review

Beginning with the articulation of Rape Trauma Syndrome (Burgess 1974), the traumatic aftermath of sexual assault on victims has become a focus of social and legal policy, scholarly inquiry, and mental health interventions. The wide variety of psychosocial treatment modalities for victims of sexual violence reported in the literature and used in practice are predominantly based on psychodynamic, cognitive-behavioural or feminist-informed theoretical frameworks. Some modalities have been specifically designed for victims of sexual violence while others have been adapted from use with other traumatized populations. Although there is evidence of effective treatments for addressing traumatic stress in victims of many types of trauma, modalities specific to victims of sexual assault have not been systematically tested. Evidence suggests that trauma associated with rape or sexual assault differs from trauma stemming from other experiences, in part due to the strong element of self-blame, the individualized nature of this type of trauma, social support and social acceptance factors, and the higher incidence of concurrent depression. Therefore, it is critical to examine the effectiveness of interventions specific to victims of sexual violence and rape.

Why Membership Is Vital to You and Your Patients

Why Membership Is Vital to You and Your Patients

Risk of Incarceration and Other Characteristics of Iraq and Afghanistan Era Veterans in State and Federal Prisons

The Health Care for Reentry Veterans (HCRV) program provides Veterans Health Administration outreach services to veterans incarcerated in state and federal prisons. This study used HCRV data to compare risk of incarceration of veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) and other veterans and to identify sociodemographic and clinical characteristics of incarcerated veterans of OEF/OIF/OND. Administrative national data were analyzed for 30,968 incarcerated veterans, including 1,201 OEF/OIF/OND veterans, contacted from October 2007 to April 2011. Odds ratios were calculated comparing the risk of incarceration among OEF/OIF/OND and other veterans in the HCRV sample and in a weighted sample of nonincarcerated veterans from the 2010 National Survey of Veterans. Stepwise logistic regressions of HCRV data examined characteristics of incarcerated veterans independently associated with OEF/OIF/OND service. Regardless of ethnicity or age, OEF/OIF/OND veterans were less than half as likely as other veterans to be incarcerated and constituted only 3.9% of the incarcerated veterans. Compared with other incarcerated veterans, OEF/OIF/OND veterans were younger, were more likely to be married, were more likely to report combat exposure, expected a shorter incarceration, were 26% less likely to have a diagnosis of drug abuse or dependence, and were three times more likely to have combat-related posttraumatic stress disorder (PTSD). OEF/OIF/OND veterans appeared to be at lower risk of incarceration than veterans of other service eras, but those who were incarcerated had higher rates of PTSD. Efforts to link these veterans to mental health services upon their release are warranted.

Dispelling the “They’ll Grow Out of It” Myth: Implications for Intervention

Dispelling the “They’ll Grow Out of It” Myth: Implications for Intervention

The new impact factor and immediacy index of World Psychiatry

The new impact factor of World Psychiatry, based on citations in the year 2011 to papers published in the journal in the years 2009 and 2010, is 6.233. The impact factor of the journal was 3.896 in 2009, 4.375 in 2010, and 5.562 last year. The journal is in the top 10 of psychiatric journals and is preceded only by the American Journal of Psychiatry, the Archives of General Psychiatry and the British Journal of Psychiatry among journals of general psychiatry. The papers that received the highest number of citations during the period considered in the calculation of the new impact factor are the Special Articles by De Hert et al 1 on the metabolic syndrome in people with schizophrenia, by A.C. McFarlane 2 on the long-term costs of traumatic stress, by D. Cicchetti 3 on resilience, and by A. Bateman and P. Fonagy 4 on mentalization based treatment for borderline personality disorder; the WPA guidance papers on steps, obstacles and mistakes to avoid in the implementation of community mental health care 5,6 and on how to combat stigmatization of psychiatry and psychiatrists 7; the Forums “Are psychiatrists an endangered species?” 8,9, “Pathophysiology of depression: do we have any solid evidence of interest to clinicians?” 10, and “Problematic Internet use – research evidence and open issues” 11; and the Research Reports by J. Angst et al 12 on hypomania from a transcultural perspective, by O. Gureje et al 13 on the Nigerian Survey on Mental Health and Wellbeing, and by V. Patel et al 14 on reducing the treatment gap for mental disorders. The new immediacy index of the journal, based on citations in the year 2011 to papers published in the same year, is 2.556. It was 0.950 last year. The journal is in the top 3 of psychiatric journals according to this measure, preceded only by Molecular Psychiatry (3.676) and the American Journal of Psychiatry (3.583). The immediacy index of the Archives of General Psychiatry is 2.202. This immediacy index of the journal is mostly due to the high number of citations received by papers related to the development of the ICD-11 15,16,17,18,19 and by other WPA guidance papers, educational modules and recommendations 20,21,22,23,24,25. The journal editorial staff is grateful to the authors, the referees and the WPA task forces who made these accomplishments possible.

Status of Stigma, 2012

Back to table of contents Previous article Next article Taking IssueFull AccessStatus of Stigma, 2012Steven S. Sharfstein, M.D., M.P.A.Steven S. SharfsteinSearch for more papers by this author, M.D., M.P.A.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ps.631011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The word “stigma,” stemming from the Greek, means a sign or a branding mark. Erving Goffman is best known for his classic work on asylums and on stigma. In 1963, he defined stigma as “the process by which the reaction of others spoils normal identity.”Goffman addressed both “public stigma,” the reaction of others in the community at large toward people with symptoms of mental illness, and “self-stigma,” the self-blame and self-derogatory attitudes that people with mental illness may harbor about themselves. Two articles in this issue of Psychiatric Services examine strategies to reduce stigma and suggest agendas for future research and action. Corrigan and colleagues review efforts to challenge public stigma, and Mittal and colleagues summarize findings on self-stigma reduction. Both groups emphasize that stigma is essentially a public health problem and one of the main obstacles to access to care. Historically, stigma is a cause of insurance discrimination against treatment for mental illness, and the fight for parity has been a fight against stigma. The 2008 Kennedy-Wellstone legislation improved on the 1996 Domenici-Wellstone parity bill by establishing the principle of equal insurance coverage for psychiatric treatment with the rest of medicine.Stigma is also present at all levels of medical education. Physicians in training are actively discouraged from pursuing psychiatry as a career. I remember medical school faculty saying, “Psychiatry? Why would you want to do that?” Some of the most overt signs of public stigma are the obstacles encountered by community mental health workers in finding suitable housing, employment, and rehabilitation opportunities for their clients. Self-stigma is one reason that we, as providers of care, have such a difficult time engaging individuals in treatment, which leads to high no-show rates in community clinics. Stigma explains why some individuals who are disabled by serious mental illness—and families who are distressed by an ill family member—do not seek care. Peer support services are an effective way to address self-stigma.Will we ever see an end to the stigma that is associated with mental illness? No, not as long as there are untreated, delusional, disheveled, threatening, homeless individuals on our streets and in high-profile media examples of violence. The elimination of stigma is unlikely despite the best efforts to educate the public and to empower individuals in their recovery process. Great progress can be made to counter stigma by expanding access to effective care and by improving our own attitudes—that is, the attitudes of mental health professionals—as we encounter our patients, in our use of language about individuals with mental illness and mental illness itself, and in communications among ourselves and with our patients and at all levels in the treatment system.Sheppard Pratt Health System, Baltimore FiguresReferencesCited byDetailsCited bySpecial IssueCommunication Strategies to Counter Stigma and Improve Mental Illness and Substance Use Disorder PolicyEmma McGinty, Ph.D., M.S., Bernice Pescosolido, Ph.D., Alene Kennedy-Hendricks, Ph.D., Colleen L. Barry, Ph.D., M.P.P.2 October 2017 | Psychiatric Services, Vol. 69, No. 2Criminal Activity or Treatable Health Condition? News Media Framing of Opioid Analgesic Abuse in the United States, 1998–2012Emma E. McGinty, Ph.D., M.S., , Alene Kennedy-Hendricks, Ph.D., Julia Baller, Ph.D., Jeff Niederdeppe, Ph.D., Sarah Gollust, Ph.D., Colleen L. Barry, Ph.D., M.P.P.1 December 2015 | Psychiatric Services, Vol. 67, No. 4The Stigma ComplexAnnual Review of Sociology, Vol. 41, No. 1News Media Framing of Serious Mental Illness and Gun Violence in the United States, 1997-2012American Journal of Public Health, Vol. 104, No. 3Nurse Education Today, Vol. 34, No. 3Effects of News Media Messages About Mass Shootings on Attitudes Toward Persons With Serious Mental Illness and Public Support for Gun Control PoliciesEmma E. McGinty, M.S., Daniel W. Webster, Sc.D., M.P.H., and Colleen L. Barry, Ph.D., M.P.P.1 May 2013 | American Journal of Psychiatry, Vol. 170, No. 5 Volume 63Issue 10 October 2012Pages 953-953 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012

Biology and the Future of Psychoanalysis: A New Intellectual Framework for Psychiatry Revisited

Free AccessBiology and the Future of Psychoanalysis: A New Intellectual Framework for Psychiatry RevisitedEric R. KandelEric R. KandelSearch for more papers by this authorPublished Online:August 2012https://doi.org/10.1521/prev.2012.99.4.607PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. The Role of Implicit Memory in the Development and Recovery from Trauma-Related DisordersOnline publication date: 18 January 2022. Go to citation Crossref Google Scholar2. The psychological effects of stillbirth on parents: A qualitative evidence synthesis of psychoanalytic literatureOnline publication date: Go to citation Crossref Google Scholar3. Forms of freedom: Towards a psychoanalytic conception of autonomyOnline publication date: 24 March 2021. Go to citation Crossref Google Scholar4. The Impact of Visual Art and High Affective Arousal on Heuristic Decision-Making in ConsumersOnline publication date: 26 November 2020. Go to citation Crossref Google Scholar5. Online publication date: Go to citation Crossref 6. The Natural Philosophy of ExperiencingOnline publication date: 8 November 2018. Go to citation Crossref Google Scholar7. Art TherapyOnline publication date: 6 November 2015. Go to citation Crossref Google Scholar8. Staging the TruthOnline publication date: 7 July 2015. Go to citation Crossref Google ScholarRichard D. Chessick9. What Hath Freud Wrought? Current Confusion and Controversies About the Clinical Practice of Psychoanalysis and Psychodynamic PsychotherapyOnline publication date: 15 December 2014. Go to citation Crossref 10. The emerging synthesis of development and evolution: A new biology for psychoanalysisOnline publication date: 19 May 2014. Go to citation Crossref Google Scholar11. Two Views of Passionate Love: Why Infatuation is Better Explained by the Transference Model than the Evolutionary ModelOnline publication date: Go to citation Crossref Google Scholar12. Chapitre 5. Processus de socialisation et délinquance sexuelleOnline publication date: Go to citation Crossref Google Scholar Volume 99Issue 4Aug 2012 Information© 2012 N.P.A.P.PDF download

Cognitive remediation has global cognitive and functional benefits for people with schizophrenia when combined with psychiatric rehabilitation

[Summary and Commentary of Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168, 472–485.] [Extract] Objectives of the review: To determine the effects of cognitive remediation therapy to treat cognitive problems that affect functioning of people with schizophrenia and whether study method or potential moderators influence the estimates.

Preparedness Key to Effectively Helping Children After Disasters

Preparedness Key to Effectively Helping Children After Disasters

The Health Literacy of Adults With Severe Mental Illness

The Health Literacy of Adults With Severe Mental Illness

A Comparison of Psychiatry and Internal Medicine: A Bibliometric Study

Psychiatric education needs to expose students to a broad range of topics. One resource for psychiatric education, both during initial training and in later continuing medical education, is the scientific literature, as published in psychiatric journals. The authors assessed current research trends in psychiatric journals, as compared with internal-medicine counterparts and examined their relevance to psychiatric education. The authors classified abstracts and original articles as biological or non-biological, based on methodology, from 2008 in Archives of General Psychiatry and The American Journal of Psychiatry, as compared with The Archives of Internal Medicine and Annals of Internal Medicine. Biological and non-biological studies were similarly frequent in psychiatric journals (48.2% and 51.8%, respectively). Internal-medicine journals had a non-biological and epidemiological predominance (22.2% biological, 77.8% non-biological: epidemiological, 59.9%; reviews, 21.4%; clinical, 13.2%; other, 5.4%). Psychiatric journals publish more biological studies than internal-medicine journals. This tendency may influence psychiatric education and practice in a biological direction, with less attention to psychosocial or clinical approaches to psychiatry.

The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-up

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-upVicki Montesano, Ph.D.Vicki MontesanoSearch for more papers by this author, Ph.D.Published Online:1 Feb 2012https://doi.org/10.1176/appi.ps.2012p191aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-upMcGlashanThomas H.M.D.WalshBarbara C.Ph.D., and WoodsScott W.M.D., New York, Oxford University Press, 2010, 256 pages, $54.95The handbook The Psychosis-Risk Syndrome is a summary of over a decade of research and clinical practice at PRIME (Psychosis Risk Identification, Management, and Education), the Yale University psychosis-risk clinic. The focus of the book is the psychosis-risk syndrome that precedes the onset of schizophrenia and the utilization of the Structured Interview for Psychosis-Risk Syndromes (SIPS) assessment to assist clinicians in determining risk. The authors contend that early detection and intervention in the first episode and the psychosis-risk phase reduce the severity of the disorder and delay its onset.According to the authors, one step toward prevention is the ability to identify and define the period leading up to a first psychotic break. The SIPS, developed by McGlashan and his colleagues and utilized at their psychosis-risk (prodromal) clinic, rates symptom and syndrome severity and generates diagnoses. It provides the clinician with a tool to determine whether the patient is psychotic or is at risk of developing psychosis in the future.The handbook is separated into three parts. The first part provides an overview of risk syndromes and psychosis and then focuses on the development of the SIPS assessment. The SIPS is an objective measure that captures multiple domains and provides the clinician with parameters to monitor the potential development of psychosis. The authors use the first part to describe the SIPS (including its validity, reliability, and diagnostic criteria) and lay the groundwork for its use.The second part of the handbook provides the reader with a brief overview of PRIME and then discusses utilization of the SIPS in practice. The reader can find a copy of the SIPS in an appendix of the handbook, which avoids disrupting the flow of the handbook. Numerous deidentified case presentations bring the process of administering the SIPS to life. The third part of the handbook focuses on the PRIME clinic and provides a brief overview of its organizational structure and practical implications.The psychosis-risk syndrome is one of the most controversial debates in DSM-5 development. In a recent article, Frances (1) discussed the consequences of identifying individuals at risk of psychosis. For example, there is concern about inappropriately exposing individuals to antipsychotic medications that negatively affect health. According to Frances, psychiatry does not have the tools to identify individuals before they become psychotic. In addition, findings from the North American Prodrome Longitudinal Study indicate that the majority of individuals identified as at risk of developing psychosis do not actually do so (2).Despite the controversy, I would recommend The Psychosis-Risk Syndrome to clinicians because it raises awareness of psychosis risk and the need to monitor patients for potential psychosis. The inclusion of the SIPS is thought provoking; however, Frances (1) pointed out the difficulty in transferring knowledge from research to practice. It is not clear whether the SIPS is ready for mainstream clinical settings, although the authors should be applauded for their work, particularly during this pivotal time in the field of psychiatry.Dr. Montesano is clinical assistant professor of psychiatry and manager of the Best Practices in Schizophrenia Treatment (BeST) Center, Department of Psychiatry, Northeast Ohio Medical University. Rootstown.The reviewer reports no competing interests.References1 Frances A : Prophet of preventive psychiatry recants: pulls support for psychosis risk and the use of antipsychotics. Psychiatric Times, July 2011, p 10 Google Scholar2 Addington J , Cornblatt BA , Cadenhead KS , et al.: At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry 168:800–805, 2011 Link, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 63Issue 2 February 2012Pages 191-192 Metrics PDF download History Published online 1 February 2012 Published in print 1 February 2012