Early intervention at the onset of psychotic disorders is a highly attractive theoretical notion that is receiving increasing international interest. In practical terms, it amounts to first deciding when a psychotic disorder can be said to have commenced and then offering potentially effective treatment at the earliest possible point. A second element involves ensuring that this intervention constitutes best practice for this phase of illness and is not merely the translation of standard treatments developed for later stages and the more persistently ill subgroups of the disorder. Furthermore, it means ensuring that this best practice model is actually delivered to patients and families. The relative importance of these elements in relation to outcome has not yet been established. This article outlines a framework for preventive intervention in early psychosis, based on more than a decade of experience initially gained within a first-generation model. This experience has been followed, after a prolonged gestation, by the birth of the Early Psychosis Prevention and Intervention Centre (EPPIC), a comprehensive "real-world" model of care targeting the multiple clinical foci underpinning the preventive task. Data are reported to illustrate the topography and impact of delay in treatment in our regional setting, and the results of an initial evaluation of the EPPIC model are presented. The latter demonstrate a significant improvement in symptomatic and functional outcome when the second-generation model is contrasted with the first. The implications of these findings and future developments are discussed.

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Choosing to listen to self-identified sad music after experiencing negative psychological circumstances seems paradoxical given the commonly-held view that people are motivated to seek a positive affective state when distressed. We examined the motivations people described to listen to music they identified as sad, particularly when experiencing negative circumstances, and the self-reported effects of this activity. We asked adults to respond to an online survey and analyzed their narrative reports using a modified grounded theory approach. Responses were received from 65 adults across five countries. The process that underlies choosing to listen to sad music as well as the self-regulatory strategies and functions of sad music were identified. The music-selection strategies included: connection; selecting music based on memory triggers; high aesthetic value; and message communicated. The functions of these strategies were in the domains of (re-)experiencing affect, cognitive, social, retrieving memories, friend, distraction, and mood enhancement. We additionally modelled the underlying psychological process that guides sad music listening behaviour and the effects of listening. These findings present core insights into the dynamics and value of choosing to listen to self-identified sad music when coping with negative psychological circumstances.

The present study sought to understand the rural and remote influences on people's identification of, and response to, mental health problems. Twenty-two key informants living in northern and western South Australia were interviewed. They included mental health and generalist health professionals, other human service workers and mental health consumers. Three themes are reported here: reluctance to acknowledge mental health problems and the avoidance of appropriate help; stigma and the avoidance of mental health services; and the influence of rural and remote circumstances. Most informants considered that many mental health problems were amenable to help from generalist workers, with backup support from mental health specialists. Informants thought this intervention to be appropriate because a common view of mental health problems as 'insanity' and a culture of self-reliance created a reluctance to seek help from a mental health specialist. These themes need to be taken into account when designing mental health interventions for rural and remote communities.

BackgroundWell-designed prospective studies of substance misuse in first-episode psychosis can improve our understanding of the risks associated with comorbid substance misuse and psychosis.AimsTo examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis.MethodThe study was a prospective 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services.ResultsSubstance misuse was independently associated with increased risk of in-patient admission, relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors. Substance misuse was not associated with remission or time to remission of positive symptoms. Heavy substance misuse was associated with increased risk of in-patient admission, relapse and shorter time to relapse.ConclusionsSubstance misuse is an independent risk factor for a problematic recovery from first-episode psychosis.

PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.

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