From the Editor-in-Chief's Desk

This issue brings us noteworthy explorations of treatment interventions in schizophreniform and related disorders, along with psychotic symptoms associated with mood and anxiety disorders. These articles cast an encouragingly wide net over adjunct and “alternative” therapies as well as addressing the efficacy of early identification and the opportunity for prevention. We also include a contemplation of attention-deficit/hyperactivity disorder (ADHD) symptom management urging a more nuanced view of critical periods during the day.

Vesco et al. offer a case report of the real-world possibilities of complementary pharmacotherapy in complex cases. The authors' summary of the existing research on omega-3 (Ω3) in the treatment of mood and anxiety disorders and psychotic symptoms is alone worth your time. Their case description of a two-year adjunctive intervention in a young woman with bipolar disorder with psychosis and generalized anxiety disorder adds fascinating clinical insight. Though the authors are conscientious about the limitations and possible confounds of their investigation, they note that their study design and encouraging result offer the “potential hope of accumulating and enduring benefit.”

Elsewhere, Savitz et al. report on an extended open-label trial of paliperidone in a large sample of teenagers diagnosed with schizophrenia. The two-year duration is significant in and of itself, and the authors note that “this is the longest and largest safety study of an antipsychotic medication for adolescent schizophrenia that is available.” Hopefully the study data will be of continued use to researchers approaching schizophrenia management. Savitz et al. report that ongoing paliperidone therapy decreased and maintained PANSS scores over the study period, an impressive result.

Vernal et al. present the results of an unusual study that nonetheless holds great potential for the treatment and prevention of schizophrenia and related disorders in adolescents. The authors describe a “naturalistic study with clinician's choice antipsychotic treatment” of adolescents with either not otherwise specified (NOS) psychotic disorder or schizophrenia-spectrum disorders. The hurdles are many: “the nonrandomized design, naturalistic treatment setting and choice, lack of research diagnostic interviews and specific psychopathology ratings, still relatively small sample size, and short duration of follow-up” are all limitations, Vernal et al. concede.

Yet the results are heartening. Though the NOS subjects fared better, both groups improved. And the novel heterogeneous clinical decision-making captured here suggests, the authors write, “that early treatment and intervention in youth during the initial stages of psychotic disorders are critical for increasing the chances of improving the symptomatic and functional outcome in this vulnerable population.”

Finally, Salee reviews early morning functioning (EMF) impairments in ADHD and the lack of efficacious medication interventions for oft-overlooked symptoms that can have an outsize effect on family morale. “The severity of these early morning symptoms and related functional impairments are moderate to severe for a majority of their children,” Salee writes, and parents describe relationships as “negatively affected.” He concludes that EMF is worthy of further study, and that targeted interventions are warranted.

I hope you find these articles of use.