bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep in Psychiatric Disorders: Where are We Now?
Authors: Lee Elliott Kyung , Douglass Alan B
Published: January 2017

Although the precise function of sleep is unknown, decades of research strongly implicate that sleep has a vital role in central nervous system (CNS) restoration, memory consolidation, and affect regulation. Slow-wave sleep (SWS) and rapid eye movement (REM) sleep have been of significant interest to psychiatrists; SWS because of its putative role in CNS energy recuperation and cognitive function, and REM sleep because of its suggested involvement in memory, mood regulation, and possible emotional adaptation. With the advent of the polysomnogram, researchers are now beginning to understand some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. The same neurochemistry that controls the sleep-wake cycle has also been implicated in the pathophysiology of numerous psychiatric disorders. Thus it is no surprise that several psychiatric disorders have prominent sleep symptoms. This review will summarize normal sleep architecture, and then examine sleep abnormalities and comorbid sleep disorders seen in schizophrenia, as well as anxiety, cognitive, and substance abuse disorders.
Sleep Pathologies in Depression and the Clinical Utility of Polysomnography
Authors: Sculthorpe Lauren D , Douglass Alan B
Published: January 2017

Abnormal sleep accompanies many psychiatric conditions, but has long been recognized as a particularly conspicuous feature of affective disorders. More than a mere epiphenomenon, the powerful link between sleep and mood regulation is most dramatically demonstrated by the high efficacy of sleep deprivation in alleviating depression. Indeed, the sleep abnormalities that accompany depression may be due to the same neuropathologies that are responsible for its mood and cognitive symptoms. This powerful link between sleep and mood regulation makes polysomnography (PSG) a useful window into the underlying pathophysiology of depression, yet it is underused, particularly in clinical diagnosis. Recent depression research has emphasized the importance of establishing biologically relevant subtypes of depression with treatment specificity and prognostic value. PSG measures, among other biological markers, may be of importance in establishing these subtypes. Two subtypes of depression that appear to have robust biological differences, the melancholic and atypical subtypes, have recently been shown to have different sleep profiles that can aid in differential diagnosis. Further, routine use of PSG in the workup of a depressed patient would minimize the chances of misdiagnosis in those suffering from primary sleep disorders such as sleep apnea, which can present secondary mood symptoms resembling depression. Increased use of PSG in clinical psychiatric practice would enlarge the body of data available for defining new depressive subtypes in the future. It would also serve an immediate purpose in the separation of atypical, compared with melancholic, depression, and the differential diagnosis of depression from primary sleep disorders.
Development and Psychometric Properties of the Mental Health Knowledge Schedule
Authors: Evans-Lacko Sara , Little Kirsty , Meltzer Howard , Rose Diana , Rhydderch Danielle , Henderson Claire , Thornicroft Graham
Published: January 2017

Objective:

Stigma has been conceptualized as comprised of 3 constructs: knowledge (ignorance), attitudes (prejudice), and behaviour (discrimination). We are not aware of a psychometrically tested instrument to assess knowledge about mental health problems among the general public. Our paper presents the results of the development stage and the psychometric properties of the Mental Health Knowledge Schedule (MAKS), an instrument to assess stigma-related mental health knowledge among the general public.

Methods:

We describe the development of the MAKS in addition to 3 studies that were carried out to evaluate the psychometric properties of the MAKS. Adults aged 25 to 45 years in socioeconomic groups: B, C1, and C2 completed the instrument via face-to-face interview ( n = 92) and online ( n = 403).

Results:

Internal reliability and test-retest reliability is moderate to substantial. Validity is supported by extensive review by experts (including service users and international experts in stigma research).

Conclusion:

The lack of a valid outcome measure to assess knowledge is a shortcoming of evaluations of stigma interventions and programs. The MAKS was found to be a brief and feasible instrument for assessing and tracking stigma-related mental health knowledge. This instrument should be used in conjunction with other attitude- and behaviour-related measures.
Is Peacekeeping Peaceful? A Systematic Review
Authors: Sareen Jitender , Stein Murray B , Thoresen Siri , Belik Shay-Lee , Zamorski Mark , Asmundson Gordon JG
Published: January 2017

Objective:

To systematically review the literature on the association between deployment to a peacekeeping mission and distress, mental disorders, and suicide.

Methods:

Peer-reviewed English publications were found through key word searches in MEDLINE, PsycINFO, Scopus, and Embase, and by contacting authors in the field. Sixty-eight articles were included in this review.

Results:

Some studies have found higher levels of postdeployment distress and posttraumatic stress disorder (PTSD) symptoms. Most studies have not shown an increased risk of suicide in former peacekeepers. Correlates of distress and PTSD symptoms included level of exposure to traumatic events during deployment, number of deployments, predeployment personality traits or disorder, and postdeployment stressors. Perceived meaningfulness of the mission, postdeployment social supports, and positive perception of homecoming were associated with lower likelihood of distress.

Conclusions:

Most peacekeepers do not develop high levels of distress or symptoms of PTSD. As postdeployment distress is consistently shown to be associated with high levels of exposure to combat during deployment, targeted interventions for peacekeepers who have been exposed to high levels of combat should be considered.
Brain Illness and Creativity: Mechanisms and Treatment Risks
Authors: Flaherty Alice W
Published: January 2017

Brain diseases and their treatment may help or hurt creativity in ways that shape quality of life. Increased creative drive is associated with bipolar disorder, depression, psychosis, temporal lobe epilepsy, frontotemporal dementia, Parkinson disease treatments, and autism. Creativity depends on goal-driven approach motivation from midbrain dopaminergic systems. Fear-driven avoidance motivation is of less aid to creativity. When serotonin and norepinephrine lower motivation and flexible behaviour, they can inhibit creativity. Hemispheric lateralization and frontotemporal connections must interact to create new ideas and conceptual schemes. The right brain and temporal lobe contribute skill in novelty detection, while the left brain and frontal lobe foster approach motivation and more easily generate new patterns of action from the novel perceptions. Genes and phenotypes that increase plasticity and creativity in tolerant environments with relaxed selection pressure may confer risk in rigorous environments. Few papers substantively address this important but fraught topic. Antidepressants (ADs) that inhibit fear-driven motivation, such as selective serotonin reuptake inhibitors, sometimes inhibit goal-oriented motivation as well. ADs that boost goal-directed motivation, such as bupropion, may remediate this effect. Benzodiazepines and alcohol may be counterproductive. Although dopaminergic agonists sometimes stimulate creativity, their doing so may inappropriately disinhibit behaviour. Dopamine antagonists may suppress creative motivation; lithium and anticonvulsant mood stabilizers may do so less. Physical exercise and REM sleep may help creativity. Art therapy and psychotherapy are not well studied. Preserving creative motivation can help creativity and other aspects of well-being in all patients, not just artists or researchers.
Assertive Community Treatment in the Netherlands: Outcome and Model Fidelity
Authors: van Vugt Maaike D , Kroon Hans , Delespaul Philippe A E G , Dreef Fred G , Nugter Annet , Roosenschoon Bert-Jan , van Weeghel Jaap , Zoeteman Jeroen B , Mulder Cornelis L
Published: January 2017

Objective:

The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system.

Method:

In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness ( n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics.

Results:

High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores.

Conclusions:

Our evidence supports the importance of model fidelity for improving patient outcomes.
Increased Risk of Avoidable Hospitalization among Patients with Schizophrenia
Authors: Lin Herng-Ching , Huang Chung-Chien , Chen Shu-Fen , Chen Yi-Hua
Published: January 2017

Objective:

Some studies suggest that hospitalizations for certain conditions, called ambulatory care sensitive conditions (ACSCs), are potentially avoidable. However, almost no study has addressed the risk of ACSC hospitalizations specifically for patients with severe mental illness. Our study examines the risk of ACSC hospitalizations among patients with schizophrenia in Taiwan, using a 5-year, nationwide, population-based database.

Methods:

Our study included 2503 patients with schizophrenia and 20 024 matched patients without schizophrenia. Poisson regression analysis was then performed in which the number of ACSC hospitalizations from 2002 to 2006 (including ruptured appendix, asthma, cellulitis, congestive heart failure, diabetes, gangrene, hypokalemia, immunizable conditions, malignant hypertension, pneumonia, pyelonephritis, and perforated or bleeding ulcer) was regressed against the independent variable of whether or not a patient had a schizophrenia diagnosis in 2001.

Results:

Results show that 9.83% of patients with schizophrenia and 4.71% of patients in the comparison group experienced ACSC hospitalizations from 2002 to 2006. After adjusting for each patient's sex, age, level of urbanization, geographic location of residence within a community, and monthly income, patients with schizophrenia had a 3.26-fold higher (95% CI 3.00 to 3.54, P < 0.001) risk of experiencing ACSC hospitalizations than the comparison participants. After excluding the conditions of diabetes, hypertension, and asthma, patients with schizophrenia independently had a 2.46-fold higher risk of ACSC hospitalizations (95% CI 2.12 to 2.86, P < 0.001), compared with participants in the comparison group.

Conclusions:

We conclude that schizophrenia patients are at a higher risk for hospitalizations owing to ACSCs, despite a national health insurance system providing universal coverage to citizens.
Nutrient Intakes are Correlated with Overall Psychiatric Functioning in Adults with Mood Disorders
Authors: Davison Karen M , Kaplan Bonnie J
Published: January 2017

Objective:

To evaluate the relation between nutrient intake and psychiatric functioning in adults with confirmed mood disorders.

Method:

A cross-sectional study was conducted of the intake of major (that is, carbohydrates, fat, and protein) and minor (that is, vitamins and minerals) nutrients (from 3-day food records and a Food Frequency Questionnaire), Global Assessment of Functioning (GAF) scores, and symptoms of depression and mania (the Hamilton Depression Rating Scale and the Young Mania Rating Scale) in 97 community-based adults with mood disorders whose diagnoses were confirmed with structured interviews.

Results:

Significant correlations were found between GAF scores and energy (kilocalories), carbohydrates, fibre, total fat, linoleic acid, riboflavin, niacin, folate, vitamin B6, vitamin B12, pantothenic acid, calcium, phosphorus, potassium, and iron (all P values < 0.05), as well as magnesium ( r = 0.41, P < 0.001) and zinc ( r = 0.35, P < 0.001). Though modest in magnitude, the pattern of correlations was consistent, indicating higher levels of mental function associated with a higher intake of nutrients. Depression and mania scores, which were generally mild or moderate, did not individually show consistent patterns. When dietary supplement use was added to nutrient intakes from food, GAF scores remained positively correlated ( P < 0.05) with all dietary minerals.

Conclusion:

This detailed analysis in a clinically diagnosed sample was consistent with prior epidemiologic surveys, revealing an association between higher levels of nutrient intakes and better mental health. Nutrient intakes warrant further consideration in the treatment of people with mood disorders.
Prevalence of Prescribed Attention-Deficit Hyperactivity Disorder Medications and Diagnosis among Canadian Preschoolers and School-Age Children: 1994–2007
Authors: Brault Marie-Christine , Lacourse Éric
Published: January 2017

Objective:

To describe trends in the prevalence of prescribed attention-deficit hyperactivity disorder (ADHD) medication by Canadian preschoolers and school-age children and to compare these with trends in the prevalence of the ADHD diagnosis between 1994 and 2007.

Methods:

Subjects participated in the National Longitudinal Survey on Children and Youth, a Canadian prospective survey collecting data biennially. Three cross-sectional samples of nonreferred children, aged 3 to 9 years and representative of Canadian children for 1994–1995 ( n = 12 595), 2000–2001 ( n = 13 904), and 2006–2007 ( n = 14 655), were selected for the analyses. Information on prescribed medications and ADHD diagnosis was reported by each child's parents. Prevalence was estimated at each cycle, taking the child's age and sex into account.

Results:

The estimated prevalence of prescribed medications and ADHD diagnosis in Canada was generally low (less than 3%), but higher for boys (less than 4%) and school-age children (less than 5%). Preschoolers' prevalence of both prescribed medications and ADHD diagnosis stayed stable between 1994 and 2007 (1% or less), while that of school-age children increased nearly 2-fold. Boys' prevalence was higher than that of girls, but girls show the steepest increase over time, up to 2.1-fold. The association between prescribed medications and ADHD diagnosis has strengthened during the 2000s: a greater number of medications were used for children with ADHD (from 43% in 2000 to 59% in 2007) while off-label use of prescribed medications decreased among school-age children.

Conclusions:

The upward trend in the prevalence of prescribed ADHD medications and ADHD diagnosis currently observed in contemporary societies is also occurring in Canada, except with preschoolers.
Factor Structure of Borderline Personality Disorder Symptomatology in Adolescents
Authors: Speranza Mario , Pham-Scottez Alexandra , Revah-Levy Anne , Barbe Remy P , Perez-Diaz Fernando , Birmaher Boris , Corcos Maurice
Published: January 2017

Objective:

To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology.

Method:

The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs.

Results:

The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors.

Conclusions:

The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.
Risk Assessment Instruments in Clinical Practice
Authors: Côté Gilles , Crocker Anne G , Nicholls Tonia L , Seto Michael C
Published: January 2017

Objective:

To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD).

Method:

This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men.

Results:

Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification.

Conclusions:

The findings confirm that there remains a significant gap between research evidence and risk assessment practice.
La consommation d'alcool et de drogue des étudiants suite à la fusillade de Dawson: Une analyse différenciée selon le sexe
Authors: Dugal Natasha , Guay Stéphane , Boyer Richard , Lesage Alain , Séguin Monique , Bleau Pierre
Published: January 2017

Objectif:

Étudier l'incidence de la dépendance à l'alcool ou aux drogues chez les étudiants exposés à la fusillade du Collège Dawson dans les 18 mois suivant celle-ci, identifier les précurseurs du développement d'une dépendance à une substance psychoactive en tenant compte de la sévérité d'exposition à l'événement, et examiner si la consommation d'alcool 18 mois après les événements est en lien avec les différents groupes de symptômes d'état de stress post-traumatique (ESPT).

Méthode:

La population à l'étude est composée de l'ensemble des étudiants du Collège Dawson au moment de l'événement. Les analyses ont été faites auprès de 854 étudiants inscrits au Collège au moment de la fusillade.

Résultats:

Cinq pour cent des femmes et 7% des hommes présentent pour la première fois de leur vie un problème de dépendance à une substance suite à la fusillade. Pour les hommes, leur jeune âge, la présence de pensées suicidaires au cours de leur vie, ainsi que le fait d'avoir vu le tireur au moment de la fusillade sont les principaux précurseurs de cas incidents de dépendance. Aucun des précurseurs étudiés n'est significatif pour les femmes. Les hommes et les femmes se distinguent également quant aux symptômes d'ESPT qui prédisent la consommation d'alcool 18 mois après la fusillade.

Conclusion:

La principale retombée de l'étude est de souligner l'importance de considérer le sexe des individus pour étudier leur consommation de substances psychoactives suite à un traumatisme.
Suicidal Behaviours in Affective Disorders: A Defcit of Cognitive Inhibition?
Authors: Richard-Devantoy Stéphane , Gorwood Philip , Annweiler Cédric , Olié Jean-Pierre , Le Gall Didier , Beauchet Olivier
Published: January 2017

Objective:

Suicide has been related to affective disorders. We hypothesized that suicide could be associated with cognitive inhibition deficit. Our study aimed to systematically review all published articles that examined the relation between cognitive inhibition defcit and suicidal behaviours (that is, suicide attempt or suicidal ideation) in patients with affective disorders.

Method:

We performed an English and French MEDLINE and EMBASE search, ranging from 1970 to 2010, indexed under the MeSH terms of suicide, neuropsychology, neuropsychological tests, and executive function, combined with the following title and abstract terms: neuropsychological functions, executive functioning, and executive performance.

Results:

Among the 164 selected studies, 9 observational studies met the selection criteria and were included in the final analysis. The number of participants ranged from 57 to 244 (28% to 66%, respectively, were men). Executive dysfunction was more frequently found among patients with suicidal behaviours. In particular, higher cognitive inhibition deficit was observed in depressed subjects with suicide behaviours, compared with depressed subjects without any suicidal behaviour. The results of the meta-analysis showed a higher impairment in inhibition score, according to the number of perseverations in the Wisconsin Card Sorting Test (Cohen d = 0.68) than in inhibition according to the time needed to perform the Trail-Making Test part B ( d = 0.01) among patients with suicidal behaviour, compared with patients with no suicidal behaviour.

Conclusion:

This systematic review and meta-analysis showed a positive association between cognitive inhibition defcit and suicide attempts in patients with affective disorders. Future research should examine whether cognitive inhibition deficit precedes the suicidal behaviour.
The Enablers and Barriers to the Use of Direct Observation of Trainee Clinical Skills by Supervising Faculty in a Psychiatry Residency Program
Authors: Madan Robert , Conn David , Dubo Elyse , Voore Peter , Wiesenfeld Leslie
Published: January 2017

Objective:

Studies have reported that medical trainees do not get sufficient direct observation. Our study aimed to determine the frequency of direct observation and the enablers and barriers to direct observation in the department of psychiatry at a large Canadian university.

Method:

Focus groups and interviews explored the role and use of direct observation, followed by a survey both of faculty and of residents.

Results:

Direct observation was used in various contexts in the residents' last rotation. Missed opportunities are identified. Enablers include financial compensation, guidelines, and a discussion at the beginning of each clinical rotation. Barriers are identified at the resident, faculty, and administrative levels.

Conclusions:

Direct observation is used in many contexts in psychiatric training. While there are barriers which limit its use, our data indicate numerous potential enablers and missed opportunities for more observation.
Treatment of Psychopathology in People with Intellectual and other Disabilities
Authors: Sturmey Peter
Published: January 2017

Objective:

To review the psychosocial, pharmacological, and other treatments of psychopathology in people with intellectual disabilities (IDs), autism, and other developmental disabilities (DDs).

Method:

Systematic reviews and meta-analyses of psychosocial, pharmacological, and other treatments for people with DDs are reviewed.

Results:

There is strong evidence for applied behaviour analysis (ABA) and other behavioural treatments of some forms of psychopathology. There is little good evidence to support the effectiveness of cognitive-behavioural therapy, cognitive therapy, sensory interventions, and other forms of psychosocial interventions. Recently, more randomized controlled trials (RCTs) of psychopharmacology have been published, especially with people with autism spectrum disorders. Most RCTs were for externalizing behaviour problems, rather than for psychopathology. These RCTs offer only preliminary support for the effectiveness of pharmacotherapy. No evidence was found for the effectiveness of other biological treatments.

Conclusions:

Current research supports the use of ABA and other behavioural interventions for some forms of psychopathology. Evidence for the effectiveness of other interventions is limited or absent.
Racial Discrimination Experienced by Aboriginal University Students in Canada
Authors: Currie Cheryl L , Wild T Cameron , Schopflocher Donald P , Laing Lory , Veugelers Paul
Published: January 2017

Objectives:

Racial discrimination is an established life course social determinant of health associated with adverse psychological outcomes among minority populations. However, little is known about the extent to which Aboriginal people in Canada may experience racial discrimination and consequent adverse psychological effects. This study sought to measure the extent to which Aboriginal university students living in an urban area of Canada experienced racism, to triangulate this evidence with US data and qualitative findings, and to examine the impact of these experiences on mental health.

Methods:

Data for this mixed method study were collected via in-person surveys with a volunteer sample of Aboriginal university students ( n = 60) living in a mid-sized city in central Canada in 2008–2009.

Results:

Results indicate Aboriginal university students experienced more frequent racism across a greater number of life situations than African- and Latino-American adults in the United States. Student reactions to these experiences were symptomatic of what has been termed racial battle fatigue in the United States. Students who considered themselves traditional or cultural Aboriginal persons were significantly more likely to experience discrimination.

Conclusions:

Results underline the need for policies aimed at reducing racism directed at Aboriginal people in urban areas and the growth of services to help Aboriginal people cope with these experiences. Results highlight the need for further research to determine the potential pathogenic consequences of racial discrimination for Aboriginal people in Canada.
The Incidence of First-Episode Schizophrenia-Spectrum Psychosis in Adolescents and Young Adults in Montreal: An Estimate from an Administrative Claims Database
Authors: Anderson Kelly K , Fuhrer Rebecca , Abrahamowicz Michal , Malla Ashok K
Published: January 2017

Objective:

There has been increasing interest in the psychiatric literature on research and service delivery focused on first-episode psychosis (FEP), and accurate information on the incidence of FEP is crucial for the development of services targeting patients in the early stages of illness. We sought to obtain a population-based estimate of the incidence of first-episode schizophrenia-spectrum psychosis (SSP) among adolescents and young adults in Montreal.

Methods:

Population-based administrative data from physician billings, hospitalizations, pharmacies, and public health clinics were used to estimate the incidence of first-episode SSP in Montreal. A 3-year period (2004–2006) was used to identify patients with SSP aged 14 to 25 years. We used a 4- to 6-year clearance period to remove patients with a history of any psychotic disorder or prescription for an antipsychotic.

Results:

We identified 456 patients with SSP, yielding a standardized annual incidence of 82.9 per 100 000 for males (95% CI 73.7 to 92.1), and 32.2 per 100 000 for females (95% CI 26.7 to 37.8). Using ecologic indicators of material and social deprivation, we found a higher-incidence proportion of SSP among people living in the most deprived areas, relative to people living in the least deprived areas.

Conclusions:

Clinical samples obtained from psychiatric services are unlikely to capture all treatment-seeking patients, and epidemiologic surveys have resource-intensive constraints, making this approach challenging for rare forms of psychopathology; therefore, population-based administrative data may be a useful tool for studying the frequency of psychotic disorders.
Predicting Hospital Length of Stay for Geriatric Patients with Mood Disorders
Authors: Ismail Zahinoor , Arenovich Tamara , Grieve Charlotte , Willett Peggie , Sajeev Gautam , Mamo David C , MacQueen Glenda M , Mulsant Benoit H
Published: January 2017

Objective:

To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds.

Method:

Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument—Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models.

Results:

Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living.

Conclusions:

Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.
The Impact of Winning and Losing on Family Interactions: A Biological Approach to Family Therapy
Authors: Sloman Leon , Sturman Edward D
Published: January 2017

Objective:

To examine the connection between winning and losing and family functioning. We do this by hypothesizing a link between successful outcomes in individual competition and in functional family interaction. This enables us to show how therapeutic interventions can be directed toward the attachment system, by lowering anxiety and fostering mutual trust, and toward the social rank system, by promoting success and feelings of empowerment.

Method:

A search of online databases was conducted with key search terms related to winning and losing, and their effects on attachment patterns and family interactions.

Results:

Winning in agonistic encounters has been associated with lowered dysphoria, anxiety, and hostility. These affective states trigger positive patterns of family interaction through their effect on the social rank and attachment systems.

Conclusion:

Continued success promotes adaptive cycles of interaction, whereas inability to accept loss has the reverse effect. Early humans, who were more successful in competition, were better able to promote the survival and well-being of other family members, which would have accelerated our phylogenetic adaptation.
The Significance of At-Risk or Prodromal Symptoms for Bipolar I Disorder in Children and Adolescents
Authors: Hauser Marta , Correll Christoph U
Published: January 2017

While in the early identification and intervention of psychosis-specific instruments and risk criteria have been generated and validated, research into indicated preventive strategies for bipolar I disorder (BD I) has only recently gained momentum. As the first signs of BD I often start before adulthood, such efforts are especially important in the vulnerable pediatric population. Data are summarized regarding the presence and nature of potentially prodromal, that is, subsyndromal, symptoms prior to BD I, defined by first-episode mania, focusing on pediatric patients.

Research indicates the possibility of early identification of youth at clinical high risk for BD. Support for this proposition comes from retrospective studies of BD I patients, as well as prospective studies of community samples, offspring of BD I subjects, youth with depressive disorders, and patients at high risk for psychosis or with bipolar spectrum disorders without lifetime history of mania. These data provide essential insight into potential signs and symptoms that may enable presyndromal identification of BD I in youth. However, except for offspring studies, broader prospective approaches that focus on youth at clinical high risk for BD I and on developing specific interviews and (or) rating scales and risk criteria are mostly missing, or in their early stage. More work is needed to determine valid and sufficiently specific clinical high-risk criteria, to distinguish risk factors, endophenotypes, and comorbidities from prodromal symptomatology, and to develop phase-specific interventions that titrate the risk of intervention to the risk of transition to mania and to functional impairment or distress. Moreover, studies are needed that determine potential differences in prodromal symptoms and trajectories between children, adolescents, and adults, and the best phase-specific interventions.
The Significance of At-Risk Symptoms for Psychosis in Children and Adolescents
Authors: Schimmelmann Benno Graf , Walger Petra , Schultze-Lutter Frauke
Published: January 2017

The early detection and treatment of people at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. Currently, the 2 most broadly used sets of at-risk criteria, that is, ultra-high risk (UHR) and basic symptom criteria, were developed mainly in adult samples. We review the data regarding the presence and relevance of at-risk symptoms for psychosis in children and adolescents. The few existing studies suggest that attenuated psychotic symptoms (APS) and brief limited intermittent psychotic symptoms (BLIPS) do have some clinical relevance in young adolescents from the general population. Nevertheless, their differentiation from atypical psychotic symptoms or an emerging schizotypal personality disorder, as well as their stability and predictive accuracy for psychosis, are still unclear. Further, standard interviews for UHR criteria do not define a minimum age for the assessment of APS and BLIPS or guidelines as to when and how to include information from parents. APS and basic symptoms may be predictive of conversion to psychosis in help-seeking young adolescents. Nevertheless, the rate and timing, and thus the required observation time, need further study. Moreover, no study has yet addressed the issue of how to treat children and adolescents presenting with at-risk symptoms and criteria. Further research is urgently needed to examine if current at-risk criteria and approaches have to be tailored to the special needs of children and adolescents. A preliminary rationale for how to deal with at-risk symptoms for psychosis in clinical practice is provided.
Childhood Trauma as a Cause of Psychosis: Linking Genes, Psychology, and Biology
Authors: van Winkel Ruud , van Nierop Martine , Myin-Germeys Inez , van Os Jim
Published: January 2017

Recent studies have provided robust evidence for an association between childhood trauma (CT) and psychosis. Meta-analyses have quantified the association, pointing to odds ratios in the order of around 3, and prospective studies have shown that reverse causation is unlikely to explain the association. However, more work is needed to address the possibility of a gene–environment correlation, that is, whether genetic risk for psychosis predicts exposure to CT. Nevertheless, multiple studies have convincingly shown that the association between CT and psychosis remains strong and significant when controlling for genetic risk, in agreement with a possible causal association. In addition, several studies have shown plausible psychological and neurobiological mechanisms linking adverse experiences to psychosis, including induction of social defeat and reduced self-value, sensitization of the mesolimbic dopamine system, changes in the stress and immune system, and concomitant changes in stress-related brain structures, such as the hippocampus and the amygdala, findings that should be integrated, however, in more complex models of vulnerability. It is currently unclear whether genetic vulnerability plays a role in conferring the mental consequences of adversity, and which genes are likely to be involved. The current, limited evidence points to genes that are not specifically involved in psychosis but more generally in regulating mood (serotonin transporter gene), neuroplasticity (brain-derived neurotrophic factor), and the stress-response system ( FKBP5), in line with a general effect of CT on a range of mental disorders, rather than suggesting specificity for psychosis.
From Social Experience to Illness Experience: Reviewing the Psychological Mechanisms Linking Psychosis with Social Context
Authors: Kidd Sean A
Published: January 2017

This review was undertaken to describe the psychological processes that are associated with the social experiences and behaviours of people with psychosis. A systematic search was conducted using MEDLINE and PsyclNFO search engines. In each of the major topic domains, the search was comprised of review articles published from 2004 to present, and individual article searches for papers published from 2010 to present. The key psychological mechanisms in this context are social cognition, self-concept, emotion, and communication. While diverse in content, there were several cross-cutting themes in these literatures. These include evidence of the presence of social processing difficulties in high-risk and psychosis populations that have both state and trait characteristics, are related to, but not fully accounted for by, neurocognition and symptomatology, and have significant implications for social functioning. There are numerous established and promising treatments linked to our understanding of social cognition. Limitations cutting across these literatures include a substantial reliance on cross-sectional studies that use control groups comprised of people who have not experienced significant psychological or social adversity. There is also limited inquiry into how psychological mechanisms may differ owing to sex, ethnicity, and race. Despite these issues, this line of inquiry is very promising as part of the larger movement toward an integrative model of psychosis that is able to account for the complex interactions of social, biological, and psychological risks.
The Influence of Perceived Social Support on Medication Adherence in First-Episode Psychosis
Authors: Rabinovitch Mark , Cassidy Clifford , Schmitz Norbert , Joober Ridha , Malla Ashok
Published: January 2017

Objective:

Our study examines the unique influence of social and family support on adherence to medication in a sample of patients treated for first-episode psychosis (FEP).

Method:

Social and family support using the Multidimensional Scale of Perceived Social Support and medication adherence (consensus of subjective and objective data) were evaluated on a monthly basis during a 6-month period in a sample of 82 FEP patients. The relation between social support and adherence was evaluated using correlational and linear regression analyses, controlling for other relevant variables. A longitudinal analysis using hierarchical linear models was conducted to model change in adherence over time.

Results:

Monthly correlations between social support and adherence were significant at 4 of 7 time points during a 6-month period. There was a modest correlation between the percentage of months of good adherence and the average level of family support across the study period. The linear regression failed to demonstrate a significant relation between baseline social support and overall adherence during the entire study period. Change in social support over time was inversely associated with change in adherence.

Conclusions:

Our study emphasizes the concurrent influence of social (mostly family) support on adherence but this effect does not persist over time. Changes in the degree of social support may have a complex effect on changes in adherence.
New Developments in the Psychological Management of Chronic Pain
Authors: Morley Stephen , Williams Amanda
Published: January 2017

After reviewing how psychological treatment for chronic pain comes to have its current form, and summarizing treatment effectiveness, we explore several areas of development. We describe third wave therapies, such as mindfulness; we discuss what the research literature aggregated can tell us about what trials are more useful to conduct; and we outline some areas of promise and some failures to deliver on promise. The article is drawn together using the framework of the normal psychology of pain, identifying some of its most important implications for improving life for people with chronic pain.
Risk Factors for Progression of Alzheimer Disease in a Canadian Population: The Canadian Outcomes Study in Dementia (COSID)
Authors: Herrmann Nathan , Harimoto Tetsuhiro , Balshaw Robert , Lanctôt Krista L ,   The Canadian Outcomes Study in Dementia (COSID) Investigators (members)5
Published: January 2017

Objective:

To determine risk factors for clinically significant progression during 12 months in patients with mild-to-moderate Alzheimer disease.

Method:

Community-dwelling patients with mild-to-moderate Alzheimer disease were enrolled in a 3–year prospective study, the Canadian Outcomes Study in Dementia (commonly referred to as COSID), at 32 Canadian sites. Assessments included the Global Deterioration Scale (GDS) for disease severity, the Mini-Mental State Examination (MMSE) for cognition, the Functional Autonomy Measurement System (SMAF) for daily functioning, and the NeuroPsychiatric Inventory (NPI) for behaviour, measured at baseline and at 12 months. Logistic regression identified factors associated with GDS decline, and subsequent stepwise regression identified key independent predictors. Area under the curve (AUC) was then calculated for the model.

Results:

Among 488 patients (mean age 76.5 years [SD 6.4], MMSE 22.1 [SD4.6], 44.1% male), 225 (46%) showed GDS decline. After adjusting for age, baseline risk factors for deterioration included the following: poorer cognition (lower MMSE score, OR 0.55; 95% CI 0.4 to 0.72 per 5 points, P = 0.001), greater dependence (lower SMAF, OR 0.72; 95% CI 0.63 to 0.83 per 5 points, P = 0.001), and more neuropsychiatric symptoms (higher NPI, OR 1.11; 95% CI 1.02 to 1.2 per 5 points, P = 0.02), with a protective effect of male sex (OR 0.59; 95% CI 0.39 to 0.9, P = 0.02), and higher (worse) GDS score (very mild, compared with mild OR 0.25; 95% CI 0.09 to 0.70, P = 0.01; compared with moderate, OR 0.08; 95% CI 0.03 to 0.23, P < 0.001; compared with moderately severe, OR 0.03; 95% CI 0.01 to 0.11, P < 0.001). The AUC was 73% ( P < 0.001) (sensitivity 90% and specificity 33%).

Conclusion:

The progression of Alzheimer disease in Canada can be predicted using readily available clinical information.
Poverty and Mental Illness
Authors: Saraceno Benedetto , Barbui Corrado
Published: January 2017

Objective

To assess the relationship between poverty and mental illness in order to stimulate debate on future international cooperation programs in mental health.

Method

Epidemiological data in the international literature addressing the issue of material poverty as a risk factor for the development of mental illness and as a prognostic factor for the outcome of mental illness were reviewed.

Results

The international literature reviewed supports the notion that material poverty is a risk factor for a negative outcome among mentally ill people. In addition, preliminary epidemiological data suggest that service-related variables may be determinants of outcome of mental illnesses. In our view, cooperation with developing countries is a great opportunity to evaluate mental health services in a natural setting.

Conclusions

A new generation of programs for international cooperation in mental health is needed, in which knowledge and technology transfer is based on a service-research attitude. Attention should be focused on variables related to the poverty of services that might be linked to the course and outcome of mental illnesses.
Are Dependency and Self-Criticism Risk Factors for Major Depressive Disorder?
Authors: Zaretsky Ari E , Fava Maurizio , Davidson Katharine G , Pava Joel A , Matthews John , Rosenbaum Jerrold F
Published: January 2017

Objective

To determine whether dependent and self-critical personality traits are associated with specific types of life events and whether these traits change with pharmacotherapy.

Method

Overall, 142 depressed outpatients completing 8 weeks of fluoxetine treatment were administered the Life Experiences Survey (LES) at baseline and the Dysfunctional Attitude Scale (DAS) and Hamilton Depression Rating Scale (HDRS) at baseline and endpoint.

Results

The DAS dependency subscale, but not the self-criticism subscale, showed significant correlations with life events regardless of congruency. Baseline HDRS scores were positively correlated with both DAS subscales and total score. The DAS subscales, the total DAS score, and the HDRS all improved significantly with treatment.

Conclusions

These results confirm a growing body of research that has found an association between sociotropic or dependent personality traits and life events.
The Self-Mutilative Nature of Severe Onychophagia: A Comparison with Self-Cutting
Authors: Wells Jennifer H , Haines Janet , Williams Christopher L , Brain Kerryn L
Published: January 2017

Objective:

To investigate the psychophysiological pattern associated with severe and mild onychophagia, and to compare this pattern with that demonstrated by previous research on self-cutting.

Method:

Comparisons between the psychophysiological responses accompanying 3 behaviours were made using a guided imagery methodology. Imagery ofnail-related, skin-cutting, and neutral events were presented in 4 stages.

Results:

Experiment I distinguished participants exhibiting severe and mild onychophagia by the severity and frequency of nail-biting and by the pattern of psychophysiological response across the stages. Experiment II indicated that the change in psychophysiological arousal accompanying severe onychophagia was not as dramatic as that demonstrated for skin-cutting. The behaviour seems to be less effective in reducing tension.

Conclusion:

Severe onychophagia appears to manage the level of tension experienced by an individual, instead of dramatically reducing it in times of crisis. Such a process is consistent with that demonstrated in individuals with obsessive-compulsive disorder.
Paternal Filicide: A Study of 10 Men
Authors: Marleau Jacques D , Poulin Bernard , Webanck Thierry , Roy Renée , Laporte Line
Published: January 2017

Objective:

To describe the psychiatric and sociodemographic profiles of 10 men who killed 1 or more of their children.

Method:

Data were gathered from psychiatric, psychological, and criminological assessments found in the files of 10 filicidal men hospitalized at the Institut Philippe Pinel de Montréal between 1982 and 1994.

Results:

Many situational factors were present during the period preceding the offence (such as the possibility of a separation or financial problems). Most of these homicides have been classified as pathological filicides. At the time of the offence, the most frequent diagnoses were mood disorders. Eight subjects had personality disorders, one-half of which were borderline personality disorders. Four men had psychotic symptoms at the time of the offence. Six of the 10 men also killed or attempted to kill their spouses.

Conclusion:

Many factors are involved in the dynamics of a filicidal situation. It is therefore difficult to identify specific warning signals for the prevention of this type of homicide. However, mental health professionals and the general population must be made aware of the importance of early assessment of possible filicidal tendencies when a man verbalizes delusional ideas about his child and/or if he manifests disorganized and bizarre behaviour.