bluuebunny/crossref_metadata_2025 huggingface dataset:
Winning and Losing: An Evolutionary Approach to Mood Disorders and Their Therapy
Authors: Sloman Leon , Sturman Edward D , Price John S
Published: January 2017

Objective:

To advance a new evolutionary model that examines the effects of winning and losing on mood and physiological variables. Previous studies have focused on the involuntary defeat strategy in de-escalating conflict. Here, we propose that there also exists an involuntary winning strategy (IWS) that is triggered by success and characterized by euphoria and increased self-confidence. It motivates efforts to challenge, and promotes reconciliation.

Method:

Previous studies are presented, including data on student athletes, demonstrating the impact of winning and losing on mood.

Results:

Winning is consistently shown to be related to physiological changes such as increased testosterone and serotonin levels in primates. It reliably leads to mood changes that serve to motivate winners to continue their competitive efforts.

Conclusion:

When the IWS functions optimally, success leads to success in an adaptive cycle. Over time, the initial differences between the winners and losers of agonistic encounters become magnified in a process known as difference amplification. As a result of assortative mating, the children of people who have entered into an adaptive cycle will inherit traits from both parents that will, in turn, give them an increased competitive advantage. In this manner, difference amplification could have accelerated human evolution by natural selection. Vignettes of clinical interventions are also used to illustrate therapeutic strategies designed to disrupt maladaptive cycles and promote adaptive behaviour.
Postdischarge Care for Depression in Ontario
Authors: Lin Elizabeth , Diaz-Granados Natalia , Stewart Donna E , Bierman Arlene S
Published: January 2017

Objective:

People hospitalized for depression are often discharged before the acute phase of their illness has resolved and need timely care transitions to prevent relapse. We examined 30-day postdischarge service use for Ontarians, aged 15 years or older, who were hospitalized for depression. We focused on a pattern consistent with guideline and policy directions: higher rates of physician visits, postdischarge, combined with lower rates of emergency department (ED) admissions or rehospitalization.

Methods:

Administrative data for the fiscal year of 2005 were used to identify hospitalizations for depression and subsequent physician visits, ED admissions, or readmissions for depression within 30 days, postdischarge. Sex, age, income, and geographic location were examined along with the relation between health care resources (beds, EDs, and physicians) and postdischarge service use.

Results:

Sixty-three percent of patients discharged for depression were followed, within 30 days, by a physician visit for depression. Twenty-five percent were either rehospitalized or visited an ED. Women and people from urban or high income areas were more likely to have postdischarge physician visits. Readmissions and ED visits were correlated with number of EDs, but postdischarge physician visits were not related to the number of general practitioners, family physicians, and psychiatrists in the local area.

Conclusion:

One-third of Ontarians hospitalized for depression did not receive recommended follow-up outpatient care within 30 days of discharge and one-quarter received follow-up through ED visits or readmissions, highlighting the need to improve coordination and integration across care settings for these patients. There are tested transitional and outpatient models that improve quality and outcomes of depression care that merit serious consideration.
Motivational Interviewing in Adolescent Treatment
Authors: Naar-King Sylvie
Published: January 2017

This paper briefly reviews the research literature on motivational interviewing (MI) and behaviour change in adolescents and then discusses the implications of adolescent cognitive and social–emotional developmental processes for the relational and technical components of MI. Research suggests that MI is efficacious in improving substance use in adolescents. Research has been slower to emerge in other behaviours, but available randomized controlled trials suggest that MI has great promise for improving mental and physical health outcomes in this developmental period. The relational and technical components of MI are highly relevant for the adolescent developmental period, and studies have shown that these components are related to outcomes in this population. There are several ways to include MI in clinical interventions for adolescents, ranging from MI in brief settings to using MI as a platform from which all other treatments are offered. Future research is necessary to test the effects of MI in adolescent group settings and the full integration of MI into other adolescent treatment approaches.
Anxiety: An Evolutionary Approach
Authors: Bateson Melissa , Brilot Ben , Nettle Daniel
Published: January 2017

Anxiety disorders are among the most common mental illnesses, with huge attendant suffering. Current treatments are not universally effective, suggesting that a deeper understanding of the causes of anxiety is needed. To understand anxiety disorders better, it is first necessary to understand the normal anxiety response. This entails considering its evolutionary function as well as the mechanisms underlying it. We argue that the function of the human anxiety response, and homologues in other species, is to prepare the individual to detect and deal with threats. We use a signal detection framework to show that the threshold for expressing the anxiety response ought to vary with the probability of threats occurring, and the individual's vulnerability to them if they do occur. These predictions are consistent with major patterns in the epidemiology of anxiety. Implications for research and treatment are discussed.
The Association of Treatment of Depressive Episodes and Work Productivity
Authors: Dewa Carolyn S , Thompson Angus H , Jacobs Phillip
Published: January 2017

Objective:

About one-third of the annual $51 billion cost of mental illnesses is related to productivity losses. However, few studies have examined the association of treatment and productivity. The purpose of our research is to examine the association of depression and its treatment and work productivity.

Methods:

Our analyses used data from 2737 adults aged between 18 and 65 years who participated in a large-scale community survey of employed and recently employed people in Alberta. Using the World Health Organization's Health and Work Performance Questionnaire, a productivity variable was created to capture high productivity (above the 75th percentile). We used regression methods to examine the association of mental disorders and their treatment and productivity, controlling for demographic factors and job characteristics.

Results:

In the sample, about 8.5% experienced a depressive episode in the past year. The regression results indicated that people who had a severe depressive episode were significantly less likely to be highly productive. Compared with people who had a moderate or severe depressive episode who did not have treatment, those who did have treatment were significantly more likely to be highly productive. However, about one-half of workers with a moderate or severe depressive episode did not receive treatment.

Conclusions:

Our results corroborate those in the literature that indicate mental disorders are significantly associated with decreased work productivity. In addition, these findings indicate that treatment for these disorders is significantly associated with productivity. Our results also highlight the low proportion of workers with a mental disorder who receive treatment.
Responses to Mental Health Stigma Questions: The Importance of Social Desirability and Data Collection Method
Authors: Henderson Claire , Evans-Lacko Sara , Flach Clare , Thornicroft Graham
Published: January 2017

Objective:

To evaluate the impact on the general public of England's Time to Change program to reduce mental health-related stigma and discrimination using newly developed measures of knowledge and intended behaviour regarding people with mental health problems, and an established attitudes scale, and to investigate whether social desirability affects responses to the new measures and test whether this varies according to data collection method.

Method:

The Mental Health Knowledge Schedule (MAKS) and Reported and Intended Behaviour Scale (RIBS) were administered together with the 13-item version of the Marlowe-Crowne Social Desirability Scale to 2 samples (each n = 196) drawn from the Time to Change mass media campaign target group; one group was interviewed face to face, while the other completed the measures as an online survey.

Results:

After controlling for other covariates, interaction terms between collection method and social desirability were positive for each instrument. The social desirability score was associated with the RIBS score in the face-to-face group only (β = 0.35, 95% CI 0.14 to 0.57), but not with the MAKS score in either group; however, MAKS scores were more likely to be positive when data were collected face to face (β = 1.53, 95% CI 0.74 to 2.32).

Conclusions:

Behavioural intentions toward people with mental health problems may be better assessed using online self-complete methods than in-person interviews. The effect of face-to-face interviewing on knowledge requires further investigation.
Protective Associations of School Connectedness with Risk of Depression in Nova Scotia Adolescents
Authors: Langille Don , Rasic Daniel , Kisely Steve , Flowerdew Gordon , Cobbett Shelley
Published: January 2017

Objective:

To determine whether school connectedness demonstrated an independent protective association with risk of depression in students in grades 10 to 12 attending a high school in a rural community in southwestern Nova Scotia.

Methods:

Students at a high school in rural Nova Scotia participated in a self-completion survey in May 2009. Students were asked about a wide range of health-related factors to determine their needs for health services and promotion. Examining girls and boys separately, we used logistic regression to examine associations of an established measure of school connectedness with risk of depression as measured by the 12-item Center for Epidemiologic Studies Depression (CES-D) Scale, while including numerous potential confounding variables in our models.

Results:

The response rate was 95.2% among registered students present in class during the survey. Four hundred eight students (216 girls and 192 boys) completed both the CES-D12 and the School Connectedness Scale. Higher school connectedness was independently protective of risk of depression in girls (OR 0.85; 95% CI 0.78 to 0.93, P < 0.01) and in boys (OR 0.81; 95% CI 0.71 to 0.91, P < 0.01).

Conclusions:

Among adolescents in rural Nova Scotia, higher school connectedness has protective associations with risk of depression in both girls and boys, independent of a wide range of factors known to be associated with depression in adolescents. School may be a key place for helping adolescents to develop positive mental health.
Comparative Safety of Antipsychotics: Another Look at the Risk of Diabetes
Authors: Moisan Jocelyne , Turgeon Mélanie , Desjardins Olivier , Grégoire Jean-Pierre
Published: January 2017

Objective:

The association between the use of antipsychotics and diabetes mellitus (DM) is still unclear, as depicted by several conflicting reports. Our study aims to assess the risk of DM in new users of antipsychotics.

Methods:

Our nested case–control study used the Quebec Health Insurance Board databases. People in the source cohort were DM-free and had initiated an antipsychotic treatment. Subjects were cohort members who initiated an antidiabetic or had a diagnosis of DM during their follow-up period. Three variables were used to assess antipsychotic exposure: the antipsychotic used (any typical, clozapine, olanzapine, quetiapine, risperidone, or more than 1 drug); the number of 30-day periods of use; and antipsychotic use at index date (current or past). A paired multivariate logistic regression model was used to calculate adjusted odds ratios.

Results:

Among the 88 467 people included in the cohort, 6109 subjects with DM were identified and were matched to 61 090 control subjects. New users of quetiapine were less likely to develop DM than new users of typical antipsychotics (OR, 0.89; 95% CI 0.81 to 0.99). The risk of DM was not statistically different across the atypical antipsychotics. A longer exposure to any antipsychotic (for each 30-day period, OR 1.009; 95% CI 1.006 to 1.011) and current use of antipsychotics (OR 1.26; 95% CI 1.17 to 1.36) were associated with DM.

Conclusion:

These results suggest that metabolic parameters of people exposed to antipsychotics should be monitored, irrespective of the drug taken, among the drugs available at the time of analysis. Innocuité comparative des antipsychotiques: un autre regard sur le risque de diabète
Religious Attendance, Spirituality, and Major Depression in Canada: A 14-Year Follow-up Study
Authors: Balbuena Lloyd , Baetz Marilyn , Bowen Rudy
Published: January 2017

Objective:

Although there have been numerous studies on the relation of religion or spirituality and major depression, few used a longitudinal, nationally representative sample. Our study sought to examine the effect of religious attendance, self-declared importance of spiritual values, and self-identification as a spiritual person on major depression.

Method:

Data coming from 8 waves (1994 to 2008) of the longitudinal Canadian National Population Health Survey were used. People ( n = 12 583) who were not depressed at baseline (1994) were followed during 14 years. Depression at each cycle was assessed using the Composite International Interview—Short Form for Major Depression. Weibull proportional hazards regression was used to model longitudinal risk of depression, with religious attendance or spirituality as a predictor.

Results:

At baseline, monthly religious attenders tended to be older, female, and married, compared with occasional and nonattenders. The Weibull regression model revealed a 22% lower risk of depression for monthly attenders (hazard ratio 0.78, 95% CI 0.63 to 0.95), compared with nonattenders, after controlling for age, household income, family and personal history of depression, marital status, education, and perceived social support. Neither self-reported importance of spiritual values nor identification as a spiritual person was related to major depressive episodes.

Conclusion:

Attending religious services at least monthly has a protective effect against major depression.
Sex Differences in Suicides among Children and Youth: The Potential Impact of Help-Seeking Behaviour
Authors: Rhodes Anne E , Khan Saba , Boyle Michael H , Tonmyr Lil , Wekerle Christine , Goodman Deborah , Bethell Jennifer , Leslie Bruce , Lu Hong , Manion Ian
Published: January 2017

Objective:

To describe sex differences in health service use among children and youth who died by suicide.

Method:

This is a retrospective study of children and youth (aged 10 to 25 years) living in Ontario who died by suicide between April 1, 2003, and December 31, 2007. Coroner records were individually linked to outpatient physician visit, emergency department (ED) presentation, and inpatient stay administrative health care records for 724 people (192 girls and 532 boys). Only 77 (10.6%) were aged 10 to 15 years. The health services types used, number of contacts made, and the last contact were compared in boys and girls.

Results:

About 80% of subjects had contact with the health care system in the year before their death, typically to an outpatient physician and (or) the ED. However, not all were seen for mental health reasons. Girls had more outpatient physician and ED contact than boys and closer in time to their death. Further, girls were more likely than boys to have contact in more than one setting. Still, boys and girls did not differ in their use of an outpatient psychiatrist, some ED presentations, and in the nature and number of inpatient stays.

Conclusions:

While most people were seen by an outpatient physician and (or) in the ED in the year before their death, not all received mental health care. Further research is needed to determine whether boys and girls who died by suicide differ from their peers in their health service use to guide preventive interventions.
Obstacles de l'accès au traitement rapportés par des personnes aux prises avec un trouble anxieux
Authors: Perreault Michel , Lafortune David , Laverdure Anick , Chartier-Otis Mariko , Bélanger Claude , Marchand André , Bouchard Stéphane , Milton Diana
Published: January 2017

Objectifs:

La présente étude traite des obstacles au traitement auxquels se butent des personnes qui sont aux prises avec un trouble anxieux (TA) et qui n'ont pas obtenu de services pour leur problème. Les recommandations que formulent ces personnes pour améliorer l'accès au traitement sont rapportées.

Méthode:

Un questionnaire diffusé sur le Web traitant de l'accessibilité du traitement pour les troubles anxieux a été rempli par 610 personnes domiciliées au Québec et ayant rapporté souffrir d'anxiété. Des chi-carrés ont été effectués pour comparer les réponses des personnes qui ont reçu des services ( n = 151) avec les réponses de celles qui n'en ont pas reçu ( n = 434).

Résultats:

Les délais d'attente trop importants pour obtenir un traitement (X2 = 29,66; dl = 1; P < 0,001), les difficultés éprouvées pour joindre un professionnel par téléphone (X2 = 13,75; dl = 1; P < 0,001) ainsi que la distance géographique des lieux de services (X2 = 4,34; dl = 1; P = 0,04) sont les obstacles qui ont nui aux participants qui n'ont pas reçu les services désirés davantage qu'à ceux qui les ont obtenus.

Conclusions:

Les obstacles et les recommandations des participants mettent en lumière le besoin d'accroître l'accès aux professionnels de la santé en ce qui concerne les délais d'attente, de former et informer davantage les professionnels de première ligne en matière de dépistage et de traitement des TA, ainsi que de développer l'offre de services psychothérapeutiques dans le réseau de santé public.
Psychotherapy, Antidepressants, and Their Combination for Chronic Major Depressive Disorder: A Systematic Review
Authors: Spijker Jan , van Straten Annemieke , Bockting Claudi L H , Meeuwissen Jolanda A C , van Balkom Anton J L M
Published: January 2017

Objective:

Recommendations for treatment of chronic major depressive disorder (cMDD) are mostly based on clinical experiences and on the literature on treatment-resistant depression (TRD) but not on a systematic review of the literature.

Method:

We conducted a systematic review of 10 randomized controlled trials (RCTs), with 17 comparisons between antidepressants (ADs), psychotherapy, or the combination of both interventions.

Results:

The best evidence is for the combination of psychotherapy and ADs, and especially for the combination of the cognitive behavourial analysis system of psychotherapy and ADs. Evidence is very weak for both ADs alone and psychotherapy alone. Assessment of TRD was mostly absent in the studies.

Conclusion:

The best treatment for cMDD is a combination of psychotherapy and ADs. However, there is a lack of well-performed RCTs in both ADs and psychotherapy and their combination for cMDD. Therefore, the conclusions are preliminary. Psychothérapie, antidépresseurs, et leur combinaison pour le trouble dépressif majeur chronique: une revue systématique
Comorbid Anxiety Disorders in Canadians with Bipolar Disorder: Clinical Characteristics and Service Use
Authors: Hawke Lisa D , Provencher Martin D , Parikh Sagar V , Zagorski Brandon
Published: January 2017

Objective:

To examine the impact of anxiety disorders comorbid to bipolar disorder (BD) in a large, nationally representative sample, to describe the sociodemographic and clinical profiles of Canadians living with BD and with or without comorbid anxiety disorders, to identify the characteristics uniquely associated with comorbid anxiety, and to examine treatment patterns.

Method:

We analyzed data from the Canadian Community Health Survey: Mental Health and Well-Being, conducted among 38 492 Canadians. People meeting the criteria for BD ( n = 808) were compared based on the presence or absence of an assessed anxiety disorder (that is, social phobia, panic disorder, and agoraphobia).

Results:

People with BD and a comorbid anxiety disorder fare worse in terms of BD relapses, suicidality, and sleep disturbance, and are more likely to be taking psychiatric medication. They have more impairment in their work and social functioning and rate their health and life satisfaction lower. Despite the greater severity, they are not receiving additional psychological treatment, they feel they are not receiving the treatment they need, and they report more barriers to treatment.

Conclusions:

This study confirms the critical impact of comorbid anxiety on the course of BD in a large, nationally representative sample and reveals that the psychological treatment needs of this population are not being met. Clinical and research implications are discussed.
Effects of Methylphenidate on Acute Math Performance in Children with Attention-Deficit Hyperactivity Disorder
Authors: Grizenko Natalie , Cai Emmy , Jolicoeur Claude , Ter-Stepanian Mariam , Joober Ridha
Published: January 2017

Objective:

Examine the short-term (acute) effects of methylphenidate (MPH) on math performance in children with attention-deficit hyperactivity disorder (ADHD) and what factors predict improvement in math performance.

Method:

One hundred ninety-eight children with ADHD participated in a double-blind, placebo-controlled, randomized crossover MPH trial. Math response to MPH was determined through administration of math problems adjusted to their academic level during the Restricted Academic Situation Scale (RASS). Student t tests were conducted to assess change in math performance with psychostimulants. Correlation between change on the RASS and change on the math performance was also examined. Linear regression was performed to determine predictor variables.

Results:

Children with ADHD improved significantly in their math with MPH ( P < 0.001). The degree of improvement on the RASS (which evaluates motor activity and orientation to task) and on math performance on MPH was highly correlated. A child's age at baseline and Wechsler Individual Achievement Test (WIAT)-Numerical Operations standard scores at baseline accounted for 15% of variances for acute math improvement.

Conclusions:

MPH improves acute math performance in children with ADHD. Younger children with lower math scores (as assessed by the WIAT) improved most on math scores when given psychostimulants. Les effets du méthylphénidate sur la performance aiguë en math chez des enfants souffrant du trouble de déficit de l'attention avec hyperactivité
Canada-Wide Effect of Regulatory Warnings on Antidepressant Prescribing and Suicide Rates in Boys and Girls
Authors: Rhodes Anne E , Skinner Robin , McFaull Steven , Katz Laurence Y
Published: January 2017

Objective:

To examine the impact of the Health Canada regulatory warnings regarding antidepressant (AD) prescribing on suicide rates in boys and girls under the age of 18 and aged 18 to 19 years in Canada between 2004 and 2009. We hypothesized that an increase in suicide rates would be specific to girls, reflecting higher AD prescribing rates in girls than boys.

Method:

We graphed and tested the difference between Canada-wide suicide rates before and after the regulatory warning periods (either from 1995 to 2006 or from 1995 to 2009) in boys and girls under the age of 18 or aged 18 to 19 years. For comparison with prior studies, we estimated rate ratios and 95% confidence intervals using either Poisson regression or negative binomial regression.

Results:

There was no statistically significant increase in suicide rates in girls under the age of 18, or aged 18 to 19 years in response to the AD regulatory warnings. In boys under the age of 18 or aged 18 to 19 years, suicide rates declined after 2003.

Conclusions:

We did not find increased rates of suicide after the AD regulatory warnings in boys or girls under the age of 18 or aged 18 to 19 years in Canada-wide rates. However, this does not rule out the possibility that such an effect occurred in some jurisdictions in girls and (or) the regulatory warnings prevented the trend toward declining suicide rates. Factors influencing the downward trend in boys merit further attention.
An Observational Study of Bullying as a Contributing Factor in Youth Suicide in Toronto
Authors: Sinyor Mark , Schaffer Ayal , Cheung Amy H
Published: January 2017

Objective:

Bullying has been identified as a potential contributing factor in youth suicide. This issue has been highlighted in recent widely publicized media reports, worldwide, in which deceased youth were bullied. We report on an observational study conducted to determine the frequency of bullying as a contributing factor to youth suicide.

Method:

Coroner records were reviewed for all suicide deaths in youth aged between 10 and 19 in the city of Toronto from 1998 to 2011. Data abstracted were recent stressors (including bullying), clinical variables, such as the presence of mental illness, demographics, and methods of suicide.

Results:

Ninety-four youth suicides were included in the study. The mean age was 16.8 years, and 70.2% were male. Bullying was present in 6 deaths (6.4%), and there were no deaths where online or cyberbullying was detected. Bullying was the only identified contributing factor in fewer than 5 deaths. The most common stressors identified were conflict with parents (21.3%), romantic partner problems (17.0%), academic problems (10.6%), and criminal and (or) legal problems (10.6%). Any stressor or mental and (or) physical illness was detected in 78.7% of cases. Depression was detected in 40.4% of cases.

Conclusions:

Our study highlights the need to view suicide in youth as arising from a complex interplay of various biological, psychological, and social factors of which bullying is only one. It challenges simple cause-and-effect models that may suggest that suicide arises from any one factor, such as bullying.
Neurocognitive Functioning in Overweight and Obese Patients with Bipolar Disorder: Data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)
Authors: Silveira Leonardo E , Kozicky Jan-Marie , Muralidharan Kesavan , Bücker Joana , Torres Ivan J , Bond David J , Kapczinski Flavio , Kauer-Sant'Anna Marcia , Lam Raymond W , Yatham Lakshmi N
Published: January 2017

Objective:

Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode.

Method:

Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight-obese patients, and normal weight healthy control subjects.

Results:

There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group.

Conclusions:

These data suggest that overweight-obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD.
Toward a Comprehensive Clinical Staging Model for Bipolar Disorder: Integrating the Evidence
Authors: Duffy Anne
Published: January 2017

Objectives:

To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence.

Method:

A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discussed.

Results:

The concept of BD has broadened, resulting in an increased spectrum of disorders subsumed under this diagnostic category. Different staging models for BD have been proposed based on the early psychosis literature, studies of patients with established BD, and prospective studies of the offspring of parents with BD. The overarching finding is that there are identifiable sequential clinical phases in the development of BD that differ in important ways between classical episodic and psychotic spectrum subtypes. In addition, in the context of familial risk, early risk syndromes add important predictive value and inform the staging model for BD.

Conclusions:

A comprehensive clinical staging model of BD can be derived from the available evidence and should consider the natural history of BD and the heterogeneity of subtypes. This model will advance both early intervention efforts and neurobiological research.
Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy
Authors: Kutcher Stan , Wei Yifeng , Morgan Catherine
Published: January 2017

Objective:

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

Method:

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students' knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

Results:

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students' knowledge scores increased significantly and substantively, compared with baseline ( P < 0.001, d = 1.11), and this was maintained at 2-month follow-up ( P < 0.001, d = 0.91). Similar findings for attitude improvement were found ( P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up ( P < 0.001, d = 0.52).

Conclusions:

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.
Reconcilable Differences: The Marriage of Qualitative and Quantitative Methods
Authors: Goering Paula N , Streiner David L
Published: January 2017

Qualitative research consists of methods that allow for a more in-depth understanding of phenomena and encompasses techniques such as focus groups, in-depth interviews, and participant observation. The guidelines that pertain to sampling and analysis are different from those which govern quantitative techniques, but they can be applied just as rigorously to ensure the validity of the results. This article introduces these methods and criteria and illustrates how qualitative and quantitative methods can be combined in order to improve what is learned from each.
Developing Effective Services for Patients with Personality Disorders
Authors: Links Paul S
Published: January 2017

Objective:

This review focused on empirical research that addressed the effectiveness of service models for the care of patients with personality disorders.

Method:

Services discussed included those delivering acute care, such as crisis and emergency services and acute psychiatric hospitalization; continuing care, such as outpatient services, day hospital treatment, and assertive community treatment programs; and other community programming, such as integrated treatment for comorbid substance abuse and psychoeducational interventions for families of patients with personality disorders. The review focused on studies that included patients with personality disorders, and it measured outcomes relevant to patients with personality disorders. Evidence from randomized controlled trials was highlighted.

Results:

Few systematic studies of acute services were available. Community programming can decrease the risk of suicide attempts and reliance on inpatient admissions. Services must develop methods of ensuring compliance with treatment. Assertive community treatment for Axis II patients should be developed, implemented, and tested. Comprehensive programming for patients with personality disorders must include integrated treatment for substance abuse and family psychoeducational programs.

Conclusion:

Promising new models of care for patients with personality disorders are ready for testing and wider application.
The First Asylums in Canada: A Response to Neglectful Community Care and Current Trends
Authors: Sussman Sam
Published: January 2017

Objective:

Humane treatment and care of mentally ill people can be viewed from a historical perspective. Intramural (the institution) and extramural (the community) initiatives are not mutually exclusive.

Method:

The evolution of the psychiatric institution in Canada as the primary method of care is presented from an historical perspective. A province-by-province review of provisions for mentally ill people prior to asylum construction reveals that humanitarian motives and a growing sensitivity to social and medical problems gave rise to institutional psychiatry. The influence of Great Britain, France, and, to a lesser extent, the United States in the construction of asylums in Canada is highlighted. The contemporary redirection of the Canadian mental health system toward “dehospitalization” is discussed and delineated.

Results:

Early promoters of asylums were genuinely concerned with alleviating human suffering, which led to the separation of mental health services from the community and from those proffered to the criminal and indigent populations. While the results of the past institutional era were mixed, it is hoped that the “care” cycle will not repeat itself in the form of undesireable community alternatives.

Conclusion:

Severely psychiatrically disabled individuals can be cared for in the community if appropriate services exist.
Impairment of Semantic Categorization Processes among Thought-Disordered Schizophrenic Patients
Authors: Mesure Gérald , Passerieux Christine , Besehe Chrystel , Widlöcher Daniel , Hardy-Baylé Marie-Christine
Published: January 2017

Objective:

To explore semantic categorization strategies in patients with schizophrenia.

Method:

A short-term memory-recognition task that reveals the effects associated with categorization was created and applied to 2 groups of patients with schizophrenia and depression.

Results:

Only the schizophrenic subgroup with formal thought disorder (measured using Andreasen's Thought, Language, and Communication [TLC] scale) exhibited a deficiency in semantic categorization strategies during the task.

Conclusion:

These results support the hypothesis of the impairment of the processes involved in the processing of contextual information inpatients with schizophrenia who suffer from formal thought disorder.
Stalking Part II: Victims' Problems with the Legal System and Therapeutic Considerations
Authors: Abrams Karen M , Robinson Gail Erlick
Published: January 2017

Objective:

This paper is the second of 2 parts reviewing the topic of stalking. It focuses on victims' difficulties with the legal system and the psychotherapeutic tasks for victims and therapists.

Method:

Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information.

Results:

Victims suffer emotional consequences from being stalked. Additional stress is caused by the legal system's lack of understanding of the causes and consequences of stalking and inadequate and unenforced laws. The treatment of victims requires a comprehensive approach, including education, supportive psychotherapy, and discussion of practical measures. Therapists may over identify with the patient's powerlessness or hesitate to take on a case out of fear of the stalker. Female therapists may protect themselves against the realization of their own vulnerability by blaming the victim, while male therapists may feel defensive or overprotective.

Conclusion:

Stalking is a crime with major mental health consequences which is often poorly understood by society. Therapists need to be aware of the victim's emotional reactions, the types of legal and practical supports available, and the possible biases of society. Further education and research should be encouraged.
Pleural Disease in the Intensive Care Unit
Authors: Jantz Michael A. , Sahn Steven A.
Published: January 2017

Pleural disease itself is an unusual cause for admission to the intensive care unit (ICU). Pleural complications of diseases and procedures in the ICU are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pneumothorax may be overlooked in the critically ill patient due to alterations in radiologic appearance in the supine patient. The development of a pneumothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and management of pleural effusion, pneumothorax, tension pneumothorax, and bronchopleural fistula in the critically ill patient. In addition, we review the potential complications of thoracentesis and chest tube thoracostomy, including re-expansion pulmonary edema.
The Management of Atrial Fibrillation in the ICU
Authors: Marik Paul E. , Zaloga Gary P.
Published: January 2017

Atrial tachyarrhythmias are the most frequent arrhythmias occurring in ICU patients, being particularly common in patients with cardiovascular and respiratory failure. Unlike ambulatory patients in whom atrial fibrillation/flutter (AF) is likely to be short lived, in the critically ill these arrhythmias are unlikely to resolve until the underlying disease process has improved. Urgent cardioversion is indicated for hemodynamic instability. Treatment in hemodynamically stable patients includes correction of treatable precipitating factors, control of the ventricular response rate, conversion to sinus rhythm, and prophylaxis against thromboembolic events in those patients who remain in AF. Diltiazem is the preferred agent for rate control, while procainamide and amiodarone are generally considered to be the antiarrhythmic agents of choice.
Critical Care of the Lung Volume Reduction Surgery Patient
Authors: Edelman Jeffrey D. , Kotloff Robert M.
Published: January 2017

Lung volume reduction surgery (LVRS) offers the potential to improve lung function, exercise tolerance, and quality of life for patients with advanced emphysema. At present, the specific role of this procedure in the treatment of advanced emphysema is a subject of ongoing investigation. LVRS is most commonly performed bilaterally via either median sternotomy or video thoracoscopic approach with resection of the most severely affected lung tissue to reduce the overall lung volume by 20–30%. This results in improvements in lung elastic recoil, airway conductance, chest wall, and diaphragmatic function leading to greater inspiratory and expiratory airflow, decreased hyperinflation, and improved exercise tolerance. The greatest improvement after LVRS occurs within 3–6 months after surgery. In the perioperative period, however, lung function may be compromised by surgical incisions, pain, chest tubes, retained secretions, pneumonia, and parenchymal injury associated with resection. The risks of LVRS are not insignificant, with reported mortality prior to hospital discharge ranging from 2.5 to 14%. Pulmonary complications may include respiratory failure, persistent air leaks, pneumonia, tracheobronchitis, retained secretions, atelectasis, pneumothorax, bleeding, and sternal wound infections or dehiscence. Cardiac and gastrointestinal complications are the most common extrathoracic causes of perioperative morbidity after LVRS. Although many patients have an uneventful postoperative course, patients who experience complications frequently require prolonged mechanical ventilation and intensive care. Critical care practitioners must therefore be familiar with LVRS, its potential complications, and the ICU management of LVRS patients.
Recognition and Management of Anxiety in the Intensive Care Unit
Authors: Pollack Mark H. , Stern Theodore A.
Published: January 2017

Anxiety is common among patients receiving intensive care. We discuss the signs and symptoms of anxiety in the intensive care unit. Appropriate treatment of anxiety should be initiated in a timely fashion so that patient compliance with treatment will be enhanced and the morbidity associated with critical illness can be reduced. Pharmacological and nonpharmacological strategies for management of anxiety are also presented.
Developing Methods for Preventing and Detecting Substance Abuse in the Operating Room: A Disease Approach
Authors: Castellano Frank C.
Published: January 2017

Substance abuse is an occupational hazard for health care workers in the operating room setting. Anesthesiologists have a higher rate of substance abuse than their physician counterparts. Anesthesia residents have the highest incidence of substance abuse among anesthesia providers. By creating a disease model for substance abuse, pharmacists may be better able to understand, detect, and prevent substance abuse in the operating room area. The development of comprehensive methods for dispensing and monitoring controlled substance use in the operating room should include systems that limit exposure, provide accountability and consistency, and provide education for the medical staff.
Quality Improvement: Pharmacy Involvement in the Operating Room
Authors: Hawkins Patti R.
Published: January 2017

The operating room (OR) environment historically has had minimal pharmacy involvement in the provision of drug therapy to the surgical patient. A pharmacy-initiated quality assessment and improvement program in the OR can impact patient outcomes by ensuring safe, appropriate, and optimal medication use. This article describes various components of a pharmacy quality improvement program in the OR, and focuses on the drug-use evaluation opportunities in this practice setting. Interdepartmental roles in the delivery of care are discussed, as well as documentation tools and strategies. Nontraditional targets for evaluation such as anesthetic administration techniques and postoperative pain management are examined. The advantages of a pharmacist in the OR to coordinate these processes are also described.
Cardioplegia Solution
Authors: Golembiewski Julie , Bourtsos Nancy
Published: January 2017

The mechanisms of the metabolic and ultrastructural changes that occur as a result of myocardial ischemia during cross-clamping of the aorta and the secondary injury that can occur during reperfusion after removal of the cross-clamp are important determinants of the composition and method of administration of cardioplegia solution (CS). Traditionally, basic principles of myocardial protection included hypothermia, potassium-induced diastolic cardiac arrest, buffering, membrane stabilization, and control of osmolarity and osmotic pressure. As the mechanisms of myocardial ischemia and reperfusion are further shown, methods of providing myocardial protection continue to expand. Current trends favor blood cardioplegia administration via a more complex approach to protect as much of the myocardium as possible; exogenous metabolic substrate enhancement in the presence of oxygen to allow aerobic metabolism to continue, with an end result of additional available myocardial energy; and warm (37°C) blood CS to optimize the metabolic rate for cellular repair. Thus, today the cardiothoracic surgeon can offer patients with energy-depleted hearts and those requiring more complex surgery improved myocardial protection with active myocardial resuscitation before and after the aortic cross-clamp is placed and removed. To this end, the pharmacist, ideally an operating room (OR) pharmacist, has a vital role in ensuring proper preparation, composition, storage, and quality control/assurance of CS. The basic principles of myocardial ischemic and reperfusion injury and how they relate to myocardial protection, CS composition, and methods of administration are described. By understanding these principles, in addition to surgeon and institution-specific factors, the pharmacist can build the foundation needed to maximize the role of pharmacy in ensuring optimal myocardial protection during open-heart surgery.
Gender Equity Issues in Clinical Research
Authors: Nickman Nancy A.
Published: January 2017

Past research on the health of women has focused primarily on reproductive concerns such as breast cancer, infertility, contraception, menstrual disorders, and menopause. Today, the notion of women's health research includes such diverse areas as cardiovascular and cerebrovascular diseases, osteoporosis, mental health and substance abuse, obesity, and diabetes. In effect, the emphasis on women's health has changed from that of diseases which only affect women to include diseases which also affect women. Although the amount of research on women's health has increased since 1970, gender equity issues in clinical research are still in existence. This article describes why changes are occurring in the national research agenda on women's health. Gender differences in health statistics and examples of problem areas in women's health research are presented. Current changes at the National Institutes of Health (NIH) and Public Health Service (PHS) and potential changes in the United States Food and Drug Administration (FDA) and the pharmaceutical industry are also discussed.
Advances in Hormonal Contraception
Authors: Jennings Jenifer C.
Published: January 2017

Breakthroughs involving innovative methods of hormonal and nonhormonal birth control have been severely limited in the United States over the last 30 years. This trend has changed with the introduction of new choices in birth control in the 1990s. This article focuses on these advances in hormonal contraception and provides information on the use of oral contraceptives, hormonal implants, and injectable methods of contraception currently available in the United States. Each method is assessed and recommendations are made for proper patient and method selection. This information is intended to supply the pharmacist with sufficient information to appropriately counsel patients on the use of hormonal contraception in the 1990s.