bluuebunny/crossref_metadata_2025 huggingface dataset:
Providing Psychiatric Backup to Family Physicians by Telephone
Authors: Kates Nick , Crustolo Anne-Marie , Nikolaou Lambrina , Craven Marilyn A , Farrar Sheryl
Published: January 2017

Objective:

To examine whether links between psychiatric services and family physicians can be strengthened and additional support provided for family physicians if a psychiatrist is available by phone to respond to clinical calls from family physicians.

Method:

A psychiatrist, who visited 18 family physicians in 5 practices on a regular basis to provide clinical consultations, was available to provide telephone backup concerning mental health problems the family physicians encountered. All calls received by the psychiatrist were documented and analysed at the end of a 12-month period.

Results:

Over the course of one year, 128 calls were received from the 5 practices. Fifty were considered urgent, while 78 involved more routine management or medication issues. Telephone advice enabled the family physicians to handle these cases more effectively, often reducing utilization of other mental health services and providing support that was not otherwise available. The average time spent per call was 8 minutes, which meant the psychiatrist was only spending 20 minutes per week on the phone responding to family physicians' requests.

Conclusion:

Providing telephone backup to family physicians is a time-efficient and effective method of supporting family physicians and reducing utilization of mental health services. It is applicable to psychiatrists working in any clinical setting.
Depression in Primary Care—More like Asthma Than Appendicitis: The Michigan Depression Project
Authors: Klinkman Michael S , Schwenk Thomas L , Coyne James C
Published: January 2017

Objective:

To explore the relationships between detection, treatment, and outcome of depression in the primary care setting, based upon results from the Michigan Depression Project (MDP).

Methods:

A weighted sample of 425 adult family practice patients completed a comprehensive battery of questionnaires exploring stress, social support, overall health, health care utilization, treatment attitudes, self-rated levels of stress and depression, along with the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D), and the Structured Clinical Interview for DSM-III (SCID), which served as the criterion standard for diagnosis. A comparison sample of 123 depressed psychiatric outpatients received the same assessment battery. Family practice patients received repeated assessment of depressive symptoms, stress, social support, and health care utilization over a period of up to 60 months of longitudinal follow-up.

Results:

The central MDP findings confirm that significant differences in past history, severity, and impairment exist between depressed psychiatric and family practice patients, that detection rates are significantly higher for severely depressed primary care patients, and that clinicians use clinical cues such as past history, distress, and severity of symptoms to “detect” depression in patients at intermediate and mild levels of severity. As well, there is a lack of association between detection and improved outcome in primary care patients.

Conclusion:

These results call into question the assumption that “depression is depression” irrespective of the setting and physician, and they are consistent with a model of depressive disorder as a subacute or chronic condition characterized by clinical parameters of severity, staging, and comorbidity, similar to asthma. This new model can guide further investigation into the epidemiology and management of mood disorders in the primary care setting.
The Meaning of Body Image for Women with Eating Disorders
Authors: Jarry Josée L
Published: January 2017

Objective:

To propose a theoretical model accounting for the meaning and function of body image disturbances for individuals with eating disorders. This model departs from available conceptualizations of body image focused on attractiveness and emphasizes the role of body image preoccupations in the regulation of self-esteem and affect.

Method:

This model was developed on the basis of the author's clinical observations and the available empirical research.

Results:

Three main functions of body image are described. The first one, “affiliation,” consists of using one's appearance in the establishment of interpersonal relationships, both at the level of friendship and romance. The second function, “avoidance,” consists of using one's body image to avoid abuse, be it psychological, physical, or sexual. The third function, “expression,” consists of using one's body image to communicate to the self and others one's capacity for accomplishment or one's inner feelings of dejection.

Conclusion:

This model is designed to be a therapeutic tool within body image therapy. Body image therapy can be most effective when focused on the unique meaning of body image for each individual patient.
A Group Therapy Approach to Facilitate Integration of Risk Information for Women at Risk for Breast Cancer
Authors: Esplen Mary Jane , Toner Brenda , Hunter Jonathan , Glendon Gordon , Butler Kate , Field Barbara
Published: January 2017

Objective:

To describe and illustrate elements of a group counselling approach designed to enhance the communication of risk information on breast cancer (BC) to women with a family history of this disease. Breast cancer is a leading cause of female cancer death. The most important risk factor for BC is a positive family history in at least 1 first-degree relative, and approximately one-third of women with BC have a family history of the disease. Recent evidence suggests that there is a significant psychological impact associated with having a family history of BC, and this may influence the psychological adjustment and response to being counselled for personal risk. New counselling approaches are required.

Method:

This paper describes a group therapy approach that incorporates principles of supportive-expressive therapy designed to address the emotional impact of being at risk for BC and to promote accuracy of perceived risk. The key elements of the intervention are described along with clinical illustrations from groups that are part of an ongoing study to develop and standardize the group therapy.

Conclusion:

Qualitative data from the groups suggest that this model of therapy is both feasible and effective.
Affect and Marital Adjustment in Women's Rating of Dyspareunic Pain
Authors: Meana Marta , Binik Irv , Khalife Samir , Cohen Deborah
Published: January 2017

Objective:

To investigate the extent to which depressive symptomatology, anxiety, and marital adjustment mediate pain ratings in women suffering from dyspareunia.

Method:

Seventy-six women with dyspareunia were administered the depression and anxiety scales of Derogatis's Brief Symptom Inventory and the McGill Pain Questionnaire. They also underwent a manual-visual gynecological examination, an ultrasound, and a colposcopy in an attempt to identify potential evidence and type of organicity.

Results:

Depressive symptomatology, anxiety, and marital adjustment together accounted for a significant amount of the variance in pain ratings, although only anxiety and marital adjustment were independent predictors of pain ratings in the entire group of women with dyspareunia. When multiple regression analyses were then applied to different diagnostic subgroups of dyspareunia, the independent predictors of pain rating varied depending on the findings from the gynecological examinations.

Conclusion:

Affect and marital adjustment appear to be significant predictors of dyspareunic pain rating, although the independent contribution of psychosocial variables may vary depending on the presence and type of organic findings.
Therapy with Lesbian Couples: The Issues and the Interventions
Authors: Igartua Karine J
Published: January 2017

Objective:

To highlight difficulties that are unique to lesbian couples by reviewing the data that contrast lesbian and heterosexual couples and exploring the theories that explain the observed differences in couple dynamics.

Method:

A review of the literature contrasting demographics and relationship characteristics in lesbians and heterosexual couples was conducted, and a review of lesbian psychotherapy literature was performed.

Results:

The differences in couple dynamics may be attributed to female relational styles and the stresses of being in a relationship that is not socially sanctioned (homophobia).

Conclusions:

Therapists should not use heterosexual standards when evaluating lesbian relationships because this may lead to misconstruance of a couple's emotional intensity as pathological. They should, however, recognize the problems that stem from pathological levels of fusion. When evaluating a couple, clinicians must assess the level of internalized homophobia so as to understand when the couple's difficulties originate from unresolved conflicts over sexual orientation.
Supervision of Termination in Psychotherapy
Authors: Robb Marjorie , Cameron Paul M
Published: January 2017

Objective:

To propose a model for teaching and supervising the termination process in psychoanalytic psychotherapy.

Method:

Group supervision of the 12-week termination phase of psychotherapy with a patient who had been in psychotherapy with a senior resident for 2 years.

Results:

This supervisory method provided a positive termination experience for the patient and valuable group-teaching experience for residents at various levels in their training.

Conclusion:

A group supervisory teaching process is a particularly effective way of teaching the termination process and is more efficient in terms of time, energy, and dissemination of knowledge than a traditional one-on-one supervision model.
The Use of Psychotropic Medication in Preschoolers: Some Recent Developments
Authors: Minde K
Published: January 2017

Objective:

To provide an overview of the use of psychotropic drugs in preschoolers.

Method:

Literature review.

Results:

Although controversy persists, the evidence suggests that preschool children are being given an increasing number of psychotropic drugs, especially by general practitioners and pediatricians.

Conclusion:

There is an urgent need to formally evaluate the efficacy of psychotropic medication for young children.
The Use of Psychotropic Medication in Preschoolers: Indications, Safety, and Efficacy
Authors: Greenhill Laurence L
Published: January 2017

Objective:

To review the indications, safety, and efficacy of psychotropic medications used in preschoolers.

Methods:

Proprietary prescription-use databases indicate that practitioners are prescribing psychotropic medications for preschool patients at an increasing rate. A Medline search was conducted using drug exposure for children below the age of 6 years to identify efficacy and safety reports of these agents in the preschool age-group.

Results:

The search yielded 22 reports that mention exposure to medications, including maternal exposure, accidental overdose, and adverse events in preschool children. Safety issues highlight the age-specific vulnerabilities of this age-group, including hepatotoxicity from valproic acid, among others. In addition, the prominence of adverse-event responses in this age group may be related to polypharmacy not seen in school-age children or adolescents. Less than a dozen controlled efficacy studies of psychotropic agents were identified for children in the preschool age-group. These are limited by the small numbers of subjects in the reports. Only 2 disorders described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), attention-deficit hyperactivity disorder (ADHD) and autistic disorder, are mentioned. The Food and Drug Administration (FDA) approved psychotropic medications for preschoolers but limited their use to medical purposes, not psychiatric, with the exception of use for ADHD.

Conclusions:

Because data about psychotropic drug safety and efficacy in adults have not been extended to children, new psychopharmacological research is required before clinicians can use these agents to treat psychiatric disorders in the preschool age-group.
Pediatric Psychopharmacology and the Interaction between Drugs and the Developing Brain
Authors: Vitiello Benedetto
Published: January 2017

With increasing frequency, psychotropic medications are being prescribed to young children, often for long periods of time. The interaction between psychotropics and the developing brain has not been systematically investigated in humans. Data collected from animals suggest that developing neurotransmitter systems can be exquisitely sensitive to early inhibition or stimulation by pharmacological agents, which can lead to permanent changes in adult life. Most of these data are collected from rodents, and their extrapolation to humans is difficult. More relevant models could be developed, for instance using primates. In humans, the focus of research has traditionally been on the possible teratogenic effects of prenatal drug exposure. Recently introduced quantitative imaging techniques can offer new approaches to studying the effects of psychotropics on the developing brain. This research has clear implications for the safety and efficacy of psychopharmacologic drug use in children.
Autism and other Pervasive Developmental Disorders: Exploring the Dimensional View
Authors: Myhr Gail
Published: January 2017

Objective:

To examine empirical data on children with autistic disorder (AD), Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) for continuities or distinguishing features between disorders and to see to what extent the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria reflect observed data.

Method:

Studies were identified in 4 ways. 1) A Medline search from 1976 to the present of articles with the key words autism, pervasive developmental disorder, autistic spectrum disorder, and Asperger; of these articles, those with mesh headings or textwords “cluster,” which identified cluster analyses deriving pervasive developmental disorder (PDD) subtypes, were retained. 2) The Journal of Autistic and Developmental Disorders from 1990 to the present was hand-searched to identify other empirically derived studies on diagnosis, prevalence, classification, and validity of PDD subtypes. 3) Key review articles were searched for their references. 4) The references of all identified articles were searched.

Results:

Eight cluster studies were retained for their relevance to diagnostic issues, as were 7 empirically derived studies delineating clinical characteristics of children with AD, Asperger's syndrome, or PDD-NOS. Data suggest that children with PDD may fit into 1 of 2 overlapping groups, including a lower-functioning group with greater developmental compromise, social aloofness, and a greater number of autistic symptoms and a higher-functioning group with higher IQ, fewer autistic symptoms, and more prosocial behaviour. The PDD subtypes resemble each other and can be seen as existing on a continuum, differing only by degree of impairment.

Conclusion:

Children exhibiting the triad of autistic impairments can be seen as suffering from disorders on a PDD continuum. While the DSM-IV does identify a lower-functioning autistic group (AD), the higher-functioning group is less well served. Asperger's disorder as defined in the DSM-IV is not clearly distinguishable from AD and PDD-NOS, and the PDD-NOS subcategory is not operationalized. Further research is required to elaborate criteria for the higher-functioning PDD group, and measures related to etiology, outcome, and treatment response may help determine which diagnostic criteria can meaningfully separate one disorder from another.
What Does Early Antisocial Behaviour Predict? A Follow-up of 4- and 5-Year-Olds from the Ontario Child Health Study
Authors: Lipman Ellen L , Bennett Kathryn J , Racine Yvonne A , Mazumdar Rupak , Offord David R
Published: January 2017

Objective:

To examine the predictive accuracy of antisocial behaviours among 4- and 5-year-old children for problem behaviours 4 years later (ages 8 and 9 years).

Method:

Data from the Ontario Child Health Study (1983) and Follow-Up (1987) are used. Predictive accuracy is conceptualized using positive predictive value (PPV) and sensitivity. The predictive accuracy of early antisocial behaviours for the 1987 outcomes is examined overall, by gender, by variable thresholds of predictor and outcome by gender, and by using contextual variables alone or in combination with antisocial behaviour recorded in 1983.

Results:

The predictive accuracy of 1983 antisocial behaviour for 1987 outcome is generally modest and differs by gender (better for boys for externalizing disorder [PPV = 41%, sensitivity = 57%]; better for girls for internalizing disorder [PPV = 13%, sensitivity = 80%]; better for boys for conduct problems [PPV = 54%, sensitivity = 21%]). Using either gender-specific thresholds or gender-neutral thresholds does not alter predictive accuracy in a consistent way, nor does the use of a single contextual variable. Use of a cumulative risk index increases PPV but decreases sensitivity.

Conclusions:

The predictive accuracy of antisocial behaviour in 4-and 5-year-old children over 4 years in a nonclinical community population is limited. The clinical, research, and policy implications of this work are discussed.
The Integration of Child Psychiatry into a Psychiatry Clerkship OSCE
Authors: Hanson Mark , Hodges Brian , McNaughton Nancy , Regehr Glenn
Published: January 2017

Objective:

To integrate child psychiatry into a psychiatry clerkship Objective Structured Clinical Examination (OSCE).

Method:

Child psychiatry OSCE stations were designed to evaluate clerks' skills in the identification of 4 common conditions. Child psychiatrists wrote case scenarios and checklists and supported standardized patient (SP) training for these stations. A bank of 4 child psychiatry OSCE stations is now available for use in the psychiatry OSCE. Child psychiatry faculty have been trained as examiners for ongoing administration of this OSCE.

Results:

This bank of child psychiatry OSCE stations has examined 402 clerks. Mean student scores for content were 68% to 86% and for process were 69% to 76%. Station reliability and examiner feedback were acceptable.

Conclusions:

Child psychiatry has been successfully integrated into a psychiatry clerkship OSCE. Although the commitment in terms of monetary and faculty costs has been considerable, the accompanying educational benefits of such integration warranted this expense.
Culture and Munchausen-by-Proxy Syndrome: The Case of an 11-Year-Old Boy Presenting with Hyperactivity
Authors: Amirali Evangelia L , Bezonsky Rhona , McDonough Rita
Published: January 2017

Objectives:

To discuss some of the challenges presented to the clinician who deals with a possible Munchausen-by-proxy (MBP) syndrome.

Method:

The case of an 11-year-old boy presenting with hyperactivity is discussed. Information from the initial assessment and the 9-month follow-up period is presented. We highlight some cultural considerations as they apply to this immigrant family. A commentary by Dr H Schrier follows the presentation.

Results:

The positive outcome is discussed in relation to the validation of the diagnosis as well as to cultural issues.

Conclusion:

Cultural issues and dynamic factors may be important when we consider the diagnosis of MBP syndrome in an immigrant family with different expectations from our health care system.
Psychiatry and the Burden of Mental Illness
Authors: Bland Roger C
Published: January 2017

Objective:

To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system.

Methods:

Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery.

Results:

Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly.

Conclusions:

Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry.
Community Case Study: Suicide Cluster in a Small Manitoba Community
Authors: Wilkie Clarke , Macdonald Sharon , Hildahl Keith
Published: January 2017

Objectives:

To review a cluster of suicides and suicidal ideation in a First Nations community.

Method:

The medical records and autopsy reports of the victims are reviewed. Collateral information obtained in the community is presented. A series of psychiatric assessments conducted at the local health centre in a 3-day period is outlined. The dilemma of developing appropriate treatment plans is discussed.

Results:

In the period from February 3 to May 5, 1995, an isolated northern Manitoba First Nations community had 6 suicides in a population of less than 1500. Several other suicide attempts occurred. Community resources were strained. Alcohol was a factor in 4 of the suicides. Previous sexual assault was cited in 4 of 5 female cases presenting with suicidal ideation.

Conclusions:

Cluster suicide is a shared psychiatric and public health problem of major concern. Dreams of beckoning are common following a suicide. Communities should have a prepared plan to deal with a suicide. Resources should be provided quickly in an effort to prevent a cluster of suicides from occurring. High-risk individuals must be identified. Substance abuse must be addressed. Resources to assess and treat victims of sexual abuse must be available.
Life after Chi-Squared: An Introduction to Log-Linear Analysis
Authors: Streiner David L , Lin Elizabeth
Published: January 2017

Chi-squared tests are used to examine the relationships among categorical variables. However, they are difficult to use and interpret when more than 2 variables are involved. In such cases, it is better to use a related statistic, called log-linear analysis. This article is an introduction to log-linear models, illustrating how they can be used to tease apart relationships among several variables in looking at the factors associated with photonumerophobia.
Group Treatment for Substance Abuse in Schizophrenia
Authors: Addington Jean , el-Guebaly Nady
Published: January 2017

Objectives:

A review of the relevant research suggests a need to develop an appropriate, effective, and replicable treatment to help individuals with schizophrenia and substance abuse problems. This pilot study describes a biweekly group specifically designed to help the individual with both schizophrenia and substance abuse. The components of the group were support, psychoeducation, and skills training. Attention was also paid to the stage of recovery.

Method:

Eighteen subjects attended the group and were assessed pregroup. Thirteen subjects completed a 1-year follow-up, and 5 subjects were assessed between 3 and 6 months.

Results:

At the follow-up assessment, 8 subjects (44%) were abstinent.

Conclusions:

This type of treatment appears to be effective for reducing substance abuse in this population.
Paraphrenia Redefined
Authors: Ravindran Arun V , Yatham Lakshmi N , Munro Alistair
Published: January 2017

Background:

Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it “atypical psychosis,” “schizoaffective disorder,” or “delusional disorder” for lack of a better diagnostic category. Virtually no systematic research on paraphrenia has been conducted in the past 60 years.

Method:

The authors distinguish paraphrenia from “late paraphrenia,” a diagnosis used mainly in the United Kingdom, and provide a neo-Kraepelinian description of paraphrenia that would be compatible with the formats of DSM-IV and ICD-10. Using a questionnaire adapted from this description, intake cases in 2 Canadian psychiatric centres (Ottawa [Ontario] and Dartmouth [Nova Scotia]) were surveyed. Cases of paraphrenia were distinguished from those of schizophrenia and delusional disorder and were examined at the time of intake and immediately prior to discharge.

Results:

For logistical reasons, collecting a totally consecutive series was not possible. However, during an 18-month period, investigators in both centres identified 33 cases closely fitting paraphrenia. The outstanding features of these cases are enumerated, and an outline description of paraphrenia is derived.

Conclusion:

It is possible to define and recognize paraphrenia; it is a viable diagnostic entity. Further research would benefit paraphrenia and schizophrenia patients. Cases in this study have been coded to permit follow-up investigations.
Identification of Childhood Psychiatric Disorder by Informant: Comparisons of Clinic and Community Samples
Authors: MacLeod Roderick J , McNamee Jane E , Boyle Michael H , Offord David R , Friedrich Marjorie
Published: January 2017

Objective:

To compare the identification of psychiatric disorder as informed by parents versus teachers in children aged 6–11 years and parents versus adolescents in youth aged 12–16 years in clinic versus community samples.

Method:

Study data come from parallel surveys in Hamilton, Ontario, of children aged 6–16 years. The surveys included consecutive referrals (N = 1150) between 1989 and 1991 to the region's 2 agencies providing outpatient child mental health services. Also, a simple random sample (N = 1689) was used, drawn in 1989 from students attending public schools. Conduct disorder, hyperactivity, emotional disorder, and somatization disorder were assessed by informants using the original Ontario Child Health Study scales.

Results:

The percentage of children identified with a disorder was markedly higher in the clinic sample, irrespective of the type of disorder, the age and sex of the child, and who provided the assessment. Also, there was a statistically significant differential shift between parents and teachers in the percentage of children identified with disorder. The ratio of children aged 6–11 years identified with conduct disorder or hyperactivity by parents versus teachers was higher in the clinic sample than in the community sample. Among youth aged 12–16 years, a similar pattern emerged for parents as informants versus the adolescents themselves, but it was statistically nonsignificant.

Conclusions:

The data suggest that the relative contribution of informants to the identification of childhood psychiatric disorder varies by sample type: clinic and community. If risk factors for child disorder are influenced by contextually specific factors wedded to informants, then studies conducted in clinic versus community samples may lead to discrepant information about the determinants of psychopathology. The extent of this problem needs to be assessed by comparing the results of parallel studies conducted in clinic versus community samples.
Long-Term Medical Conditions and Major Depression in the Canadian Population
Authors: Patten Scott B
Published: January 2017

Objectives:

To evaluate associations between long-term medical conditions and major depression in the Canadian population, and to examine the impact of these conditions on health care service use and disability.

Methods:

Data from the first wave of the Canadian National Population Health Survey (NPHS) were used. The NPHS used a probability sample of 17 626 Canadians and included questions about long-term medical conditions, health care service use, and disability and a brief predictor of major depression. Contingency tables and graphical techniques were used to evaluate associations between the variables of interest.

Results:

Various chronic medical conditions were associated with an elevated prevalence of major depression. There was no evidence that subjects with major depression and comorbid medical conditions were more likely to be admitted to hospital or to be high users of physician services. However, major depression comorbid with chronic medical conditions was associated with a greater than expected extent of activity limitations.

Conclusions:

Chronic illness may increase the risk of depression or the duration of depressive episodes; either effect could lead to an increased prevalence. Alternatively, major depression may predispose individuals to certain chronic illnesses. Comorbid major depression and chronic medical conditions are associated with a considerable burden of disability in the Canadian population but not excessive use of physician services.
Clinical Predictors of Short-Term Outcome in Electroconvulsive Therapy
Authors: Lam Raymond W , Bartley Simon , Yatham Lakshmi N , Tam Edwin M , Zis Athanasios P
Published: January 2017

Objectives:

Electroconvulsive therapy (ECT) remains one of the most effective biological treatments for major depression. However, there is little information on the clinical use of ECT, and most studies were conducted before the introduction of newer antidepressants and before improvements in ECT delivery. This study examined ECT use in a university teaching hospital to determine predictors of short-term ECT outcome.

Methods:

This was a retrospective chart review of ECT over the period 1994–1996. Data extracted from the chart included demographic information, clinical features of depression, and documented antidepressant trials. Outcome measures, based on the chart notes, included Clinical Global Impression (CGI) and cognitive side effects of ECT at 1 week post-ECT or at discharge if sooner.

Results:

Of 174 patients who received ECT, 130 had a diagnosis of unipolar major depressive disorder. Of these 130 patients, 92% were refractory to at least 1 antidepressant medication. After a clinical course of ECT, 87% were rated as “much” or “very much” improved on the CGI. Moderate side effects were noted in 16% of patients, while only 7% had marked side effects. Medication resistance was not related to ECT response. No significant clinical predictors (symptoms, chronicity, number of antidepressant trials) of ECT outcome were found on a stepwise multiple-regression analysis.

Conclusions:

These results support previous studies showing that ECT results in very good short-term response in major depressive disorder and that the cognitive side effects of ECT are reasonable. Despite the limitations of this study (retrospective, chart review, global measures), the results will inform clinicians who are recommending ECT for their patients.
A Comparison of Short-Term Group and Individual Therapy for Sexually Abused Women
Authors: Stalker Carol A , Fry Richard
Published: January 2017

Objective:

To compare the effectiveness of 10 sessions of group therapy with that of 10 sessions of individual therapy in a sample of 86 adult women seeking treatment for the effects of childhood sexual abuse.

Method:

Participants were randomly assigned to the 2 treatment modalities and tested at assessment, pretherapy following a 10-week wait condition, posttherapy, and 6-month and 12-month follow-up.

Results:

Participants had fewer symptoms and better psychosocial functioning posttherapy and were further improved at the 6- and 12-month follow-up. Neither treatment modality was superior to the other. Approximately one-half of the sample sought further treatment during the follow-up periods.

Conclusions:

Improvement in symptoms and functioning was associated with short-term treatment in both modalities, but many patients remained distressed and required further treatment. Future research should investigate whether sexually abused women who meet criteria for specific diagnoses require more focused and/or longer-term therapy.
Prenatal Factors and Adult Mental and Physical Health
Authors: Susser Ezra B , Brown Alan , Matte Thomas D
Published: January 2017

Objective:

To review research on prenatal influences on adult mental and physical health and draw implications for future directions in psychiatric research.

Method:

Schizophrenia is selected as an example from mental health and cardiovascular disease as an example from physical health. For each of these disorders, empirical findings on prenatal influences are reviewed, and the methods used to demonstrate them are critiqued.

Results:

Research on prenatal antecedents of these conditions has proceeded in parallel: intriguing findings have related fetal growth restriction or fetal insult to adult health; similar types of causal pathways have been proposed to explain the relationships; and research has been plagued by similar limitations, including lack of precise prenatal exposure data and difficulty of controlling confounding. The prevailing view of disease causation, which is not well-suited to investigation of prenatal antecedents, impedes research in both fields. Yet, there has been little interchange between researchers in the 2 fields.

Conclusions:

We propose a causal paradigm that could serve as a guide for future investigations on the prenatal antecedents of adult health and promote interchange between research on mental and physical health. The paradigm reflects current thinking in epidemiology by encompassing not only risk factors as traditionally conceived but also causal chains over time and causal influences at multiple levels of organization. Implications for the design of new research are illustrated with reference to an ongoing study.
Precursors to Schizophrenia: Do Biological Markers Have Specificity?
Authors: Tarrant C Jane , Jones Peter B
Published: January 2017

This review addresses childhood antecedents and biological markers of schizophrenia within a neurodevelopmental framework. General-population birth-cohort studies illustrate delays in developmental milestones, abnormalities in social functioning, and cognitive deficits throughout childhood, adolescence, and early adulthood. Abnormal neurology and motor dysfunction have been measured in children prior to the onset of schizophrenia, at first onset of disease, and in those with chronic schizophrenia Minor physical anomalies, a static marker of developmental disturbance, are also increased in schizophrenia. None of these factors has high specificity for this disorder.

This review examines the associations between these precursors and some etiological factors for schizophrenia, comments on their lack of complete specificity to this psychotic syndrome, and considers their usefulness as predictors of risk.
Des variations intersexuelles relatives aux traitements en psychiatrie
Authors: Godfroid Ivan O
Published: January 2017

Objectif:

L'auteur revoit la documentation abordant l'influence des facteurs sexuels sur l'efficacité des traitements les plus couramment utilisés en psychiatrie. Il propose d'optimaliser l'efficacité et la tolérance des thérapies en tenant compte du sexe du patient.

Méthode:

Une vue d'ensemble aborde successivement les traitements pharmacologiques, psychothérapeutiques et autres (psychochirurgie, électroconvulsivothérapie (ECT). Des conclusions intermédiaires sont tirées pour chaque chapitre.

Résultats:

Les publications sur le sujet sont rares et inégales. D'un point de vue pharmacologique, les différences intersexuelles sont marquées et touchent tant l'absorption, la distribution, le métabolisme, que l'excrétion des substances. Il en résulte des variations dans la biodisponibilité qui ont des répercussions sur l'efficacité et les effets secondaires; celles-ci touchent les antidépresseurs, les neuroleptiques, le lithium, et aussi les hypnotiques, sédatifs et anxiolytiques. Le cycle menstruel et la prise de contraceptifs oraux sont à l'origine d'interactions significatives. L'influence de l'effet sexospéciflque sur l'efficacité des psychothérapies a été peu étudiée. Certaines différences semblent toutefois possibles, mais un effort de recherche important devra être consenti avant de pouvoir tirer des conclusions reproductibles. Certains types de traitement «physiques», tels la psychochirurgie et l'ECT, semblent peu influencés par le sexe du patient.

Conclusions:

Il existe une influence certaine du sexe du patient sur l'efficacité du traitement qui lui est administré. Cette influence est toutefois souvent limitée, mais elle entre en ligne de compte dans l 'optimalisation de la réponse et de la tolérance à la thérapie. La recherche dans ce domaine de la psychiatrie devrait être encouragée.
A Comparison of Male and Female Adolescents Referred to an Eating Disorder Program
Authors: Geist Rose , Heinmaa Margus , Katzman Debra , Stephens Derek
Published: January 2017

Objective:

To compare gender-related psychopathology and psychiatric diagnoses in male and female adolescents referred to an adolescent eating disorder program.

Method:

All adolescents presenting at the Eating Disorder Program at our hospital completed the semistructured Diagnostic Interview for Children and Adolescents – Revised (DICA-R) and self-report scales, including the Children's Depression Inventory (CDI), the Brief Symptom Inventory (BSI), the Eating Disorder Inventory (EDI-2), and the Family Assessment Measure (FAM-III), during their initial assessment. The 157 subjects (21 male, 136 female) were classified into Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) eating disorder (ED) subtypes and then recombined into male and female restricters (R) and ED-related groups: showing eating-related concerns but not having a DSM-IV diagnosis. We compared the male and female restricter groups and ED-related group on 5 specific psychological dimensions to examine comorbid psychiatric diagnosis, ED-specific and nonspecific psychopathology, EDI clinical and provisional subscales, and family functioning using multivariate analyses of covariance (MANCOVAs).

Results:

Males endorsed statistically significant lower drive for thinness and body dissatisfaction than did females. However, there are no representative norms for adolescent males on these variables. The ED-related group also endorsed statistically significant lower drive for thinness and body dissatisfaction (specific ED psychopathology) than did the ED-restricter groups. The males in both groups endorsed fewer EDI items than did their female counterparts, but the differences were not statistically significant. Comorbid psychiatric diagnoses of depression and anxiety in male and female restricters were common but did not distinguish the groups.

Conclusions:

Our results suggest that male and female adolescents with EDs are clinically similar to each other and therefore resemble adults for lack of gender-specific effects on self-reported psychopathology, family functioning, and comorbid psychiatric disorders.
Family-of-Origin Characteristics in Bipolar Disorder: A Controlled Study
Authors: Cooke Robert G , Young L Trevor , Mohri Linda , Blake Pamela , Joffe Russell T
Published: January 2017

Objective:

To assess the family-of-origin characteristics of patients with bipolar disorder relative to those of control subjects.

Method:

Fifty-six euthymic patients meeting research diagnostic criteria for bipolar disorder and 21 control subjects completed the Family Environment Scale (FES) for the family they grew up with.

Results:

The 2 groups showed strikingly similar profiles on 10 indices of family functioning or structure.

Conclusions:

The results do not support the hypothesis that specific family attributes contribute to the development of bipolar disorder.
Elderly Suicide in Alberta: Difference by Gender
Authors: Quan Hude , Arboleda-Flórez Julio
Published: January 2017

Objective:

To determine differences by gender among elderly persons who commit suicide on demographic characteristics, place of suicide, suicide method, previous suicide behaviour, and precipitant stressor.

Method:

This study included completed suicides of individuals aged 55 years and over during 1984–1995 in Alberta (n = 920). Information was abstracted from suicide records of medical examiners.

Results:

Relative to elderly female suicides, elderly males who commit suicide characteristically use guns to commit suicide (43.8%), are single (12.5%), live in rural areas (46.7%), and have a lower frequency of previous suicide attempts (16.5%). Physical illness and financial difficulty as precipitant stressors of suicide are significantly more frequent among males (40.3% and 8.7% respectively) than females (29.9% and 1.8% respectively). Mental illness as a precipitant stressor is more common among females, 35.8% for women and 15.3% for men.

Conclusions:

Lethal methods of suicide and physical illness and financial difficulty as precipitant stressors of suicide are more common among elderly males than females who commit suicide.
Obsessive-Compulsive Spectrum Disorders: Effective Treatment with Paroxetine
Authors: Ravindran Arun V , Lapierre Yvon D , Anisman Hymie
Published: January 2017

Objective:

To examine whether, like pure obsessive-compulsive disorder, obsessive-compulsive spectrum disorders are treatable with a selective serotonin reuptake inhibitor (SSRI).

Method:

Case histories of patients prescribed paroxetine for compulsive collecting, skin-picking, and trichotillomania were reviewed.

Results:

All patients were successfully treated with paroxetine.

Conclusions:

Obsessive-compulsive spectrum disorders may share a serotonin-related dysfunction, and SSRIs may prove effective in their treatment.
Cost Savings Associated with Fitness-to-Stand-Trial Assessments in Detention Centres: A Pilot Program
Authors: Chaimowitz Gary A , Ferencz Joseph
Published: January 2017

Objective:

To determine whether fitness-to-stand-trial assessments “in detention” offer cost benefits over inpatient assessments.

Method:

The development of a pilot “fitness clinic” in a detention centre is described, and the results of 1 year of assessments are presented. The cost benefit of fitness assessments conducted in detention centres is outlined.

Results:

Significant cost savings were realized by operating fitness clinics in detention centres.

Conclusion:

Fitness clinics in detention centres offer important benefits and are recommended as an adjunct to forensic programs.
Psychotic Side Effects of Psychostimulants: A 5-Year Review
Authors: Cherland Esther , Fitzpatrick Renée
Published: January 2017

Objective:

To examine the rate of psychotic and mood-congruent psychotic side effects of stimulant medications in children treated for attention-deficit hyperactivity disorder (ADHD).

Method:

A chart review was completed of all children diagnosed with ADHD in an outpatient clinic from January 1989 to March 1995.

Results:

Over 5 years, 192 children were diagnosed with ADHD. Ninety-eight children received treatment at the clinic with stimulants. Six children developed psychotic or mood-congruent psychotic symptoms during treatment. Children on medication were followed for an average of 1 year and 9 months.

Conclusions:

Awareness of the potential for psychotic side effects from stimulant medications is important when prescribing for children. A large prospective study would be useful to predict the frequency and classification of the side effects in children.
The NIMH Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder: Just Say Yes to Drugs Alone?
Authors: Pelham William E
Published: January 2017

The outcome, merits, and limitations of the Multimodal Treatment Study for Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, are described and discussed. Consideration is given to design issues that make the MTA a landmark study for clinicians and researchers working with ADHD children. These include the large, heterogeneous sample, the state-of-the-art treatment, the lengthy treatment period, the extensive documentation of treatment manuals, and the attention paid to treatment fidelity and adherence. Also highlighted are facets of the design that predisposed the study in favour of a differentially positive outcome for pharmacological relative to behavioural treatment. Primary among these is the fact that outcome was measured 4–6 months after the intensive phase of behaviour treatment and after therapeutic contact with the behaviour therapist had ended but while medication treatment was active and in its most intensive phase. Finally, the outcome for the combined treatment condition in the MTA is discussed in the context of the extant literature and directions for future research.
Lessons from Large Trials: The MTA Study as a Model for Evaluating the Treatment of Childhood Psychiatric Disorder
Authors: Boyle Michael H , Jadad Alejandro R
Published: January 2017

Objective:

To review the methodology of the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA study, and its implications for the design of future child mental health treatment studies.

Method:

The characteristics of large-scale studies envisioned by trialists engaged in cardiovascular and cancer research provide the framework for reviewing key elements of the MTA study—objectives, research questions, measurement, sampling, and exposure to treatment—and discussing important methodological decisions the MTA investigators had to make.

Results:

The MTA study is a complex, standardized, carefully implemented, randomized control trial. Review of the MTA study indicated that future studies should be aligned clearly with either effectiveness or efficacy objectives but not both. Questions selected for study should be simple, clear, and important. Measurement, sampling, and data collection must adhere to the principle of simplicity to ensure maximum participation. All methodological decisions should be geared to attaining the research objectives: in effectiveness trials, this means evaluating treatments that have a high potential for dissemination if proven successful and recruiting only new referrals from child mental health settings.

Conclusions:

The MTA study has raised the standard for technical excellence in child treatment research and will draw attention to some fundamental issues in large-scale child treatment studies, including articulating objectives and questions, setting priorities for measurement and sampling, and identifying treatments for evaluation that have a high probability of dissemination if found effective.