bluuebunny/crossref_metadata_2025 huggingface dataset:
Excess of Psychoses among the French West Indian Population
Authors: Ballon Nicolas , Ursulet Gilbert , Merle Sylvie , Eynaud Michel , Charles-Nicolas Aimé , Michalon Max
Published: January 2017

Objective:

To investigate and compare the prevalence of psychoses in the French West Indies (FWI) and in continental France.

Method:

As part of an international epidemiologic multicentre study under the authority of the World Health Organization French Collaborating Center (WHO-CC), we questioned 7257 individuals selected from the general population in France and in the FWI, using the Mini International Neuropsychiatric Interview. We compared data using the chi-square test.

Results:

We found a significant discrepancy between the rate of psychoses at the continental French sites (1.8%) and the FWI sites (4.4%) ( P < 0.0001). After homogenizing the rate of missing interviews, our results remained significant.

Conclusions:

Such a drastic increase in the rate of psychoses in the FWI population cannot be explained solely on the basis of either the classical migration hypothesis or other currently accepted hypotheses. More attention should be given to new parameters such as 1) the recent and significant abuse of crack cocaine and cannabis in the FWI, 2) the continued existence of magic practices in a significant portion of the French Afro-Caribbean population, and 3) the expression of mood disorders with overvalued ideation or psychotic symptomatology.
Recent Advances in the Treatment of Borderline Personality Disorder
Authors: Paris Joel
Published: January 2017

Objective:

To examine recent research on the treatment of borderline personality disorder (BPD).

Method:

A narrative review of all recent controlled trials of therapy for patients with BPD.

Results:

Various psychotherapeutic and psychopharmacological methods can be used to reduce impulsivity and dysphoric mood in this disorder.

Conclusion:

There is strong support for well-structured forms of psychotherapy, but evidence for pharmacotherapy in BPD is mixed. Treatment can usually be carried out in an outpatient setting.
Sex and Informant Effects on Diagnostic Comorbidity in an Adolescent Community Sample
Authors: Romano Elisa , Tremblay Richard E , Vitaro Frank , Zoccolillo Mark , Pagani Linda
Published: January 2017

Objective:

To investigate sex and informant effects on comorbidity rates for anxiety disorders, depressive disorders, attention-deficit hyperactivity disorder (ADHD), and conduct–oppositional disorder (CD–ODD) in an adolescent community sample.

Method:

The Diagnostic Interview Schedule for Children-2.25 (DISC-2.25) was administered to 1201 adolescents and their mothers.

Results:

The highest comorbidity risk found was between ADHD and CD–ODD, with odds ratios (ORs) of 17.6 for adolescent reports and 12.0 for mother reports. The second-highest comorbidity risk, with ORs of 13.2 for adolescent reports and 11.0 for mother reports, was between anxiety and depressive disorders. There was not much overlap between internalizing and externalizing disorders. Adolescent girls had higher rates of coexisting anxiety and depressive disorders, whereas adolescent boys had higher rates of coexisting ADHD and CD–ODD. There was partial support for the hypothesis that adolescent-reported comorbidity rates would exceed mother-reported rates.

Conclusions:

There is a greater cooccurrence of within-category, compared with between-category, disorders. Adolescent girls are more likely to have coexisting internalizing disorders, while adolescent boys are more likely to have coexisting externalizing disorders. Mothers tend to report more externalizing disorders (that is, ADHD), while adolescents generally report more internalizing disorders.
Treatment of Child Neglect: A Systematic Review
Authors: Allin Heather , Wathen C Nadine , MacMillan Harriet
Published: January 2017

Objective:

Child neglect is the most common type of child maltreatment. Our objective was to systematically evaluate the available evidence regarding the effectiveness of child neglect treatment programs, including those focused on victims of childhood neglect and (or) their caregivers.

Method:

We comprehensively searched the Medline, Psycinfo, and Eric databases from January 1980 to May 2003. Two authors independently reviewed 54 studies that met inclusion criteria. Fourteen articles met our design criterion and were assessed for their methodological quality according to guidelines developed by the US Preventive Services Task Force.

Results:

Of the 14 studies included in the review, 2 were rated as good, and 3 were rated as fair. We found evidence that 2 specific types of play therapy and a therapeutic day treatment program had beneficial effects for children. Further, parents and children in families where neglect had occurred showed improvement with multisystemic therapy.

Conclusions:

Rigorous studies of treatments for neglected children and their families are lacking. Well-designed and well-conducted evaluations are urgently required to identify effective treatments, which should then be made available to children and their caregivers.
Obsessive-Compulsive Symptoms and Positive, Negative, and Depressive Symptoms in Patients with Recent-Onset Schizophrenic Disorders
Authors: de Haan Lieuwe , Hoogenboom Britt , Beuk Nico , van Amelsvoort Therese , Linszen Don
Published: January 2017

Objectives:

To study the relation between obsessive-compulsive symptoms (OCS) and positive, negative, and depressive symptoms in patients with recent-onset schizophrenic disorders.

Methods:

We undertook a prospective study of 113 consecutively hospitalized patients with recent-onset schizophrenia or related disorders diagnosed according to DSM-IV criteria. We compared 3 subgroups: one without comorbid OCS, one with OCS not fulfilling DSM-IV criteria for obsessive-compulsive disorder (OCD), and one with comorbid OCD diagnosed according to DSM-IV criteria. We assessed OCS severity at admission and 6 weeks thereafter with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Positive and Negative Syndrome Scale (PANSS) and the Montgomery–Asberg Depression Rating Scale (MADRS) were independently administered.

Results:

At admission, patients with schizophrenic disorders and OCD had higher mean MADRS scores than both other groups; patients with OCS not fulfilling DSM-IV criteria for OCD had lower mean PANSS negative subscale scores than both other groups. After 6 weeks, there were no significant between-group differences, and OCS severity remained constant.

Conclusions:

Acute patients with recent-onset schizophrenia and OCD have more severe depressive symptoms but do differ in negative symptoms, compared with patients without comorbid OCD. Mild OCS may be related to less severe negative symptoms. During regular inpatient treatment, OCS severity remains constant.
Validation of the Deployment Risk and Resilience Inventory in French-Canadian Veterans: Findings on the Relation between Deployment Experiences and Postdeployment Health
Authors: Fikretoglu Deniz , Brunet Alain , Poundja Joaquin , Guay Stéphane , Pedlar David
Published: January 2017

Objectives:

This study had a twofold purpose: to validate the French-Canadian version of a measure of deployment risk and resilience factors and to examine the relation between deployment risk and resilience factors and postdeployment functioning.

Method:

Canadian veterans at an outpatient clinic ( n = 131) completed a mail-in survey that included a measure on deployment risk and resilience factors, the Deployment Risk and Resilience Inventory (DRRI) (1), as well as measures on psychological and physical health.

Results:

Internal consistency and test–retest reliability coefficients for the DRRI scales were very good. As expected, DRRI risk factors were negatively associated with psychological and physical functioning, and DRRI resilience factors were positively associated with psychological and physical functioning. Low- as well as high-magnitude deployment risk factors were associated with functioning.

Conclusions:

The French-Canadian version of the DRRI is a reliable and valid measure of deployment risk and resilience factors. Deployment risk and resilience factors are associated with a host of problems in physical and psychological functioning for veterans.
Impairment of Autonoetic Awareness for Emotional Events in Schizophrenia
Authors: Neumann Aurore , Philippot Pierre , Danion Jean-Marie
Published: January 2017

Objective:

To investigate the subjective states of awareness accompanying recognition of emotional events in patients with schizophrenia.

Method:

During the learning phase, a set of neutral pictures associated with emotional sentences was presented to 24 patients with schizophrenia and 24 healthy control subjects. During the test phase, participants had to recognize target pictures and valence and to report their subjective state of awareness (Remember, Know, or Guess) associated with recognition of pictures and valence.

Results:

Patients with schizophrenia exhibited poor recognition of pictures and emotional valence. The frequency of Remember responses associated with recognition of pictures and of valence was lower in patients than in control subjects.

Conclusions:

Autonoetic awareness for emotional events is reduced in schizophrenia, with patients presenting difficulties in consciously recollecting the specific details that make events emotional.
Treatment of Perinatal Mood and Anxiety Disorders: A Review
Authors: Misri Shaila , Kendrick Kristin
Published: January 2017

Objectives:

To review the nonpharmacologic and pharmacologic treatment modalities for perinatal mood and anxiety disorders and to discuss the importance of weighing the risks and the benefits of exposing the fetus or baby to maternal mental illness as opposed to exposure to antidepressant medications.

Methods:

We conducted a literature search of the PubMed and MEDLINE databases. Key words included the following: perinatal, pregnancy, postpartum, depression, anxiety, pharmacologic, nonpharmacologic, psychotherapy, and treatment.

Results:

Recent literature reflects that both pharmacologic and nonpharmacologic treatments for perinatal women are associated with positive and negative outcomes. No treatment decision was found to be risk-free. The detrimental effects of untreated mental illness on the mother, as well as on the baby, highlight the need for treatment intervention. The long-term effects of exposure to either medications or maternal mental illness are unknown, as yet.

Conclusion:

Women with perinatal depression and anxiety disorders require timely and efficient management with a goal of providing symptom relief for the suffering mother while simultaneously ensuring the baby's safety. Although knowledge in the area of appropriate intervention is constantly evolving, rigorous and scientifically sound research in the future is critical.
International Health and Psychiatry
Authors: Bland Roger C
Published: January 2017

Objective:

To abstract and evaluate data on psychiatric illness and health care in Canada from a recent major World Bank/World Health Organization (WHO) publication.

Method:

A review of the publication and related material provides a picture of the level of disability produced by neuropsychiatric disorders. Changing patterns of life expectancy in developing countries, and some social factors associated with prevention are extracted.

Results:

Psychiatric disorders account for 15% of disability and premature death in developed countries. A surprisingly small percentage is accounted for by psychoses, and more than expected by post-traumatic stress disorders. Violence against women is highlighted as a risk factor for psychiatric disorders. Objectives for health care systems — improving outcomes, reaching the disadvantaged and containing costs — are detailed.

Conclusions:

Although little formal attention is given to psychiatric disorders, there is a wealth of information about the extent of disability produced by neuropsychiatric disorders, and future directions of health care systems.
Premorbid and Postmorbid School Functioning in Bipolar Adolescents: Description and Suggested Academic Interventions
Authors: Quackenbush Doug , Kutcher Stan , Robertson Heather A , Boulos Carolyn , Chaban Peter
Published: January 2017

Objective:

This study was designed to describe and evaluate the manner in which changes in school functioning are associated with bipolar affective disorder (BAD) in adolescence.

Method:

Pre- and post-illness onset school functioning data were collected from a sample of 44 adolescents with a DSM-III-R diagnosis of BAD. A variety of assessment measures were used, including personal interview, a review of school history and formal academic testing.

Results:

Our findings reveal an overall profile of generally good to excellent premorbid school functioning in most adolescent onset bipolar patients, which subsequently shows marked deterioration along several dimensions (work effort, academic achievement, peer relationships and extracurricular involvement) following BAD onset.

Conclusions:

Onset of bipolar illness in adolescence negatively impacts on the teenager's ability to function effectively in the school environment. Specific program modifications are required in order to optimize the bipolar teenager's success at school. These are identified and discussed.
The Phenomenon of Rapid Cycling in Bipolar Mood Disorders: A Review
Authors: Persad E , Oluboka Oj , Sharma V , Mazmanian D , Kueneman K
Published: January 2017

Objective:

To review the various pharmacological and nonpharmacological factors associated with the induction of rapid cycling in bipolar mood disorder, and to introduce the idea that parturition may also have a role. Factors known to contribute to bipolar mood disorder rapid cycling include antidepressant agents, female gender and middle age. Currently, there is evidence that hypothyroidism may also play a role.

Method:

A critical review of the literature was undertaken.

Conclusion:

Caution should be exercised in the use of antidepressants in patients with bipolar mood disorders.
The Prevalence of Major Depressive Disorder and Low Self-Esteem in Medical Inpatients
Authors: Silverstone Peter H , Lemay Tania , Elliott Jasen , Hsu Vicky , Starko Rachel
Published: January 2017

Objective:

To determine the prevalence of major depressive disorder in acutely ill medical inpatients, and the relationship of this to low self-esteem.

Method:

A total of 186 patients were interviewed 6 or 7 days following admission to detect the presence of DSM-IV major depressive disorder (MDD). Patients were assessed using a new brief psychiatric interview, the Silverstone Concise Assessment for Depression (SCAD), which has previously been validated for use in the physically ill. The cognitive function of the patients was measured, using the Mini-Mental State Examination (MMSE), with patients scoring less than 22 on the MMSE being excluded from the study. The patients' self-esteem was also assessed, using the Rosenberg self-esteem rating scale. The severity and type of the patients' medical illness, and the recognition of psychiatric illness by both nurses and physicians were also noted.

Results:

The results showed that 18 patients (9.7%) were depressed. The depressed patients were significantly younger than the nondepressed patients (mean age 46.3 ± 3.9 years versus 57.1 ± 1.5 years, respectively) and were significantly more likely to be female (61% versus 44%, respectively). The depressed patients had a significantly lower self-esteem than the nondepressed patients, whose self-esteem was no different from the general population. However, the depressed patients were not more severely ill than the nondepressed patients. The results also demonstrated that both nurses and physicians were poor at recognizing the presence of major depression, with nurses recognizing 33% of cases compared to 22% for medical staff.

Conclusions:

The results from this study demonstrate that while there is an increase in the incidence of depression in medically ill patients, this is not as great as has been previously reported, and is not related to severity of illness. The results from this study, therefore, are in keeping with other recent findings which show that the prevalence rates for MDD in medical patients is between 5% to 10%, rather than the previously accepted range of 20% to 40%.
Intensive Use of Mental Health Care
Authors: Mustard Cameron A , Derksen Shelley , Tataryn Douglas
Published: January 2017

Objective:

To describe the profile of the intensive use of mental health services over a 4-year period in a population of 1.1 million people.

Methods:

Data obtained from computerized hospital separation records and physician reimbursement claims were combined to form patient-based histories of mental health care utilization. Users of mental health services in a 24-month period were hierarchically classified as having a psychotic disorder (ICD-9-CM 295–299) or a nonpsychotic disorder (ICD-9-CM 300–301, 306–309, 311). Intensive use was defined as 12 or more contact months or a minimum of 2 episodes of therapy in the 24-month period. The cohort of intensive users were followed over the subsequent 24-month interval to describe the persistence of intensive use.

Results:

In the initial observation period, intensive users constituted 27.4% of individuals in treatment for psychotic disorder and 4.4% of persons in treatment for nonpsychotic disorder. These 2 groups, which represent 7.4% of all users of mental health care, were responsible for 53% of physician services, 72.7% of contacts with psychiatrists, and 64.4% of acute psychiatric bed days in the initial period. In the follow-up period, intensive use status was replicated by 44.6% of the cohort.

Conclusions:

The diagnostic and therapeutic characteristics of intensive users of mental health services are heterogeneous. There is substantial persistence of intensive mental health service use over time.
Research Training and Productivity among Faculty: The Canadian Association of Professors of Psychiatry and the Canadian Psychiatric Association Survey
Authors: El-Guebaly Nady , Atkinson Mark
Published: January 2017

Objective:

This survey assesses the research training and productivity of academic faculty in Canadian departments of psychiatry and compares the findings with those of colleagues in the United States.

Method:

A questionnaire was adapted to suit the Canadian milieu and was distributed to a target population of 2484, including a core 522 full-time faculty.

Results:

The response rate among full-time faculty was 65%, but only 26.5% for clinical and adjunct faculty. A small proportion (16%) of our MD and a greater proportion (57%) of our PhD respondents were included in a fairly lenient definition of researcher. Departments seek to recruit PhDs with an active involvement in research. Overall there appear to be more similarities than differences in research interests with our colleagues in the United States. The pharmaceutical industry was the most frequently mentioned source of research funding for MDs, while the availability of a mentor was perceived as the most influential factor determining the choice of a research career.

Conclusions:

Recommendations include adequate exposure to research during medical school and residency as well as appropriate inducements for the recruitment and retention of practising researchers.
Characteristics of Psychogeriatric Patient Visits to a General Hospital Emergency Room
Authors: Shulman Richard W , Marton Peter , Fisher Anne , Cohen Carole
Published: January 2017

Objective:

This study describes psychogeriatric patients who visit the Emergency Room (ER) in a teaching hospital with a comprehensive psychogeriatric service.

Method:

A survey assessing demographic and clinical characteristics was completed for every psychiatric ER patient during a 2-year period.

Results:

One hundred and seventy-three ER patients aged over 60 (mean age 71.2) were assessed. Fifty-three percent were previously known to the psychogeriatric service. The majority of these previously known psychogeriatric patients who used the ER suffered from mood disorders. The majority of new psychogeriatric patients seen in the ER had an organic brain syndrome (OBS).

Conclusions:

Few OBS patients who visited the ER were previously known to the psychogeriatric service, but many new OBS patients accessed the psychogeriatric service via the ER. For patients with mood disorders, particularly if suicidal, the ER was used as part of their service delivery system.
From Evidence to Conclusions in Psychiatric Research
Authors: Bilsker Dan
Published: January 2017

Objective:

To identify problems in the derivation of conclusions from evidence in psychiatry research.

Method:

The scientific model of falsificationism is described as determining the logical requirements for proving conclusions from research evidence. Common types of problematic conclusions are identified, and examples from the current research literature are given.

Results:

Poorly formed conclusions are based on inadequate hypotheses, ambiguously phrased, blind to negative findings, fallacious in logic, or neglectful of alternative explanations.

Conclusions:

The risks of accepting poorly formed conclusions are premature closure of scientific investigations, poor basis for decisions in psychiatric practice, and provision of misinformation to patients. It is recommended that practitioners be attentive to this aspect of critically appraising research.
The Role of the Thalamus in Schizophrenia
Authors: Andreasen Nancy C
Published: January 2017

Background:

Explaining the diversity of symptoms that occur in schizophrenia is a major conceptual challenge. Perhaps the most powerful strategy is to identify a fundamental cognitive process and/or a fundamental neural circuit.

Methods:

Convergent data from our research group in Iowa and from investigators in other centres are summarized.

Results:

The thalamus plays a key role in information processing. A defect in circuitry connecting the thalamus, frontal cortex, and cerebellum could explain a wide range of symptoms. Neuropathology and imaging studies suggest that patients with schizophrenia may have abnormalities in this circuitry.

Conclusion:

The fundamental deficit in schizophrenia may be conceptualized as a “cognitive dysmetria” characterized by impairments in coordinating the perception, encoding, retrieval, and prioritization of experience and information.
Shadows of the Truth in Patients with Spinal Pain: A Review
Authors: Giles Lynton GF , Crawford Colin M
Published: January 2017

Objective:

Spinal pain with or without referred pain is a major and costly health problem that can arise from many anatomical structures. Sophisticated diagnostic imaging devices cannot show some of these structures, and frequently imaging provides only a shadow of the truth. This review illustrates how symptoms may well have an organic cause that is not detectable by current methods of examination, including imaging.

Method:

This study reviews some histopathological findings that can be associated with spinal pain with or without referred pain but cannot be seen on imaging.

Result:

Some histopathological changes illustrate imaging device limitations.

Conclusion:

Awareness of the considerable limitations of even sophisticated imaging devices is necessary when managing patients with acute or chronic spinal pain with or without referred pain. Symptoms may well be genuine and not of psychogenic origin: a diagnosis of malingering, therefore, should not be made lightly.
Emotional Distress and Substance Abuse as Risk Factors for Suicide Attempts
Authors: Overholser James C , Freiheit Stacy R , DiFilippo Julia M
Published: January 2017

Background:

Both depression and hopelessness have been found to be closely related to suicide risk among adolescents and adults. Substance abuse has also been found to play a role in the suicide process with adults, but it is still unclear how much substance abuse influences suicide in adolescents.

Method:

The present study examined the relationship between substance abuse, emotional distress, and suicidal intent among 115 adolescent psychiatric inpatients who had attempted suicide.

Results:

Measures of emotional distress, as well as the measures of substance abuse, were significantly intercor-related. Correlations across domains (emotional distress versus substance abuse), however, varied by gender. Among adolescent females, both depression and hopelessness were significantly related to suicidal intent, whereas among adolescent males, only depression was related to suicidal intent. Also, alcohol abuse was significantly related to depression and hopelessness in adolescent males.

Conclusions:

Hopelessness may not be as useful an indicator of suicide risk among adolescent males as it is with adolescent females. Intervention and prevention programs designed for adolescent females should identify and address feelings of depression and hopelessness. New intervention and prevention programs may need to be developed for adolescent males.
Outcome Evaluation of a Short-Term Mental Health Day Treatment Program
Authors: Howes Janice L , Haworth Heather , Reynolds Paul , Kavanaugh Marie
Published: January 2017

Objectives:

To determine whether a structured, 6-week mental health day treatment program was meeting its objectives and to examine the program's effectiveness with specific patient groups.

Method:

Self-report questionnaires focusing on psychiatric symptoms, assertiveness, stress management, and social functioning were completed by patients directly prior to admission (pretest), at discharge (posttest), and at 4-month follow-up. Clinician ratings, including the DSM-III-R Global Assessment of Functioning (GAF) scale, were collected. Ninety-one participants completed pre- and posttests, and 51 completed the 4-month follow-up.

Results:

The majority of the participants displayed affective disorders or adjustment disorders. There was significant reduction in psychiatric symptoms and improvement in assertiveness, social functioning, and stress management from pretest to posttest. These gains were maintained at follow-up. All diagnostic groups responded similarly, except the bipolar disorder group.

Conclusion:

These data indicate that the program was meeting its objectives and offer strong support for the usefulness of short-term day treatment for a wide range of patients. The bipolar group performed differently compared with the other subsamples. The reliability of the GAF scale and when it may be most useful are discussed.
Psychotherapy Outcome Research in Child Psychiatric Disorders
Authors: Pearsall Donald F
Published: January 2017

Objective:

To compile, review, and comment upon the application of psychotherapy to the treatment of psychiatric disorders first appearing in childhood and adolescence.

Method:

Representative research papers published over the past 4 decades on the subject of psychotherapy of children and adolescents were compiled. Selection for inclusion in this review was based upon salience to the subject of treatment of child psychiatric disorders. Special consideration was given to large-scale and metaanalytic studies, as well as to studies comparing psychotherapy with other forms of treatment.

Results:

There is mixed evidence for the efficacy of psychotherapy for child psychiatric disorders. There are few direct comparisons between treatment modalities in the child psychiatric literature. Methodological problems include a history of theoretical development of therapies without reference to current conceptions of mental illness, a paucity of direct comparisons among psychotherapies and between psychotherapy and other psychiatric treatments, inconsistent definition of psychotherapy from study to study, and inconsistency in stated outcome measures. In general, cognitive–behavioural therapies performed better in application to child psychiatric disorders than did insight-oriented therapies.

Conclusions:

Outcome research in child-oriented psychotherapy is still in its infancy. There are simply too few studies of many therapies and many conditions to draw firm conclusions about efficacy. More work is needed in matching discrete, consistently applied therapies to selected psychiatric pathologies. Questions regarding psychotherapy's potential application to prevention of mental illness and to management of distress surrounding mental illness (as distinct from treatment of the illness itself) remain to be answered.
Sharing Psychiatric Care with Primary Care Physicians: The Toronto Doctors Hospital Experience (1991–1995)
Authors: Turner Ty , de Sorkin Alicia
Published: January 2017

Objectives:

To investigate the shared mental health care experience of the psychiatry department of a small urban general hospital, which serves an ethnoculturally diverse population.

Methods:

A chart survey was undertaken of all patients referred by community physicians to a new shared care program between January 1991 and December 1995. Selected demographic and diagnostic characteristics were collected and analyzed.

Results:

Seven hundred and thirteen patients were assessed. They were principally female, ethnoculturally varied, and highly comorbid. The most striking association involved mood and substance-related disorders.

Conclusion:

The Doctors Hospital experience shows that the shared care approach can reach large numbers of patients through a multiplier effect. Additionally, this approach has the potential to enhance access for ethnoculturally varied and diagnostically complex groups.
Sharing Care: The Psychiatrist in the Family Physician's Office
Authors: Kates Nick , Craven Marilyn A , Crustolo Anne-Marie , Nikolaou Lambrina , Allen Chris , Farrar Sheryl
Published: January 2017

Objective:

One way of strengthening ties between primary care providers and psychiatrists is for a psychiatrist to visit a primary care practice on a regular basis to see and discuss patients and to provide educational input and advice for family physicians. This paper reviews the experiences of a program in Hamilton, Ontario that brings psychiatrists and counsellors into the offices of 88 local family physicians in 36 practices.

Method:

Data are presented based on the activities of psychiatrists working in 13 practices over a 2-year period. Data were gathered from forms routinely completed by family physicians when making a referral and by psychiatrists whenever they saw a new case. An annual satisfaction questionnaire for all providers participating in the program was also used to gather information.

Results:

Over a 2-year period, 1021 patients were seen in consultation by one full-time equivalent psychiatrist. The average duration of a consultation was 51 minutes, and a family member was present for 12% of the visits. Twenty-one percent of the patients were seen for at least one follow-up visit, 75% of which were prearranged. In addition, 1515 cases were discussed during these visits without the patient being seen. All participants had a high satisfaction rating for their involvement with the project.

Conclusions:

Benefits of this approach include increased accessibility to psychiatric consultation, enhanced continuity of care, support for family physicians, and improved communication between psychiatrists and family physicians. This model, which has great potential for innovative approaches to continuing education and resident placements, demands new skills of participating psychiatrists.
Coming Alive: The Psychotherapeutic Treatment of Patients with Eating Disorders
Authors: de Groot Janet , Rodin Gary
Published: January 2017

Objective:

To describe a dynamic psychotherapeutic approach specifically developed for women with eating disorders.

Method:

The developmental origins and psychological disturbances associated with eating disorders are outlined based on a review of the literature and the authors' observations. Principles from contemporary psychodynamic theories that focus on subjectivity and inter subjectivity are applied to the treatment of women with eating disorders and are illustrated with clinical vignettes. Theoretical models employed include inter subjective and relational theory, self psychology, and feminist psychodynamic theory.

Results:

Relative unresponsiveness to a child's subjective experience and to child-initiated cues are thought to contribute to psychological disturbances among women with eating disorders. These disturbances include impairment in the sense of effectiveness, in the capacity to appreciate and tolerate emotions, and in the continuity and cohesiveness of self-experience. Self-imposed starvation, binge–purge episodes, and excessive exercise may act as psychic organizers in women with these vulnerabilities. An active psychotherapeutic approach with sustained interest in the patient's authentic subjective experience promotes the identification, organization, and integration of emotional experience and the consolidation of a more differentiated sense of self.

Conclusion:

In the psychotherapeutic treatment of women with eating disorders, a therapeutic posture of sustained empathic enquiry contributes to the patient's curiosity about her own subjective world. Feeling understood in a therapeutic relationship and feeling assisted in organizing and understanding one's subjective experience contributes to the gradual unfolding of the psychological sense of self.
Geriatric Psychiatry Outreach Practices in the Province of Ontario: The Role of the Psychiatrist
Authors: Ginsburg Lynne , Hamilton Pam , Madora Patti , Robichaud Leah , White Jan
Published: January 2017

Objective:

To determine the mode of practice of multidiscliplinary and interdisciplinary teams in the field of geriatric psychiatry in the province of Ontario with specific reference to the role of the psychiatrist on the teams.

Method:

Teams were identified, and a simple questionnaire was developed and submitted to every team at an annual conference.

Results:

Responses were obtained from 38 out of 47 teams. The composition of the teams is variable as regards size and represented discliplines. Nine teams do not have psychiatrists directly affiliated with them. Eighteen teams, 4 of which are based in teaching hospitals, have fewer than 1 full-time equivalent (FTE) psychiatrist. Among these teams, 4 have fewer than 0.1 FTE psychiatrist and 10 have fewer than 0.5 FTE psychiatrist. Eleven teams include between 1 and 1.5 FTE psychiatrists on their staff. Four teams (10.5%) require that the initial assessment of all patients be undertaken by a psychiatrist. In 18 (47%) of the teams, assessment by a psychiatrist can be infrequent or nonexistent. Discussion of the referral with a psychiatrist occurs in the majority of teams, but in a significant minority (10 [27%]), this occurs quite infrequently or not at all.

Conclusion:

Geriatric psychiatry outreach practices in Ontario involve many different disciplines in the assessment and follow-up of geriatric psychiatry patients, often without the ready availability of psychiatric input. We applaud the expanding roles of different disciplines in this practice. We are concerned, however, at the paucity of psychiatrists working in this field.
Le virage ambulatoire en psychiatrie: Réactualiser nos principes de psychiatrie communautaire ou rater le virage !
Authors: Léouffre Pierre , Tempier Raymond
Published: January 2017

Objectif:

Mise à jour des principes de la psychiatrie communautaire dans le contexte de la reconfiguration ambulatoire des services.

Méthode:

Analyse de l'évolution de certains modèles de type communautaire en Italie, en France, en Hollande, et aux États-Unis.

Résultats:

La désinstitutionnalisation voulait soustraire les patients aux effets néfastes des institutions asilaires, mais elle n'a pas abouti à la réintégration sociale d'un grand nombre d'entre eux. Les succès et les échecs de la pratique communautaire ont mis en lumière la variété des besoins des patients et leur constance.

Conclusions:

L'amélioration de la qualité de vie et de l'intégration des services devrait guider le choix des ressources nécessaires et leur organisation.
Typical and Atypical Antipsychotics in Adolescent Schizophrenia: Efficacy, Tolerability, and Differential Sensitivity to Extrapyramidal Symptoms
Authors: Lewis Ralph
Published: January 2017

Objective:

To review the existing literature on the efficacy and tolerability of antipsychotics for adolescent psychosis. The review focuses in particular on literature regarding adverse effects that are thought to have an increased incidence in young patients and on the possible neurobiological bases for such differential sensitivity.

Method:

Pertinent studies were sought using Medline searches, supplemented by selected bibliographies, and reviewed.

Results:

There is a relative paucity of research in this area; in particular, well-controlled trials are lacking. The existing literature suggests fairly good efficacy of both typical and atypical antipsychotics in the treatment of psychotic disorders in children and adolescents. However, the incidence of certain side effects, particularly extrapyramidal symptoms (EPS), is found to be higher in young patients compared with adults. Positron emission tomography (PET) receptor studies in adults have demonstrated that the incidence of EPS is related to dose-dependent dopamine type-2 (D2) receptor occupancy and that there is a significant relationship between the number of these receptors and age.

Conclusions:

Improved tolerability is leading to the increasing use of atypical antipsychotics for adolescent patients, though these new drugs do have specific adverse effects of their own. There is a need for more controlled studies of atypical antipsychotics in children and adolescents. In particular, dose-finding studies are needed to determine the optimal dose range to produce the greatest improvement with the least side effects for each of these new drugs.
Attention-Deficit Hyperactivity Disorder Subtypes and Comorbid Disruptive Behaviour Disorders in a Child and Adolescent Mental Health Clinic
Authors: Lalonde Justine , Turgay Atilla , Hudson James I
Published: January 2017

Objective:

To assess demographic characteristics and patterns of comorbid disruptive behaviour disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]) in subtypes of attention-deficit hyperactivity disorder (ADHD).

Method:

One hundred youths consecutively referred to a community child and adolescent mental health clinic and subsequently diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were evaluated. The diagnosis was made by a child psychiatrist and was based on information from physicians, parents, teachers, and diagnostic interviews with the youths and their parents.

Results:

The major findings were: 1) ADHD combined (C) type was diagnosed in 78% of the subjects, while 15% had inattentive (I) type and 7% had hyperactive—impulsive (HI) type; and 2) patterns of comorbid disruptive behavioural disorders significantly differed among subtypes. Specifically, subjects with the I type showed lower rates of comorbid ODD than those with the C type (33% and 85%; P < 0.001) and HI type (33% and 100%; P = 0.005); subjects with the HI type displayed a higher prevalence of CD than those with the I type (57% and 0%; P = 0.005) and C type (57% and 8%; P = 0.003). These results should be considered tentative because the reliability of the diagnostic procedures was not formally assessed and the number of subjects in the I and HI groups was small.

Conclusion:

ADHD subtypes showed significant differences in the distribution of comorbid disruptive behaviour disorders. These results support the utility of ADHD subtypes but should be replicated with a larger sample of I and HI type subjects using more rigorous diagnostic methods.
Adolescents on Neuroleptic Medication: Is This Population at Risk for Tardive Dyskinesia?
Authors: McDermid Stephanie A , Hood Jane , Bockus Sandra , D'Alessandro Enzo
Published: January 2017

Objective:

To assess the incidence of tardive dyskinesia (TD) in a sample of adolescents treated with neuroleptic medication and to identify the presence of any risk factors for TD within the affected group.

Method:

A retrospective chart review was conducted for 40 cases. The Abnormal Involuntary Movement Scale (AIMS) was used to measure side effects from medication at 6-month intervals over 2 years. Drug exposure was converted to chlorpromazine (CPZ) equivalents and the presence of risk factors for TD, such as a diagnosis of affective disorder, medication noncompliance, early age of illness onset, and concomitant antiparkinsonian medication, was also noted.

Results:

Of the 40 cases reviewed, 2 patients (5%) met diagnostic criteria for TD, and another 5 patients (12.5%) showed symptoms of TD.

Conclusions:

TD is a serious risk at any age. Medication noncompliance, early age of illness onset, and concomitant use of antiparkinsonian medication may increase susceptibility to TD and should be carefully monitored.
Mental Health Legislation and the Right to Appropriate Treatment
Authors: O'Reilly Richard L
Published: January 2017

Objective:

To demonstrate how mental health legislation and its implementation can detract from a patient's “right to health.”

Method:

The author surveyed colleagues working at the London and St Thomas Psychiatric Hospitals about cases where the structure or implementation of the Mental Health Act in Ontario (1) impeded the provision of good psychiatric care.

Results:

Four clinical vignettes illustrate specific problems; possible solutions to these difficulties are suggested.

Conclusion:

Physicians must remain vigilant in their role as advocates for patients' right to appropriate treatment.
Optimal Haloperidol Dosage in First-Episode Psychosis
Authors: Zhang-Wong J , Zipursky RB , Beiser M , Bean G
Published: January 2017

Objective:

To determine optimal doses of haloperidol for the treatment of a first episode of psychosis.

Method:

A 4-week prospective controlled clinical trial with “optimal dose” defined as the dose at which either of the following occurs: 1) significant improvement, defined as a 15% or greater decrease in scores on the Positive And Negative Syndrome Scale (PANSS), or 2) the onset of extrapyramidal symptoms. Beginning with 2 mg daily, haloperidol was increased weekly to 5 mg, 10 mg, and finally 20 mg daily until either 1) or 2) occurred.

Results:

Optimal doses for the 36 subjects were 2 mg daily for 15 subjects, 5 mg daily for 11, 10 mg daily for 7, and 20 mg daily for 3. On average, subjects whose optimal dose was 2 mg daily showed the greatest improvement. Among the 27 subjects evidencing clinical response to treatment, 20 had plasma haloperidol levels below 5 ng/ml.

Conclusion:

Many people suffering a first psychotic episode respond to haloperidol doses well below levels in common use.
The Impact of Primary Mental Health Care in a Prison System in Brazil
Authors: Taborda José GV , Bertolote José M , Cardoso Rogério G , Blank Paulo
Published: January 2017

Objective:

To analyze the impact of a psychiatric service in a prison general hospital that refers prisoners with mental disorders to a separate forensic psychiatric hospital (FPH).

Method:

Analysis of data on prison population and referrals to the FPH.

Results:

Despite a 10.9% increase in the overall prison system population over 3 years, referrals from the prison general hospital with the new psychiatric service to the FPH were reduced by 36.5%, whereas referrals from other prisons increased by 120.4%.

Conclusion:

Our results demonstrate the efficiency of the new primary health care approach.
Psychiatric Aspects of Sexual Abuse Involving Persons with Developmental Disabilities
Authors: McCreary Bruce D , Thompson John
Published: January 2017

Objective:

To consider psychiatric issues that relate to the prevention and management of sexual abuse involving persons with developmental disabilities as either abusers or victims.

Method:

Seven case descriptions illustrate the clinical challenges raised by allegations of sexual abuse.

Results:

Mental disorders and communication problems often coexist with the cognitive impairment that is primary in developmental disabilities. Pedophilic behaviour prompts allegations of abuse, and posttraumatic stress disorder often follows abuse. Difficulties communicating with others may preclude the detection of abuse or normal legal proceedings once an allegation is made.

Conclusions:

Psychiatric expertise applied both directly and indirectly through others is relevant in the prevention of sexual abuse and the management of those with developmental disabilities who are abusers or abused.
Prevalence of Problem Gambling: A Replication Study 7 Years Later
Authors: Ladouceur Robert , Jacques Christian , Ferland Francine , Giroux Isabelle
Published: January 2017

Objectives:

To investigate the relationship between availability of gambling activities and participation in gambling, maximum amount of money lost in 1 day to gambling, and number of pathological gamblers.

Method:

Two random samples (1002 and 1257 adults) were surveyed 7 years apart using the South Oaks Gambling Screen to identify pathological gamblers.

Results:

Seven years later, significantly more people reported having gambled, and the number of pathological gamblers had increased by 75%.

Conclusions:

These findings support the hypothesis that increases in the availability of gambling are related to increases in the number of problem gamblers.
Attention-Deficit Hyperactivity Disorder in Children and Youth: A Quantitative Systematic Review of the Efficacy of Different Management Strategies
Authors: Klassen Anne , Miller Anton , Raina Parminder , Lee Shoo K , Olsen Lise
Published: January 2017

Objective:

To obtain estimates of the relative efficacy of 3 main treatment strategies for attention-deficit hyperactivity disorder (ADHD) in children and youth (age < 18 years).

Methods:

Design: quantitative systematic review of randomized trials. Subjects: 999 patients with ADHD from 26 randomized trials. Interventions: medications alone, behavioural interventions alone, and a combination of these 2 modalities. Main outcome measure: differences in scores between treatment groups on commonly used teacher- and parent-completed behaviour rating scales.

Results:

Medication-only therapy was efficacious in ADHD. Behavioural therapies used alone appeared not to be efficacious in ADHD. Combination therapy was more efficacious than placebo or no treatment for parent but not teacher ratings, not more efficacious than drug therapy alone, and more efficacious than behavioural treatments alone based on parent but not teacher ratings.

Conclusion:

Though stimulant medications were found to be an effective treatment strategy for ADHD in children and youth, it proved difficult to assess the relative benefits of behavioural interventions alone and combined medication and behavioural therapy because of the paucity of treatment studies other than medication-only treatment studies and heterogeneity of various kinds that exist in relation to ADHD studies and treatments.