bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic Monitoring Training Program Implementation in the Community Setting Was Associated with Improved Monitoring in Second-Generation Antipsychotic-Treated Children
Authors: Ronsley Rebecca , Rayter Mark , Smith Derryck , Davidson Jana , Panagiotopoulos Constadina
Published: July 2017

Objective:

To determine whether implementation of a metabolic monitoring training program (MMTP) in an urban community-based setting improved monitoring in children treated with second-generation antipsychotics (SGAs) and changed prescription rates of SGAs to children.

Method:

The MMTP was implemented in the Vancouver Coastal Health Child and Youth Mental Health Teams (CYMHTs) on January 1, 2009. A retrospective review of paper charts and electronic records for children seen at the CYMHTs from September 1, 2007, to May 1, 2010, was performed to collect the following data: age, sex, foster care, immigrant status, Axis I diagnosis, and medications. In SGA-treated children, anthropometric measurements and blood work completed at baseline and 3, 6, and 12 months were also collected.

Results:

Among the 1114 children seen pre-MMTP and 1262 children seen post-MMTP implementation, 174 (15.4%) and 81 (6.4%), respectively, were SGA-treated ( P < 0.001). Among the SGA-treated children seen at the CYMHTs after MMTP implementation, 38.3% had a copy of the MMTP in their paper chart. Metabolic monitoring increased by up to 40% at baseline ( P < 0.01), 20% at 3 ( P < 0.01) and 6 months ( P < 0.01), and 18% at 12 months after MMTP implementation.

Conclusions:

Implementation of an MMTP was associated with significantly improved monitoring rates of anthropometric and blood work parameters at baseline and the 3- and 6-month time points, with a trend for improvement at the 12-month time point, in SGA-treated children cared for in urban community mental health clinics. In addition, a 56% decrease in SGA prescriptions was observed following MMTP implementation in this population.
Molecular Genetics of the Psychosis Phenotype
Authors: DeRosse Pamela , Malhotra Anil K , Lencz Todd
Published: July 2017

Objective:

Relative to recent successes in elucidating the genetic mechanisms associated with complex diseases, including macular degeneration, diabetes mellitus, type 2, heart disease, and cancer, molecular genetic approaches to psychiatric illness have met with more limited success. While factors such as small allelic effects, allelic heterogeneity, and variation in population substructure have received considerable attention in attempt to explain the paucity of significant results in psychiatric genetics, significantly less focus has been directed toward phenotypic factors.

Method:

Data derived from molecular genetic studies of the psychosis phenotype in patients with a range of psychiatric illnesses are reviewed.

Results:

Available data suggest that genes do not respect the boundaries of the current diagnostic system but may confer risk for symptom-based phenotypic variation that traverses those boundaries.

Conclusions:

Molecular genetic studies offer convincing evidence for a relation between genetic variation and symptom-based phenotypic variation within psychiatric illness. These data may provide novel insights into the pathophysiology of schizophrenia and other related disorders. The exploration of relations between genetic variation and symptom variation that traverses traditional diagnostic boundaries may ultimately lead to more refined classification systems that more closely reflect the genetic etiology of psychiatric illness.
Pharmacotherapy of Alcohol Use Disorders and Concurrent Psychiatric Disorders: A Review
Authors: Lev-Ran Shaul , Balchand Kam , Lefebvre Lisa , Araki Keyghobad Farid , Le Foll Bernard
Published: July 2017

Alcohol use disorders (AUDs) are among the most prevalent psychiatric disorders. Epidemiologic studies have shown a high prevalence of concurrent psychiatric disorders among people with AUDs as well as a higher prevalence of AUDs in people with psychiatric disorders than in the general population. Though psychiatric patients with concurrent AUDs are at increased risk for morbidity and mortality, they are commonly undertreated for their alcohol-related disorders. The efficacy of pharmacotherapy for AUDs is well documented. Our paper reviews the common pharmacotherapies available for AUDs and focuses on the available research regarding treatment of AUDs among psychiatric populations with mood, anxiety, and psychotic disorders. Despite the high prevalence of concurrent AUDs and psychiatric disorders, very limited information has been collected using a randomized controlled trial design targeting those concurrent conditions. Several prevalent psychiatric disorders have not been studied when co-occurring with AUDs. Further research of pharmacological treatments for concurrent AUDs and psychiatric diagnoses is urgently needed.
Quality of Resident Violence Risk Assessments in Psychiatric Emergency Settings
Authors: Wong Leslie , Morgan Andrew , Wilkie Treena , Barbaree Howard
Published: July 2017

Objective:

To identify how psychiatric residents perceive their ability to conduct violence risk assessments and the risk factors they considered relevant in an emergency department setting.

Method:

We surveyed 55 of 159 psychiatric residents at the University of Toronto as to their experience and education in assessing suicide and violence risk. The residents, and a comparison group of 11 of 16 staff psychiatrists in the Law and Mental Health program at the Centre for Addiction and Mental Health, then participated in a mock interview with one of the authors. The subjects were directed to ask for all risk factors that would be relevant in determining the violence risk of a hypothetical patient with homicidal ideation. The risk factors they requested were compared with the risk factors found in the Historical, Clinical and Risk Management-20 (HCR-20) structured clinical judgment tool.

Results:

Psychiatric residents, on average, inquired about 6 fewer HCR-20 risk factors than staff psychiatrists (8.5, compared with 14.7). The number of HCR-20 items identified by residents correlated with several items; more risk factors were elicited by residents in a higher year of training, those who had received more formal and informal education, the number of patients for whom they had discharged a duty to warn, and the number of suicidal and violent patients they had previously assessed. Confidence at assessing violence risk was not correlated with performance.

Conclusions:

Psychiatric residents identify significantly fewer risk factors for violence than staff psychiatrists. Resident performance was correlated with increasing experience and education. It was not related to self-confidence in performing this task.
Acupuncture for Depression: A Review of Clinical Applications
Authors: Wu Junmei , Yeung Albert S , Schnyer Rosa , Wang Yunfei , Mischoulon David
Published: July 2017

While increasing numbers of patients are seeking acupuncture treatment for depression in recent years, there is limited evidence of the antidepressant (AD) effectiveness of acupuncture. Given the unsatisfactory response rates of many Food and Drug Administration- approved ADs, research on acupuncture remains of potential value. Therefore, we sought to review the efficacy and safety of acupuncture treatment for depression in clinical applications. We conducted a PubMed search for publications through 2011. We assessed the adequacy of each report and abstracted information on reported effectiveness or efficacy of acupuncture as monotherapy for major depressive disorder (MDD) and as augmentation of ADs. We also examined adverse events associated with acupuncture, and evidence for acupuncture as a means of reducing side effects of ADs. Published data suggest that acupuncture, including manual-, electrical-, and laser-based, is a generally beneficial, well-tolerated, and safe monotherapy for depression. However, acupuncture augmentation in AD partial responders and nonresponders is not as well studied as monotherapy; and available studies have only investigated MDD, but not other depressive spectrum disorders. Manual acupuncture reduced side effects of ADs in MDD. We found no data on depressive recurrence rates after recovery with acupuncture treatment. Acupuncture is a potential effective monotherapy for depression, and a safe, well-tolerated augmentation in AD partial responders and nonresponders. However, the body of evidence based on well-designed studies is limited, and further investigation is called for.
Pathways to Forensic Mental Health Care in Toronto: A Comparison of European, African-Caribbean, and other Ethnoracial Groups in Toronto
Authors: Flora Nina , Barbaree Howard , Simpson Alexander I F , Noh Samuel , McKenzie Kwame
Published: July 2017

Objective:

To describe pathways taken to care by a sample of patients in a secure forensic unit who have been found not criminally responsible or unfit to stand trial, and to investigate the pathways taken by patients within 3 ethnoracial subgroups of origin: European, African or Caribbean, and Other.

Method:

Fifty patients from secure forensic units were interviewed using the Encounter Form developed for pathways mapping undertaken in the World Health Organization field trials. Differences in the types of caregivers seen, the total number of caregivers seen, and the time taken to reach forensic psychiatric services were compared across the 3 ethnoracial groupings.

Results:

Most people committed their index offence after they had already had contact with general mental health services. Few significant differences were observed in the pathways to secure forensic units across the European, African-Caribbean, and Other ethnoracial groups.

Conclusions:

These findings suggest that improvements in general mental health services may be a key to decreasing the use of forensic psychiatric services. Further research is required to explore factors that may predict and prevent offending. Larger studies are needed to examine ethnoracial differences in pathways to care.
On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change
Authors: Corrigan Patrick W , Rao Deepa
Published: July 2017

People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stigma, programs led by peers as well as those led by social service providers.
Evidence-Based Review of Clinical Outcomes of Guideline-Recommended Pharmacotherapies for Generalized Anxiety Disorder
Authors: Bereza Basil G , Machado Márcio , Ravindran Arun V , Einarson Thomas R
Published: July 2017

Objective:

To quantify the rates of clinical outcomes of Canadian Psychiatric Association (CPA) guideline-recommended pharmacotherapies for generalized anxiety disorder (GAD) by drug classification within each treatment line.

Methods:

Evidence from original research cited by the CPA was included. Pooled analyses, duplicates, and studies with nonextractable data were excluded. Response, remission, and baseline-endpoint or mean reductions scores of the Hamilton Anxiety Rating Scale (HARS) were extracted. The Cochrane Collaboration's computer program, Review Manager, version 5, with a random effects model, was used to pool results.

Results:

A total of 50 articles were cited as evidence for managing GAD by the CPA. There was sufficient evidence of remission with first- or third-line agents to pool reported rates, and with agents from all 3 treatment lines to pool response rates and reduction in HARS scores. The mean range of effect size varied considerably from study to study within each treatment line. Comparison of pooled remission rates between first- and second-line agents was not possible. While the range of values by drug and drug class overlapped, the summary results for the probability of response and reduction in HARS scores was greater for first-line, compared with second-line, treatments. Drug components for third-line treatments were heterogeneous and produced mixed results.

Conclusion:

Despite the abundance of evidence in its totality presented in the CPA guidelines, there is inadequate evidence to formulate recommendations based on the pooled results from this study alone. However, such analysis provides an additional resource for clinicians to make more effective treatment decisions for individual patients with GAD.
The Essential and Potentially Inappropriate Use of Antipsychotics across Income Groups: An Analysis of Linked Administrative Data
Authors: Puyat Joseph H , Law Michael R , Wong Sabrina T , Sutherland Jason M , Morgan Steven G
Published: July 2017

Objective:

To examine the essential and potentially inappropriate use of antipsychotics across income groups.

Method:

Linked health, pharmaceutical use, and income data from British Columbia were analyzed to examine antipsychotic use in 2 study cohorts. In the first cohort, the essential use of antipsychotics was assessed among adults who had a recorded diagnosis of schizophrenia in a 2-year period, 2004–2005. In the second cohort, potentially inappropriate use of antipsychotics was examined in people with no recorded diagnosis of schizophrenia or bipolar disorders in 2004–2005. The second cohort was also composed exclusively of seniors with a dementia-related diagnosis who are either in long-term care or living in the community. Income-related differences in antipsychotic use in these 2 cohorts were assessed using logistic regression, controlling for health and sociodemographic characteristics known to influence medicine use.

Results:

Among adults, the prevalence of essential antipsychotic use was high (85%), with higher odds of use evident among those in the middle-income group. Among seniors, the prevalence of potentially inappropriate antipsychotic treatment is 23%, with prevalence higher in long-term care (56%) than in the community (13%). No income-related differences were found in long-term care; however, in the community, higher odds of use were found in low-income seniors.

Conclusion:

People from low-income households have slightly lower levels of essential antipsychotic use and are more likely to receive potentially inappropriate antipsychotic treatment.
Examining the Association between Psychiatric Illness and Suicidal Ideation in a Sample of Treatment-Seeking Canadian Peacekeeping and Combat Veterans with Posttraumatic Stress Disorder
Authors: Richardson J Don , St Cyr Kate CM , McIntyre-Smith Alexandra M , Haslam David , Elhai Jon D , Sareen Jitender
Published: July 2017

Objective:

Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation.

Methods:

Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic ( n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist—Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation.

Results:

Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% ( n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (β = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (β = 0.043, P = 0.58).

Conclusions:

Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD.
Forty-Five-Year Mortality Rate as a Function of the Number and Type of Psychiatric Diagnoses Found in a Large Danish Birth Cohort
Authors: Madarasz Wendy , Manzardo Ann , Mortensen Erik Lykke , Penick Elizabeth , Knop Joachim , Sorensen Holger , Becker Ulrik , Nickel Elizabeth , Gabrielli William
Published: July 2017

Objective:

Psychiatric comorbidities are common among psychiatric patients and typically associated with poorer clinical prognoses. Subjects of a large Danish birth cohort were used to study the relation between mortality and co-occurring psychiatric diagnoses.

Method:

We searched the Danish Central Psychiatric Research Registry for 8109 birth cohort members aged 45 years. Lifetime psychiatric diagnoses (International Classification of Diseases, Revision 10, group F codes, Mental and Behavioural Disorders, and one Z code) for identified subjects were organized into 14 mutually exclusive diagnostic categories. Mortality rates were examined as a function of number and type of co-occurring diagnoses.

Results:

Psychiatric outcomes for 1247 subjects were associated with 157 deaths. Early mortality risk in psychiatric patients correlated with the number of diagnostic categories (Wald ×2 = 25.0, dl = 1, P < 0.001). This global relation was true for anxiety and personality disorders, but not for schizophrenia and substance abuse, which had intrinsically high mortality rates with no comorbidities.

Conclusions:

Risk of early mortality among psychiatric patients appears to be a function of both the number and the type of psychiatric diagnoses.
Neurocognitive Vulnerability: Suicidal and Homicidal Behaviours in Patients with Schizophrenia
Authors: Richard-Devantoy Stéphane , Orsat Manuel , Dumais Alexandre , Turecki Gustavo , Jollant Fabrice
Published: July 2017

Objective:

Schizophrenia is associated with an increase in the risk of both homicide and suicide. The objectives of this study were to systematically review all published articles that examined the relation between neurocognitive deficits and suicidal or homicidal behaviours in schizophrenia, and to identify vulnerabilities in suicidal and homicidal behaviour that may share a common pathway in schizophrenia.

Methods:

A systematic review of the literature was performed using MEDLINE to include all studies published up to August 31, 2012.

Results:

Among the 1760 studies, 7 neuropsychological and 12 brain imaging studies met the selection criteria and were included in the final analysis. The neuropsychological and functional neuroimaging studies were inconclusive. The structural imaging studies reported various alterations in patients with schizophrenia and a history of homicidal behaviour, including: reduced inferior frontal and temporal cortices, increased mediodorsal white matter, and increased amygdala volumes. Patients with a history of suicidal acts showed volumetric reductions in left orbitofrontal and superior temporal cortices, while right amygdala volume was increased, though, these findings have rarely been replicated. Finally, no study has directly compared neurocognitive markers of suicidal and homicidal risk.

Conclusion:

These results suggest that brain alterations, in addition to those associated with schizophrenia, may predispose some patients to a higher risk of homicide or suicide in particular circumstances. Moreover, some of these alterations may be shared between homicidal and suicidal patients. However, owing to several limitations, including the small number of available studies, no firm conclusions can be drawn and further investigations are necessary.
Characterizing Suicide in Toronto: An Observational Study and Cluster Analysis
Authors: Sinyor Mark , Schaffer Ayal , Streiner David L
Published: July 2017

Objective:

To determine whether people who have died from suicide in a large epidemiologic sample form clusters based on demographic, clinical, and psychosocial factors.

Method:

We conducted a coroner's chart review for 2886 people who died in Toronto, Ontario, from 1998 to 2010, and whose death was ruled as suicide by the Office of the Chief Coroner of Ontario. A cluster analysis using known suicide risk factors was performed to determine whether suicide deaths separate into distinct groups. Clusters were compared according to person- and suicide-specific factors.

Results:

Five clusters emerged. Cluster 1 had the highest proportion of females and nonviolent methods, and all had depression and a past suicide attempt. Cluster 2 had the highest proportion of people with a recent stressor and violent suicide methods, and all were married. Cluster 3 had mostly males between the ages of 20 and 64, and all had either experienced recent stressors, suffered from mental illness, or had a history of substance abuse. Cluster 4 had the youngest people and the highest proportion of deaths by jumping from height, few were married, and nearly one-half had bipolar disorder or schizophrenia. Cluster 5 had all unmarried people with no prior suicide attempts, and were the least likely to have an identified mental illness and most likely to leave a suicide note.

Conclusions:

People who die from suicide assort into different patterns of demographic, clinical, and death-specific characteristics. Identifying and studying subgroups of suicides may advance our understanding of the heterogeneous nature of suicide and help to inform development of more targeted suicide prevention strategies.
Do Patients Really Prefer Individual Outpatient Follow-up Visits, Compared with Group Medical Visits?
Authors: Remick Ronald A , Remick Abigail K
Published: July 2017

Objective:

Access to outpatient psychiatric care remains problematic in Canada. We have been using group medical visits (GMV) to treat psychiatric outpatients with mood and anxiety disorders. Our study aimed to show that patients are similarly satisfied with GMV and individual psychiatric treatment, hence the concern that patients truly prefer individual treatment may be unfounded.

Method:

Our study compared patient satisfaction in people who have had previous individual psychiatric care and are now receiving GMV to determine whether there is a treatment preference.

Results:

Questionnaire data were analyzed using repeated measures ANOVA. The ANOVAs showed no differences in patients' experiences with individual treatment, compared with GMV. In addition, we found when asked directly, most patients preferred GMV or had no treatment preference.

Conclusions:

These findings indicate that patients' perspectives of individual psychiatric treatment and GMV are roughly equal. This suggests that the method of GMV deserves further study and comparison with other clinical models of psychiatric outpatient treatment.
From Pharmacogenetics to Pharmacogenomics: The Way toward the Personalization of Antidepressant Treatment
Authors: Fabbri Chiara , Porcelli Stefano , Serretti Alessandro
Published: July 2017

Objective:

Major depressive disorder is the most common psychiatric disorder, worldwide, yet response and remission rates are still unsatisfactory. The identification of genetic predictors of antidepressant (AD) response could provide a promising opportunity to improve current AD efficacy through the personalization of treatment. The major steps and findings along this path are reviewed together with their clinical implications and limitations.

Method:

We systematically reviewed the literature through MEDLINE and Embase database searches, using any word combination of “antidepressant,” “gene,” “polymorphism,” “pharmacogenetics,” “genome-wide association study,” “GWAS,” “response,” and “adverse drug reactions.” Experimental works and reviews published until March 2012 were collected and compared.

Results:

Numerous genes pertaining to several functional systems were associated with AD response. The more robust findings were found for the following genes: solute carrier family 6 (neurotransmitter transporter), member 4; serotonin receptor 1A and 2A; brain-derived neurotrophic factor; and catechol- O-methyltransferase. Genome-wide association studies (GWASs) provided many top markers, even if none of them reached genome-wide significance.

Conclusions:

AD pharmacogenetics have not produced any knowledge applicable to routine clinical practice yet, as results were mainly inconsistent across studies. Despite this, the rising awareness about methodological deficits of past studies could allow for the identication of more suitable strategies, such as the integration of the GWAS approach with the candidate gene approach, and innovative methodologies, such as pathway analysis and study of depressive endophenotypes.
Physical Child Abuse Potential in Adolescent Girls: Associations with Psychopathology, Maltreatment, and Attitudes toward Child-Bearing
Authors: Pajer Kathleen A , Gardner William , Lourie Andrea , Chang Chien-Ni , Wang Wei , Currie Lisa
Published: July 2017

Objective:

Adolescent mothers are at increased risk of mistreating their children. Intervening before they become pregnant would be an ideal primary prevention strategy. Our goal was to determine whether psychopathology, exposure to maltreatment, preparedness for child-bearing, substance use disorders (SUDs), IQ, race, and socioeconomic status were associated with the potential for child abuse in nonpregnant adolescent girls.

Method:

The Child Abuse Potential Inventory (CAPI) was administered to 195 nonpregnant girls (aged 15 to 16 years; 54% African American) recruited from the community. Psychiatric diagnoses from a structured interview were used to form 4 groups: conduct disorder (CD), internalizing disorders (INTs; that is, depressive disorder, anxiety disorder, or both), CD + INTs, or no disorder. Exposure to maltreatment was assessed with the Childhood Trauma Questionnaire, and the Childbearing Attitudes Questionnaire measured maternal readiness.

Results:

CAPI scores were positively correlated with all types of psychopathology, previous exposure to maltreatment, and negative attitudes toward child-bearing. IQ, SUDs, and demographic factors were not associated. Factors associated with child abuse potential interacted in complex ways, but the abuse potential of CD girls was high, regardless of other potentially protective factors.

Conclusions:

Our study demonstrates that adolescent girls who have CD or INT are at higher risk of perpetrating physical child abuse when they have children. However, the core features of CD may put this group at a particularly high risk, even in the context of possible protective factors. Treatment providers should consider pre-pregnant counselling about healthy mothering behaviours to girls with CD.
Methamphetamine Enhances the Development of Schizophrenia in First-Degree Relatives of Patients with Schizophrenia
Authors: Li Huabing , Lu Qiong , Xiao Enhua , Li Qiuyun , He Zhong , Mei Xilong
Published: July 2017

Objective:

Although there is some evidence that methamphetamine (MA) abuse may play a causative role in the development of schizophrenia, studies directly linking these 2 are rare.

Methods:

In our study, the effect of MA abuse on the development of schizophrenia was investigated in 15 MA abusers who are offspring of patients with schizophrenia and 15 siblings of MA abusers without a history of drug abuse. Cognitive deficits and resting-state brain function were evaluated in all participants. Correlations between cognitive deficits and schizophrenia development were investigated.

Results:

Significantly more cognitive impairments were observed in MA abusers, compared with their siblings without a history of drug use. Significant abnormalities in regional homogeneity (ReHo) signals were observed in resting brain in MA abusers. Decreased ReHo was found to be distributed over the bilateral cingulate gyrus, right Brodmann area 24, and bilateral anterior cingulate cortex. Seven MA abusers were diagnosed with schizophrenia, while 1 control sibling was diagnosed with schizophrenia during the 5-year follow-up. The cognitive scores correlated with the development of schizophrenia in MA abusers.

Conclusion:

Our study provides direct evidence for the causative role of MA use in the etiology of schizophrenia and highlights the role of MA-induced brain abnormalities in cognitive deficiency and development of schizophrenia.
Time Trends in Suicide-Related Behaviours in Girls and Boys
Authors: Rhodes Anne E , Bethell Jennifer , Carlisle Corine , Rosychuk Rhonda J , Lu Hong , Newton Amanda
Published: July 2017

Objective:

To examine the incidence and nature of emergency department (ED) presentations for nonfatal suicide-related behaviours (SRBs) over time, in boys and girls living in Ontario. We hypothesize declining rates (fiscal years [FYs] 2002/03 to 2006/07) ceased thereafter owing to renewed regulatory warnings against prescribing antidepressants and the economic recession.

Method:

We graphed and tested differences in ED SRB incidence rates for FYs 2002/03 to 2010/11. We estimated rate ratios and 95% confidence intervals using negative binomial regression controlling for changes in the underlying population (age, community size, and neighbourhood income quintile). We examined the nature of the incident (index) presentations over time in terms of the method(s) used and events occurring before and after the index event.

Results:

ED SRB incidence rates decreased by 30% in boys and girls from FYs 2002/03 to 2006/07, but not thereafter. This trend was most evident in girls who self-poisoned and in girls' presentations to hospital with mental illness in the preceding year. Within a year of the index event, the proportion of girls with a repeat ED SRB presentation also declined by about one-third, but beyond FYs 2005/06 to 2009/10. However, the proportion admitted subsequent to the index event increased by about one-third. In boys, their patterns of presentations to hospital with mental illness and SRB repetition over time were similar to girls, but estimated with greater variability.

Conclusions:

While the decline in ED SRB rates to FY 2006/07 is encouraging, the lack of decline thereafter and an increase in subsequent admissions merits ongoing monitoring and evaluation.
Predictors of Alcohol and Drug Dependence
Authors: Fleury Marie-Josée , Grenier Guy , Bamvita Jean-Marie , Perreault Michel , Caron Jean
Published: July 2017

Objective:

Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances from the general population; and to determine predictors of substance dependence over a 2-year period. Variables that differentiate people dependent on substances according to sex and age were also assessed.

Methods:

Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only. Using a comprehensive framework, various aspects were considered as predictors for multivariate statistics.

Results:

Participants with substance dependence at time 2 only showed worse clinical conditions, life events, life and health perception, and neighbourhood characteristics than other participants, but only 2.5% used health care services. Male sex, younger age, stigmatization, and impulsiveness were predictors of substance dependence. Regarding sex, females with dependence were only more likely to suffer from social phobia than males. In terms of age categories, participants over 50 with substance dependence were more likely to have a lower household income and less social support than younger people.

Conclusion:

Stigmatization was the strongest predictor of substance dependence. Our study also confirmed that males and younger people were more likely to have substance dependence. Anti-stigmatization, prevention, and outreach programs are needed to overcome the reluctance of this clientele to use health care services. Health professionals should also pay more attention to life and health perception and neighbourhood characteristics of newly identified drug users.
Psychiatric Disorders in Outpatients with Borderline Intellectual Functioning: Comparison with Both Outpatients from Regular Mental Health Care and Outpatients with Mild Intellectual Disabilities
Authors: Wieland Jannelien , Haan Sara Kapitein-De , Zitman Frans G
Published: July 2017

Objective:

In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs).

Method:

Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152).

Results:

Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common.

Conclusion:

Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.
A Survey of Mental Health Services at Post-Secondary Institutions in Alberta
Authors: Heck Emma , Jaworska Natalia , DeSomma Elisea , Dhoopar Arjun Sunny , MacMaster Frank P , Dewey Deborah , MacQueen Glenda
Published: July 2017

Objectives:

The relatively high prevalence of mental health problems among students at post-secondary institutions in Canada is well documented; in contrast, less is known about the adequacy of mental health services available to Canadian post-secondary students on campuses. Our study sought to examine the current state of campus mental health initiatives and services in Alberta as well as the extent to which resources identified in mental health literature as being key in mental health problem prevention and promotion appear to be available.

Methods:

A 60-question, online survey was sent to staff (primarily front-line workers; n = 45) at Alberta's 26 publicly funded post-secondary institutions. Responses were organized according to small (less than 2000 students), medium (2000 to 10 000 students), and large (10 000 or more students) institutions.

Results:

All of Alberta's post-secondary institutions were represented in the responses. Mental health initiatives and services are available, to varying extent, at all of Alberta's post-secondary institutions. However, many institutions do not have initiatives and (or) services aimed at identifying students with mental health problems or policies for monitoring their mental health services. Additionally, smaller institutions are less likely to offer certain services (for example, gatekeeper training and campus medical services), compared with larger ones. Finally, a systematic review or an evaluation of services appears to be infrequently conducted.

Conclusions:

These findings highlight the need for post-secondary institutions in Alberta, and by extension in Canada, to develop and institute a comprehensive strategy to evaluate and optimize the delivery of mental health initiatives and services.
The Incidence and Prediction of Self-Injury among Sentenced Prisoners
Authors: Martin Michael S , Dorken Shannon K , Colman Ian , McKenzie Kwame , Simpson Alexander I F
Published: July 2017

Objective:

Prevention of self-injurious behaviour is an important priority in correctional settings given higher rates among inmates. Our study estimated the reported incidence of self-injury during the first 180 days in prison and tested potential risk and protective factors using official prison records.

Methods:

We conducted a retrospective cohort study using secondary data for 5154 admissions to the Correctional Service of Canada during 2011. Relative risks were estimated with Poisson regression. Recursive partitioning was used to create a parsimonious model of characteristics of offenders who engage in self-injury.

Results:

Thirty-six of 5154 (0.7%) offenders engaged in 1 or more incidents of self-injury during their first 180 days of incarceration. Educational and occupational achievement, family history, demographic factors, mental health service use, and results of mental health screening at intake were predictive of self-injury. Recursive partitioning models identified about 23% of inmates who presented with multiple risk factors, and had increased incidence of self-injury. A comparison of a model using information at intake to a model also incorporating events in prison suggested that events in prison added little to the detection of self-injury.

Conclusions:

Given high rates of most risk factors, screening for self-injury during early incarceration will be overinclusive. However, it may identify a group of inmates with complex needs for whom interdisciplinary responses are needed to address wide-ranging social, family, behavioural, and mental health deficits.
Validation of the French Version of the Yale Food Addiction Scale: An Examination of its Factor Structure, Reliability, and Construct Validity in a Nonclinical Sample
Authors: Brunault Paul , Ballon Nicolas , Gaillard Philippe , Réveillère Christian , Courtois Robert
Published: July 2017

Objective:

The concept of food addiction has recently been proposed by applying the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for substance dependence to eating behaviour. Food addiction has received increased attention given that it may play a role in binge eating, eating disorders, and the recent increase in obesity prevalence. Currently, there is no psychometrically sound tool for assessing food addiction in French. Our study aimed to test the psychometric properties of a French version of the Yale Food Addiction Scale (YFAS) by establishing its factor structure and construct validity in a nonclinical population.

Method:

A total of 553 participants were assessed for food addiction (French version of the YFAS) and binge eating behaviour (Bulimic Investigatory Test Edinburgh and Binge Eating Scale). We tested the scale's factor structure (factor analysis for dichotomous data based on tetrachoric correlation coefficients), internal consistency, and construct validity with measures of binge eating.

Results:

Our results supported a 1-factor structure, which accounted for 54.1% of the variance. This tool had adequate reliability and high construct validity with measures of binge eating in this population, both in its diagnosis and symptom count version. A 2-factor structure explained an additional 9.1% of the variance, and could differentiate between patients with high, compared with low, levels of insight regarding addiction symptoms.

Conclusions:

In our study, we validated a psychometrically sound French version of the YFAS, both in its symptom count and diagnostic version. Future studies should validate this tool in clinical samples.
The Expanding Cognitive-Behavioural Therapy Treatment Umbrella for the Anxiety Disorders: Disorder-Specific and Transdiagnostic Approaches
Authors: Rector Neil A , Man Vincent , Lerman Bethany
Published: July 2017

Cognitive-behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders. CBT treatments are based on disorder-specific protocols that have been developed to target individual anxiety disorders, despite that anxiety disorders frequently co-occur and are comorbid with depression. Given the high rates of diagnostic comorbidity, substantial overlap in dimensional symptom ratings, and extensive evidence that the mood and anxiety disorders share a common set of psychological and biological vulnerabilities, transdiagnostic CBT protocols have recently been developed to treat the commonalities among the mood and anxiety disorders. We conducted a selective review of empirical developments in the transdiagnostic CBT treatment of anxiety and depression (2008–2013). Preliminary evidence suggests that theoretically based transdiagnostic CBT approaches lead to large treatment effects on the primary anxiety disorder, considerable reduction of diagnostic comorbidity, and some preliminary effects regarding the impact on the putative, shared psychological mechanisms. However, the empirical literature remains tentative owing to relatively small samples, limited direct comparisons with disorder-specific CBT protocols, and the relative absence of the study of disorder-specific compared with shared mechanisms of action in treatment. We conclude with a treatment conceptualization of the new transdiagnostic interventions as complementary, rather than contradictory, to disorder-specific CBT.
Cost-Effectiveness of a Rapid Response Team Intervention for Suicidal Youth Presenting at an Emergency Department
Authors: Latimer Eric A , Gariépy Geneviève , Greenfield Brian
Published: July 2017

Objective:

To investigate the cost-effectiveness of a rapid response team (RRT), compared with usual care (UC), for treating suicidal adolescents.

Methods:

Suicidal adolescents ( n = 286) presenting at an emergency department were enrolled in a trial to compare UC with enhanced outpatient care provided by an RRT of health professionals. Functioning (Child Global Assessment Scale) and suicidality (Spectrum of Suicidal Behavior Scale) scores were measured at baseline and 6 months later. Resource use and cost data were collected from several sources during the same period.

Results:

As previously reported, there was no statistically or clinically significant difference in either functioning or suicidality between the groups. Costs of the RRT were lower by $1886, thus –$1886 (95% CI –$4238 to $466), from the perspective of the treating hospital, and by $991, thus –$991 (95% CI –$5580 to $3598), from the perspective of society. If decision makers are not willing to pay for any improvement in functioning or suicidality, the RRT has a 95% probability of being cost-effective from the perspective of the treating hospital. From the point of view of society, the probability of the intervention being cost-effective is about 70% for functioning and 63% for suicidality. The difference between the 2 perspectives is mainly attributable to the cost of hospitalizations outside the treating hospital.

Conclusions:

An RRT intervention appears to be cost-effective, compared with UC, from the point of view of the treating hospital, but there is no difference from the point of view of society.
The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS)
Authors: Rej Soham , Segal Marilyn , Low Nancy C P , Mucsi Istvan , Holcroft Christina , Shulman Kenneth , Looper Karl
Published: July 2017

Objective:

Despite being a common and potentially serious condition, nephrogenic diabetes insipidus (NDI) remains poorly understood in older lithium users. Our main objective was to compare the prevalence of NDI symptoms and decreased urine osmolality ([UOsm] < 300 milli-Osmoles [mOsm/kg]) among geriatric and adult lithium users. We also assessed NDI symptoms, serum sodium (Na+), and urine specific gravity (USG) as possible surrogate measures of decreased UOsm, and ascertained whether potential etiologic factors independently correlated with decreased UOsm.

Method:

This was a cross-sectional study of 100 consecutive outpatients treated with lithium from 6 tertiary care clinics, of which 45 were geriatric (aged 65 years and older) and 55 adult (aged 18 to 64 years). Patients completed a symptom questionnaire and underwent laboratory tests, including UOsm, serum Na+, and USG.

Results:

Geriatric and adult lithium users had similar rates of decreased UOsm (12.5%, compared with 17.9%, P = 0.74), but geriatric patients reported less symptoms ( P < 0.05). Although UOsm did not correlate with symptoms or current serum Na+, USG of less than 1.010 was suggestive of UOsm of less than 300 mOsm/kg. Age, lithium duration, and serum lithium level were independently associated with UOsm.

Conclusions:

The prevalence of decreased UOsm is similar in geriatric and adult lithium users, but older patients are less likely to report urinary and thirst symptoms. Although subjective symptoms do not correlate with UOsm, USG may be a cost-efficient clinical surrogate measure for UOsm. We suggest clinicians increase their vigilance for decreased UOsm, especially in lithium users with advanced age, longer duration of lithium exposure, and higher lithium levels. This may potentially prevent lithium intoxication, falls, hypernatremic events, and renal dysfunction.
Treatment-Resistant Depression in Primary Care across Canada
Authors: Rizvi Sakina J , Grima Etienne , Tan Mary , Rotzinger Susan , Lin Peter , McIntyre Roger S , Kennedy Sidney H
Published: July 2017

Objective:

Treatment-resistant depression (TRD) represents a considerable global health concern. The goal of the InSight study was to investigate the prevalence of TRD and to evaluate its clinical characterization and management, compared with nonresistant depression, in primary care centres.

Methods:

Physicians completed a case report on a consecutive series of patients with major depressive disorder ( n = 1212), which captured patient demographics and comorbidity, as well as current and past medication.

Results:

Using failure to respond to at least 2 antidepressants (ADs) from different classes as the definition of TRD, the overall prevalence was 21.7%. There were no differences in prevalence between men and women or among ethnicities. Patients with TRD had longer episode duration, were more likely to receive polypharmacy (for example, psychotropic, lipid-lowering, and antiinflammatory agents), and reported more AD related side effects. Higher rates of disability and comorbidity (axes I to III) were associated with treatment resistance. Obesity and being overweight were also associated with treatment resistance. While the selection and sequencing of pharmacotherapy by family physicians in this sample was in line with recommendations from evidence-based treatment guidelines, the wait time to make a change in treatment was 6 to 8 weeks in both groups, which exceeds guideline recommendations.

Conclusions:

These real-world data demonstrate the high prevalence of TRD in primary care settings, and underscore the substantial burden of illness associated with TRD.