bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of Antidepressant Use in Relation to Recent and Past Major Depressive Episodes
Authors: Patten Scott B , Wang Jian Li , Williams Jeanne VA , Lavorato Dina H , Beck Cynthia A , Bulloch Andrew GM
Published: January 2017

Objective:

There has been a trend toward increasing antidepressant (AD) use in recent decades. We used data from the National Population Health Survey (NPHS) to determine whether this trend is continuing and to provide updated estimates of the frequency of use.

Methods:

The NPHS is a longitudinal general health survey that began collecting data in 1994. The NPHS evaluates past-year major depressive episodes (MDEs) using a brief diagnostic instrument. At each biannual interview (from 1994 to 2006) current medication use is recorded. We estimated the frequency with which ADs were taken by respondents (aged 12 years and older) with and without past-yearMDEs. These frequencies were cross-tabulated by sex, year of interview, and the reported duration of symptoms.

Results:

ADs are taken by about 5.4% of the household population at any point in time. Most respondents taking ADs did not report past-year MDEs but 63.9% of respondents taking ADs in the absence of past-year episodes reported previous episodes or being diagnosed by a health professional with depression. This pattern is consistent with long-term treatment for relapse prevention. The overall frequency of use of ADs is increasing only in respondents without past-year episodes.

Conclusions:

AD use among community residents with past-year MDEs is no longer increasing. The continued increase in the overall frequency of use may point toward broadening indications for AD treatment and may indicate that people are taking these medications for longer periods of time.
Dual Diagnosis: A National Study of Psychiatric Hospitalization Patterns of People with Developmental Disability
Authors: Lunsky Yona , Balogh Rob
Published: January 2017

Objective:

To report national demographics and diagnostic profiles of people with developmental disability hospitalized for psychiatric reasons, and to contrast results to psychiatric hospitalizations among patients with no comorbid developmental disability.

Method:

People with developmental disability across Canada were identified using data administered by the Canadian Institute for Health Information. Among this cohort of people with developmental disability, records of hospitalization for psychiatric reasons were aggregated for the 2005/06 fiscal year (April 2005 to March 2006). Descriptive statistics on province of residence, age, sex, specific diagnoses, length of stay, and hospitalization frequency were calculated and compared with people without developmental disability.

Results:

In Canada, people with developmental disability were hospitalized a total of 8378 times in 2005/06; among these, 3478 (42%) were for psychiatric conditions. The number of people with developmental disability hospitalized for a psychiatric condition represents about 2% of the general population hospitalized for such conditions. Among people with developmental disability hospitalized for a psychiatric condition most were men and people aged between 15 and 34 years. For almost all psychiatric disorder categories, people with developmental disability were hospitalized at rates significantly different than their counterparts without developmental disability. Lengths of hospital stays for psychiatric conditions were very similar when comparing the study groups; however, people with developmental disability were more likely to have 2 or more hospitalizations during the year.

Conclusions:

People with developmental disability display unique hospitalization patterns, compared with the general population.
The Epidemiology of Excess Mortality in People with Mental Illness
Authors: Lawrence David , Kisely Stephen , Pais Joanne
Published: January 2017

Objective:

To investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time.

Method:

We conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review.

Results:

There is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing.

Conclusions:

Without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
Time Trends in Mortality Associated with Depression: Findings from the Stirling County Study
Authors: Murphy Jane M , Gilman Stephen E , Lesage Alain , Horton Nicholas J , Rasic Daniel , Trinh Nhi-Ha , Alamiri Bibi , Sobol Arthur M , Fava Mazio , Smoller Jordan W
Published: January 2017

Objective:

To address the question of whether a mortality risk associated with depression in a 1952 representative sample of Stirling County adults changed in a new sample in 1970, and whether there was a change in associations with cigarette smoking and alcoholism.

Method:

Sample members were interviewed about depression and cigarette smoking. General physicians were interviewed by psychiatrists regarding alcoholism. Information about death as of December 31, 1992, was provided by Statistics Canada. Proportional hazards models were fitted in the 2 samples to assess the mortality risks associated with depression among men and women during 20 years of follow-up, and additionally among men with heavy smoking and alcoholism. Specific causes of death were investigated.

Results:

Hazard ratios representing the association between depression and premature death among men were 2.6 (95% CI 1.4 to 4.9) and 2.8 (95% CI 1.5 to 5.1), respectively, in the 1952 and 1970 samples for the first 10 years of follow-up. Hazard ratios for women were 1.4 (95% CI 0.6 to 3.2) and 1.2 (95% CI 0.5 to 2.9). The risk associated with depression among men was independent of alcoholism and heavy smoking. Depression and alcoholism were significantly associated with death by external causes and circulatory disease; heavy smoking was significantly associated with malignant neoplasms.

Conclusion:

The mortality associated with depression did not change during the period from 1952 to 1970. Depressed men experienced a significant mortality risk that was not matched among depressed women and also was not due to alcoholism and heavy smoking.
Pharmacoepidemiology of Benzodiazepine and Sedative-Hypnotic Use in a Canadian General Population Cohort during 12 Years of Follow-up
Authors: Patten Scott B , Williams Jeanne VA , Lavorato Dina H , Kassam Aliya , Sabapathy C David
Published: January 2017

Objective:

Benzodiazepines (BDZs) and similar sedative-hypnotics (SSHs) can have both beneficial and adverse effects. Clinical practice guidelines indicate that the course of treatment should usually be brief (a few weeks), but patients often take these medications for longer periods of time. We hypothesized that treatment with antidepressants (ADs) would be associated with a shorter duration of SSHs use as mood and anxiety disorders may underlie the symptoms usually targeted by BDZ treatment.

Method:

Our study used data from a Canadian longitudinal general health study, the National Population Health Survey, which has collected data since 1994. Data are currently available to 2006. At each interview, all medications taken in the preceding 2 days are recorded. In our study, we used proportional hazard models to describe patterns of initiation and discontinuation of these medications in the general population.

Results:

At each interview, the frequency of BDZ-SSH use was 2% to 3%. About 1% of the population initiated use in each 2-year follow-up period. Contrary to expectation, taking ADs predicted initiation of BDZ-SSHs, but not discontinuation.

Conclusions:

Unexpectedly, respondents taking ADs had a higher frequency of new BDZ-SSH use. AD use may be a marker for depression severity or comorbidity, such that the observed results may be an artifact of confounding by these factors. Irrespective of etiology, initiation of AD treatment does not appear to negate the risk of long-term BDZ-SSH use.
Propriétés psychométriques de la version française de l'inventaire de sentiment de culpabilité
Authors: Kedia Gayannée , Berthoz Sylvie
Published: January 2017

Objectif:

Le sentiment de culpabilité est essentiel au bon fonctionnement interpersonnel mais peut également jouer un rôle dans les conduites autodestructrices. Bien qu'il existe une vingtaine d'échelles de culpabilité en anglais, aucune n'a été à ce jour validée en langue française. Cette étude pallie ce manque en proposant une version française de l'Inventaire de culpabilité (IC, « Guilt Inventory ») qui évalue le sentiment de culpabilité état et trait, ainsi que les standards moraux.

Méthode:

Sept cent trente-huit étudiants ont rempli l'IC français ainsi que des échelles évaluant l'anxiété trait et état, et les compétences empathiques. Dans un sous-groupe de cet échantillon, nous avons également évalué la dépression, la désirabilité sociale et les facteurs de personnalité.

Résultats:

L'analyse factorielle exploratoire, menée sur la moitié des participants, a conduit à conserver 18 des 20 items de l'IC trait, et 9 des 10 items de l'IC état, mais à écarter l'échelle des standards moraux. L'analyse factorielle confirmatoire, effectuée sur l'autre moitié de l'échantillon, a validé cette structure en deux facteurs. Les corrélations attendues entre les scores de culpabilité, d'affectivité négative et de fonctionnement interpersonnel ont été observées.

Conclusion:

Cette étude suggère que la version française de l'IC constitue une mesure satisfaisante du sentiment de culpabilité trait et état et pourrait s'avérer un instrument utile tant pour la recherche qu'à des fins cliniques.
Trends in Alcohol and Drug Use among Canadian Adolescents, 1990–2006
Authors: Elgar Frank J , Phillips Natalie , Hammond Nicole
Published: January 2017

Objective:

To report trends in rates of drunkenness, alcohol use, and drug use among Canadian adolescents.

Method:

Five national school-based surveys were carried out between 1990 and 2006 as part of the Canadian Health Behaviour in School-aged Children study ( n = 4504 to 7010). Students in Grades 6, 8, and 10 were surveyed about the frequency of their drunken episodes and consumption of beer, liquor, and wine. Grade 10 students were also surveyed about their use of drugs.

Results:

Rates of drunkenness and alcohol use declined slightly from 1990 to 2006, but about one-half of Grade 10 students in 2006 had used cannabis at least once in their lifetime (up from one-third in 1990). Lifetime prevalence rates of using other drug substances were below 10%.

Conclusions:

Timely information on alcohol and drug use among adolescents is important to health policy. Declining trends in alcohol misuse is encouraging; however, the proliferation of cannabis use indicates a need for continued surveillance and education about the risks associated with frequent cannabis use.
Antidepressant Combinations: Widely Used, but Far from Empirically Validated
Authors: Thase Michael E
Published: January 2017

This paper reviews the evidence on combining antidepressants (ADs) for treatment of major depressive disorder. Although widely used and usually safe, the efficacy of even the most widely prescribed combinations of ADs has not been established by properly controlled, adequately powered, clinical trials. This stands in contrast to several adjunctive strategies for AD nonresponders, including adjunctive lithium, thyroid hormone, or newer-generation antipsychotics. The wide use of AD combinations no doubt reflects the limited efficacy of commonly used ADs and the unmet need for effective strategies for patients with treatment-resistant depression. Although of unproven efficacy, potential merits of combining selected ADs include: 1) avoiding discontinuation-emergent symptoms and cross-titration schedules, 2) at worst, the second AD should be as effective in combination as it would be as a monotherapy following a switch, and 3) the possibility of complementary neuropharmacologic effects that may enhance efficacy or improve tolerability. The dearth of controlled studies of such a commonly used strategy for such a highly prevalent condition is symptomatic of shortcomings in the way clinically relevant research is funded, points to the need for industry–academic–federal collaborations, and underscores the need for large, practice-based, research groups that can efficiently complete publicly funded studies of high public health impact.
Pattern of Psychotropic Drug Use among Older Adults Having a Depression or an Anxiety Disorder: Results from the Longitudinal ESA Study
Authors: Préville Michel , Vasiliadis Helen-Maria , Bossé Cindy , Dionne Pierre-Alexandre , Voyer Philippe , Brassard Joëlle ,   Scientific Committee of the ESA Study
Published: January 2017

Objective:

To document the use of psychotropic drugs in Quebec older adult population with a depressive or anxiety disorder.

Method:

Data from the Enquête sur la Santé des Aînés (ESA) study conducted between 2005 and 2008 using a representative sample ( n = 1869) of community-dwelling adults aged 65 years and older were used to examine the use of psychotropic drugs in the Quebec older adult population.

Results:

Our results indicate that only 46.9% of the older adults with a diagnosis of depression or anxiety during the 24-month period studied according to the Régie de l'assurance maladie du Quebec (RAMQ) register used antidepressants (AD) for 400 days (12.9 months) on average during this period. Also, 59% of the RAMQ's mental health disorder patients used a mean daily dose of 5 mg of a diazepam equivalent for 338 days (10.9 months) on average during the same period. However, 10.0% of the older adults without any symptoms (ESA) at T1 and at T2 and any RAMQ depression and anxiety diagnosis between T0 and T2 were AD users during the 24-month period studied. They represent 26.2% of the AD users and consumed them for 494 days (15.9 months) on average during the 24-month period studied. Finally, the number of days of AD and benzodiazepine use was not associated with partial or total remission.

Conclusions:

This result questions the population effectiveness of these drugs in this population.
Mortality Associated with Benzodiazepines and Benzodiazepine-Related Drugs among Community-Dwelling Older People in Finland: A Population-Based Retrospective Cohort Study
Authors: Gisev Natasa , Hartikainen Sirpa , Chen Timothy F , Korhonen Mikko , Bell J Simon
Published: January 2017

Objective:

To investigate the association between the use of benzodiazepines (BDZs) and BDZ-related drugs and mortality among community-dwelling people aged 65 years and older in Finland.

Method:

This was a population-based retrospective cohort study. Records of all reimbursed drugs purchased by all 2224 residents of Leppävirta, Finland, aged 65 years and older in 2000 were extracted from the Finnish National Prescription Register. Diagnostic data were extracted from the Special Reimbursement Register. All-cause mortality was assessed after 9 years using national registers. Cox proportional hazards models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals for mortality among prevalent users of BDZs and BDZ-related drugs in 2000 ( n = 325), compared with nonusers of BDZs and BDZ-related drugs between 2000 and 2008 ( n = 1520).

Results:

BDZs and BDZ-related drugs were used by 325 out of the 2224 residents (14.6%) in 2000. The 9-year mortality was 50.2% among BDZ and BDZ-related drug users in 2000 and 36.3% among BDZ and BDZ-related drug nonusers between 2000 and 2008 (HR 1.53; 95% CI 1.28 to 1.82). After adjusting for baseline age, sex, antipsychotic drug use, and diagnostic confounders, the HR was 1.01 (95% CI 0.84 to 1.21).

Conclusions:

Use of BDZs and BDZ-related drugs was associated with an increased mortality hazard in unadjusted analyses. However, after adjusting for age, sex, antipsychotic drug use, and diagnostic confounders, the use of BDZs and BDZ-related drugs was not associated with excess mortality.
Parenting Behaviours Associated with the Development of Adaptive and Maladaptive Offspring Personality Traits
Authors: Johnson Jeffrey G , Liu Lydia , Cohen Patricia
Published: January 2017

Objectives:

To investigate the associations of beneficial parenting behaviours with adaptive and maladaptive offspring personality traits that persist into adulthood among individuals in the community.

Methods:

Families ( n = 669) participating in the Children in the Community Study were interviewed during the childhood, adolescence, emerging adulthood, and adulthood of the offspring at the mean ages of 6, 14, 16, 22, and 33 years.

Results:

Twelve types of beneficial maternal and paternal child-rearing behaviour, reported by offspring at the mean age of 16 years, were associated with elevated offspring personality resiliency, at the mean ages of 22 and 33 years, and with low offspring personality disorder trait levels. These longitudinal associations remained significant when histories of childhood behaviour problems and parental psychiatric disorder were controlled statistically. Similar linear (that is, dose-dependent) associations were observed between the number of beneficial parenting behaviours during childhood and adaptive and maladaptive offspring traits at the mean ages of 22 and 33 years. Maternal and paternal behaviours were independently associated with both adaptive and maladaptive offspring traits.

Conclusions:

Beneficial maternal and paternal child-rearing behaviours may promote the development of adaptive offspring personality traits that endure into adulthood, and they may be prospectively associated with reduced levels of maladaptive offspring traits. These associations may not be attributable to childhood behaviour problems or parental psychiatric disorders, and they may be equally evident during early and middle adulthood.
Association of Mental Health with Health Care Use and Cost: A Population Study
Authors: Cawthorpe David , Wilkes Thomas C R , Guyn Lindsay , Li Bing , Lu Mingshan
Published: January 2017

Objective:

To compare the health costs of groups with and without psychiatric diagnoses (PDs) using 9 years of physician billing data.

Methods:

A dataset containing registration data for all patients receiving public mental health service was constructed and subsequently matched, on age and sex, in a final patient to comparison patient ratio of 1:8, with health care users who did not receive treatment in the mental health system. Three groups emerged: a patient PD group—patients with psychiatric disorders treated in public mental health care ( n = 76 677); a comparison patient PD group—comparison patients with PDs treated in physicians only ( n = 277 627); and a patient–comparison patient non-PD group—patients (treated in specialized publicly funded care or by their physician) without PDs ( n = 329 177). Examining over 42 million billing records for all of these patients, we compared the average number of visits and the average health only (nonpsychiatric) billing cost per each patient during the 9-year study period across the groups.

Results:

Among all health care users in the data, the health costs (Total Costs – Mental Health Costs) were greater on average for the patients with PD group ($3437) and the comparison patient PD group ($3265), compared with patient–comparison patient non-PD group ($1345). Forty-six percent of the comparison sample had a PD.

Conclusions:

Having a mental health problem is related to greater health-related expenditures. This has important policy implications on how mental health resources are constructed and rationed within the health care system.
Nonmedical Prescription Opioid Use and Mental Health and Pain Comorbidities: A Narrative Review
Authors: Amari Erica , Rehm Jürgen , Goldner Elliot , Fischer Benedikt
Published: January 2017

Objective:

In North America, the prevalence of nonmedical prescription opioid use (NMPOU), and morbidity and mortality related to prescription opioid analgesics (POAs) has risen sharply. Epidemiologic studies have suggested a high prevalence of mental health and pain comorbidities in NMPOU samples. Given the potential importance for interventions, a narrative review was conducted on studies reporting data on the co-occurrence of NMPOU with mental health problems and pain symptoms in general, treatment, or special populations.

Method:

A search of MEDLINE, PubMed, PsycINFO, and Web of Science using defined search terms yielded 74 studies on NMPOU and mental health and (or) pain. Thirty-nine studies published between 1997 and 2009 were included in the review-based on the data they provided on NMPOU and mental health and pain comorbidities.

Results:

Our review found strong associations between NMPOU and the comorbidities of interest. Associations between NMPOU and mental health were strongest for depression (OR range 1.2 to 4.3) followed by anxiety disorders (OR range 1.2 to 3.0) in general and treatment populations. The prevalence of pain ranged from 14.5% to 61.5% in general, treatment, and street drug user samples reporting NMPOU.

Conclusions:

The extensive associations observed between NMPOU and mental health and pain comorbidities suggest that effective preventive or treatment interventions for NMPOU must consider and attend to these comorbidities. As POAs are widely available and used in North America, POAs may increasingly be used in nonmedical ways for pain or mental health problems not effectively diagnosed or treated.
Mortality Associated with Major Depression in a Canadian Community Cohort
Authors: Patten Scott B , Williams Jeanne VA , Lavorato Dina , Wang Jian Li , Khaled Salma , Bulloch Andrew GM
Published: January 2017

Objective:

Prior studies have reported that major depressive episodes (MDEs) are associated with elevated mortality. However, the association has not always persisted after adjustment for other mortality risk factors. In our study, we examine this issue using data from a longitudinal Canadian study (the National Population Health Survey [NPHS]). The NPHS included a more comprehensive set of mortality determinants than prior studies, allowing a more comprehensive assessment of the effect of MDEs on mortality.

Methods:

The NPHS began data collection in 1994 and follow-up data were available to 2006 at the time of this analysis. The NPHS assessed depression using a short-form version of the Composite International Diagnostic Interview. Mortality was assessed as part of the cohort's follow-up, including linkage to vital statistics data.

Results:

During follow-up, 2019 deaths occurred in the eligible part of the NPHS cohort. Consistent with prior studies, MDEs were strongly predictive of mortality when basic adjustments were made for age and sex (hazard ratio [HR] 2.0, 95% Cl 1.4 to 2.9). The association disappeared with adjustment for other variables that predict mortality risk (HR 1.1, 95% Cl 0.7 to 1.7).

Conclusions:

MDE is a strong predictor of mortality in the general population. This analysis failed to identify an independent effect of MDE when adjustments were made for other risk factors. However, the lack of a strong independent effect on mortality does not preclude an etiologic impact of MDE. MDE itself is intertwined with health-related changes that predict mortality and its impact may be mediated by these variables.
Trends in Primary Methamphetamine-Related Admissions to Youth Residential Substance Abuse Treatment Facilities in Canada, 2005–2006 and 2009–2010
Authors: Verdichevski Marina , Burns Robin , Cunningham James K , Tavares Joey , Callaghan Russell C
Published: January 2017

Objective:

During the last decade, methamphetamine use and issues surrounding its toxicity have triggered major concern in the Canadian government, leading to significant changes in drug policy and funding strategies to limit the societal impact of methamphetamine-related harms. This concern appears justified by research which found in 2005–2006 that 21 % of all youth admissions to inpatient substance abuse treatment centres in Canada were due primarily to methamphetamine abuse. Given these patterns of treatment use and targeted governmental initiatives, an open question is whether the demand for methamphetamine treatment found in 2005–2006 has decreased. Our study aims to provide follow-up estimates of admissions for 2009–2010, as well as important trend information for these periods.

Method:

We developed a comprehensive list of all Canadian residential youth substance abuse treatment facilities. The executive director of each facility was asked about the site's annual caseload, and the proportion of cases primarily due to methamphetamine abuse within the past 12 months.

Results:

Our survey data for the periods of 2005–2006 and 2009–2010 show marked reductions in admissions. In 2009–2010, we found that about 6% of all admissions were due primarily to methamphetamine abuse, a substantial drop from the 21% reported in our 2005–2006 study.

Conclusions:

Our data show a significant national reduction in methamphetamine-related admissions. Other reports show that methamphetamine-related treatment admissions in the United States and Mexico declined sharply during 2005–2008, reportedly in association with Mexico's methamphetamine precursor chemical controls, raising the possibility that the controls may also be associated with the declines reported here.
Autism Spectrum Disorders and Maternal Serum alpha-Fetoprotein Levels during Pregnancy
Authors: Abdallah Morsi W , Grove Jakob , Hougaard David M , Nørgaard-Pedersen Bent , Ibrahimov Fuad , Mortensen Erik L
Published: January 2017

Objective:

Numerous studies have been trying to disentangle the complex pathophysiology of autism spectrum disorders (ASD). In our study, we explored the potential role of maternal serum (MS) alpha-fetoprotein (AFP) in the prediction and the pathophysiology of ASD.

Methods:

A total of 112 patients with ASD and 243 control subjects were included in a case–control study, using a historic birth cohort maintained at Statens Serum Institute. Measurements of MS-AFP were obtained from a multicentre screening program, whereas clinical data were obtained from nationwide registers. Association between MS-AFP and ASD status was analyzed using logistic regression models and nonparametric tests.

Results:

Crude, but not adjusted, estimates showed that MS-AFP levels were slightly, but significantly, higher in mothers of children with ASD, compared with their control subject counterparts. People with ASD had an odds ratio of 2.33, with 95% confidence intervals of 1.00 to 5.39, to have MS-AFP above 2.5 multiple of median. Excluding subjects with congenital malformation comorbidities did not alter the direction of our estimates (OR 2.60; 95% Cl 1.04 to 6.51, P = 0.04).

Conclusion:

Biologic plausibility of its role in the pathophysiology of ASD makes AFP a good candidate for further larger-scale studies to confirm such an association and to determine whether this pattern is unique to ASD or related to other psychiatric disorders as well.
Enculturation and Alcohol Use Problems among Aboriginal University Students
Authors: Currie Cheryl L , Wild T Cameron , Schopflocher Donald P , Laing Lory , Veugelers Paul J , Parlee Brenda , McKennitt Daniel W
Published: January 2017

Objective:

To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada.

Methods:

Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students ( n = 60) in 2008/2009.

Results:

Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards.

Conclusions:

This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting.
Effectively Working on Rehabilitation Goals: 24-Month Outcome of a Randomized Controlled Trial of the Boston Psychiatric Rehabilitation Approach
Authors: Swildens Wilma , van Busschbach Jooske T , Michon Harry , Kroon Hans , Koeter Maarten W J , Wiersma Durk , van Os Jim
Published: January 2017

Objective:

To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands.

Method:

A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR ( n = 80) or CAU ( n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved.

Results:

The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures.

Conclusions:

The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life.
Perception of Teratogenic Risk and the Rated Likelihood of Pregnancy Termination: Association with Maternal Depression
Authors: Walfisch Asnat , Sermer Corey , Matok Ilan , Einarson Adrienne , Koren Gideon
Published: January 2017

Objective:

Women are often exposed to various medications and medical conditions during pregnancy. Unrealistically high maternal teratogenic risk perception, related to these exposures, may lead to abrupt discontinuation of therapy and (or) termination of a wanted pregnancy. The association between maternal depression and the teratogenic risk perception has not been studied, nor were the actions resulting from this perception. Our objectives were to explore the association between maternal depression, teratogenic risk perception, and the rated likelihood to terminate pregnancy. Additionally, we evaluated possible benefits of counselling.

Methods:

We administered the Edinburgh Postnatal Depression Scale (EPDS) to all women who attended the Motherisk Clinic between October 2007 and April 2010. A visual analogue scale was used to determine maternal risk perception in relation to the specific exposure, and the rated likelihood to terminate the pregnancy, before and after counselling.

Results:

We analyzed data from 413 women. Maternal teratogenic risk perception and the rated likelihood to terminate the pregnancy were significantly lower following counselling. An EPDS score of 13 or more was significantly associated with a higher rated likelihood to terminate the pregnancy ( P = 0.03). In a multivariable regression analysis, an EPDS score of 13 or more was found to be an independent predictor of a higher personal teratogenic risk perception ( P = 0.03).

Conclusions:

Both maternal depression and exposure-directed counselling are associated with maternal risk perception and the rated likelihood to terminate pregnancy. Appropriate counselling may reduce fear of teratogenicity and the likelihood of pregnancy termination.
Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy
Authors: Pringsheim Tamara , Doja Asif , Gorman Daniel , McKinlay Duncan , Day Lundy , Billinghurst Lori , Carroll Alan , Dion Yves , Luscombe Sandra , Steeves Thomas , Sandor Paul
Published: January 2017

This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.
Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation
Authors: Steeves Thomas , McKinlay B Duncan , Gorman Daniel , Billinghurst Lori , Day Lundy , Carroll Alan , Dion Yves , Doja Asif , Luscombe Sandra , Sandor Paul , Pringsheim Tamara
Published: January 2017

This clinical guideline provides recommendations for nonpharmacological treatments for tic disorders. We conducted a systematic literature search for clinical trials on the treatment of tics. One evidence-based review (including 30 studies) and 3 studies on behavioural interventions, 3 studies on deep brain stimulation (DBS), and 3 studies on transcranial magnetic stimulation (TMS) met our inclusion criteria. Based on this evidence, we have made strong recommendations for the use of habit reversal therapy and exposure and response prevention, preferably embedded within a supportive, psychoeducational program, and with the option to combine either of these approaches with pharmacotherapy. Although evidence exists for the effcacy of DBS, the quality of this evidence is poor and the risks and burdens of the procedure are fnely balanced with the perceived benefts. Our recommendation is that this intervention continues to be considered an experimental treatment for severe, medically refractory tics that have imposed severe limitations on quality of life. We recommend that the procedure should only be performed within the context of research studies and by physicians expert in DBS programming and in the management of tics. There is no evidence to support the use of TMS in the treatment of tics. However, the procedure is associated with a low rate of known complications and could continue to be evaluated within research protocols. The recommendations we provide are based on current knowledge, and further studies may result in their revision in future.
Patterns of Depression and Treatment in Pregnant and Postpartum Women
Authors: Bowen Angela , Bowen Rudy , Butt Peter , Rahman Kazi , Muhajarine Nazeem
Published: January 2017

Objective:

To determine the course of depression and the effects of treatment during pregnancy and into the postpartum period.

Method:

This is a longitudinal study of a community sample of 649 pregnant women who were assessed in early pregnancy (17.4 ± 4.9 weeks), late pregnancy (30.6 ± 2.7 weeks), and postpartum (4.2 ± 2.1 weeks) with the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were encouraged to seek assessment and treatment. We used generalized estimating equation modelling to determine the predicted mean depression scores, taking age, ethnicity, history of depression, and previous and present treatment status into account.

Results:

The unadjusted prevalence of depression (EPDS ≥ 12) was 14.1% ( n = 91) in early pregnancy, 10.4% ( n = 62) in late pregnancy, and 8.1% ( n = 48) postpartum. Twelve per cent of women were engaged in treatment. The predicted mean EPDS score decreased over the course of the pregnancy into the postpartum period, most significantly when women were engaged in counselling or taking psychotropic medication. Counselling was the more common method of treatment during pregnancy and medication in the postpartum period. Women who were depressed and untreated were more likely to be younger, more stressed, have less support, have a history of depression, and use alcohol.

Conclusions:

We confirm that depressive symptoms improve over the course of the pregnancy into the postpartum period, particularly for women who receive treatment. Our study is unique as it takes the history of depression, present and past treatment status, and the longitudinal nature of the data into account.
Bipolar Disorder: The Shift to Overdiagnosis
Authors: Mitchell Philip B
Published: January 2017

Sometimes dramatically changing vogues in diagnostic practice in psychiatry resemble the volatility of international share markets. One such quickly shifting diagnostic area has been that of bipolar disorder (BD). Historically regarded as a relatively uncommon condition until recent decades, the construct of BD underwent a major expansion in the 1990s and 2000s with promulgation of the concept of the soft bipolar spectrum disorder, from which the recent research focus on subthreshold BD presentations was derived. Related to this has been renewed interest in treatments for BD from the pharmaceutical industry. The increasing rates of diagnosis have largely related to BD II, for which there has been a dramatic broadening of diagnostic criteria. This article critically reviews research data, both for broadening the diagnostic criteria for BD and, conversely, for the growing evidence of overdiagnosis in clinic practice. Why does this debate matter? I would suggest that there are many valid reasons to be concerned about overdiagnosis: first, the potential for overtreatment or inappropriate treatment of such patients with mood stabilizing treatments, including antipsychotics; second, the potential for diagnostic oversimplification, with consequent diagnostic deskilling and loss of credibility for the psychiatric profession; and third, the potential major impact on etiologic research for this condition. Psychiatry should not uncritically accept the shift to overdiagnosis, which has developed a rapid momentum in recent decades, in both clinical and academic circles. We must ensure, as a profession, that any change in diagnostic practice is underpinned by rigorous and critical research inquiry.
Predictors of Psychiatric Aftercare among Formerly Hospitalized Adolescents
Authors: Carlisle Corine E , Mamdani Muhammad , Schachar Russell , To Teresa
Published: January 2017

Objective:

Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization.

Method:

We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge.

Results:

Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare.

Conclusions:

Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth.
Childhood Maltreatment and Substance Use Disorders among Men and Women in a Nationally Representative Sample
Authors: Afifi Tracie O , Henriksen Christine A , Asmundson Gordon J G , Sareen Jitender
Published: January 2017

Objective:

To examine the association between a history of 5 types of childhood maltreatment (that is, physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several substance use disorders (SUDs), including alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine, in a nationally representative US adult sex-stratified sample.

Method:

Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative US sample of adults aged 20 years and older (n = 34 653). Logistic regression models were conducted to understand the relations between 5 types of childhood maltreatment and SUDs separately among men and women after adjusting for sociodemographic variables and Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I and II mental disorders.

Results:

All 5 types of childhood maltreatment were associated with increased odds of all individual SUDs among men and women after adjusting for sociodemographic variables, with the exception of physical neglect and heroin abuse or dependence, emotional neglect, and amphetamines and cocaine abuse or dependence among men (adjusted odds ratio range 1.3 to 4.7). After further adjustment for other DSM Axis I and II mental disorders, the relations between childhood maltreatment and SUDs were attenuated, but many remained statistically significant. Differences in the patterns of findings were noted for men and women for sexual abuse and emotional neglect.

Conclusions:

This research provides evidence of the robust nature of the relations between many types of childhood maltreatment and many individual SUDs. The prevention of childhood maltreatment may help to reduce SUDs in the general population.
A Review of Pharmacoepidemiologic Studies of Antipsychotic Use in Children and Adolescents
Authors: Patten Scott B , Waheed Waqar , Bresee Lauren
Published: January 2017

Objective:

In Canada, treatment of children and adolescents with antipsychotics is almost always off label. A single atypical agent, aripiprazole, only recently received regulatory authorization for use in the group aged 15 to 17 years. This regulatory approval was restricted to treatment of schizophrenia. The objective of this review was to summarize pharmacoepidemiologic reports examining the frequency of use of these medications.

Methods:

A literature search was used to identify English-language studies examining the pharmacoepidemiology of antipsychotics in children and adolescents. The results of identified studies were summarized using narrative review methods.

Results:

In countries where longitudinal data are available, increased antipsychotic use has been consistently observed. Generally, most or all of this increase can be attributed to second-generation antipsychotics (SGAs). Major international differences are evident in the literature. European studies describe lower overall frequencies of use than North American studies (most of which were conducted in the United States). SGAs in children and adolescents are used more often in boys than in girls, and are increasingly used for treatment of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD).

Conclusions:

Determining the most appropriate frequency of SGA use in children and adolescents will ultimately depend on decisive clarification of risks and benefits. The currently available literature highlights large international differences in the frequency of use. These differences may reflect fundamental dissimilarities in the therapeutic stance adopted toward ADHD and CD by physicians practicing in different countries.
Mental Health of Canadian Forces Members While on Deployment to Afghanistan
Authors: Garber Bryan G , Zamorski Mark A , Jetly Col Rakesh
Published: January 2017

Objective:

The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed.

Methods:

Our study consisted of a cross-sectional survey of all 2779 CF personnel deployed to the province of Kandahar, Afghanistan, from February 15, 2010, to March 15,2010.

Results:

An important minority (8.5%) of the 1572 respondents (response rate = 57%) exceeded civilian criteria for symptoms of acute traumatic stress, major depression, or generalized anxiety. Prevalence of these 3 mental health problems increased with higher combat exposure and location in more isolated posts. A much larger fraction (31 %) reported suffering a stress, emotional, alcohol, or family problem during the deployment. Only a minority of respondents with a mental health problem (26%) were currently interested in getting help. Almost one-half of respondents with a mental health problem perceived occupational dysfunction as a result, though two-thirds of respondents with occupational dysfunction were in the group without the 3 mental health problems assessed.

Conclusions:

The needs base for psychosocial support extends beyond personnel who meet conventional questionnaire criteria for traumatic stress, depression, or generalized anxiety. Future research is needed to understand what precise problems are driving this larger needs base and what precise supports (clinical or nonclinical) would be most appropriate.