bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Reactions Triggered by the Use of Cosmetic Products in Non-Specific Lipid Transfer Protein-Sensitive Patients
Authors: Giani M. , Pirrotta L. , Locanto M. , Cadoni S. , Puddu P. , De Pità O.
Published: January 2017

Nonspecific lipid transfer proteins (nsLTPs) are members of the prolamine superfamily and they are found in pollen and food, as well as in latex. Due to the strong stability both against pepsin digestion and thermal denaturation, sensitisation towards these proteins is often associated with severe systemic reactions (angioedema, urticaria, asthma, anaphylaxis, etc.) following the ingestion of both raw or fresh food and cooked or preserved food. Many studies have shown reactivity towards nsLTPs both via inhalation and orally and in this study we present two cases of nsLTPs-sensitive patients who manifested the immediate onset of skin reactions following the use of cosmetic products containing these proteins. Thus, in order to prevent immediate reactions linked to their use, it is necessary to recommend nsLTPs-sensitive patients to avoid the topical use of products containing these proteins (and obviously the ingestion of foods containing these proteins).
Comparison of Serum Specific IgE and Skin Prick Test in Polysensitized Patients
Authors: Ciprandi G. , De Amici M. , Giunta V. , Marseglia G.L.
Published: January 2017

The aim of this study is to evaluate serum specific-IgE in a large group of poly sensitized patients with the same SPT result (such as ++++) comparing two diagnostic methods. Six hundred ten patients (310 females; median age 32 years) suffering from allergic rhinitis were studied. Serum specific-IgE were measured by ImmunoCap assay. Skin prick test was also performed. There was a significant difference between serum specific-IgE values in these polysensitized patients. In conclusion, the serum specific-IgE measurement in polysensitized patients seems to be more appropriate than SPT.
Preterm Newborns are Provided with Triggering Receptor Expressed on Myeloid Cells-1
Authors: Garofoli F. , Borghesi A. , Mazzucchelli I. , Tzialla C. , Di Comite A. , Tinelli C. , Manzoni P. , Stronati M.
Published: January 2017

Triggering receptor expressed on myeloid cells-1 (TREM-1) and soluble fraction (sTREM-1) are useful markers of infection in adults. Neonates, especially preterm infants, are exposed to high risk of sepsis due to the immature immune system and few data are available regarding TREM-1, mainly focused on the soluble form. We therefore decided to investigate the baseline assessment of TREM-1, membrane and soluble receptors, in preterm newborns without clinical or microbiological evidence of infection, in order to precociously measure the possible changes due to sepsis and compare them to the obtained reference values. Fifty-nine newborns were enrolled in the study. Median and Interquartile range of TREM-1 were: in monocytes 96% [94–98] with 71 Mean Fluorescence Intensity (MFI) [50–94]; in PMNs: 80% [68–87]; soluble TREM-1: 29.1 pg/ml [14.55–103.93]. Monocyte expression and soluble TREM-1 concentrations appeared comparable to healthy adults, while not all PMNs expressed this receptor, possibly due to their immaturity. Birth weight negatively correlated with sTREM-1, while there were no statistical significances with gestational age, maternal age, gender, mode of delivery, patent ductus arteriosus, intrauterine growth restriction, premature rupture of membranes and TREM-1 or sTREM-1. We also reported a statistical relationship between monocyte TREM-1 and surfactant administration and between sTREM-1 and antenatal steroid prophylaxis. Even if untrained, the neonatal immune system of preterm newborns is equipped with TREM-1 system, but further studies are needed to evaluate the functionality in newborns.
Long-Term Assessment of Plasma Lipids in Transplant Recipients Treated with Tacrolimus in Relation to Fatty Liver
Authors: Tarantino G. , Palmiero G. , Polichetti G. , Perfetti A. , Sabbatini M. , Basile V. , Kadilli I. , Federico S. , Capone D.
Published: January 2017

Immunosuppression has improved graft and recipient survival in transplantation but is associated with possible adverse effects including cardiovascular diseases. The impact of tacrolimus on the lipidic profile has been debated for several years. Twenty-nine kidney transplant recipients on tacrolimus treatment were monitored for six years, and multiple laboratory parameters investigating the lipid asset, as well as glucose profile, were carried out. Tacrolimus has been responsible for significant changes in plasma lipid concentrations only for the first six months, but not for the remaining time of observation. Similarly, in the same periods, glycemic imbalance was highlighted. The liver enzyme activity showed a modest derangement during the tacrolimus treatment, suggesting the presence of lipid accumulation in the liver. Fatty liver reversed in the long term follow-up. Tacrolimus, although it is not a completely safe option in the first months of the immunosuppressive protocols in organ transplanted recipients, still retains a certain role in the long-term post-transplantation immunosuppressive approach with high cardiovascular risks
Adenoids during Childhood: The Facts
Authors: Marseglia Gl , Caimmi D , Pagella F , Matti E , Labò E , Licari A , Salpietro A , Pelizzo G , Castellazzi Am
Published: January 2017

Adenoids are constantly exposed to viral and bacterial agents as well as to allergens. They play a major role in the upper airways immunity, being effector organs in both mucosal-type and systemic-type adaptive immunity. Because of both their immunological function and their specific location, adenoids are considered to be as reservoirs of viruses and bacteria. Reiterative infections may therefore contribute both to Eustachian tube dysfunction and to tissue hypertrophy. Nasal endoscopy is a key diagnostic tool to detect both adenoid hypertrophy and adenoiditis. Moreover, such a procedure may be very helpful in detecting bacterial biofilms that could justify the concomitant presence of recurrent episodes of otitis media, chronic and occult sinusitis in children. Even though the connection between allergies and adenoidal diseases is not completely clear, allergic diseases cause an inflammatory state that influences adenoidal tissue as well, configuring the picture of allergic adenoiditis, a condition in which adenoid tissue exhibit numerous IgE positive mast cells. Several studies are still needed to better understand the relationship between allergies and infections and the influence they play on adenoids during childhood.
FEF25–75 Might Be a Predictive Factor for Bronchial Inflammation and Bronchial Hyperreactivity in Adolescents with Allergic Rhinitis
Authors: Ciprandi G , Tosca Ma , Castellazzi Am , Cairello F , Salpietro C , Arrigo T , Del Giudice Miraglia M
Published: January 2017

Allergic rhinitis and asthma are closely associated. Bronchial hyperreactivity (BHR) is a pathophysiological characteristic of asthma. Allergic inflammation is characterized by eosinophilic infiltrate and may by indirectly assessed by exhaled nitric oxide (FeNO). Forced expiratory flow between 25% and 75% of vital capacity (FEF25–75) may predict BHR in adult patients with allergic rhinitis. The aim of this study was to evaluate the presence of BHR in a large group of adolescents with allergic rhinitis and whether FEF25–75 might be related with BHR and FeNO. Methods 150 adolescents with allergic rhinitis were enrolled. Clinical examination, skin prick test, spirometry, methacholine challenge, and FeNO were performed in all patients. Results Severe BHR is quite frequent in allergic adolescents. Impaired FEF25–75 values (such as ⩽ 65% of predicted) constitute a relevant predictive factor for severe BHR (OR 4.4). FeNO levels were significantly related with BHR. Conclusion This study provides evidence that impaired FEF25–75 values might predict severe BHR and BHR is related with FeNO in adolescents. Therefore, BHR should be suspected in adolescents with low FEF25–75 values.
Fractional Exhaled Nitric Oxide Measurements in Rhinitis and Asthma in Children
Authors: Del Giudice Miraglia M , Marseglia Gl , Leonardi S , Tosca Ma , Marseglia A , Perrone L , Ciprandi G
Published: January 2017

Exaled nitric oxide (FeNO) is considered a good noninvasive marker to assess airway inflammation in asthma and allergic rhinitis. In asthma, exhaled NO is very useful to verify adherence to therapy, and to predict upcoming asthma exacerbations. It has been also proposed that adjusting anti-inflammatory drugs guided by the monitoring of exhaled NO, could improve overall asthma control. Other studies showed increased FeNO levels in subjects with allergic rhinitis.
TLR2 and TLR4 Gene Polymorphisms and Atopic Dermatitis in Italian Children: A Multicenter Study
Authors: Salpietro C , Rigoli L , Del Giudice Miraglia M , Cuppari C , Di Bella C , Salpietro A , Maiello N , La Rosa M , Marseglia Gl , Leonardi S , Briuglia S , Ciprandi G
Published: January 2017

Background Genetic factors have an important role in atopic dermatitis (AD) predisposition. Toll like receptor (TLR) are important mediators between environment and immune system. There are incosnsitent studies about TLSR polymorphisms in AD. Objective This study examined whether single nucleotide polimorphisms (SNPs) in the genes for TLR2 and TLR4 could be associated with the AD phenotypes and with its clinical severity in a large group of Italian children. Methods 187 children with Ad and 150 healthy children were recruited. AD severity was assessed by SCORAD. TLR2 (A-16934T and R753Q polymorphisms) and TLR4 (D299G and T399I SNPs) were genotyped by PCR-RFLP. Results The frequency of the R753Q was significantly higher in AD children (16.0%) compared with controls (6.0%, P=0.004; OR2.99,95%CI 1.39–6.41; RR 1.46,95%CI 1.14–1.69). AD patients a significantly different frequency of the D299G SNP (14.9%) in comparison with the controls (6.6%, P = 0.01; OR 2.46, 95%CI 1.17–5.17; RR 2.24; 95%CI 1.15–4.45). Conclusion Children with AD may have a distinct genotype and the TLR-2 R753Q SNP was prevalent in a subset of patients with AD characterized by a more severe clinical picture.
Inhalation Therapy in Asthmatic and Not Asthmatic Children
Authors: Lo Valvo L , Leonardi S , Marseglia Gl , Del Giudice Miraglia M , Salpietro C , Ciprandi G , La Rosa M
Published: January 2017

The use of inhaled aerosols allows selective treatment of the lungs directly by achieving high drug concentrations in the airway while reducing systemic adverse effects by minimizing systemic drug levels. Aerosol drug delivery is painless and often convenient, but the proliferation of inhaler devices has resulted in a confusing number of choices for clinicians who are selecting a delivery device for aerosol therapy. There are advantages and disadvantages associated with each device category. Several factors can guide clinicians to choose a device for a specific patient. This choice has to be tailored according to the patient's needs, situation and preference. Whatever the chosen inhaler, inhaler technique is the critical factor in the correct use of delivery devices and patient education has a key-role for improving technique and compliance.
The Immunological Effects of Dust Containing Metals and Compounds in Workers of a Plant Producing Plastic Materials. Preliminary Study
Authors: Boscolo P. , Di Gioacchino M. , Cervone M. , Di Giacomo F. , Ballone E. , Giuliano G.
Published: January 2017

Lymphocyte subpopulations were studied in 14 men working in a plant producing plastic materials in comparison with a control group of similar age and smoking habit. The workers were exposed to dust containing particles of calcium carbonate, polyvinylchloride, phtalates, unsaturated oils, paraffin wax, iron oxides, titanium bioxides, barium, zinc, lead and lead chromate. In the exposed workers, T helper/ inducer lymphocytes (mainly CD4+-CD45RO- “virgin” lymphocytes) and CD19+ B lymphocytes were significantly reduced without changes of serum IgM, IgG and IgA. A highly significant correlation was found between B lymphocytes (reduced in the workers about 40 %) and CD4+-CD45R0+ “memory” lymphocytes (reduced about 20 %). Moreover, blood lead (correlated with urinary chromium) demonstrated a highly significant negative correlation with B lymphocytes.

This study demonstrates that combined exposure to toxic agents produces specific modifications in the lymphocyte subsets without changes in immunoglobulins and confirms the results of previous studies showing that the exposure to lead or chromate induces reduction of lymphocytes in the peripheral blood.
The Serum Level of Agalactosyl IgG in Rheumatoid Arthritis Patients Treated with Methotrexate
Authors: Lacki J. K. , Mackiewicz U. , Mackiewicz S. , Muller W.
Published: January 2017

To verify the hypothesis that methotrexate may affect the serum level of agalactosyl IgG (IgG[0]) we followed the changes in IgG galactosylation patterns in a cohort of rheumatoid arthritis patients treated with either methotrexate (MTX) or nonsteroidal antiinflammatory drugs (NSAID).

The average values of IgG[0] in RA patients at the beginning of the observation were significantly higher as compared to healthy controls (0.45 ± 0.39 vs. −0.03 ± 0.09, p<0.05). The findings of IgG[0] after one-year follow-up were also higher as compared to healthy controls (0.38 ± 0.39 vs. −0.03 ± 0.09, p<0.05).

We did not notice any statistically significant difference in IgG[0] between MTX and NSAID treated patients at the beginning of the study (0.49 ± 0.42 vs. 0.42 ± 0.38, NS). However, during one-year MTX treatment IgG[0] significantly dropped (0.49 ± 0.42 vs. 0.25 ± 0.24, p<0.01). We did not establish any fluctuation in IgG[0] in the group of patients treated with NSAID (0.42 ± 0.38 vs. 0.46 ± 0.45, NS).

The data thus far obtained suggest that IgG[0] may serve as an indicator for the disease course in patients with RA. Secondly, the clinical improvement and IgG[0] decrease after methotrexate implies, that the immunoregulatory abnormality in RA may be susceptible to correction by immunotherapy.
Research Ethics and Forensic Patients
Authors: Regehr Cheryl , Edwardh Marlys , Bradford John
Published: January 2017

Objective:

To discuss ethical and legal issues arising from research conducted on forensic psychiatric patients.

Method:

A review of the literature and ethical and legal guidelines related to research ethics with human subjects.

Conclusion:

Forensic patients who are research subjects are particularly vulnerable to coercion and abuse as a result of the dual vulnerabilities stemming from their status as both prisoners and psychiatric patients. Researchers in the area of forensic mental health must carefully consider ethical guidelines and ensure that the rights of participants are respected and upheld.
Living Conditions and Emotional Profiles of Cambodian, Central American, and Québécois Youth
Authors: Rousseau Cécile , Drapeau Aline , Platt Robert
Published: January 2017

Objective:

To compare Cambodian and Central American adolescent refugees to Quebec with their Quebec-born peers in regard to emotional and behavioural problems, feelings of competence, and risk-behaviour profiles, and to examine relations between emotional variables and living conditions in the 3 groups.

Method:

The sample consisted of 76 Cambodian, 82 Central American and 67 Québécois youth living in the Montreal area. The teenagers' internalization and externalization symptoms were assessed using the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR); the YSR also provided a measure of their feelings of competence. Risk behaviour was reported by the teenagers. The socioeconomic status of the teenagers' households was taken into account in multiple regression analyses conducted for each group.

Results:

The level of emotional and behavioural problems reported by teenagers was lowest in Central Americans and highest in Québécois; the latter group also reported more risk behaviours than did either refugee group. The socioeconomic status of the Cambodian and Central American refugee households was lower than that of the Québécois. Living conditions were not a major determinant of emotional distress in young Cambodians, but low annual income was associated with internalizing symptoms among Central American youth. The most powerful predictor of externalizing symptoms among the Québécois youth was having a single-parent household.

Conclusion:

This study underscores the contrast between the living conditions of young Cambodian and Central American refugees to Quebec and those of Quebec-born youth. These refugees' precarious socioeconomic status is not accompanied by an increase in adolescents' emotional and behavioural problems.
Major Depression Prevalence in Calgary
Authors: Patten Scott B
Published: January 2017

Objective:

To estimate the 12-month period prevalence of major depression in Calgary.

Methods:

Subjects (n = 2542) were selected using random digit dialing (RDD) and interviewed by telephone using the Composite International Diagnostic Interview-Short Form for Major Depression (CIDI-SFMD). A subset of this sample was recontacted and administered the full mood disorders section of the CIDI.

Results:

The weighted proportion of the sample scoring in the positive range on the major depression predictor was 14.7%. Validation data determined that approximately three-quarters of these subjects would be expected to have major depression according to the CIDI. Hence, the estimated 12-month period prevalence of major depression was approximately 11.0%.

Conclusions:

This prevalence estimate is higher than most, but not all, previous Canadian estimates and resembles that of the American National Comorbidity Survey (NCS). Calgary may have a high prevalence of major depression; however, because methodologically comparable studies are not available, to conclude this would be premature. Selection bias due to the RDD sampling (and the associated relatively high rate of nonresponse) may have led to an inflated prevalence estimate. Alternatively, because it allows increased anonymity and emotional “distance” from the nonprofessional interviewers, telephone-based data collection may be more sensitive to psychopathology than face-to-face interviewing.
Recent Advances in Evidence-Based Psychiatry
Authors: Geddes John , Carney Stuart
Published: January 2017

Background:

There is increasing interest in the potential contribution of evidence-based medicine to clinical decision making in psychiatry. In this article, we describe some of the recent advances in evidence-based psychiatry and outline future challenges.

Method:

Narrative review

Content:

The successful introduction of evidence-based practice into psychiatry requires the acquisition of new skills by clinicians. It is also important that policy statements that aim to be evidence-based, such as clinical practice guidelines, use rigorous methods to synthesize the primary evidence and do not overlook its limitations. One result of the systematic reviewing of evidence is the identification of important residual clinical uncertainties. Primary research can then be focused on these questions. For questions regarding therapy in psychiatry, it will be necessary to undertake some large, simple randomized trials. Making the best available evidence readily accessible in a clinical setting, however, remains a significant challenge.

Conclusions:

Collaboration between clinicians, researchers, policy-makers, and those involved in information technology is required to optimize the contribution of evidence-based medicine in psychiatry.
Epidemiology of Problem Gambling in Prince Edward Island: A Canadian Microcosm?
Authors: Doiron Jason P , Nicki Richard M
Published: January 2017

Objectives:

To gather information that describes the extent of gambling and problem gambling in Prince Edward Island (PEI), to rigorously analyze the relation between gambling activities and problem gambling, to document cognitive and emotional correlates of problem gambling, and to identify an at-risk gambling group.

Method:

We selected a random, stratified sample (n = 809) to represent the adult population of PEI. We administered both the South Oaks Gambling Screen (SOGS) and an early version of the Canadian Problem Gambling Index (CPGI) to participants who had gambled.

Results:

The current rate of problem gambling was 3.1%. Problem gamblers were likely to be under age 30 years, to be single, and to report cognitive, emotional, and substance abuse correlates. Multiple-regression analysis identified a unique and substantial relation between problem gambling and video lottery terminal (VLT) use. We identified a group of at-risk gamblers (scoring 1 or 2 on the SOGS), comprising 14% of the sample.

Conclusions:

Gambling and problem gambling patterns in PEI resemble those in most other provinces. The relation found between problem gambling, VLT use, and cognitive, emotional, and substance use correlates should apply to the greater population as well.
A Prospective Study of Sex-Specific Effects of Major Depression on Alcohol Consumption
Authors: Wang JianLi , Patten Scott B
Published: January 2017

Objective:

To evaluate the impact of major depression on alcohol use in the Canadian general population.

Method:

This study was based on a 2-year follow-up of the Canadian National Population Health Survey (NPHS) longitudinal cohort. Subjects reporting various patterns of drinking, with and without major depression, were selected using the 1994–95 NPHS data. Data collected during a reevaluation of these subjects 2 years later were analyzed to determine whether having major depression at the 1994–95 interview predicted subsequent changes in drinking patterns.

Results:

Subjects who were depressed in 1994–95 were generally not at higher risk of starting drinking or drinking more frequently than once a week. However, women who were depressed, especially those who were 19 years old or older, were at higher risk of having 5 or more drinks at least once monthly.

Conclusion:

These results confirm that mood disorders can impact on alcohol consumption in women. A component of the well-known association between alcohol consumption and major depression is due to “reverse” causal effects. Proper management of depression in women may contribute to the prevention of problem drinking.
Clinical Implications of a Link between Fetal Alcohol Spectrum Disorder and Attention-Deficit Hyperactivity Disorder
Authors: O'Malley Kieran D , Nanson Jo
Published: January 2017

Objective:

To provide an overview of the animal and human research literature on the link between fetal alcohol spectrum disorder (FASD) and attention-deficit hyperactivity disorder (ADHD).

Method:

We conducted a comprehensive literature review that addressed the history of, and current research on, fetal alcohol syndrome (FAS) and FASD, as well as that on ADHD in children.

Results:

In animal and human research, there is emerging clinical, neuropsychological, and neurochemical evidence of a link between FASD and ADHD.

Conclusions:

The evidence of the link between these 2 conditions has implications for clinical management. The clinical quality of ADHD in children with FASD often differs from that of children without FASD. For children with FASD, ADHD is more likely to be the earlier-onset, inattention subtype, with comorbid developmental, psychiatric, and medical conditions. Children with FASD are commonly not mentally retarded but present complex learning disabilities, especially a mixed receptive-expressive language disorder with deficits in social cognition and communication (reminiscent of sensory aphasia and apraxia), working memory problems, and frequently, a mathematics disorder. Comorbid psychiatric conditions include anxiety, mood, conduct, or explosive disorders. As well, cardiac, renal, or skeletal problems are more likely to be present. Because these children have a disturbance in brain neurochemistry, or even brain structure (that is, in the corpus callosum), their response to standard psychostimulant medication can be quite unpredictable.
Panic in the Emergency Room
Authors: Lynch Patrick , Galbraith Kim M
Published: January 2017

Objective:

This paper examines the relation between coronary artery disease (CAD) and panic disorder (PD), discusses the implications of this relation to the general medical system, and suggests future assessment and intervention strategies for emergency departments.

Method:

We reviewed the literature on CAD and PD using Medline and PsycINFO.

Results:

PD is more expensive to our nonpsychiatric, general medical system than any other psychiatric condition. The main reason for PD patients' continued use of general medicine for their psychological symptoms is that their PD remains undiagnosed. In the emergency room (ER), PD patients with chest pain have their PD go undiagnosed about 98% of the time. By having ERs implement specific assessment and intervention strategies for patients presenting with chest pain, the savings to the general medical system could be substantial.

Conclusions:

By improving recognition of PD in the ER, there is the potential to generate large savings in general medical care. With the availability of empirically supported or effective psychological and pharmacologic treatments for PD, appropriately diagnosing and subsequently treating patients with PD may prevent them from experiencing many years of disability and higher rates of fatal coronary events.
Old and Homeless: A Review and Survey of Older Adults Who Use Shelters in an Urban Setting
Authors: Stergiopoulos Vicky , Herrmann Nathan
Published: January 2017

Objectives:

Research on the mental health and service needs of homeless seniors has been scant. This paper reviews the available literature and presents findings of a Toronto survey in an effort to describe the demographics of homeless seniors, their level of impairment, and their mental and physical health needs.

Methods:

We searched the Medline, AgeLine, and PsycINFO databases, using the following key words: elderly homeless, elderly hostel users, and urban geriatrics. To better describe the service needs of the elderly homeless, we obtained demographic data from the Community and Neighbourhood Services Department and distributed a survey questionnaire to 11 Toronto hostel directors. The questionnaire elicited data relating to reasons for shelter use, problem behaviours, and mental health needs of those over age 65 years.

Results:

Although seniors represent a small percentage of the homeless population, their numbers are growing. The available literature suggests a high prevalence of psychiatric disorders and cognitive impairment in this population, with a greater proportion of older women than men having severe mental illness. Further, our survey suggests that the service needs of elderly hostel users in Toronto differ from those of their younger counterparts.

Conclusion:

The homeless elderly are the most vulnerable of this impoverished population. Although more research is needed to define their mental and physical health needs and ways of meeting them, their characteristics appear to be unique. Geriatric psychiatrists could play a significant role in evaluating and treating this population more comprehensively.
A Follow-up Study of Persons Found Not Criminally Responsible on Account of Mental Disorder in British Columbia
Authors: Livingston James D , Wilson Derek , Tien George , Bond Lynda
Published: January 2017

Objective:

To describe the characteristics of individuals found not criminally responsible on account of mental disorder (NCRMD) after the 1992 Criminal Code amendments and to track their movement through the forensic system, as well as to unveil the changes to British Columbia's forensic psychiatric system that resulted from Bill C-30.

Method:

Profile information relating to persons found NCRMD between February 4, 1992, and February 4, 1998, in British Columbia was collected and analyzed. Community follow-up data was collected and analyzed for a 24-month period following a subject's discharge from hospital.

Results:

A substantially greater number of individuals entered the forensic psychiatric system in British Columbia after Bill C-30 was implemented. The post-1992 forensic psychiatric population contained fewer persons charged with serious index offences and a greater number of persons charged with relatively minor offences. The length of hospitalization for the NCRMD cohort decreased substantially after the 1992 Criminal Code amendments.

Conclusion:

The Bill C-30 provisions have made the NCRMD defence an attractive option for defendants and legal counsel.
The Antisuicidal and Mortality-Reducing Effect of Lithium Prophylaxis: Consequences for Guidelines in Clinical Psychiatry
Authors: Müller-Oerlinghausen Bruno , Berghöfer Anne , Ahrens Bernd
Published: January 2017

The suicide-related mortality among patients with affective disorders is approximately 30 times higher, and overall mortality 2 to 3 times higher, than suicide-related mortality in the general population. Lithium has demonstrated possibly specific antisuicidal effects apart from its prophylactic efficacy: it significantly reduces the high excess mortality of patients with affective disorders. To date, suicide-prevention effects have not been shown for antidepressant or anticonvulsant long-term treatment. Clozapine appears to reduce the suicide rate in schizophrenia patients. Against this background, guidelines and algorithms for selecting an appropriate prophylactic strategy for affective disorders should consider the presence of suicidality in patient history. Appropriate lithium prophylaxis prevents approximately 250 suicides yearly in Germany, although lithium salts are infrequently prescribed within the National Health Scheme (specifically, to 0.06% of the population). Rational treatment strategies most likely would demand that prescription rates be about 10 times higher.
Interventions to Reduce the Stigma Associated with Severe Mental Illness: Experiences from the Open the Doors Program in Germany
Authors: Gaebel Wolfgang , Baumann Anja E
Published: January 2017

Stigma associated with mental illness and psychiatric treatment and the discrimination toward people with mental illnesses that frequently results from this are main obstacles preventing early and successful treatment. To reduce such stigma and discrimination, especially toward people with schizophrenia, the World Psychiatric Association antistigma program Open the Doors is currently being implemented in 27 countries. Since August 1999, the campaign has been executed in 7 project centres in Germany. Public information programs and educative measures aimed at selected target groups should improve the public's knowledge regarding symptomatology, causes, and treatment options for schizophrenia and schizophreniform disorders. Improved knowledge should in turn abolish prejudice and negative perceptions and facilitate the social reintegration of those suffering from mental illness.
Violence by Psychiatric Patients: The Impact of Archival Measurement Source on Violence Base Rates and Risk Assessment Accuracy
Authors: Douglas Kevin S , Ogloff James R
Published: January 2017

Objective:

This study examined the impact of using various archival sources of violence data on the recorded base rate of violence and on the accuracy of violence risk assessments in a sample of civil psychiatric patients.

Method:

Violence in the community, after release from involuntary hospitalization, was measured with 3 types of archival data: criminal records, psychiatric hospital readmission records, and readmission records from multiple general hospitals.

Results:

Findings indicated that the different measurement sources each identified unique incidents of violence, which were correlated moderately or not at all with one another, and that the estimated base rate of violence varied substantially as a function of outcome source. Not surprisingly, using a combination of sources identified the highest base rate of violence. Predictive validity estimates also varied widely under different measurement procedures and were more stable when a combination of sources was used.

Conclusions:

It is important in practical and research terms for studies of psychiatric patient violence to use multiple sources of outcome data.
Test Wisconsin chez les patients souffrant de schizophrénie, et leurs frères et soeurs
Authors: Hamaoui Youssef El , Elyazaji Meryem , Yaalaoui Sakina , Rachidi Linda , Saoud Mohamed , d'Amato Thierry , Moussaoui Driss , Dalery Jean , Battas Omar
Published: January 2017

Objectif:

Le premier objectif de ce travail est de confirmer que les patients souffrant de schizophrénie et leurs frères et sœurs non malades partagent un même déficit des fonctions exécutives, lorsqu'on les compare à des sujets témoins sains. Le deuxième objectif est d'étudier les relations entre les performances au test de classification catégorielle de cartes du Wisconsin (WCST) et la durée et l'intensité des symptômes cliniques, ainsi que les différentes dimensions cliniques.

Méthode:

Quatre-vingt dix sujets ont participé à cette étude, répartis en 3 groupes de 30: un groupe de patients souffrant de schizophrénie, un groupe formé de leurs frères et sœurs, et un groupe témoin. L'intensité des symptômes a été évaluée par l'échelle des symptômes positifs et négatifs (PANSS), et le fonctionnement social par l'échelle globale du fonctionnement (EGF). Le WCST a été administré aux 3 groupes.

Résultats:

Les patients souffrant de schizophrénie et leurs frères et soeurs présentaient des performances significativement plus faibles au WCST que celles des témoins. L'analyse statistique a montré que le groupe des patients présentait un déficit des performances au WCST significativement plus important que les 2 autres groupes. Les frères et sœurs présentaient également des performances significativement plus faibles que celles des témoins. D'autre part, aucune relation significative n'a été trouvée entre la performance au WCST et les autres variables, notamment l'âge, le sexe, le niveau d'instruction, la durée de la maladie, le traitement, et les différents scores PANSS et EGF.

Conclusion:

Les patients souffrant de schizophrénie et leurs frères et sœurs non malades partagent les mêmes déficits des fonctions exécutives. Ces résultats suggèrent que les performances au WCST peuvent être considérées comme un marqueur de vulnérabilité à la schizophrénie chez les frères et sœurs de patients atteints de schizophrénie.
Serum Monitoring of Antipsychotic Drug Levels during Concomitant Administration of Sertraline and Antipsychotic Medication
Authors: Pierson Kathleen , Addington Donald , Addington Jean , Patten Scott
Published: January 2017

Objective:

To assess whether pharmacokinetic drug interactions occur when sertraline is added to antipsychotic medications.

Method:

Forty-eight patients with remitted DSM-IV schizophrenia and comorbid major depression were randomized to placebo for 6 weeks or sertraline 50 mg for 4 weeks followed by sertraline 50 mg to 100 mg for 2 weeks for nonresponders. Treatment with the patients' usual antipsychotic continued. Weekly clinical outcome assessments occurred for 6 weeks, and serum samples for drug monitoring were collected at Weeks 1, 5, and 6. Serum concentrations of sertraline and antipsychotics were measured with standard assays.

Results:

In both placebo- and sertraline-treated groups, most patients displayed minor fluctuations in antipsychotic serum levels over 6 weeks. There was no clinical evidence of drug interactions in the sertraline-treated group.

Conclusions:

Clinically significant adverse effects did not occur despite variable antipsychotic serum levels with or without sertraline. Concern about pharmacokinetic interactions should not deter the use of sertraline for depression in individuals with schizophrenia.
Forgetfulness: A Role in Noncompliance with Antidepressant Treatment
Authors: Bulloch Andrew G , Adair Carol E , Patten Scott B
Published: January 2017

Objectives:

To determine the degree of noncompliance with antidepressant treatment in the Alberta population and to investigate the reasons for noncompliance.

Method:

We used data from the Alberta Mental Health Survey, a telephone survey conducted in 2003 ( n = 5323 adults), to produce population-based estimates of the frequency of noncompliance and the reported reasons for noncompliance.

Results:

Reported noncompliance was 41.7% (95% confidence interval [CI], 36.9% to 46.6%) for respondents taking 1, 2, or 3 antidepressants. Noncompliance for those taking 1 antidepressant was 42.0% (95%CI, 36.9% to 47.2%), whereas noncompliance for those taking 2 or 3 antidepressants was 39.4% (95%CI, 26.7% to 53.6%). Among respondents currently taking at least one antidepressant, 64.9% (95%CI, 57.4% to 71.7%) reported that forgetfulness was the most common reason for noncompliance. Of respondents taking 1 medication, 64.1% (95%CI, 56.0% to 71.4%) reported forgetfulness as did 71.3% (95%CI, 48.3% to 86.8%) of those taking 2 or 3 medications. Both the frequency of noncompliance and the reported reasons for noncompliance were independent of sex and age.

Conclusion:

Our study replicates prior reports that indicate that noncompliance is common with antidepressant treatment. Forgetting to take medication is the most important reported reason for this noncompliance.
Personality Disorders and the Five-Factor Model among French Speakers in Africa and Europe
Authors: Rossier Jérôme , Rigozzi Christine ,   Personality Across Culture Research Group (16 members)3
Published: January 2017

Objective:

To describe the relation between personality disorders (PDs) and the Five-Factor Model (FFM)—a dimensional model describing normal personality traits known for its invariance across cultures—in 2 different cultural settings. Several authors have suggested that PDs may be more accurately described using a dimensional model instead of a categorical one.

Method:

Subjects from 9 French-speaking African countries ( n = 2014) and from Switzerland ( n = 697) completed both the French version of the International Personality Disorder Examination screening questionnaire, assessing the 10 DSM-IV PDs, and the French version of the Revised NEO Personality Inventory, assessing the 5 domains and 30 facets of the FFM.

Results:

Correlations between PDs and the 5 domains of the FFM were similar in both samples. For example, neuroticism was highly correlated with borderline, avoidant, and dependent PDs in both Africa and Switzerland. The total rank-order correlation (rho) between the 2 correlation matrices was very high (rho = 0.93) and significant ( P < 0.001), as were the rhos for all domains of the FFM and all PDs, except paranoid and dependent PDs. However, the rhos for PDs across facet scales were all highly significant ( P < 0.001). Moreover, 80% of Widiger and colleagues' predictions and 70% of Lynam and Widiger's prototypes, concerning the relation between PDs and the FFM, were confirmed in both samples.

Conclusions:

The relation between PDs and the FFM was stable in 2 samples separated by a great cultural distance. These results suggest that a dimensional approach and in particular the FFM may be useful for describing PDs in various cultural settings.

Objectif:

Décrire la relation entre les troubles de la personnalité (TP) et le Modèle en cinq facteurs (MCF) — un modèle dimensionnel décrivant les traits de personnalité normaux réputé pour son invariance entre les cultures — dans 2 milieux culturels différents. Plusieurs auteurs ont suggéré que les TP peuvent être décrits plus précisément à l'aide d'un modèle dimensionnel plutôt que catégorique.
Predictors of Remission and Recovery in a First-Episode Schizophrenia Spectrum Disorder Sample: 2-Year Follow-up of the OPUS Trial
Authors: Petersen Lone , Thorup Anne , Øqhlenschlæger Johan , Christensen Torben Øqstergaard , Jeppesen Pia , Krarup Gertrud , Jørrgensen Per , Mortensen Erik Lykke , Nordentoft Merete
Published: January 2017

Objective:

To examine the frequency and predictors of good outcome for patients with first-episode schizophrenia spectrum disorder (SSD).

Method:

We conducted a 2-year follow-up of a cohort of patients ( n = 547) with first-episode SSD. We evaluated the patients on demographic variables, diagnosis, duration of untreated psychosis (DUP), premorbid functioning, psychotic and negative symptoms, substance abuse, adherence to medication, and service use. ORs were calculated with logistic regression analyses.

Results:

A total of 369 patients (67%) participated in the follow-up interview. After 2 years, 36% remitted and 17% were considered fully recovered. Full recovery was associated with shorter DUP, better premorbid adjustment, fewer negative symptoms at baseline, no substance abuse at baseline, and adherence to medication and OPUS treatment.

Conclusions:

Several predictive factors were identified, and focus should be on potentially malleable predictors of outcome, for example, reducing DUP and paying special attention to patients who are unlikely to achieve good outcome, for example, patients with a substance abuse problem and poor premorbid adjustment.
Systematic Services Audit of Consecutive Suicides in New Brunswick: The Case for Coordinating Specialist Mental Health and Addiction Services
Authors: Lesage Alain , Séguin Monique , Guy Andrée , Daigle France , Bayle Marie-Noëlle , Chawky Nadia , Tremblay Nancy , Turecki Gustavo
Published: January 2017

Objective:

To weight the potential of promotion, prevention, and treatment programs to help establish priorities in multipronged suicide prevention strategies.

Methods:

Psychological autopsy methods served to collect information on consecutive suicides over 14 months in New Brunswick ( n = 102). A panel of researchers, clinicians, provincial planners, and consumers reviewed the cases and applied a systematic needs assessment procedure to establish interventions and services received, unmet needs at the individual level, and programmatic and systemic shortcomings.

Results:

More than two-thirds of the individuals suffered from a depressive disorder and a similar proportion from substance (essentially alcohol) abuse or dependence; one-half also presented a personality disorder. In the last year, more than one-half had been in contact with a mental health services specialist, but less than 5% had contact with addiction services, though one-third had previous contact in their lifetime. In one-third of the cases, service gaps called for greater coordination and integration of mental health specialists and addiction services within the health care system. In one-half of the cases, system needs were found to be unmet for public awareness efforts aimed at encouraging individuals to consult health and social services professionals, and in terms of training efforts geared to improving detection, treatment, and referral for mental illness, substance-related problems, and suicidal behaviour by primary medical, social, and specialist services.

Conclusion:

This study supports multipronged suicide prevention strategies that should include integrated public promotion, professional development campaigns, and better program coordination. Authorities in New Brunswick have opted to favour the latter strategy component, whose development and application must be evaluated to determine its impact on suicide rates.
The Prevention of Depression in Children and Adolescents: A Review
Authors: Gladstone Tracy RG , Beardslee William R
Published: January 2017

Objective:

To review the recent literature on the prevention of clinical diagnoses of depression in children and adolescents.

Method:

Several preventive intervention programs targeting depressive diagnoses in youth were reviewed. These programs based their prevention strategies on cognitive-behavioural and (or) interpersonal approaches, which have been found to be helpful in the treatment of depression. In addition, family-based prevention strategies were reviewed. Also, nonspecific risk factors for youth depression, including poverty and child maltreatment, were discussed as important considerations in prevention programs targeting youth depression.

Results:

In general, successful prevention programs targeting youth depression are based on evidence-based treatment programs for youth depression, structured and outlined in manuals, involve careful training of personnel implementing the protocols, and include assessment of fidelity to the intervention protocols. The programs were consistent with cognitive-behavioural and (or) interpersonal psychotherapy traditions. Overall, it appears that there is reason for hope regarding the role of interventions in preventing depressive disorders in youth.

Conclusions:

Several new directions for future research on the prevention of depression in youth were outlined. Future research is needed to establish an empirical base for the prevention of depression in high-risk youth and should: focus on targeted and indicated prevention approaches, attend to moderators of intervention effects, include approaches that aim to enhance the family environment, attend to nonspecific risk factors for disorder, and focus on the dissemination phase of prevention research.
Using the Conners' Teacher Rating Scale—Revised in School Children Referred for Assessment
Authors: Charach Alice , Chen Shirley , Hogg-Johnson Sheilah , Schachar Russell J
Published: January 2017

Objective:

Predictive validity of the Conners' Teacher Rating Scale–Revised (CTRS-R) was evaluated against a semi-structured clinical teacher interview in school children referred for diagnostic assessment of attention-deficit hyperactivity disorder (ADHD). We hypothesized that extreme scale values would increase diagnostic certainty and that classification errors would be associated with comorbid conditions.

Method:

Children ( n = 1038), aged 6 to 12 years, were screened using the CTRS-R and their teachers were interviewed. Three levels of T scores on the 3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subscales of the CTRS-R were compared with DSM-IV symptom thresholds by interview. Where subscale scores and interviews showed highest agreement, presence of comorbid disruptive behavioural disorders, reading disability, language impairment, and low IQ were investigated for children classified correctly, compared with incorrectly.

Results:

T scores of 60 and above on all CTRS-R DSM-IV subscales offered high sensitivity, from 91% to 94%. Only on subscales M (hyperactive–impulsive) and N (total) did T scores of less than 60 offer posttest probabilities of less than 10%, confirming that a child does not reach diagnostic threshold by interview. T scores of 80 and more offered high specificity, from 88% to 93%, but did not provide high posttest probabilities that children reach diagnostic criteria. Classification errors were associated with more language impairment among false positives than true positives on the M (18.9%, compared with 11.3%, P = 0.04) and N (19.0%, compared with 9.5%, P = 0.023) subscales, and more reading disabilities among false positives than among true positives on the N subscale (35.2%, compared with 21.6%, P = 0.009).

Conclusions:

The ability of the CTRS-R to predict whether clinically referred children reach DSM-IV criteria for ADHD at school is limited.