bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial Magnetic Stimulation in the Treatment of Mood Disorder: A Review and Comparison with Electroconvulsive Therapy
Authors: Hasey Gary
Published: July 2017

Objective:

To review repetitive transcranial magnetic stimulation (rTMS) as a mode of therapy for depression.

Method:

The following aspects of rTMS were reviewed and compared with electroconvulsive therapy (ECT): history, basic principles, technical considerations, possible mode of action, safety, adverse effects, and effects on mood in both healthy individuals and those suffering from bipolar disorder (BD) or depression.

Results:

rTMS may selectively increase or decrease neuronal activity over discrete brain regions. As a result of this focused intervention with TMS, the potential for unwanted side effects is substantially reduced, compared with ECT. In open trials, rTMS and ECT are reported to be equally efficacious for patients having depression without psychosis, but the therapeutic benefits reported in double-blind sham-rTMS controlled trials are more modest.

Conclusion:

The antidepressant and antimanic effects of rTMS depend on technical considerations such as stimulus frequency, intensity, and magnetic coil placement, which may not yet be optimized. Biological heterogeneity among the patients treated with rTMS may also contribute to differing efficacy across clinical trials. rTMS may possess tremendous potential as a treatment for mood disorder, but this has not yet been realized. rTMS must still be regarded as an experimental intervention requiring further refinement.
Developmental Neurobiology: Implications for Pediatric Psychopharmacology
Authors: Carrey Normand
Published: July 2017

Pediatric psychopharmacology can only be properly understood within the context of developmental neurobiology. Normal maturation of the brain is characterized by the complex anatomic, molecular, and organizational changes required for optimal adaptive functioning. In many areas of the developing nervous system, neurons, cell processes, neurotransmitters, and trophic nerve growth factors are produced in far greater numbers and in different areas than in the mature brain. Psychopathology and stressful environments can lead to enduring changes in brain structure and functioning. A few select psychopharmacological treatments are reviewed to assess their potential impact on CNS development. More clinical and basic science studies are needed to determine whether current treatments have neurotoxic or neuroprotective effects when administered over extended critical early periods of the lifespan.

La psychopharmacologie pédiatrique ne peut être bien comprise que dans le contexte de la neurobiologie du développement. La maturation normale du cerveau est caractérisée par les changements anatomiques, moléculaires et organisationnels complexes nécessaires à l'apprentissage fonctionnel optimal. Dans de nombreuses zones du système nerveux en développement, les neurones, les transformations des cellules, les neurotransmetteurs et les facteurs de croissance du nerf trophique sont produits en bien plus grand nombre que dans le cerveau parvenu à maturité, et dans des secteurs différents. La psychopathologie et les milieux stressants peuvent entraîner des changements permanents de la structure et du fonctionnement du cerveau. Quelques traitements psychopharmacologiques choisis sont examinés pour en évaluer l'effet potentiel sur le développement du système nerveux central. D'autres études cliniques et scientifiques fondamentales sont nécessaires pour déterminer si les traitements actuels ont des effets neurotoxiques ou neuroprotecteurs, lorsqu'on les administre sur une période prolongée durant les premières phases critiques de la durée de vie.
Predictors of Success and Satisfaction in the Practice of Psychiatry: A Preliminary Follow-up Study
Authors: Garfinkel Paul E , Bagby R Michael , Schuller Deborah R , Williams Charmaine C , Dickens Susan E , Dorian Barbara
Published: July 2017

Background:

Few studies have examined the predictors of psychiatrists' perceived success and personal satisfaction with their careers. The present study examines self-reported success and personal satisfaction with their careers in a cohort of psychiatrists followed for more than 20 years.

Methods:

A total of 29 psychiatrists, all of whom had participated in a study during their residency 21 to 24 years earlier, completed a self-report questionnaire. The first set of questions addressed the type and characteristics of their professional practice; the second set assessed aspects of their nonprofessional practice; and the third set assessed aspects of their nonprofessional, personal lifestyles. The personality traits of neuroticism and extraversion were assessed during the residency years and were used as predictors. Composite measures of self-perceived external success and personal satisfaction were computed. Regression models were constructed to determine the best predictors of these composite measures.

Results:

Neuroticism proved to be a significant predictor of external success but not of personal satisfaction, with higher scores predicting a lower rating of perceived external success. There were 2 practice characteristics—involvement with research and practising from an orientation other than psychoanalytic—that predicted perception of success. One personal lifestyle characteristic—the perception that one's nonprofessional life sustained professional life—also predicted perception of success. The best predictor of personal satisfaction was overall satisfaction with nonprofessional aspects of life.

Conclusions:

Personality, nonprofessional social support, and engaging in research are associated with greater perceived success and personal satisfaction with a career in psychiatry.
Association of QEEG Findings with Clinical Characteristics of OCD: Evidence of Left Frontotemporal Dysfunction
Authors: Tot Şenel , Özge Aynur , Çömelekoğlu Ülkü , Yazici Kemal , Bal Nilgün
Published: July 2017

Objective:

Our objectives were 1) to determine hemispheric asymmetry and regional differences on the EEGs of patients with obsessive–compulsive disorder (OCD); and 2) to investigate the effects of sex, treatment response, illness duration, and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores on quantitative electroencephalographic (QEEG) measurements.

Method:

We recorded EEGs (12-channel) from 22 unmedicated patients with OCD but no depression and from 20 age- and sex-matched control subjects. All patients and control subjects underwent detailed neurological and psychiatric evaluations including the Hamilton Depression Rating Scale (HDRS) and Y-BOCS.

Results:

QEEG revealed higher frequencies of slow-wave bands and lower frequencies of alpha activity at predominantly left frontotemporal localization in patients with OCD, compared with control subjects. Analysis of variance of QEEG parameters and clinical characteristics showed that sex had a significant effect on delta and alpha frequencies of frontotemporal areas during hyperventilation (HV). Increasing total Y-BOCS score correlated positively with increased frequencies of right parietal delta activity and decreased frequencies of right frontotemporal alpha activity during HV. A significantly increased left frontal slow-wave activity and decreased beta activity during HV in treatment responders led us to consider that frontal lobe functions were better in this group of patients. Illness duration had no important effect on QEEG.

Conclusion:

Patients with OCD showed important frontotemporal dysfunction, predominantly in the left hemisphere. This was particularly evident in female subjects and in treatment responders. QEEG may be beneficial in understanding the neurobiological basis of OCD.
Ecstasy and Drug Consumption Patterns: A Canadian Rave Population Study
Authors: Gross Samantha R , Barrett Sean P , Shestowsky John S , Pihl Robert O
Published: July 2017

Objective:

This study investigates the drug consumption patterns of a sample of rave attendees in the city of Montreal, Quebec, and seeks to identify the prevalence of 3,4-methylendioxymethamphetamine (MDMA) and other drug use in this population.

Method:

We administered a self-report questionnaire to 210 respondents. For various licit and illicit substances, participants reported their age of first use, number of lifetime uses, and usage in the previous 30 days.

Results:

We found a significant rank order for the sequence of first use: 1) alcohol, 2) nicotine, 3) cannabis, 4) LSD, 5) psilocybin, 6) amphetamine, 7) cocaine, 8) MDMA, 9) gamma-hydroxybutyrate (GHB), 10) ephedrine, 11) ketamine. Alcohol and cannabis were the most commonly used substances, both in cumulative number of lifetime uses and in usage in the preceding 30 days. MDMA and amphetamine were also notable as the next 2 most popular drugs for use in the preceding 30 days and in terms of those who had tried the drugs at least once. We identified a progressive rank order of experimentation, with early alcohol or cannabis use (or both) associated with the early use of all other drugs tried by more than 25% of the sample. We found MDMA and amphetamine use to be prevalent, as was general experimentation with all drugs studied, other than heroin.

Conclusion:

Drug consumption levels were substantial in this “rave” population, particularly with respect to recent use of MDMA, amphetamine, cannabis, and alcohol. Results also indicate that the sequence of drug experimentation in this population follows an identifiable pattern.
Evidence That Latitude is Directly Related to Variation in Suicide Rates
Authors: Davis George E , Lowell Walter E
Published: July 2017

Objective:

To use available suicide-rate data from 20 countries to see patterns and relations more clearly.

Method:

We obtained raw suicide rates from the Organization for Economic Cooperation and Development (OECD) database from 1960 through 1997 and calculated averages and standard deviations.

Results:

There is a positive linear relation between the variation in suicide rate and geographic latitude.

Conclusions:

The variation in light-dark cycles is superimposed upon human mood.
Breaking the Myths: New Treatment Approaches for Chronic Depression
Authors: Michalak Erin E , Lam Raymond W
Published: July 2017

Background:

Chronic depressive disorders are common, accounting for approximately one-third of all cases of depression and posing a major public health problem. In the past, chronic depression has been thought to be treatment-resistant, and evidence suggests that it is currently underdiagnosed, misdiagnosed, and suboptimally treated.

Objectives:

To review the subtypes of chronic depression and the evidence-base concerning their optimal treatment and to discuss some key clinical issues and areas of future research.

Methods:

We identified key studies and randomized controlled trials (RCTs) by systematically searching electronic databases and hand searching specialist journals and bibliographies.

Results:

Chronic depressive disorders respond well to standard pharmacologic interventions in the acute and maintenance phases of treatment. Standard psychotherapies alone may not be efficacious for chronic depression (especially dysthymia). Recent evidence suggests that treatment combining psychotherapy and medications may be superior to either treatment alone.

Conclusions:

Chronic depressive disorders are amenable to treatment, provided that intervention is both thorough and intensive. Although our knowledge about the optimal treatment of chronic depression has developed rapidly, changes in clinical practice have been slower to evolve. Further research is required to assess the effectiveness of multimodal interventions for chronic depression in more naturalistic settings.
Proton Magnetic Resonance Spectroscopy of the Hippocampus and Occipital White Matter in PTSD: Preliminary Results
Authors: Villarreal Gerardo , Petropoulos Helen , Hamilton Derek A , Rowland Laura M , Horan William P , Griego Jacqueline A , Moreshead Margaret , Hart Blaine L , Brooks William M
Published: July 2017

Objective:

Previous proton magnetic resonance spectroscopy (1H-MRS) studies in posttraumatic stress disorder (PTSD) report decreased hippocampal N-acetylaspartate (NAA), an indicator of neuronal integrity. However, other areas of the brain need to be explored. The objective of this study was to investigate the specificity of hippocampal NAA concentration changes in PTSD by also examining a control region, the occipital white matter (OWM).

Methods:

Eight patients with PTSD and 5 control subjects underwent single-voxel 1H-MRS of the hippocampi and bilateral OWM. Absolute neurometabolite concentrations were determined.

Preliminary Results:

Trends toward reduced left hippocampal NAA and creatine (Cre) were found in the PTSD group. PTSD subjects also had reduced bilateral OWM Cre.

Conclusions:

The preliminary results of our study in civilians with PTSD replicate previous MRS studies and are consistent with decreased hippocampal neuronal integrity without effects in the OWM. Replication of our findings is needed.
Lamotrigine Use in Geriatric Patients with Bipolar Depression
Authors: Robillard Matthew , Conn David K
Published: July 2017

Objective:

To study the effectiveness of adding lamotrigine to the treatment of inpatient geriatric patients with bipolar disorder (BD) who were in the depressed phase and had been on lithium and valproate for at least 3 months.

Method:

Lamotrigine was started at 25 mg given at bedtime, with weekly incremental increases of 12.5 mg daily until a total dosage of either 75 mg or 100 mg was obtained. Improvement was measured by clinical interview and Hamilton Depression Rating Scale (HDRS) scores. Patients were reassessed at 6 weeks, and if their HDRS score had decreased by at least 50%, they were considered to have improved.

Results:

The study group comprised 5 women with an average age of 71.5 years (range 65 to 85). Four had rapid-cycling BD, and 1 had mixed BD. All patients had early age of onset, as judged by their first contact with a psychiatrist or their first hospitalization. The average initial HDRS score was 27 (range 20 to 35). Of the patients, 3 out of the 5 had remission of symptoms, as judged by clinical interview and reduction of their HDRS score by 50%. At 3 month follow-up, these 3 patients had not required rehospitalization and were doing well. Lamotrigine was well tolerated, and none of the patients developed a rash. One patient did develop coarse hand tremor that improved when the lamotrigine dosage was decreased.

Conclusions:

Lamotrigine in conjunction with lithium and valproate may be effective in treating geriatric patients with BD and depression.
Dissolution Profile, Tolerability, and Acceptability of the Orally Disintegrating Olanzapine Tablet in Patients with Schizophrenia
Authors: Chue Pierre , Jones Barry , Taylor Cindy C , Dickson Ruth
Published: July 2017

Objectives:

This pilot study investigates the dissolution profile, tolerability, and acceptability of an orally disintegrating olanzapine tablet in patients with schizophrenia.

Method:

Eleven patients with schizophrenia stabilized on oral olanzapine (mean dosage 12.7 mg daily [SD5.2]) were given an orally disintegrating olanzapine tablet, rather than their usual tablet, daily for 7 days. At each visit, visual assessments were made for elapsed time to initial disintegration (every 15 seconds) and complete disintegration (every 1 minute). At the end of the study, patients completed a drug-acceptance questionnaire.

Results:

The mean time to initial disintegration was 15.78 seconds, and mean time to complete disintegration was 0.97 minutes. All patients found the orally disintegrating tablet acceptable and expressed positive comments. Nonserious clinically significant adverse events, asthenia, purpuric rash, headache, depression, and insomnia (preexisting, except for asthenia and insomnia) were reported in 3 patients.

Conclusion:

The orally disintegrating olanzapine tablet disintegrates rapidly and is a well-tolerated and acceptable alternative to standard olanzapine tablets in patients with schizophrenia.
The National Survey of Mental Health and Well-Being in Australia: Impact on Policy
Authors: Henderson Scott
Published: July 2017

Objective:

To provide a synopsis of the 3-part National Survey of Mental Health and Well-Being in Australia and to examine the yield in terms of policy and other changes in mental and general health services.

Method:

Published data are examined, and a commentary is provided on service-delivery issues that the data have revealed.

Results:

One-year prevalence estimates for the common mental disorders, defined according to ICD-10 criteria and assessed using the automated version of the Composite International Diagnostic Interview (CIDI-A), have indicated rates similar to those of other countries (17.7%). Alarmingly high rates were found for alcohol and substance abuse in young persons, especially among young men. The number of years of life lost owing to disability attributable to mental disorders exceeds the number lost owing to cardiovascular disease and cancer. Only 35% of persons with 1 or more of the common mental disorders had sought help in the 12 months prior to interview. The point prevalence for mental health problems was 14% for persons aged 4 to 17 years. The point prevalence for psychotic disorders was 4.7 per 1000. An encouraging finding is that 81% of affected individuals had been to their general practitioner (GP) in the last year. However, only 20% had participated in any rehabilitation program in the past year.

Conclusions:

The Survey results are based on a national population sample, not on individuals reaching services. They have therefore proved to be of great value in influencing policy at federal and state levels and may have contributed to increased funding for both services and research.
Child Psychiatric Epidemiology and Canadian Public Policy-Making: The State of the Science and the Art of the Possible
Authors: Waddell Charlotte , Offord David R , Shepherd Cody A , Hua Josephine M , McEwan Kimberley
Published: July 2017

Epidemiological studies have characterized the high burden of suffering that child psychiatric disorders cause—14% of children (1.1 million in Canada) have clinically important disorders at any given time. In this review, we summarize the recent research and discuss several unresolved scientific issues that must be addressed to make epidemiology more useful to policy-makers. We then discuss implications for policy-making to improve children's mental health outcomes. Overall, given the high prevalence rates, increasing clinical services alone will not suffice; rather, a multifaceted mix of strategies is required.
Counsellors in Primary Care: Benefits and Lessons Learned
Authors: Kates Nick , Crustolo Anne-Marie , Farrar Sheryl , Nikolaou Lambrina
Published: July 2017

Objective:

To describe a program that integrates mental health counsellors within primary care settings, to present data on the program's impact, and to discuss lessons learned that may apply in other communities.

Methods:

This paper describes a Canadian program that brings counsellors and psychiatrists into the offices of 87 family physicians in 36 practices in a community of 460 000 in Southern Ontario. It describes the goals and organization of the program and the activities of counsellors when working in primary care. In addition, it summarizes data from the program's evaluation, including demographic data and the individual problems seen and services delivered (all from the program's database) as well as data on patient outcomes using the General Health Questionnaire (GHQ), the Centre for Epidemiological Studies Depression (CESD) Rating Scale, and consumer-satisfaction questionnaires.

Results:

Each counsellor sees an average of 161 new cases yearly. The major problems are depression, anxiety, and family problems. In fact, over 70% of individuals who are seen show significant improvements in outcomes. The program has led to a significant increase in access to mental health services, a reduction in the use of traditional mental health services, high levels of satisfaction with counsellors and family physicians, and significant improvements in symptoms and functioning of individuals seen.

Conclusion:

This program has effectively integrated counsellors within primary care settings, increasing the capacity of primary care to handle mental health problems, strengthening links between providers from different sectors, and making mental health care more accessible.
Neuropsychological Performance in DSM-IV ADHD Subtypes: An Exploratory Study with Untreated Adolescents
Authors: Schmitz Marcelo , Cadore Luciana , Paczko Marcelo , Kipper Letícia , Chaves Márcia , Rohde Luis A , Moura Clarissa , Knijnik Márcia
Published: July 2017

Objective:

To explore neuropsychological performance in untreated Brazilian adolescents suffering from attention-deficit hyperactivity disorder (ADHD).

Method:

We assessed 30 untreated adolescents with ADHD and 60 healthy control subjects, aged 12 to 16 years, using a neuropsychological battery including the Wisconsin Card-Sorting Test (WCST), the Stroop Test (ST), the Digit Span, and the Word Span.

Results:

We found neuropsychological differences among the DSM-IV ADHD subtypes. Adolescents with the predominantly inattentive subtype (ADHD-I) performed more poorly than did control subjects on both the Digit Span and the ST. On both the Digit Span and the WCST, adolescents with the combined subtype (ADHD-C) presented significantly more impairments than did control subjects. Adolescents with the predominantly hyperactive-impulsive type (ADHD-HI) did not differ significantly from the control subjects in any measure assessed, but had a better performance than did those with ADHD-C on both the Digit Span and the WCST. In addition, adolescents with ADHD-HI performed better on the ST than did adolescents with ADHD-I.

Conclusions:

These findings suggest cognitive differences among ADHD subtypes, supporting the diagnostic distinction among them. Adolescents with ADHD-HI do not seem to have significant cognitive deficits.
Benefits of Switching from Typical to Atypical Antipsychotic Medications: A Longitudinal Study in a Community-Based Setting
Authors: Cook Peter E , Goldberg Joel O , Van Lieshout Ryan J
Published: July 2017

Objective:

This study examines the clinical and resource utilization effects of switching stable outpatients with schizophrenia from a typical to an atypical antipsychotic medication.

Method:

We monitored 43 schizophrenia patients from a community mental health program who tolerated switching from typical to atypical antipsychotic medications. We used the Positive and Negative Syndrome Scale (PANSS), Lehman Quality of Life Interview (QOL), and service utilization data for 2 years before and 2 years after the switch.

Results:

The switch to atypical antipsychotics was associated with significant improvements in positive symptoms, in general psychopathology, and in quality of life. Resource requirements, including case-management and crisis services and hospitalization days, were significantly reduced. We observed no changes in the sample's already low levels of negative symptoms.

Conclusions:

In stable outpatients with schizophrenia in a real-world setting, switching to an atypical antipsychotic can result in sustained, significant improvement in clinical response and quality of life, as well as in reduced need for hospitalization and community support,.
Posttraumatic Symptoms and Disability in Paramedics
Authors: Regehr Cheryl , Goldberg Gerald , Glancy Graham D , Knott Theresa
Published: July 2017

Objective:

The concern that secondary gain may result in an overreporting of trauma symptoms in those seeking compensation or taking stress leave from work has raised questions about the relation between posttraumatic stress and disability. This study attempts to examines the relation between traumatic stress symptoms and the use of work leave in an anonymous sample of emergency-service workers who are not currently seeking compensation.

Method:

A total of 86 paramedics completed questionnaires that addressed exposure to traumatic events, use of mental health stress leave, social support, current level of distress, and personality patterns. Comparisons were made between groups who had used mental health stress (MHS) leave and those who had not. Logistic regression was used to determine the best predictors of using leaves.

Results:

Current levels of social support were associated with previous use of mental health stress leave. In addition, significantly more individuals who had taken MHS leave in the past reported posttraumatic stress symptoms in the high or severe range. People with personality patterns characterized by suspiciousness, hostility, and isolation and having a tendency toward demanding, controlling, and manipulative behaviour in relationships were also more likely to have taken an MHS leave.

Conclusion:

Although social support and trauma symptoms were associated with the use of MHS leave, in this study, personality style was the strongest factor differentiating those individuals who took MHS leave from those who did not.
Validation of a French Version of the Impact of Event Scale-Revised
Authors: Brunet Alain , St-Hilaire Annie , Jehel Louis , King Suzanne
Published: July 2017

Objective:

This report presents a French translation and validation of the Impact of Event Scale-Revised (IES-R) in a population of women exposed to a natural disaster during or preceding pregnancy.

Method:

A total of 223 francophone women who were either pregnant at the time of the 1998 ice storm or who became pregnant shortly thereafter completed the IES-R and other questionnaires 6 months after the disaster.

Results:

The French IES-R has good internal consistency, with alpha coefficients ranging from 0.81 to 0.93 for its 3 subscales and total score. The test–retest reliability of the scale, although examined with another sample, proved to be satisfactory, with correlation coefficients ranging from 0.71 to 0.76 for its 3 subscales and total score. Its convergent validity with perceived life threat and general psychiatric symptoms was judged to be marginally acceptable. Finally, a principal components analysis was conducted and a 3-factor solution, which explained 56% of the variance, was retained: a hyperarousal factor (7 items), an avoidance factor (6 items), and an intrusion factor (6 items).

Conclusions:

The French version of the IES-R has satisfactory internal validity and test–retest reliability. Further, the factor structure of the translation was similar to the proposed theoretical structure of the IES-R.
Differentiating Symptoms of Complicated Grief and Depression among Psychiatric Outpatients
Authors: Ogrodniczuk John S , Piper William E , Joyce Anthony S , Weideman Rene , McCallum Mary , Azim Hassan F , Rosie John S
Published: July 2017

Objective:

This study examined whether dimensions of complicated grief (CG) could be distinguished from dimensions of depression and whether these dimensions were differentially affected by group psychotherapy for CG.

Method:

A total of 398 psychiatric outpatients who had experienced one or more significant death losses provided ratings on standard measures of grief and depression. Factor analysis of the 56 items from these measures was used to explore the possibility that grief and depression symptoms would form separate dimensions of distress. Subsamples of the patients also participated in 1 of 2 forms of short-term group therapy for CG. Repeated-measures analysis of variance and calculation of effect sizes were performed to examine changes in the dimensions following treatment.

Results:

The grief items formed 3 distinct clusters representing different dimensions of CG. None of the depression items loaded highly on these grief dimensions. The depression items formed 2 distinct clusters. Two of the grief dimensions demonstrated the most improvement following group therapy that addressed CG. There was also evidence for differential effectiveness of the 2 forms of group therapy.

Conclusions:

When assessing psychiatric patients who have death losses, clinicians should consider different types of grief reactions. Different types of grief reactions may be responsive to different treatments. In the absence of depressive symptoms, clinicians should not assume the absence of CG.
Filicidal Women: Jail or Psychiatric Ward?
Authors: Laporte Line , Poulin Bernard , Marleau Jacques , Roy Renée , Webanck Thierry
Published: July 2017

Objective:

This study aims to examine the legal procedure that women who are charged with killing their children experience and to compare the variables that discriminate between those found guilty and those who received a medical disposition.

Method:

The sample comprises 32 adult women who killed their biological children in the province of Quebec over an 11-year period (1981 to 1991).

Results:

Of the sample, 18 women were found guilty, and 14 received a medical disposition. Of those who were the object of a penal disposition, most received a sentence that exceeded 2 years. Women who were sentenced to prison had a lower socioeconomic status and, compared with those who received a medical disposition, were more likely to have had a criminal and substance abuse history. Further, this latter subgroup of women were more likely to have a psychiatric history, to suffer from psychotic symptoms, and to become oriented to the mental health system immediately after their offence.

Conclusions:

These comparative results suggest that women's profiles differ according to some descriptive variables. From a clinical point of view, however, these results do not suggest that a different approach with respect to treatment of filicidal women or prevention of filicide would be more appropriate.
A Multicentre Prospective Controlled Study to Determine the Safety of Trazodone and Nefazodone Use during Pregnancy
Authors: Einarson Adrienne , Bonari Lori , Voyer-Lavigne Sharon , Addis Antonio , Matsui Doreen , Johnson Yvette , Koren Gideon
Published: July 2017

Objectives:

Trazodone and nefazodone are phenylpiperazine antidepressants. Currently, there are no adequate, well-controlled studies on the fetal safety of these drugs. Our primary objective was to determine whether the use of trazodone or nefazodone during pregnancy is associated with an increased risk for major malformations. Secondary outcomes of interest included rates of spontaneous and therapeutic abortions, rates of premature labour, and birth weight.

Methods:

Pregnant women from 5 centres who had been exposed to these drugs ( n = 147) were enrolled in the study during their first trimester. We compared the women with 2 groups of women who took either other antidepressant drugs ( n = 147) or nonteratogenic drugs ( n = 147). All the women were followed up after delivery to ascertain pregnancy outcome and the health of the baby

Results:

We have completed 147 follow-ups. There were 121 (82.4%) live births, 20 (13.6%) spontaneous abortions, and 6 (4%) therapeutic abortions. Of the live births, there were 2 (1.6%) major malformations. In all cases, drug exposure occurred during the first trimester, with 52 (35%) of the women using these drugs throughout pregnancy. The mean gestational age at birth was 38 weeks (SD 4.2), and the mean birth weight was 3306.34 g (SD 655). We found no statistically significant differences among the 3 groups in any of the endpoints of interest that we examined. Of the sample, 58 women were exposed to trazodone, and 89 were exposed to nefazodone.

Conclusion:

Our results suggest that these drugs do not increase the rates of major malformations above the baseline rate of 1% to 3%.
Clozapine Treatment in Patients with Prior Substance Abuse
Authors: Kelly Deanna L , Gale Elizabeth A , Conley Robert R
Published: July 2017

Objective:

This study examined outcomes following discharge on clozapine for treatment-resistant schizophrenia patients with and without diagnosed substance abuse histories.

Methods:

Those discharged on clozapine from a research unit between April 1991 and March 1996 were followed with respect to hospitalization status. Of the treatment-resistant patients with schizophrenia, 19 were diagnosed as individuals with substance abuse, while 26 patients had no history of abuse. Patients were openly treated with clozapine and were included in the study if they were stabilized and discharged on the medication.

Results:

Patients who had histories of abuse exhibited a better treatment response and a lower total Brief Psychiatric Rating Scale (BPRS) score at discharge, compared with the non–substance abuse group. One-year readmission rates were 21% and 23% in patients with and without prior substance abuse histories, respectively ( P = ns).

Conclusions:

Clozapine may be a therapeutic option for the dually diagnosed population and may offer benefits to patients with schizophrenia who have a history of substance abuse.
Why Should Researchers Care about Culture?
Authors: Beiser Morton
Published: July 2017

Analysis of the existing literature together with case experience reveals at least 4 implications of culture for the conduct of mental health research. Culture helps define the field of study, assists in identifying research gaps, shapes research paradigms, and supports the evolution of a cosmopolitan view of mental health.
Spirituality and Religion in Canadian Psychiatric Residency Training
Authors: Grabovac Andrea D , Ganesan Soma
Published: July 2017

Objective:

Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training.

Methods:

We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry.

Results:

We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision.

Conclusion:

Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.
Essential Fatty Acids and the Brain
Authors: Haag Marianne
Published: July 2017

Objective:

To review the role of essential fatty acids in brain membrane function and in the genesis of psychiatric disease.

Method:

Medline databases were searched for published articles with links among the following key words: essential fatty acids, omega-3 fatty acids, docosahexanoic acid, eicosapentanoic acid, arachidonic acid, neurotransmission, phospholipase A2, depression, schizophrenia, mental performance, attention-deficit hyperactivity disorder, and Alzheimer's disease. Biochemistry textbooks were consulted on the role of fatty acids in membrane function, neurotransmission, and eicosanoid formation. The 3-dimensional structures of fatty acids were obtained from the Web site of the Biochemistry Department, University of Arizona (2001).

Results:

The fatty acid composition of neuronal cell membrane phospholipids reflects their intake in the diet. The degree of a fatty acid's desaturation determines its 3-dimensional structure and, thus, membrane fluidity and function. The ratio between omega-3 and omega-6 polyunsaturated fatty acids (PUFAs), in particular, influences various aspects of serotoninergic and catecholaminergic neurotransmission, as shown by studies in animal models. Phospholipase A2 (PLA2) hydrolyzes fatty acids from membrane phospholipids: liberated omega-6 PUFAs are metabolized to prostaglandins with a higher inflammatory potential, compared with those generated from the omega-3 family. Thus the activity of PLA2 coupled with membrane fatty acid composition may play a central role in the development of neuronal dysfunction. Intervention trials in human subjects show that omega-3 fatty acids have possible positive effects in the treatment of various psychiatric disorders, but more data are needed to make conclusive directives in this regard.

Conclusion:

The ratio of membrane omega-3 to omega-6 PUFAs can be modulated by dietary intake. This ratio influences neurotransmission and prostaglandin formation, processes that are vital in the maintenance of normal brain function.
Symptom Outcome 1 Year after Admission to an Early Psychosis Program
Authors: Addington Jean , Leriger Erin , Addington Donald
Published: July 2017

Objective:

To determine the change in positive, negative, and depressive symptoms after 1 year in an early psychosis program.

Method:

One hundred and eighty subjects were included from the first 257 admissions for a first episode of psychosis to a comprehensive early psychosis program. Most had a diagnosis of schizophrenia or schizophreniform disorder. Subjects were assessed on admission to the program and at 3, 6, and 12 months after admission. All 180 subjects completed the 1-year assessment. Assessment measures included the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia.

Results:

There was a clinically and statistically significant improvement in positive symptoms by 3 months, depression increased at 3 months but significantly improved by 12 months, and negative symptoms changed little over the first year.

Conclusions:

The differential changes in symptoms in the first year after admission have implications for treatment.
The Canadian Psychiatric Association Practice Profile Survey: I. Methods and General Sample Characteristics
Authors: Lin Elizabeth , Woodside D Blake , Rhodes Anne
Published: July 2017

Objective:

To describe the rationale, methodology, and general sample characteristics of the Canadian Psychiatric Association (CPA) practice profile survey, a national survey of psychiatrists and psychiatric practice.

Method:

Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information—including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition—was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.

Results:

There was a 45.5% response rate. Questionnaires completed by nonpsychiatrists or with a large percentage of missing or incorrect data were eliminated (107 surveys), resulting in a final sample size of 1570. CPA members and those from Western Canada responded at a higher rate to the survey. The results suggest some cause for concern about future manpower shortages. Most psychiatrists practise eclectically, seeing patients across the life-span, and working in both community and institutional settings. The old and the young appear to be underserviced, compared with adults.

Conclusions:

This study represents an important step forward in evaluating the profile and activities of the profession.
The Neurobiology of Suicide and Suicidality
Authors: van Heeringen Kees
Published: July 2017

Objective:

To investigate the current state of knowledge regarding the neurobiology of suicide and suicidality.

Method:

The literature on the neurobiology of suicidality and suicide was reviewed.

Results:

There is clear evidence that the activity of 3 neurobiological systems has a role in the pathophysiology of suicidal behaviour. This includes hyperactivity of the hypothalamo-pituitary-adrenal axis, dysfunction of the serotonergic (5-HTergic) system, and excessive activity of the noradrenergic system. While the first and the last system appear to be involved in the response to stressful events, dysfunction of the serotonergic system is thought to be trait-dependent and associated with disturbances in the regulation of anxiety, impulsivity, and aggression. It can be hypothesized that neurobiological dysfunctions mediate the occurrence of suicidal behaviour through the disturbed modulation of basic neuropsychological functions.

Conclusion:

Increasing insight into the neurobiological basis of suicidal behaviour suggests that serotonin (5-HT) agonists have an important role in the treatment and prevention of suicidal behaviour. Studies of the efficacy of such drugs have, however, been disappointing. Because suicidal behaviour continues to be a major public health problem, further study is clearly needed, including research on the effect of combined pharmacologic and psychotherapeutic approaches.
Structured Interview Assessment of Symptoms and Concerns in Palliative Care
Authors: Wilson Keith G , Graham Ian D , Viola Raymond A , Chater Susan , de Faye Barbara J , Weaver Lynda A , Lachance Julie A
Published: July 2017

Objective:

Assessment in palliative care requires a multidimensional review of physical symptoms and psychosocial concerns in a format appropriate for patients with advanced illness. In this study, we describe the initial development and validation of a structured interview for assessing common symptoms and concerns faced by terminally ill individuals.

Method:

We constructed a 13-item Structured Interview for Symptoms and Concerns (SISC) based on a review of end-of-life issues and administered it to 69 patients receiving palliative care for advanced cancer. Along with the interview, each participant completed visual analog scales (VAS) addressing the same constructs. Test–retest and interrater reliability were determined, as was the concordance between interview ratings and VAS scores.

Results:

Overall, the interview items had excellent interrater reliability (intraclass correlations were > 0.90) and at least moderate temporal stability (test–retest correlations ranged from 0.50 to 0.90). Concurrent validity was evident in the good concordance between interview items and VAS measures (correlations were > 0.70). The SISC was also sensitive to individual differences between subgroups of participants who did or did not meet diagnostic criteria for anxiety or depressive disorders.

Conclusions:

This study demonstrates that structured interviews provide a reliable and valid approach to assessment in palliative care and may be an appropriate alternative for some research applications.
Palliative Care for Families: Remembering the Hidden Patients
Authors: Kristjanson Linda J , Aoun Samar
Published: July 2017

Families of patients receiving palliative care are profoundly affected by the challenges of the illness. They observe care that the patient receives, provide care for the patient, and receive support from health professionals in the form of information, counselling, or practical assistance. As they witness and participate in the patient's care, they judge the quality of care that the patient receives. They often see themselves as the patient's care advocates and may harbour regret and guilt if they believe that the patient did not have the best possible care. The illness experience profoundly affects family members' psychological and physical health; recognition of this has coined the term “hidden patients.” This article briefly synthesizes empirical work that suggests how to best support families in a palliative care context. We discuss how to define the family, emphasizing a systems approach to family care. We describe the impact of the illness on the family in terms of family members' health, family communication issues, psychological issues, needs for information, physical care demands, and family costs of caring.
Psychological Effects of the SARS Outbreak in Hong Kong on High-Risk Health Care Workers
Authors: Chua Siew E , Cheung Vinci , Cheung Charlton , McAlonan Grainne M , Wong Josephine WS , Cheung Erik PT , Chan Marco TY , Wong Michael MC , Tang Siu W , Choy Khai M , Wong Meng K , Chu Chung M , Tsang Kenneth WT
Published: July 2017

Objective:

To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs).

Method:

We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience.

Results:

Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures.

Conclusions:

In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.
Validation de la Version française du Questionnaire de Sociotropie-Autonomie de Beck et collègues
Authors: Husky Mathilde M , Grondin Olivier S , Compagnone Philippe D
Published: July 2017

Objectifs:

L'objectif de cette étude est la validation de la version française du “Sociotropy- Autonomy Scale” (SAS) de Beck et collègues. Le SAS est un autoquestionnaire de 60 items divisé en 2 dimensions mesurant la sociotropie et l'autonomie.

Méthode:

Mille vingt-huit étudiants ont rempli le SAS, dont 140 ont conjointement rempli le “Personal Style Inventory-Revised” de Robins et collègues, et 75 ont repassé le SAS à 3 mois d'intervalle.

Résultats:

L'analyse factorielle en composante principale effectuée sur les 60 items a permis de dégager 2 dimensions distinctes: la sociotropie et l'autonomie. Les analyses factorielles appliquées à chaque dimension ont permis l'identification de 6 sous-dimensions comme dans l'outil original.

Conclusion:

La version française présente des qualités psychométriques et conceptuelles satisfaisantes et permet l'étude de ces dimensions dans un échantillon francophone. La discussion des résultats porte sur l'adéquation avec la version originale de Beck.