bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective serotonin reuptake inhibitors in the treatment of affective disorders—III. Tolerability, safety and pharmacoeconomics
Authors: Goldstein Burton J. , Goodnick Paul J
Published: January 2017

The clinical use of tricyclic antidepressants (TCAs) is often complicated by toxicity and safety problems due to their effects on multiple mechanisms of action, many of which are unnecessary for therapeutic effect. The development of the selective serotonin reuptake inhibitors (SSRIs), with their selective mode of action, has resulted in a class of antidepressant drugs possessing an improved side-effect profile, while retaining good clinical efficacy. Their introduction into clinical practice has led to enhanced patient compliance with antidepressant therapy and the ability to maintain treatment over longer periods of time at an adequate therapeutic dose. Although, as a result of their selective action, side-effects associated with SSRI therapy are minimised, distinct variations between individual SSRIs in terms of their tolerability profiles have been observed. The wealth of clinical data now available has revealed differences in their potential to cause psychiatric and neurological side-effects, dermatological reactions, anticholinergic side-effects, changes in body weight, sexual dysfunction, cognitive impairment, discontinuation reactions and drug-drug interactions. Patients who suffer from concomitant depression and physical illness may experience different tolerability profiles, in addition to the greater likelihood that they will be receiving concomitant medications with the potential for pharmacokinetic drug-drug interactions with coadministered SSRI therapy. In addition, the safety margin of SSRIs in overdose may vary within the group. Knowledge of the differences that exist among the SSRIs in respect of tolerability and safety will aid physicians in the selection of the most beneficial treatment strategy for their patients. A successful clinical outcome leads to a reduced economic burden for the patient, their family and the healthcare services. Thus, pharmacoeconomic considerations are also important in choosing antidepressant therapy. The SSRIs, despite relatively higher prescription costs, have been demonstrated to be a more cost-effective option than the TCAs. Furthermore, there is evidence that the emerging clinical differences between SSRIs may translate into significantly different economic outcomes within the group.
Selective serotonin reuptake inhibitor efficacy in severe and melancholic depression
Authors: Amsterdam Jay D.
Published: January 2017

Depression with melancholic features appears to be a discrete affective syndrome characterised by profound psychomotor, cognitive and mood disturbances that are qualitatively different from other forms of depression. Some investigators have hypothesised that melancholia may have a neurological basis with psychomotor disturbances associated with selective alterations in dopamine neurotransmission and disturbances in basal ganglia function. A number of studies have examined the role of selective serotonin reuptake inhibitors (SSRIs) in the treatment of melancholia. Although relatively few prospective trials have focused on melancholic depression, several retrospective meta-analyses and trials in populations that are likely to include a high proportion of melancholic patients have provided a wealth of data. While some early studies suggested that SSRIs might be less effective in the treatment of melancholia, the results of these may have been biased and confounded by several side-effects of tricyclic antidepressants (TCAs), which might contribute to their apparent efficacy It appears, however, that the SSRIs may vary among themselves in their apparent efficacy in melancholia. In this regard, sertraline may be more efficacious than other SSRIs and similar to TCAs in the treatment of patients with melancholia. Several studies have suggested that the presence of melancholic features may predict a good response to sertraline, and it has been hypothesised that this may be the result of the relatively potent dopaminergic activity of sertraline, compared with other SSRIs.
Learning at the Interface: Doing Community College Sts Education as if Tomorrow Really Mattered
Authors: Norris Neal A.
Published: January 2017

Though there is a higher and wider significance to life, of what value is our education if we never discover it? We may be highly educated, but if we are without deep integration of thought and feeling, our lives are incomplete, contradictory and torn with many fears; and as long as education does not cultivate an integrated outlook on life, it has very little significance.1 Jiddh Krishnamurti, 1953All education springs from some image of the future. If the image of the future held by a society is grossly inaccurate, its education system will betray its youth.2 Alvin Toffler, 1974
Methylprednisolone as an Intervention Following Myocardial Infarction
Authors: Stubbs Derek F.
Published: January 2017

Results of early studies support the concept that steroid treatment may reduce mortality from acute myocardial infarction. This double-blind, randomized, 1118-patient study was performed to determine if methylprednisolone sodium succinate (MPSS, Solu-Medrol(R) Sterile Powder, The Upjohn Company) reduced 28-day mortality following myocardial infarction complicated by cardiac failure. Treatment with 30 mg/kg intravenous MPSS (maximum dose, 3 g) resulted in 28-day mortality rates of 11.7% with MPSS and 9.9% with placebo when treatment was initiated within six hours of the onset of chest pain (Group 1). Mortality rates at 28 days were 10.4% with MPSS and 14.7% with placebo when the treatment was inititated 6–12 hours after onset of chest pain (Group 2). In the late-treatment group, six-month mortality rates were 13.7% with MPSS and 20.3% with placebo (p=0.08)

Analysis of data by life table methods showed similar survival rates between MPSS- and placebo-treated patients in Group 1. In Group 2, survival rates were increased in MPSS-treated patients in the intervals from 48 hours through seven days (p=0.04) and from three months through six months (p=0.03). A Cox regression analysis showed that the relative risk of death for Group 1 patients was similar, regardless of treatment; Group 2 patients on MPSS had a significantly decreased relative risk of death (p<0.01).

MPSS treatment was not associated with increased incidence of myocardial rupture, cardiac aneurysm, early malignant ventricular arrhythmias, or other adverse cardiac events.
Positive Synergism between Diuretics and Methylprednisolone Following Acute Myocardial Infarction
Authors: Stubbs Derek F
Published: January 2017

In studies of patients with cardiac failure following an acute myocardial infarction, 1114 patients were followed for 7-day mortality. In the 45% of patients receiving diuretics on day 1, the death rate was twice that of patients not receiving diuretics. In patients treated 6 to 12 hours following the onset of chest pain, mortality was 2.8 times that of patients treated within 6 hours of the onset of chest pain. Randomization to methylprednisolone sodium succinate (MPSS, Solu-Medrol(R)Sterile Powder, The Upjohn Company) did not improve the low mortality rates of those patients who did not need diuretics nor who were treated early. However, patients who were treated late and who needed diuretics and who were randomized to MPSS had a death rate half that of those who received placebo.
Post-Acute Myocardial Infarction Symptomatic Pericarditis (PAMISP): Report on a Large Series and the Effect of Methylprednisolone Therapy
Authors: Stubbs Derek F
Published: January 2017

One thousand one hundred and fifty-eight patients sustained a presumed myocardial infarction. Ninety-six per cent of the cases were complicated by ventricular failure. Five hundred and eighty-nine patients were randomized to receive methylprednisolone sodium succinate (MPSS, Solu-Medrol(R)Sterile Powder, The Upjohn Company) (two doses of 2 to 3 g i.v. three hours apart within 12 hours of the onset of chest pain) and 569 to placebo. 7.5% of patients receiving MPSS and 18.5% of the patients on placebo had post-acute myocardial infarction symptomatic pericarditis (PAMISP) (p < 0.001). The MPSS-treated patients needed less therapy for their PAMISP, and MPSS pre-treatment attenuated and limited the PAMISP. Patients who suffered PAMISP did not differ in age or sex from patients without PAMISP, but had a 3-4-fold greater incidence of anterior acute myocardial infarctions (AMIs). The literature is also reviewed to show that MPSS is a beneficial intervention in PAMISP and other pericarditides.
Delineating the Population Served by a Mobile Crisis Team: Organizing Diversity
Authors: Landeen Janet , Pawlick Julie , Rolfe Steven , Cottee Ian , Holmes Melanie
Published: January 2017

Objective:

While mobile crisis teams have proliferated to address gaps in service for individuals with serious mental illness, research into their effectiveness is limited. This study identifies specific cohorts of individuals served by a single mobile crisis team so that appropriate program evaluation could be designed and conducted for each unique grouping.

Method:

This retrospective study analyzes specific data from 4 sets of client records ( n = 401) at 4 different time periods, using a qualitative, text-based approach. For the first 2 reviews ( n = 69 and n = 40), only data related to referral source, sex, details of the reason for referral, and the mental status assessment were known to the researchers. The first 2 sets of records were used to identify the cohorts, the third set was used to confirm these cohorts, and the fourth set was used to determine the reliability of the classification tool.

Results:

All individual cases for the mobile crisis team could be classified into one of the following categories: Symptoms Disturbing Others, Symptoms Disturbing Self, Information Seeking, For Your Information, and Other. After the third review, the cluster, Symptoms Disturbing Others, was subdivided into Symptoms Disturbing Others–General and Symptoms Disturbing Others–Suicide.

Conclusions:

This review was useful in identifying specific cohorts of individuals served by a single mobile crisis team. Clearly identifying who is served by a mobile crisis team is the first step in identifying practice guidelines and appropriate evaluation measures for each distinct group.
The Prevalence of Psychological Morbidity in West Bank Palestinian Children
Authors: Zakrison Tanya L , Shahen Amira , Mortaja Shaban , Hamel Paul A
Published: January 2017

Objective:

To determine the prevalence of psychological morbidity among Palestinian children living in the southern Bethlehem District of the West Bank during July 2000.

Methods:

We undertook a descriptive study using the Rutter A2 (parent) Scale to determine psychological morbidity. This questionnaire comprises 31 questions that were answered by a parent of the 206 subject children (ages 6 to 13 years). We selected subjects based on a multistage, randomized selection of 8 Palestinian villages and their households in the southern region of Bethlehem, West Bank. We used the Gaza Socioeconomic Adversities Questionnaire to determine differences in economic status among families.

Results:

For all families interviewed, the father was employed, none were receiving financial assistance, and all but 1 owned their own house. The results of the Rutter A2 Scale revealed a rate of psychological morbidity (“caseness”) of 42.3% among Palestinian children. The rate for boys was 46.3% and for girls, 37.8%.

Conclusions:

The prevalence of psychological morbidity among Palestinian children in the West Bank was significantly higher (factor of 2; χ2 = 23.26, df 1, P < 0.001), relative to the level of psychological morbidity determined independently for children in Gaza during 2000. We predict that these rates will have increased substantially owing to the escalated violence that began in this region 2 months after we conducted our study. We further predict that children in Israeli settlements in the West Bank will also exhibit elevated levels of psychological morbidity, relative to their counterparts in Israel.
Mental Illness in Disney Animated Films
Authors: Lawson Andrea , Fouts Gregory
Published: January 2017

Objective:

To examine the prevalence of verbalizations about mental illness in the animated feature films of The Walt Disney Company (TWDC). We discuss the results within the context of children's repeated exposure to popular animated movies and their learning of labels and stereotypes associated with mental illness. We recommend further research on this topic.

Method:

We coded 34 animated feature films produced by TWDC for mental illness references (for example, “crazy” or “nuts”). We developed a coding manual to systematize the content analysis, to ensure accuracy of the data, and to ascertain intercoder reliability.

Results:

Most of the films (that is, 85%) contain verbal references to mental illness, with an average of 4.6 references per film. The references were mainly used to set apart and denigrate the characters to whom they referred. Twenty-one percent of the principal characters were referred to as mentally ill. We discuss the contributions and limitations of the study.

Conclusions:

The findings have implications for child viewers in terms of their potentially learning prejudicial attitudes and distancing behaviours toward individuals perceived as being mentally ill. To further verify this connection, an assessment of the incidence of Disney film exposure and attitudes toward people with a mental illness, using a sample of school-aged children, is needed.
Patient Satisfaction with Outpatient Psychiatric Treatment: The Role of Diagnosis, Pharmacotherapy, and Perceived Therapeutic Change
Authors: Hasler Gregor , Moergeli Hanspeter , Bachmann Rosilla , Lambreva Evelina , Buddeberg Claus , Schnyder Ulrich
Published: January 2017

Objective:

To investigate the influence of diagnosis, type of treatment, and perceived therapeutic change on patient satisfaction following psychiatric treatment for nonpsychotic, nonsubstance-related disorders.

Method:

We mailed questionnaires, including Larsen's Client Satisfaction Questionnaire and Grawe's Bern Inventory of Treatment Goals, to outpatients who had undergone 8 or more therapy sessions 1 year following treatment.

Results:

Patients with somatoform, eating, and personality disorders were less satisfied than patients with affective, anxiety, and adjustment disorders. Symptom reduction and changes in the interpersonal domain were important outcomes associated with patient satisfaction. Although pharmacotherapy itself was not related to patient satisfaction, patients who perceived improvements in pharmacotherapy as one of the most important treatment outcomes were less satisfied than others. Preliminary evidence shows that coping with specific problems and symptoms is associated with satisfaction among male patients, whereas changes in the interpersonal domain seem to produce satisfaction among female patients.

Conclusion:

Patient-reported change and diagnostic category appear to play a relevant role in generating patient satisfaction. Further research is needed to clarify the interactions between sex, perceived outcome, and satisfaction.
Beliefs about Schizophrenia in Italy: A Comparative Nationwide Survey of the General Public, Mental Health Professionals, and Patients' Relatives
Authors: Magliano Lorenza , Fiorillo Andrea , De Rosa Corrado , Malangone Claudio , Maj Mario
Published: January 2017

Objective:

This study compared beliefs about the causes, treatments, and psychosocial consequences of schizophrenia in a sample of 714 lay respondents, 465 mental health professionals, and 709 key relatives of patients with this disorder.

Method:

We conducted the survey in 30 Italian geographic areas that we randomly selected after considering location and population density. We used the Questionnaire About Opinions on Mental Illness (QO) to collect data.

Results:

Of those surveyed, 34% of the lay respondents, 20% of the professionals, and 68% of the relatives stated that schizophrenia is exclusively caused by psychosocial factors. Lay respondents' opinions on patients' civil rights and social competence tended to be more similar to those expressed by professionals then to those reported by relatives. Lay respondents differed from the other 2 groups in their beliefs regarding the effectiveness of psychological treatments, patients' unpredictability, and whether patients should be admitted to asylums.

Conclusions:

These results suggest that the general public needs to be better informed about schizophrenia's main characteristics, available treatments, and risk for dangerous behaviours. The existing gap among the study's target populations could be reduced through campaigns aimed at increasing public awareness of the affective and civil rights of patients.
Pattern and Risk Factors for Intentional Drug Overdose in Saudi Arabia
Authors: Al-Jahdali Hamdan , Al-Johani Abdulaziz , Al-Hakawi Ahmad , Arabi Yassen , Ahmed Qanta A , Altowirky Jamal , Moamary Mohamed AL , Binsalih Salih
Published: January 2017

Background:

Attempted suicide by intentional drug overdose is an understudied subject in Saudi Arabia. Saudi Arabia is an Islamic country where suicide or attempted suicide is strictly prohibited. Despite the strong religious and constitutional sanctions against suicide, cases of intentional drug overdose occasionally occur. Our study represents the first attempt to better understand and characterize this sensitive topic.

Methods:

Using a retrospective chart review of patients aged 12 years and over with a diagnosis of intentional drug overdose between 1997 and 1999, we studied the demographic characteristics, the risk factors, the most commonly used drugs, and the resulting morbidities and mortalities of study subjects.

Results:

Most of the patients were young (mean age 22 years, SD 4.6, range 15 to 40 years), and most were Saudi nationals (n = 76; 96%). Eighty percent of the patients were women. The occurrence of intentional drug overdose peaked during the month of September (that is, 20% of total cases). Previous suicide attempts, family conflicts, and psychiatric disorders represented significant risk factors. Single-agent overdose occurred in 30% of the patients, and most of the drugs used were prescribed medications (53%). Acetaminophen represented the most common drug (30%). While some patients required prolonged hospital stay or admission to the intensive care unit, no mortalities occurred.

Conclusions:

Intentional drug overdose is a relatively uncommon reason for hospital admission in Saudi Arabia. This study identifies certain risk factors relevant to the Saudi community and raises awareness about intentional drug overdose.
Posttraumatic Stress Disorder and General Psychopathology in Children and Adolescents following a Wildfire Disaster
Authors: McDermott Brett M , Lee Erica M , Judd Marianne , Gibbon Peter
Published: January 2017

Objective:

To report on the use of the Post Traumatic Stress Disorder Reaction Index (PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) in identifying children and adolescents who may require psychological interventions following exposure to a wildfire disaster.

Method:

Six months after a wildfire disaster, we conducted a school-based program to screen for wildfire-related events, such as exposure to and perception of threat, posttraumatic stress disorder (PTSD), and general psychopathology.

Results:

The screening battery was completed by 222 children (mean age 12.5 years, SD 2.48; range 8 to 18 years). Severe or very severe PTSD was reported by 9.0% of students, while 22.6% scored in the abnormal range on the Emotional Symptoms subscale of the SDQ. Younger children and individuals with greater exposure to and perception of threat experienced higher levels of PTSD and general psychopathology. Female students reported a greater perception of threat but did not report higher levels of PTSD or other symptoms.

Conclusions:

Screening was well received by students, parents, and staff and proved feasible in the postdisaster environment. The PTSD-RI and SDQ demonstrated different individual risk associations and functioned as complementary measures within the screening battery. The identification of children at greatest risk of mental health morbidity enabled service providers to selectively target limited mental health resources.
Using Metaanalysis to Evaluate Evidence: Practical Tips and Traps
Authors: Lam Raymond W , Kennedy Sidney H
Published: January 2017

Although practising evidence-based medicine is the goal of most physicians, it can be a real challenge to sift through the vast body of data to determine the best strategies. Most clinical guidelines regard replicated randomized controlled trials (RCTs), metaanalyses, and systematic reviews as the highest level of evidence to support treatment recommendations. High-quality metaanalyses can overcome many of the drawbacks of individual RCTs and qualitative reviews. They can reduce bias, provide adequate power to demonstrate real differences in outcomes, and resolve the results of inconsistent studies. This paper focuses on basic principles and terms used in metaanalysis, so that clinicians can appropriately evaluate and use their results to guide treatment decisions.
Familial Overlap between Bipolar Disorder and Psychotic Symptoms in a Canadian Cohort
Authors: Rende Richard , Hodgins Sheilagh , Palmour Roberta , Faucher Brigitte , Allaire Jean-François
Published: January 2017

Background:

Although they were once considered separate nosologic entities, there is current interest in the etiologic overlap between bipolar disorder (BD) and schizophrenia. A critical issue concerns the familial basis of the overlap, specifically, the possibility of a distinct familial subtype of BD with psychotic features.

Methods:

We recruited individuals with BD from the community and compared them with a matched group diagnosed with no mental disorder to confirm familial aggregation for BD, schizophrenia, and psychotic symptoms. We then compared BD probands both with and without first-degree relatives with psychotic symptoms on several clinical indicators to determine the specificity of the familial aggregation.

Results:

As expected, there was evidence for familial aggregation of schizophrenia and psychotic symptoms in families having probands with BD. Familial loading for schizophrenia and psychotic symptoms was especially notable in male relatives of female probands with BD. We found no differences in the clinical profile of probands with BD stratified for familial loading for psychotic symptoms.

Conclusions:

Findings from this sample support etiologic theories arguing for a shared but nonspecific genetic etiology for BD and schizophrenia, with psychotic symptoms being a potential key indicator for genetic studies.
Long-Term Medical Conditions and Major Depression: Strength of Association for Specific Conditions in the General Population
Authors: Patten Scott B , Beck Cynthia A , Kassam Aliya , Williams Jeanne VA , Barbui Corrado , Metz Luanne M
Published: January 2017

Background:

The prevalence of major depression (MD) in persons with nonpsychiatric medical conditions is an indicator of clinical need in those groups, an indicator of the feasibility of screening and case-finding efforts, and a source of etiologic hypotheses. This analysis explores the prevalence of MD in the general population in relation to various long-term medical conditions.

Methods:

We used a dataset from a large-scale Canadian national health survey, the Canadian Community Health Survey (CCHS). The sample consisted of 115 071 subjects aged 18 years and over, randomly sampled from the Canadian population. The survey interview recorded self-reported diagnoses of various long-term medical conditions and employed a brief predictive interview for MD, the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression was used to adjust estimates of association for age and sex.

Results:

The conditions most strongly associated with MD were chronic fatigue syndrome (adjusted odds ratio [AOR] 7.2) and fibromyalgia (AOR 3.4). The conditions least strongly associated were hypertension (AOR 1.2), diabetes, heart disease, and thyroid disease (AOR 1.4 in each case). We found associations with various gastrointestinal, neurologic, and respiratory conditions.

Conclusions:

A diverse set of long-term medical conditions are associated with MD, although previous studies might have lacked power to detect some of these associations. The strength of association in prevalence data, however, varies across specific conditions.
Challenges Facing Child Psychiatry in Quebec at the Dawn of the 21st Century
Authors: Breton Jean-Jacques , Plante Marie A , St-Georges Marie
Published: January 2017

Objectives:

This study aimed to identify hospital resources by region, determine human resources by type of service and region, and describe how services generally operate in child psychiatry within the province of Quebec.

Methods:

Data collection took place from May to October 2001. We sent a semistructured questionnaire to all child psychiatry service heads. We collected human resource data and produced organizational charts based on the responses obtained. These charts were forwarded to each of the participating services for validation. We grouped Quebec's 18 social health regions into 3 categories: central (4 regions with 606 370 youths), adjoining (4 regions with 589 750 youths), and peripheral (10 regions with 368 635 youths).

Results:

The response rate was 100%. We identified 35 child psychiatry services: 13 in the central regions, 9 in the adjoining regions, and 13 in the peripheral regions. Overall, we identified 177 short-stay beds, 476 places in day or evening hospitals, and 113 places in day or evening centres. Most of these resources were located in the central regions. Quebec had 138.2 full-time equivalent (FTE) child psychiatrists (69.8% in the central regions) and 706 FTE professionals. At March 31, 2001, 4285 youths were waiting for services.

Conclusions:

We observed a shortage of child psychiatrists and professionals, regardless of the norm used. Adjoining and peripheral regions should have access to a minimal range of human and hospital resources in child psychiatry.
A National Survey of Gambling Problems in Canada
Authors: Cox Brian J , Yu Nancy , Afifi Tracie O , Ladouceur Robert
Published: January 2017

Objective:

The 1990s saw widespread expansion of new forms of legalized gambling involving video lottery terminals (VLTs) in community settings (that is, in bars and restaurant lounges) and permanent casinos in several Canadian provinces. To date, there has never been a national survey of gambling problems with representative interprovincial data. Using a new survey, we sought to compare prevalence figures across the 10 Canadian provinces.

Method:

Using the Canadian Problem Gambling Index, we investigated the current 12-month prevalence of gambling problems in the Canadian Community Health Survey: Cycle 1.2—Mental Health and Well-Being, in which a random sample of 34 770 community-dwelling respondents aged 15 years and over were interviewed. The response rate was 77%. The data are representative at the provincial level and were compared with the availability of VLTs per 1000 population and with the presence of permanent casinos for each province.

Results:

Manitoba (2.9%) and Saskatchewan (also 2.9%) had the highest prevalence of gambling problems (specifically, moderate and severe problem levels combined). These 2 provinces had significantly higher levels than the 2 provinces with the lowest prevalence of gambling problems: Quebec (1.7%) and New Brunswick (1.5%).

Conclusions:

The 12-month prevalence of gambling problems in Canada was 2.0%, with interprovincial variability. The highest prevalence emerged in areas with high concentrations of VLTs in the community combined with permanent casinos. These findings support earlier predictions that the rapid and prolific expansion of new forms of legalized gambling in many regions of the country would be associated with a considerable public health cost.
A Public Health Strategy to Improve the Mental Health of Canadian Children
Authors: Waddell Charlotte , McEwan Kimberley , Shepherd Cody A , Offord David R , Hua Josephine M
Published: January 2017

Mental health problems are the leading health problems that Canadian children currently face after infancy. At any given time, 14% of children aged 4 to 17 years (over 800 000 in Canada) experience mental disorders that cause significant distress and impairment at home, at school, and in the community. Fewer than 25% of these children receive specialized treatment services. Without effective prevention or treatment, childhood problems often lead to distress and impairment throughout adulthood, with significant costs for society. Children's mental health has not received the public policy attention that is warranted by recent epidemiologic data. To address the neglect of children's mental health, a new national strategy is urgently needed. Here, we review the research evidence and suggest the following 4 public policy goals: promote healthy development for all children, prevent mental disorders to reduce the number of children affected, treat mental disorders more effectively to reduce distress and impairment, and monitor outcomes to ensure the effective and efficient use of public resources. Taken together, these goals constitute a public health strategy to improve the mental health of Canadian children.
Principles and Strategies for Treating Personality Disorder
Authors: Livesley W John
Published: January 2017

This paper proposes a systematic framework for treating personality disorder, based on research on the nature and origins of the disorder and treatment outcome. It adopts an eclectic approach that combines interventions from different therapeutic models and delivers them in an integrated and systematic manner. Coordination of multiple interventions is achieved by emphasizing the nonspecific component of therapy, especially the treatment frame and generic interventions. Specific interventions drawn from different treatment models, including medication, are built onto this foundation as needed to tailor treatment to the individual. Coordination and integration are also achieved by conceptualizing treatment as progressing through a series of phases, each addressing different problems with different specific interventions. Five phases are described: safety, containment, regulation and control, exploration and change, and integration and synthesis. During the earlier phases, structured behavioural and cognitive interventions and medication predominate. Later in treatment, these interventions are supplemented with less structured psychodynamic, interpersonal, and constructionist strategies to explore and change maladaptive interpersonal patterns, cognitions, and traits and to forge a more integrated and adaptive self-structure or identity.
Characteristics of Methylphenidate Misuse in a University Student Sample
Authors: Barrett Sean P , Darredeau Christine , Bordy Lana E , Pihl Robert O
Published: January 2017

Objective:

Methylphenidate (MPH) is a prescription stimulant drug with known abuse potential; however, little is known about its patterns of misuse or the characteristics of its abusers.

Methods:

A sample of 50 university students reporting MPH misuse and 50 control subjects matched for age, sex, and ethnicity completed structured face-to-face interviews about their MPH and other drug use. For each substance ever used, they provided information regarding routes of administration and other substances ever coadministered, as well as details about the most recent administration. MPH users provided additional information about their reasons for use and, in 36 cases, about how they obtained the drug.

Results:

Relative to control subjects, those who misused MPH were more likely to have used various other prescription and nonprescription stimulant drugs over their lifetime, and most MPH users reported mixing the drug with other psychoactive substances. Of the MPH sample, 70% reported recreational use of the drug, while 30% reported that MPH was used exclusively for study purposes. Relative to those using it exclusively for study, recreational users were more likely to report using MPH intranasally, as well as coadministering MPH with other substances. Most of those who reported their source of MPH obtained it from an acquaintance with a prescription.

Conclusions:

Those who misuse MPH are more likely than their peers to misuse various other substances, and MPH misuse frequently occurs in the context of simultaneous polydrug use. Because the primary supply of inappropriately used MPH appears to be prescribed users, efforts should be directed toward preventing its diversion.
Stigma Beliefs of Asian Americans with Depression in an Internet Sample
Authors: Fogel Joshua , Ford Daniel E
Published: January 2017

Objective:

To study the beliefs of Asian Americans with depression about stigma associated with depression treatment among friends, employers, and family.

Method:

Participants completed the Center for Epidemiologic Studies-Depression Scale (CES-D) anonymously on the Internet. In this cross-sectional design, those who screened positive for depression were asked questions regarding stigma ( n = 68 656). We used analysis of variance (ANOVA) and analysis of covariance (ANCOVA) to compare Asian Americans with whites and also to make comparisons by age and sex. Further, we stratified for Asian Americans and used ANOVA and ANCOVA to compare age and sex. We used linear regression to assess how stigma beliefs were associated with self-reported need for depression treatment.

Results:

Asian Americans overall had greater stigma beliefs than did whites for all 3 stigma outcomes ( P < 0.001), especially those related to family. Although this same pattern existed for subjects aged between 16 and 29 years and between 30 and 45 years ( P < 0.001), among those aged under 16 years, this existed for family stigma ( P < 0.001) but not for friends or employer stigma. In our stratified analyses among Asian Americans, male participants had greater stigma beliefs than did female participants for friends ( P < 0.001) and employer ( P < 0.05) but not for family.

Conclusions:

The pattern of Asian Americans having greater stigma levels than whites may be changing among younger Asian Americans because of acculturation. Also, among Asian Americans, unlike previous research showing no sex differences for stigma, we show that male participants had greater stigma levels than did female participants. Future directions should include measuring stigma after culture-specific interventions.
Comorbid Depression among Untreated Illicit Opiate Users: Results from a Multisite Canadian Study
Authors: Wild T Cameron , el-Guebaly Nady , Fischer Benedickt , Brissette Suzanne , Brochu Serge , Bruneau Julie , Noël Lina , Rehm Jürgen , Tyndall Mark , Mun Phil
Published: January 2017

Objectives:

This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression.

Method:

Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression.

Results:

Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine ( Ps < 0.05).

Conclusions:

Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population.
Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 1: Pathophysiology and Mechanisms of Induction
Authors: Margolese Howard C , Chouinard Guy , Kolivakis Theodore T , Beauclair Linda , Miller Robert
Published: January 2017

Objective:

Tardive dyskinesia (TD) is the principal adverse effect of long-term treatment with conventional antipsychotic agents. Several mechanisms may exist for this phenomenon. Mechanisms for the lower incidence of TD with atypical antipsychotics also remain to be fully understood. We undertook to explore and better understand these mechanisms.

Methods:

We conducted a comprehensive review of TD pathophysiology literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, neuroleptics, antipsychotics, pathophysiology, and mechanisms. Additional articles were obtained by searching the bibliographies of relevant references. Articles were considered if they contributed to the current understanding of the pathophysiology of TD.

Results:

Current TD vulnerability models include genetic vulnerability, disease-related vulnerability, and decreased functional reserve. Mechanisms of TD induction include prolonged blockade of postsynaptic dopamine receptors, postsynaptic dopamine hypersensitivity, damage to striatal GABA interneurons, and damage of striatal cholinergic interneurons. Atypical antipsychotics may cause less TD because they have less impact on the basal ganglia and are less likely to cause postsynaptic dopamine hypersensitivity.

Conclusion:

Although the ultimate model for TD is not yet understood, it is plausible that several of these vulnerabilities and mechanisms act together to produce TD. The lower incidence of TD with atypical antipsychotics has helped to elucidate the mechanisms of TD.
Atypical Antipsychotics in Psychiatric Practice: Practical Implications for Clinical Monitoring
Authors: Poulin Marie-Josée , Cortese Leonardo , Williams Richard , Wine Nina , McIntyre Roger S
Published: January 2017

Objectives:

To provide practical recommendations for monitoring patients both before and during treatment with atypical antipsychotics, to assist clinicians in implementing preventative measures against diabetes, and to establish baselines according to which clinicians should initiate diabetes treatment.

Method:

A working group of Canadian specialists in psychiatry and endocrinology reviewed peer-reviewed clinical studies published in this area and other relevant papers and abstracts.

Results:

The reviewed studies further confirm that atypical antipsychotic medications are the most effective components in the medical management of many psychotic conditions; they also further emphasize the need to more stringently monitor and recognize diabetes risk factors inherent in these patients. Recommendations are based on a review of the available data, on expert opinion and consensus, and on current Canadian guidelines for the treatment of schizophrenia and management of diabetes.

Conclusions:

Patients with psychiatric disorders, most particularly schizophrenia and mood disorders, have an increased risk for type 2 diabetes and should be screened frequently, especially when other risk factors are present. The resulting recommendations offer practical steps for effectively screening patients prior to and during treatment with atypical antipsychotics. They include 1) how to conduct an initial baseline assessment, 2) when and how to monitor blood glucose and lipid levels, and 3) how to educate patients regarding such lifestyle issues as nutrition, exercise, and diet.
Recent Evidence Linking Coronary Heart Disease and Depression
Authors: Frasure-Smith Nancy , Lespérance François
Published: January 2017

Objectives:

To review the recent literature on the relation between depression and coronary heart disease (CHD), including both etiologic studies (that is, depression preceding development of CHD) and prognostic studies (that is, depression predicting prognosis in established CHD), and to assess the degree to which the literature supports a causal interpretation of the link between depression and CHD.

Method:

We searched the MEDLINE, Current Contents, and PsycINFO databases for articles published between December 15, 2003, and December 15, 2005, containing combinations of several key words related to CHD, prognosis, and depression. We reviewed papers for evidence of 6 rule-of-thumb criteria for making causal inferences: objective CHD outcome measures, prospective designs, results showing consistent and strong dose-response relations, adequate covariate adjustment, biological plausibility, and evidence from clinical trials that changing depression alters CHD risk.

Results:

We found 8 recent etiologic studies, 16 prognostic studies, 2 publications with both types of data, and 23 review papers. Although there was much methodological variability concerning measurement of depression and assessment of cardiac outcomes, the recent etiologic studies increase the evidence of a role for depression. Recent prognostic data are less consistent. Small studies showing no link between depression and CHD prognosis continue to appear, despite lack of adequate statistical power.

Conclusions:

The recent literature continues to support both an etiologic and a prognostic role for depression in CHD. Despite this evidence, there have been few clinical trials of depression treatment in CHD patients and no clinical trials of depression prevention. Additional trials are needed.
Coronary Heart Disease and Depression: A Review of Recent Mechanistic Research
Authors: Skala Judith A , Freedland Kenneth E , Carney Robert M
Published: January 2017

Objective:

Both behavioural and physiological factors have been proposed as mechanisms that may explain the negative effect of depression on coronary heart disease (CHD). Our aim is to review some of the most important findings since our prior review.

Method:

We searched MEDLINE, PsycINFO, and other sources for recent studies of candidate mechanisms, with an emphasis on publications since 2002.

Results:

Physiological pathways have received far greater attention than behavioural ones in the emerging literature. Recent studies have identified shared genetic determinants, inflammation, blood clotting, and vascular mechanisms as plausible explanatory mechanisms.

Conclusions:

Future research should focus on relations between behavioural and physiological mechanisms and on the effects of pharmacologic and psychotherapeutic treatments for depression on candidate mechanisms.
A Prospective Study of the Impact of Opening a Casino on Gambling Behaviours: 2- and 4-Year Follow-ups
Authors: Jacques Christian , Ladouceur Robert
Published: January 2017

Objective:

It is widely believed that the rate of pathological gambling is related to the accessibility and availability of gambling activities. Few empirical studies have yet been conducted to evaluate this hypothesis. Using a longitudinal prospective design, the current study evaluates the impact of a casino in Canada's Hull, Quebec region.

Method:

A random sample of respondents from Hull (experimental group) and from Quebec City (comparison group) completed the South Oaks Gambling Screen (SOGS) and gambling- related questions before the opening of the Hull Casino (pretest), 1 year after the opening (posttest), and on follow-up at Years 2 and 4.

Results:

Although, 1 year after the opening of the casino, we did observe an increase in playing casino games and in the maximum amount of money lost in 1 day's gambling, this trend was not maintained over time (2- and 4-year follow-ups). In the Hull cohort, the rate of at-risk and probable pathological gamblers and the number of criteria on the SOGS did not increase at the 2- and 4-year follow-ups. The residents' reluctance to open a local casino was generally stable over time following the casino's opening.

Conclusion:

The discussion raises different explanatory factors and focuses on the context of the Regional Exposure Model as a potentially more applicable measure of studying the expansion of gambling.
Prévalence et caractéristiques de l'association de neuroleptiques chez une cohorte de patients souffrant de troubles psychotiques
Authors: Huguelet Philippe , Khan Aqal Nawaz , Morand-Collomb Sophie , Mohr Sylvia , Etter Manuela
Published: January 2017

Objectifs:

La prescription combinée de médications antipsychotiques est fréquente, měme si elle n'est pas toujours justifiée par des données objectives. Il importe donc de déterminer l'ampleur de cette pratique et de mieux connaître les caractéristiques des patients concernés, afin notamment de pouvoir déterminer quelles associations étudier préférentiellement.

Méthode:

Les patients souffrant de troubles psychotiques et suivis pendant au moins un an dans une consultation ambulatoire de psychiatrie à Genève ont été étudiés ( n = 253). Les prescriptions qui leur ont été administrées à l'inclusion et pendant cette période ont été relevées, de měme que des données sociodémographiques et cliniques.

Résultats:

Trente-six pour cent des patients se sont vu prescrire une association de neuroleptiques pendant la période de suivi. Ces patients se distinguent par des caractéristiques évolutives défavorables: moins d'activité, assistance financière, placement en foyer, nombreuses hospitalisations avec début plus précoce du trouble. Trois quarts des patients ne changent pas de traitement pendant la période considérée. La stabilité du traitement est associée avec l'observance et l'absence d'hospitalisation pendant la période de suivi.

Conclusion:

L'association de neuroleptiques est fréquente et sans étayage scientifique, principalement chez des patients qui présentent des caractéristiques évolutives défavorables. Ces options thérapeutiques sont probablement des stratégies relativement inefficaces. De plus, ces pratiques risquent de compliquer l'évolution de ces patients, celle-ci étant déjà caractérisée par des éléments défavorables.
The Value of Neuroscience Strategies to Accelerate Progress in Psychological Treatment Research
Authors: Moras Karla
Published: January 2017

Major findings from the past 55 years of psychological treatment research indicate that 3 questions are now pivotal to continued practice-relevant progress: What is the nature of the problem(s) to be treated? What are the causal change mechanisms of efficacious psychological treatments? Can more efficient and broadly effective psychological treatments be developed? Contemporary cognitive, affective, and behavioural neurosciences offer particularly promising resources for psychological treatment research that can help accelerate progress regarding these questions. This article explains why the questions are pivotal and presents neuroscience findings to illustrate how progress can be made on each one and for diverse problems and disorders such as major depression, posttraumatic stress disorder, obsessive–compulsive disorder, drug addiction, and regulation of negative affect.