bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Service Use and Social Conditions in Patients with Psychotic Disorders
Authors: Malla Ashok K , Norman Ross MG , Scholten Derek
Published: January 2017

Objective:

To determine independent predictors of outcome on 3 separate dimensions—namely, relapse and service use, employment, and living conditions—in patients with psychotic disorders.

Method:

One hundred and thirty-four patients, most with a diagnosis of schizophrenia or schizoaffective disorder (94%), were treated and followed up in a comprehensive treatment program with inpatient and community treatment components. Complete data on several predictor and outcome variables were available on 93 patients. Relationships between predictor variables and each dimension of outcome were analyzed using Spearman correlation and multiple regression analysis.

Results:

Results showed that the use of inpatient resources (days in hospital) during the follow-up period was predicted by days in hospital prior to entry into the program, as was employment status. Although substance abuse was related to employment status, it did not have any predictive value. Better living conditions were predicted by being female and having a later age of onset.

Conclusions:

Use of inpatient resources and social dimensions of outcome in schizophrenia may be predicted by different patient- or illness-related variables. These relationships are likely to be modified by the nature and content of treatment received.
The Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Lactation: Current Knowledge
Authors: Misri Shaila , Kostaras Demetra , Kostaras Xanthoula
Published: January 2017

This article reviews the effects of the selective serotonin reuptake inhibitor (SSRI) class of antidepressants in pregnant and lactating women for the treatment of depression and anxiety disorders. An examination of the literature was conducted using Medline (1966 to present). Despite methodological concerns and the scarcity of data on this important subject, the majority of recent investigations demonstrate safety of the fetus exposed to SSRIs during pregnancy. All of the SSRIs reported in the studies are excreted into breast milk, and low levels have been found in infant serum. The implications of this for practice include identifying the effects of treatment versus nontreatment on the mother–infant dyad. Further research must examine long-term neurobehavioural teratogenicity in exposed infants.
Why are Children in the Same Family So Different? Nonshared Environment a Decade Later
Authors: Plomin Robert , Asbury Kathryn , Dunn Judith
Published: January 2017

Objective:

To review recent developments in the study of nonshared environment; that is, the environmental influences that make children growing up in the same family different, rather than similar.

Method:

We review several recent influential books and papers on the subject of nonshared environment from the decade following the 1987 paper that highlighted its importance in psychological development.

Results:

Modest progress has been made toward identifying the specific aspects of the environment responsible for nonshared environment. Although parents treat their multiple children differently, such differential treatment accounts for only a small amount of nonshared environmental influence, once genetic factors are controlled. It has been suggested that some degree of nonshared environment may be due to the fact that siblings react differently to ostensibly shared environmental influences. Peer influence and other experiences outside the family may be more important sources of systematic nonshared environment.

Conclusions:

Despite the difficulties encountered in identifying specific sources of nonshared environment, the fact remains that most environmental variance affecting the development of psychological dimensions and psychiatric disorders is not shared by children growing up in the same family. More research and theory are needed to explain why such siblings are so different. Chance, in the sense of idiosyncratic experiences, also needs to be considered.
Antipsychotic Polypharmacy: A Survey of Discharge Prescriptions from a Tertiary Care Psychiatric Institution
Authors: Procyshyn Ric M , Kennedy Nathan B , Tse Gordon , Thompson Barbara
Published: January 2017

Objective:

To perform a retrospective survey of discharge medications at a tertiary care psychiatric facility and to assess the incidence of antipsychotic polypharmacy.

Method:

This is a retrospective survey that used the Department of Pharmacy's computer database to obtain relevant discharge information on all nongeriatric patients with schizophrenia discharged from Riverview Hospital between November 1, 1996 and October 31, 1998. From a total of 492 eligible patients, 229 met the inclusion criteria and formed the database for the survey.

Results:

The main finding of the survey was that 27.5% of our discharged patients diagnosed with schizophrenia left our facility on an antipsychotic polypharmacy regimen. Compared with patients discharged on a single antipsychotic, the pooled data revealed a significantly greater use of anticholinergic agents in those patients prescribed an antipsychotic polypharmacy regimen. Further, of the atypical agents, only risperidone showed a statistically significant reduction in dosage when coprescribed with a second antipsychotic.

Conclusion:

Although antipsychotic polypharmacy persists today, as it has over the past 30 years, evidence-based data to support this controversial treatment strategy is lacking. As a result clinicians are relying on their clinical experience, and perhaps intuition, to design antipsychotic polypharmacy treatment protocols. Efforts should be made to replace subjective clinical impression with a more rational approach to antipsychotic polypharmacy—one that is based on pharmacodynamic and pharmacokinetic understanding of drug action.
Regional Cerebral Glucose Metabolism in Never-Medicated Patients with Schizophrenia
Authors: Clark Campbell , Kopala Lili , Li David K , Hurwitz Trevor
Published: January 2017

Objective:

The purpose of this study was to assess regional cerebral glucose metabolism in patients with schizophrenia who had never received antipsychotic medication and whose olfactory identification ability had been assessed. Two hypotheses were examined. First, the patients were compared with normal controls to determine whether differences in regional cerebral metabolism were apparent. Second, regional rates of metabolism were correlated with olfactory ability and the relation between them determined.

Methods:

The patient (n = 26) and control (n = 32) subjects were scanned at rest using positron emission tomography (PET) after administration of 18F-fluorodeoxyglucose (FDG). In addition, the University of Pennsylvania Smell Identification Test was administered to each patient.

Results:

Patients with schizophrenia had reduced rates of glucose metabolism in the right and left thalamus that reached significance if not corrected for multiple comparisons. However, if a Bonferroni correction was applied over the 27 regions of interest, the differences were not significant. Scores on the Smell Identification Test were negatively correlated with 8 regions of interest. When scores were analyzed using multiple regression, the left frontal cortex and the medial parietal cortex were significant predictors.

Conclusions:

The finding of reduced metabolism in the thalami is consistent with some of the previous literature, whereas the negative correlations between specific regions and olfactory function are not consistent with studies using activation paradigms.
Olanzapine Augmentation of Serotonin Uptake Inhibitors in Obsessive—Compulsive Disorder: An Open Study
Authors: Francobandiera Giorgio
Published: January 2017

Objective:

This study evaluates the clinical response to olanzapine used in association with selective serotonin reuptake inhibitors (SSRIs) or clomipramine in treatment-resistant obsessive–compulsive disorder (OCD).

Methods:

We describe the cases of 9 patients with serotonin uptake inhibitor-resistant OCD who were given an open-label adjunctive treatment of olanzapine for a minimum of 6 weeks. The response was assessed by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale (CGI).

Results:

Six patients showed improvement of symptoms after the augmentation with olanzapine. One patient (treated with clomipramine) discontinued olanzapine due to side effects, and another 2 did not respond.

Conclusion:

Olanzapine augmentation of SSRIs in treating OCD showed a good (two-thirds) response rate, and it could therefore be considered as a treatment option when conventional therapies have failed.
The Role of Estrogen in Schizophrenia: Implications for Schizophrenia Practice Guidelines for Women
Authors: Grigoriadis Sophie , Seeman Mary V
Published: January 2017

Objective:

The objective of this paper is to integrate what is known about estrogen effects on symptoms and treatment response into a global understanding of schizophrenia. The aim is to expand Canadian schizophrenia guidelines to include the specific needs of women.

Method:

We searched the Medline database; keywords included estrogen, estrogen replacement therapy, schizophrenia, psychosis, treatment, tardive dyskinesia (TD), and women. We examined reference lists from relevant articles to ensure that our review was complete. We review the evidence for the effects of estrogen in schizophrenia and we make recommendations for the next revision of official practice guidelines.

Results:

The epidemiologic evidence suggests that, relative to men, women show an initial delay in onset age of schizophrenia, with a second onset peak after age 44 years. This points to a protective effect of estrogen, confirming animal research that has documented both neurotrophic and neuromodulatory effects. Clinical research results indicate that symptoms in women frequently vary with the menstrual cycle, worsening during low estrogen phases. Pregnancy is often, though not always, a less symptomatic time for women, but relapses are frequent postpartum. Some work suggests that in the younger age groups women require lower antipsychotic dosages than men but that following menopause they require higher dosages. Estrogen has been used effectively as an adjunctive treatment in women with schizophrenia. Estrogen may also play a preventive role in TD.

Conclusions:

Symptom evaluation and diagnosis in women needs to take hormonal status into account. Consideration should be given to cycle-modulated neuroleptic dosing and to careful titration during pregnancy, postpartum, and at menopause. We recommend that discretionary use of newer neuroleptic medication and adjuvant estrogen therapy be considered.
Experiments in Change: Pretrial Diversion of Offenders with Mental Illness
Authors: Swaminath R S , Mendonca J D , Vidal C , Chapman P
Published: January 2017

Objective:

Our objective was to study the outcomes experienced by 2 communities after implementing pretrial diversion of offenders with mental illness.

Method:

The same method of diversion was implemented in a predominately urban and a predominantly rural county. We collected retrospective clinical and offence data from pretrial diversion assessments conducted in court. As well, we measured outcome for the diversion procedure in terms of actual vs expected rates of recidivism.

Results:

Prior psychiatric treatment was associated with the diverted group, and a criminal history was associated with the nondiverted group. In the larger, urban county the diversion option was offered more often to persons with psychoses, mood disorders, and minor offences. Conversely, in the smaller rural county diversion was offered most often to persons accused of serious offences. The recidivism found in urban and rural diverted groups after a year of supervised care was only 2% to 3%, but the rate of use of diversion in both counties was low, owing to selection biases.

Conclusion:

Pretrial diversion of offenders with mental illness accused of minor crimes is eminently feasible for both urban and rural settings, provided that police, crown, and treatment policies are coordinated to favour the treatment option rather than prosecution.
Prevalence and Correlates of Elder Abuse and Neglect in a Geriatric Psychiatry Service
Authors: Vida Stephen , Monks Richard C , Rosiers Pascale Des
Published: January 2017

Objective:

To determine the prevalence and correlates of 4 types of elder abuse and neglect in a geriatric psychiatry service.

Method:

We conducted a cross-sectional retrospective chart review of new in- and outpatients seen by the Montreal General Hospital Division of Geriatric Psychiatry in one calendar year.

Results:

Abuse or neglect was suspected or confirmed in 20 (16%) of 126 patients, comprising financial abuse in 16 (13%), neglect in 7 (6%), emotional abuse in 5 (4%), physical abuse in 3 (2%), and multiple abuse in 7 (6%). On bivariate analysis, patients living with nonspouse family, friends, or other persons were significantly more likely to have suffered abuse than were those living with their spouse or in a supervised setting (OR 10.5; 95%CI, 2.3 to 47.8); widowed, divorced, or separated patients were significantly more likely to have suffered abuse than were married patients (OR 4.7; 95%CI, 1.02 to 22.0). Nonsignificant trends included female sex (OR 4.1; 95%CI, 0.89 to 18.6); alcohol abuse (OR 2.1; 95%CI, 0.71 to 6.2); behaviour problems (OR 1.9; 95%CI, 0.71 to 5.2); and chronic cognitive impairment (OR 1.4; 95%CI, 0.55 to 3.8). Although living situation with nonspouse family, friends, or others and marital status of widowed, divorced, or separated were significantly associated with abuse when examined in separate logistic regression models, both were nonsignificant when examined together, suggesting collinearity. Both were retained in the model because they probably represent different aspects of vulnerability. The final model included living situation with nonspouse family, friends, or others (OR 6.1; 95%CI, 0.75 to 49.5) and widowed, divorced, or separated marital status (OR 2.4; 95%CI, 0.21 to 26.8). Nonsignificant trends included female sex (OR 2.6; 95%CI, 0.45 to 14.4); alcohol abuse (OR 2.2; 95%CI, 0.59 to 7.9); and lowest quartile on the Global Assessment of Functioning (GAF) scale (GAF < 35; OR 2.0; 95%CI, 0.64 to 6.0).

Conclusions:

The practical implications of our study are that elder abuse and neglect are common among patients referred to geriatric psychiatry services, that such services should have access to multidisciplinary expertise and resources to deal with abuse, and that certain situations may signal higher risk. In our setting, the situation of living with nonspouse family, friends, or other persons in a nonsupervised setting and a history of family disruption by widowhood, divorce, or separation were significant correlates of abuse. Suggestive but nonsignificant trends of potential importance (OR > 2.0) included female sex, alcohol abuse, and lowest quartile of functional status. Study limitations include a cross-sectional retrospective chart review design, a clinically derived sample, a small sample size, and a lack of structured instruments for several variables.
Prevalence and Outcomes of Pharmaceutical Industry—Sponsored Clinical Trials Involving Clozapine, Risperidone, or Olanzapine
Authors: Procyshyn Ric M , Chau Anthony , Fortin Patricia , Jenkins Willough
Published: January 2017

Objective:

The literature continues to highlight the debate on the ethics and merits of trials sponsored by the pharmaceutical industry. This study attempts to determine the prevalence and outcomes of industry-sponsored trials involving clozapine, risperidone, or olanzapine.

Methods:

We searched the literature from January 1, 1990, to December 31, 2001, to capture all eligible clinical trials involving clozapine, risperidone, or olanzapine. The primary outcome measured was the clinical outcome of industry-sponsored studies. Secondary outcome measures included the following parameters: disclosure of any sponsorship and financial support, author(s) employed by the industry, use of comparator drug(s) within the trial, sample size, blinding, and use of placebo.

Results:

The database comprised 372 articles. Of these trials, 124 (33.3%) were sponsored by the pharmaceutical industry. In general, trials sponsored by Eli Lilly or Janssen had better research design than trials not funded by the pharmaceutical industry. With regard to authorship, more trials funded by Eli Lilly (74.6%) were coauthored by an employee of the company, compared with trials funded by either Janssen (23.3%) or Novartis/Sandoz (5.6%). Further, more trials sponsored by Eli Lilly reported positive outcomes (92.1%), compared with Janssen-sponsored trials (88.4%) and Sandoz/Novartis-sponsored trials (72.2%). No negative results were reported in any of the industry-funded trials.

Conclusions:

One-third of the published clinical trials involving clozapine, risperidone, or olanzapine were funded by their respective manufacturer. The reported outcomes of the sponsored trials highly favour the manufacturer's product.
Patient Opinions on the Benefits of Treatment Programs in Residential Psychiatric Care
Authors: Biancosino Bruno , Barbui Corrado , Pera Valentina , Osti Michela , Rocchi Denis , Marmai Luciana , Grassi Luigi
Published: January 2017

Objective:

To assess patients' opinions on the perceived benefit of treatment delivered during their stay in a residential facility.

Method:

We administered the Opinions on Curative Factors Questionnaire (OCFQ), which was developed from previous studies and assesses several treatment modalities and therapeutic factors, to a sample of 157 severely ill psychiatric patients admitted to a residential facility.

Results:

All therapeutic factors tested by the OCFQ were considered helpful or very helpful by most of those sampled. The item with the highest score was “talking to doctor,” followed by “free pass,” “medication,” “visitors,” “nonhospital setting,” “making friends with patients,” “structure of daily life,” “support from team,” and “talking to nurses.” The least-valued item was “group activities.”

Conclusion:

Psychiatric patients consider several treatment factors to be helpful, especially those based on individual approaches or on a less restrictive therapeutic milieu that allows interactions with the outside world. These results may be a valuable contribution to improving treatment planning in residential facilities.
Hospitalization in the First Year of Treatment for Schizophrenia
Authors: Whitehorn David , Richard Julie C , Kopala Lili C
Published: January 2017

Objective:

To determine the rates of hospitalization during the first year of treatment for schizophrenia, using an epidemiologic sample.

Method:

We examined inpatient and outpatient administrative databases in the province of Nova Scotia for cases of schizophrenia (ICD-9 code 295 or 298) newly diagnosed during the years 1995 to 1998. We noted the diagnosis site (that is, inpatient or outpatient) and hospitalizations in the year following diagnosis. We also established links to the clinical database maintained by the Nova Scotia Early Psychosis Program (NSEPP).

Results:

Over the 4-year period, we identified 434 unique cases from an at-risk population of 320 000 (yielding a yearly average age-specific incidence rate of 3.3/10 000), of whom 119 had received care from the NSEPP. Of the cases, 54% were initially diagnosed while they were inpatients. In the year following diagnosis, the overall hospitalization rate, excluding initial hospitalizations, was 17%. Patients who were initially diagnosed while inpatients had a higher rate of hospitalization in the first year of treatment (25% vs 7%), compared with those initially diagnosed while outpatients. This relation was also present among patients who received care from the NSEPP.

Conclusions:

Of newly diagnosed patients with schizophrenia, 46% were not hospitalized at the time of initial diagnosis. Of all patients, 17% required hospitalization during the first year of treatment, excluding an initial hospitalization, if present. Hospitalization rates in the first year were higher among patients initially hospitalized and among those with a rural residence. Patients requiring hospitalization during the first year form an important target group for improved interventions.
Through a Glass Darkly: The Disutility of the DSM Nosology of Depressive Disorders
Authors: Parker Gordon
Published: January 2017

Objective:

To demonstrate that the dimension-weighted DSM-IV model for classifying the depressive disorders lacks utility.

Method:

The logical flaws in classifying the depressive disorders with any severity-based model (which underpin both the DSM-IV and ICD-10 systems) are noted. Integral definitional limitations to the DSM-IV definition of key depressive disorders are identified. It is argued that the DSM-IV classificatory system lacks utility for providing information on etiology and preferential management strategies. An alternative subtyping model is considered.

Results:

It is asserted that, in practice, the DSM-IV model and criteria lack explanatory power and compromise research and clinical practice.

Conclusions:

It is hoped that this article evokes wider debate about modelling and classifying the depressive disorders.
Impact of a Specialized Early Intervention Service for Psychotic Disorders on Patient Characteristics, Service Use, and Hospital Costs in a Defined Catchment Area
Authors: Goldberg Karen , Norman Ross , Hoch Jeff , Schmitz Norbert , Windell Deborah , Brown Nicole , Malla Ashok
Published: January 2017

Objective:

To evaluate the impact of a new early intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs.

Method:

We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an early intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient.

Results:

Patients in the post-PEPP phase were significantly younger ( P < 0.01), were more often male ( P < 0.05), and were less likely to be admitted to hospital with an involuntary status ( P < 0.05) or with injuries ( P < 0.05) at the time of their first hospital admission. Over the 2 years following the initial admission, post-PEPP patients had significantly fewer admissions to a regular psychiatric service ( P < 0.001) and made significantly fewer visits to the hospital emergency department ( P < 0.01). There was a significant mean reduction in costs per case of regular hospital bed use ($1028.49, SD 528.02, compared with $792. 28, SD 528.02; P < 0.01) and emergency visits ($519.18, SD 353.79, compared with $353.79, SD 345.0; P < 0.01). Time series analyses followed by Chow tests failed to confirm that these cost changes could be attributed specifically to the introduction of an early intervention service.

Conclusion:

Introduction of a specialized early intervention program may be beneficial to patients and to the health care system. To evaluate the cost–benefit ratio of early intervention services, longer term and more detailed data may be required.
The Epidemiology of Mental and Substance Use—Related Disorders among White, Chinese, and other Asian Populations in Canada
Authors: Tiwari Suresh K , Wang JianLi
Published: January 2017

Objectives:

The objectives of this study were to estimate and compare the lifetime and 12-month prevalence of mood disorders, anxiety disorders, and substance dependence in white, Chinese, and other Asian populations in Canada and to identify correlates of mental disorders in these ethnic groups.

Methods:

We used data from the Canadian Community Health Survey: Mental Health and Well-Being. The WHO's Composite International Diagnostic Interview was used to assess mental disorders diagnosed according to the DSM-IV criteria. We included subjects who were white ( n = 33 399), Chinese ( n = 733), or from other Asian populations ( n = 1113). The lifetime and 12-month prevalence of mental disorders was estimated according to ethnic group.

Results:

The lifetime and 12-month prevalence of mental disorders in Chinese participants was lower than the prevalence rates in white participants. Other Asian participants were less likely than white individuals to have had any mood and anxiety disorder in their lifetime. The 12-month prevalence of any mental disorder in Chinese participants was lower than in other Asian participants. However, the proportion of Chinese participants with perceived fair to poor mental health was higher than in the other Asian and white groups.

Conclusions:

The prevalence of mental disorders among Chinese individuals living in Canada resembles that in China's population. The prevalence of mental disorders in the Asian populations may vary by region. Studies are needed to examine subthreshold mental disorders in the Asian populations as well as ethnic differences in mental disorders in relation to sex, age, and clinical conditions.
Personality and Depression
Authors: Bagby R Michael , Quilty Lena C , Ryder Andrew C
Published: January 2017

Objective:

To examine the implications of the association between personality and depression for the understanding, assessment, and treatment of major depression.

Method:

A broad range of peer-reviewed manuscripts relevant to personality and depression was reviewed. Particular emphasis was placed on etiology, stability, diagnosis, and treatment implications.

Results:

Personality features in depressed samples reliably differ from those of healthy samples. The associations between personality and depression are consistent with a variety of causal models; these models can best be compared through longitudinal research. Research demonstrates that attention to personality features can be useful in diagnosis and treatment. Indeed, personality information has been on the forefront of recent efforts to advance the current diagnostic classification system. Moreover, personality dimensions have shown recent promise in the prediction of differential treatment outcome. For example, neuroticism is associated with preferential response to pharmacotherapy rather than psychotherapy.

Conclusions:

Consideration of personality features is crucial to the understanding and management of major depression.
The Opportunity for Psychiatry in Palliative Care
Authors: Irwin Scott A , Ferris Frank D
Published: January 2017

The need for psychiatrists to work with patients and families living with chronic life-threatening illnesses has never been greater. Further, psychiatrists may find exciting work within the relatively new field of palliative care, which is devoted to the prevention and relief of all suffering. Increasingly, individuals are living longer with multiple issues that cause suffering, interfere with their lives, and often lead to psychosocial sequelae. To ensure state-of-the-art care for patients and families throughout an illness and any ensuing bereavement period, many experienced psychiatrists are needed as consultants to, and as members of, interdisciplinary palliative care teams. This need presents limitless opportunities for psychiatrists to care for patients, provide education, and engage in research. The potential to make a difference is great.
Prevalence, Risk Factors, and Use of Health Care in Depression: A Survey in a Large Region of France between 1991 and 2005
Authors: Kovess-Masfety Viviane , Briffault Xavier , Sapinho David
Published: January 2017

Objective:

To compare the prevalence, risk factors, and use of care for depression between 2 periods, concerning changes in social factors and health care provision.

Method:

We compared data from 2 surveys carried out in a large urbanized French region (Île-de-France) 15 years apart (1991, n = 1192; 2005, n = 5308), using comparable methodology and tools.

Results:

The overall prevalence of depression has slightly increased over this period. In contrast, the tendency of people who claim they feel depressed has dramatically increased. At-risk populations have also changed during this period. The proportion of people consulting a psychiatrist for depression has not changed, while general practitioner (GP) consultations have decreased and psychologist consultations have increased 3-fold. Psychotropic use by people who are depressed has decreased significantly.

Conclusion:

The trend toward increased depressive symptoms does not correspond to an increase in depressed disorders. In a well-staffed urbanized French region, psychologists are playing a growing role in managing depression at the expense of GPs, when the use of a psychiatrist remains unchanged; decreased use of psychotropic drugs may be a consequence.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review
Authors: Sinyor Mark , Schaffer Ayal , Levitt Anthony
Published: January 2017

Objective:

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is the largest open-label, pragmatic trial that has been undertaken to examine the treatment of major depressive disorder. At a cost of US$35 million over 6 years, STAR*D sought to test the effectiveness both of pharmacotherapy and of cognitive therapy, and to ascertain whether certain treatments are more optimal after one or more failed trials.

Method:

Patients ( n = 2876) who presented to either a psychiatry or family practice setting seeking treatment for depression were included in the STAR*D analysis. In the 4 levels of STAR*D, patients were randomized to various treatment monotherapies, combinations, or augmentation strategies. The primary outcome was remission, based on the Hamilton Depression Rating Scale. Secondary outcomes were response, as measured by clinician and patient self-report as well as various measures of patients' level of function and (or) quality of life.

Results:

Remission rates for treatment levels 1 to 2 and 3 to 4 were 18% to 30% and 7% to 25%, respectively. There was no difference in effectiveness between any treatments at any treatment level. Patients with longer index episodes, more concurrent psychiatric or general medical disorders, and (or) lower measures of baseline function were less likely to achieve remission. There were no major differences between outcomes in patients treated in primary, compared with specialist care, nor were there significant differences between depression rating scores obtained through clinician ratings, compared with self-report.

Conclusion:

Results of the STAR*D trial have shed important light on the effectiveness of current treatment strategies for patients with depression.
Clinical and Sociodemographic Profiles of Male Inmates with Severe Mental Illness: A Comparison with Voluntarily and Involuntarily Hospitalized Patients
Authors: Dumais Alexandre , Côté Gilles , Lesage Alain
Published: January 2017

Objective:

To identify the clinical specificity of men with severe mental illness (aged 18 to 40 years) by legal status.

Method:

Our study compared 85 inmates with 66 involuntarily hospitalized patients (IHPs) and 50 voluntarily hospitalized patients (VHPs) with at least one Axis I diagnosis of psychosis or major affective disorder. Sociodemographics, medical information, and criminal history were drawn from interviews, medical records, and official criminal records. We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders to determine Axis I disorders and antisocial personality disorder (ASPD). Psychopathy was measured with the Psychopathy Checklist—Revised.

Results:

We found that inmates had a lower level of schooling ( P = 0.001), were more likely to have been in an intimate relationship ( P < 0.001), and were less likely to have a psychiatric hospitalization history ( P < 0.001), compared with hospitalized patients. Inmates were also more likely to meet criteria for delusional disorders or psychosis not otherwise specified ( P < 0.001) and major depression ( P = 0.001). IHPs were more likely to meet schizophrenia spectrum disorder criteria ( P < 0.001). Inmates had a higher level of comorbidity involving ASPD ( P < 0.001), psychopathy ( P < 0.001), and substance misuse ( P < 0.001). IHPs showed an intermediate level between inmates and VHPs for these comorbid disorders. VHPs had the lowest level of comorbidity with Axis I psychiatric diagnosis.

Conclusion:

Our clinical specificity hypothesis was supported: different psychopathological characteristics and social functioning profiles were identified by legal status. Specific integrated treatments should be considered for inmates and IHPs.
Major Depression and Injury Risk
Authors: Patten Scott B , Williams Jeanne VA , Lavorato Dina H , Eliasziw Misha
Published: January 2017

Objective:

Cross-sectional epidemiologic studies have inconsistently reported associations between injuries and depressive symptoms. The significance of these findings remains unclear. Major depressive episodes (MDEs) may increase the risk of injury and injuries may increase the risk of MDEs. Longitudinal data are needed to distinguish between these possibilities.

Method:

Data from the Canadian National Population Health Survey (NPHS) were used in this analysis. The NPHS is a prospective study based on a representative sample of household residents in Canada. Injuries were evaluated using self-report items. MDE was assessed using the Composite International Diagnostic Interview-Short Form for major depression.

Results:

During each round of interviews, an association between MDE and injuries was evident. In longitudinal analyses a bidirectional association was found. MDEs increased the risk of injury (adjusted hazard ratio [HR] 1.6, 95% CI 1.3 to 2.0) and injury increased the risk of MDEs (adjusted HR 1.4, 95% CI 1.1 to 1.8).

Conclusions:

Injury prevention efforts may benefit from consideration of MDE as an injury determinant. For example, particular occupational or recreational activities may have a higher risk of injury during depressive episodes. Improved access to mental health resources in clinical settings where injuries are treated may also be valuable. However, additional studies are necessary to confirm these observations and to develop evidence-based interventions.
Use of School-Based Health Centres for Mental Health Support in Cape Breton, Nova Scotia
Authors: Szumilas Magdalena , Kutcher Stan , LeBlanc John C , Langille Donald B
Published: January 2017

Objective:

To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose.

Method:

A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose.

Results:

One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support.

Conclusions:

Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.
La SUMD (Scale to Assess Unawareness of Mental Disorder): Validation et adaptation française dans une population de patients souffrant de schizophrénie
Authors: Raffard Stéphane , Trouillet Raphaël , Capdevielle Delphine , Gely-Nargeot Marie-Christine , Bayard Sophie , Larøi Franck , Boulenger Jean-Philippe
Published: January 2017

Objectifs:

L'objectif principal a été de mener la validation française de la Scale to Assess Unawareness of Mental Disorder (SUMD) auprès d'une population souffrant de schizophrénie.

Méthode:

Cent patients souffrant de troubles schizophréniques ont été inclus. Nos analyses statistiques ont évalué la fidélité inter-juges, la validité théorique, la validité convergente ou divergente. Finalement, une analyse factorielle exploratoire a été conduite.

Résultats:

Nos résultats montrent que la version francophone de la SUMD possède de bonnes qualités métrologiques. La fidélité inter-juges (CCI variant de 0,68 à 1,00) et la cohérence interne des facteurs (α de Cronbach > 0,70) sont satisfaisantes. La validité convergente ou divergente a été confirmée par des corrélations élevées entre les scores de la SUMD et le score G12 de l'échelle des syndromes positif et négatif (PANSS). Nous ne rapportons que peu de liens entre les scores de la SUMD et les variables cliniques. Enfin, nos analyses factorielles ACP confirment l'hypothèse de deux dimensions distinctes de l'insight (conscience, attribution) dans leurs aspects actuel et passé.

Conclusion:

La version française de la SUMD est une mesure fiable et valide de l'insight dans la schizophrénie. L'importance de mesurer l'insight et le développement d'interventions psychosociales afin d'améliorer l'insight des personnes souffrant de schizophrénie sont discutés.
Assessing the Prevalence of Nonmedical Prescription Opioid Use in the General Canadian Population: Methodological Issues and Questions
Authors: Fischer Benedikt , Nakamura Nadine , Ialomiteanu Anca , Boak Angela , Rehm Jürgen
Published: January 2017

Objective:

To assess the prevalence of nonmedical prescription opioid use (NMPOU) in the Canadian general adult population in the context of rising overall prescription opioid (PO) consumption and related problems in North America.

Method:

The prevalence of NMPOU was assessed as a multiitem construct in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS; n = 16 672), an ongoing cross-sectional monthly random digit dialing telephone survey representative of the general Canadian population, aged 15 years and older. CADUMS data were collected between April and December of 2008 with a response rate of 43.5%.

Results:

About 22% of CADUMS respondents reported PO use in the last year, while 0.5% reported NMPOU during the same time frame. PO use was significantly higher among women than among men, and highest in the group aged 25 to 54 years. NMPOU was similar among men and women, and highest in the group aged 15 to 24 years.

Conclusions:

CADUMS data indicate an extremely low rate of NMPOU, especially given the levels of overall PO use, other PO-use related problems, and NMPOU levels estimated in the general US population where NMPOU has been assessed to be 10 times higher than in Canada. NMPOU survey item construction and response rates appear to strongly influence and potentially compromise NMPOU survey data. Existing NMPOU data and survey methods need to be validated for this important indicator in Canada, where increasing PO use and problem levels have been recognized as a significant and rising public health problem.
Prevalence of Pervasive Developmental Disorders among Children at the English Montreal School Board
Authors: Lazoff Tamara , Zhong Lihong , Piperni Tania , Fombonne Eric
Published: January 2017

Objectives:

The prevalence of pervasive developmental disorders (PDDs) has increased. There has been speculation regarding a role of thimerosal-containing vaccines (TCVs) in this trend. Our objectives were to determine prevalence rates of PDDs among school-aged children, and to evaluate the impact of discontinuation of thimerosal use in 1996 in routine childhood vaccines on PDD rates.

Method:

Children ( n = 23 635) attending kindergarten to Grade 11 were surveyed in 71 schools from the English Montreal School Board. For children with PDD, information was obtained about their diagnostic subtype, age, sex, grade, and school. Prevalence rates were calculated for the entire school population and for each grade. Prevalence rates were also compared for children born before or after 1996.

Results:

Students ( n = 187; male to female ratio: 5.4:1) with PDD were identified, corresponding to a prevalence of 79.1/10 000 (95% CI 67.8 to 90.4/10 000). The prevalence was 25.4, 43.6, 9.7, and 0.4 for autistic disorder, PDD not otherwise specified, Asperger syndrome, and childhood disintegrative disorder, respectively. During the study period, there was a significant linear increase in prevalence (OR 1.17 per year; 95% CI 1.12 to 1.23). The trend in prevalence of PDDs was unrelated to the discontinuation of TCVs.

Conclusion:

Our study provides additional evidence that the PDD rate is close to 1%. We estimate that at least 11 500 Canadian children aged 2 to 5 years suffer from a PDD. The reasons for the upward trend in prevalence could not be determined with our methods. Discontinuation of thimerosal use in vaccines did not modify the risk of PDD.
The Relation between Disease Severity and Cost of Caring for Patients with Alzheimer Disease in Canada
Authors: Herrmann Nathan , Tam Derrick Y , Balshaw Robert , Sambrook Robert , Lesnikova Nadia , Lanctôt Krista L ,   the Canadian Outcomes Study in Dementia (COSID) Investigators
Published: January 2017

Objectives:

To characterize the cost of caring for an outpatient in Canada with Alzheimer disease (AD) based on disease severity, and to describe how costs change with increases in disease severity.

Method:

Community-dwelling patients with mild-to-moderate AD were enrolled in a 3-year, naturalistic, observational study. Assessments included cognition (Mini Mental Status Examination), global ratings (Global Deterioration Scale [GDS]), and daily function (Functional Autonomy Measurement System) as part of the Canadian Outcomes Study in Dementia. Direct (medical and nonmedical) and indirect costs were collected using resource use questionnaires. Costs at baseline were compared with costs at follow-up and correlated with disease severity.

Results:

Total costs associated with treating AD were significantly higher with greater disease severity. The mean total cost to treat patients with very mild AD (GDS = 2) was $367 per month, compared with $4063 per month for patients with severe or very severe AD (GDS = 6). From baseline to follow-up, the greatest changes in cost were observed in the group of patients with the most severe AD as measured by all scales. The largest component of total cost was indirect costs at most severity levels, though medication costs contributed the most in patients with very mild AD. Significant independent contributors to cost were being female, having more impaired activities of daily living, and exhibiting more neuropsychiatric symptoms.

Conclusions:

Costs for treating a patient with AD were strongly associated with disease severity, even though none of the patients were institutionalized. Delaying the progression of AD may reduce indirect costs and burden to caregivers.
A Brief History of Placebos and Clinical Trials in Psychiatry
Authors: Shorter Edward
Published: January 2017

The history of placebos in psychiatry can be understood only in the context of randomized controlled trials (RCTs). Placebo treatments are as old as medicine itself, and are particularly effective in dealing with psychosomatic symptoms. In psychiatry, placebos have mainly been featured in clinical drug trials. The earliest controlled trial in psychiatry (not involving drugs) occurred in 1922, followed by the first crossover studies during the 1930s. Meanwhile the concept of randomization was developed during the interwar years by British statistician Ronald A Fisher, and introduced in 3 trials of tuberculosis drugs between 1947 and 1951. These classic studies established the RCT as the gold standard in pharmaceutical trials, and its status was cemented during the mid-1950s. Nevertheless, while the placebo became established as a standard measure of drug action, placebo treatments became stigmatized as unethical. This is unfortunate, as they constitute one of the most powerful therapies in psychiatry. In recent years, moreover, the dogma of the placebo-controlled trial as the only acceptable data for drug licensing is also being increasingly discredited. This backlash has had 2 sources: one is the recognition that the US Food and Drug Administration has been too lax in permitting trials controlled with placebos alone, rather than also using an active agent as a test of comparative efficacy. In addition, there is evidence that in the hands of the pharmaceutical industry, the scientific integrity of RCTs themselves has been degraded into a marketing device. The once-powerful placebo is thus threatened with extinction.
Canadian Youth Born Large or Small for Gestational Age and Externalizing and Internalizing Problems
Authors: Van Lieshout Ryan J , Boyle Michael H
Published: January 2017

Objective:

To determine if youth born large for gestational age (LGA; birth weight above the 95th percentile) or small for gestational age (SGA; less than the fifth percentile) are at an increased risk of developing symptoms of externalizing and internalizing problems.

Method:

Data on members of the Ontario Child Health Study aged 4 to 16 years were used to examine associations between LGA, SGA, and psychopathology. This sample consisted of 2923 youth about whom parent, teacher, and self-reported levels of internalizing and externalizing symptoms were available, and whose caregivers retrospectively reported birth weight and gestational age (GA). Psychopathology was assessed using the Diagnostic and Statistical Manual of Mental Disorders–oriented scales derived from the Child Behavior Checklist.

Results:

Multilevel linear regression analyses revealed that after adjustment for parental psychopathology, socioeconomic disadvantage, sex, age, maternal age, birth order, and child health and school performance, youth born LGA had higher scores on the self-reported externalizing scale (1.39, 95% CI 0.01 to 2.78), but not internalizing scale, compared with youth born at an appropriate weight for GA (10th to 90th percentile). Parent and teacher ratings generally supported these findings in direction but did not reach statistical significance. Youth and parents reported increased levels of externalizing and internalizing symptoms in youth born SGA, but these were not statistically significant.

Conclusions:

Youth born above the 95th percentile for GA manifest increased levels of externalizing symptoms. Given increasing rates of macrosomic births, further study is warranted to replicate and determine the clinical significance of these findings, the contribution of the antecedents of LGA to this risk and the extent to which this association may be causal.