bluuebunny/crossref_metadata_2025 huggingface dataset:
Excimer UV Radiation in Dermatology
Authors: Specchio F. , Carboni I. , Cannarozzo G. , Tamburi F. , Dattola E. , Nisticò S.
Published: January 2017

Ultraviolet B (UVB 290–320 nm) radiation has been used in the treatment of different skin diseases. Light sources with narrowband UVB output spectrum have been developed with the aim of increasing the rates of “beneficial to side effect” profile of the treatment. Narrowband UVB phototherapy using fluorescent lamps (TL01, 311±2nm) has been widely adopted over the past 10 years. Monochromatic Excimer Light (MEL) represents a new source of narrow-band UVB emitting at 308 nm and guarantees a safe and effective approach to different chronic and recurrent skin diseases thanks to its potent and selective immunosuppressant action.
Italian Survey on the Use of Anti-Inflammatory Drugs in Osteoarthritis
Authors: Bianchi G. , Molfetta L. , Saggini R.
Published: January 2017

Osteoarthritis (OA) is the most common painful arthritic disease in adults, causes severe disability and worsens the quality of life of the patients. The aim of this survey, carried out on 147 Italian orthopedic doctors who attended an ISIAT (International Symposium Intra Articular Treatment) educational course in Barcelona, was to investigate some aspects of daily clinical practice in the management of OA: the most used pharmacological treatments, compliance to the most important Guidelines, the advantages of COXIBs in this setting and pharmacoeconomic aspects. The main results of this survey are: a) inflammation has become the main target in OA; b) Guidelines are a useful and valid tool for daily clinical practice; c) acetaminophen is no longer a valid therapeutical option for OA patients; d) anti-inflammatory drugs (NSAIDs and COXIBs) have a primary role in the management of OA, due to their dual activity (anti-inflammatory and analgesic); e) selectivity of COXIBs for COX-2 is very important; f) within the COXIB class, the therapeutic value of etoricoxib has been widely recognized, especially in terms of safety and cost/benefit ratio.
Vitiligo: Symptoms, Pathogenesis and Treatment
Authors: Ghafourian E. , Ghafourian S. , Sadeghifard N. , Mohebi R. , Shokoohini Y. , Nezamoleslami S. , Hamat R.A.
Published: January 2017

Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.
Rhinosinusitis and Asthma: A Very Long Engagement
Authors: Licari A. , Caimmi S. , Bosa L. , Marseglia A. , Marseglia G.L. , Caimmi D.
Published: January 2017

Upper and lower airways may be considered as a unique entity, interested by coexisting inflammatory processes that share common etiopathogenic mechanisms. Previous studies have strongly demonstrated a relationship between rhinosinusitis and asthma. This has led to the introduction of the concept of “united airways”, which has also been included in the WHO document Allergic Rhinitis and its Impact on Asthma (ARIA); this concept has important consequences also on the treatment of these disorders. To better summarize the evident connection between upper and lower airway disease we decided to describe it as a multilayered construction, each level pointing out more deeply the relationship between these entities.
Blockade of the CXCR6 Signaling Inhibits Growth and Invasion of Hepatocellular Carcinoma Cells through Inhibition of the VEGF Expression
Authors: Xu J-M. , Weng M-Z. , Song F-B. , Chen J-Y. , Zhang J-Y. , Wu J-Y. , Qin J. , Jin T. , Wang X-L.
Published: January 2017

Chemokines have been shown to play a critical role in tumor development and progression. However, little is known about the function and molecular mechanisms of CXCR6 in multiple malignancies. In the present study, we aimed to investigate the role of CXCR6 in human hepatocellular carcinoma (HCC). The expression of CXCR6 was examined by immunohistochemical assay using a tissue microarray procedure. A loss-of-function experiment was performed to explore the effects of lentivirus-mediated CXCR6 shRNA (shCXCR6) on cell proliferation and invasive potential by MTT and Transwell assays in HCC cell line (SMMC-7721). It was found that the expression of CXCR6 protein was significantly increased in HCC tissues compared with that in adjacent non-cancerous tissues (ANCT) (63.04% vs 36.96%, P=0.019), and correlated with the lymph-vascular space invasion in HCC patients ( P=0.38). Knockdown of CXCR6 repressed cell proliferation and invasion of HCC cells followed by the down-regulation of vascular endothelial growth factor (VEGF). Taken together, our findings show that high expression of CXCR6 is positively associated with distant invasion of HCC patients, and blockade of CXCR6 signaling suppresses the growth and invasion of HCC cells through inhibition of the VEGF expression, suggesting that CXCR6 may represent a promising therapeutic target for the treatment of HCC.
Association of the IRF5 SNP rs2004640 with Systemic Sclerosis in Han Chinese
Authors: Wang J. , Yi L. , Guo X. , Liu M. , Li H. , Zou H. , Gu Y. , Tu W. , Guo G. , Yang L. , Lai S. , He D. , Zhou X.
Published: January 2017

Systemic sclerosis (SSc) is a complex disease involving multiple genetic factors. An association of the IRF5 polymorphism with SSc was reported in Caucasian populations of Europe and North America, as well as in Japanese populations. The present study aimed to examine whether the SSc-associated SNP rs2004640 of IRF5 gene confer susceptibility to SSc and clinical features of SSc in a Han Chinese population. A Han Chinese cohort consisting of 424 SSc patients and 502 healthy controls were examined in the study. TaqMan assays were carried out to examine the SNP. Exact p-values were obtained (Fisher's test) from 2×2 tables of allele counts and disease status. SSc patients of Han Chinese showed increased homozygous TT genotype of the rs2004640 (p = 0.027, odds ratio (OR) = 1.4, CI =1.03–1.93), which was significantly associated with pulmonary fibrosis of SSc and ATA-positive SSc of Han Chinese. The lcSSc and ACA-positive SSc of Han Chinese appeared also in association with the increased T allele frequency. However, the Chinese dcSSc did not show any association with the rs2004640. The results were consistent with previous reports in other ethnic populations in supporting the notion that polymorphisms of IRF5 may play an important role in susceptibility to SSc.
Subclinical Carotid Atherosclerosis in Elderly Patients with Primary Sjögren Syndrome: A Duplex Doppler Sonographic Study
Authors: Zardi E.M. , Sambataro G. , Basta F. , Margiotta D.P.E. , Afeltra A.M.V.
Published: January 2017

A growing body of evidence presents a link between chronic inflammatory rheumatic diseases and atherosclerosis. To evaluate subclinical carotid atherosclerosis in an elderly group of patients with primary Sjögren syndrome compared with a control group matched for age, sex, ethnicity and cardiovascular risk factors, we enrolled 18 patients with Primary Sjögren Syndrome (mean age 65±5.93 SD) and 18 mild Ostheoarthritic patients (mean age 66±5.94 SD) from the outpatient department of Rheumatology, University “Campus Bio-Medico, Rome, Italy, matched for age, sex, ethnicity and cardiovascular risk factors. A duplex Doppler sonographic study of carotids was performed in order to evaluate intima-media thickness (IMT), stiffness and haemodynamic parameters [resistivity and pulsatility indices (RI and PI, respectively)]. No significant difference was found between primary Sjögren syndrome and control patients in IMT, stiffness and haemodynamic parameters. The lack of significant difference in subclinical atherosclerosis between elderly primary Sjögren syndrome and control matched patients, indicates that traditional cardiovascular risk factors, immunologic alterations and chronic inflammation do not influence the progression of vascular damage in the carotid circulation of patients with median disease duration of 6.5 years.
Differential Effects of Sodium Cromoglycate on Adriamycin-Induced Histamine Release from Isolated Rat and Mouse Mast Cells
Authors: Decorti Giuliana , Klugmann Fiora Bartoli , Candussio L. , Baldini L.
Published: January 2017

Adriamycin-induced histamine release has been studied on purified mast cells obtained from peritoneal cavities of mice and rats. The activity of the antineoplastic drug was compared with that of the classic basic secretagogue compound 48/80. Rat and mouse mast cells were similarly responsive to adriamycin, on the contrary, the activity of compound 48/80 was more marked in rat than in mouse.

The antianaphylactic agent sodium cromoglycate was extremely effective in preventing adriamycin-induced histamine release in both species, whereas, an inhibitory activity against compound 48/80 was evident only in rat mast cells.
Effects of Deoxycytidine on Mycoplasma-Associated Inhibition of Thymidine Incorporation and Growth in Antifolate-Containing Media
Authors: Mier James W. , Przygoda John , Allegretta Mark , Poldre Peeter A. , Kundsin Ruth B. , Rudders Richard A. , North Thomas W.
Published: January 2017

Several mycoplasma species markedly inhibit lymphokine- and mitogen-induced 3H-thymidine incorporation in cultured lymphoid cells, but have negligible short-term effects on cellular DNA synthesis as assessed by cytofluorography or by cell counts. The deoxyribonucleotide precursor deoxycytidine (dC) reverses this inhibition, but has little effect on isotope incorporation in uninfected cultures. Human lymphoblastoid leukemia cell lines contaminated with mycoplasma and hypoxanthine guanosine phosphoribosyl transferase (HGPRT)-deficient subclones do not grow in conventional HAT medium, but the unselected parent lines proliferate when dC is included in the culture medium. The beneficial effect of dC on the growth of contaminated cultures in selection medium is amplified by the addition of the cytidine deaminase inhibitor tetrahydrouridine (THU). These observations and corroborating nucleotide pool analysis suggest that dC may exert its beneficial effects on cellular proliferation and isotope utilization by inhibiting a mycoplasma-associated enzyme, thymidine phosphorylase. The data also suggest that the conversion of dC to dU by the cellular enzyme cytidine deaminase reduces the ability of dC to salvage contaminated cultures in the presence of an antifolate. The addition of dC to the culture medium in various 3H-thymidine incorporation assays makes possible the detection of stimulatory lymphokines despite the presence of mycoplasma contamination of the indicator cells. The normalization of nucleotide pools and cellular growth of mycoplasma-infected HGPRT (+) human leukemic cell lines with the addition of dC to HAT selection medium has made possible the use of infected HGPRT-deficient subclones as fusion partners in the generation of T-T hybridomas. Our studies also suggest that the ability of cells to grow in HAT medium only when dC is included is presumptive evidence for mycoplasma infection.
Modulation of Antigen-Induced Arthritis in Rats by Oral Administration of Type I Interferon
Authors: Yoshino S.
Published: January 2017

We investigated the effect of oral administration of type I interferon (IFN) on antigen-induced arthritis (AIA) in rats that was induced by immunization with methylated bovine serum albumin (mBSA) followed by intraarticular injection of the antigen. When IFN was orally given before immunization, the severity of AIA was significantly suppressed. Oral IFN also downregulated both delayed type hypersensitivity and in vitro proliferative responses to mBSA. The serum from IFN-fed rats decreased joint inflammation as well as proliferation to mBSA. In contrast, in rats fed IFN after the onset of AIA, neither joint swelling nor the proliferation of T cells to mBSA was affected. Feeding IFN before, but not after immunization with mBSA was effective in suppressing the production of IL-2 by lymph node cells. These data suggest that IFN may be active by the oral route and have a preventive effect on antigen-driven inflammatory diseases that appears to be due the suppression of IL-2 production resulting in the downregulatin of the T cell activation.
The in Vitro Activity of Two Urinary Polypeptides Respect to G- and GM-CSF and IL3 on the Peripheral CFU of Normal and Leukemic Subjects
Authors: Notario A. , Mazzucchelli I. , Rolandi M. L. , Fossati G.
Published: January 2017

We isolated two polypeptides on HPLC from the acetonic precipitate of the urine of normal subjects and of patients with untreated AML, APL and AMML. Before separation the quantity of the total urinary factor from leukemic patients was 50±10 mg/24h and from normal subjects was 10±5 mg. We tested the total polypeptidic extract and the two main fractions obtained on liquid cultures of the peripheral CFU of normal and leukemic subjects (AML, APL, CML and CMmL). Colony growth, cell morphology changes and the main cellular markers were examined at the beginning and at the 5th and 10th days of incubation in RPMI 1640 medium. Testing conditions were basal and as determined by the addition of the polypeptidic fractions, both alone and in association with trans-retinoic acid (t-RA) or thioproline (T). Simultaneously and under the same experimental conditions, we tested the activity of G- and GM-CSF and IL3. The results obtained prove the colony stimulating activity of the two fractions and of crude extract; they also prove the ability of such agents to modify the behavior in vitro of peripheral CFU. The urinary extracts are also able to stimulate a moderate differentiation of the elements and an increase both in fibroblasts and in adhesion molecules. We conclude that the dosage of growth factors in urine may be usefull as important marker in several hemopoietic pathological conditions or as a possible source of growth factors.
Intracellular Antimycobacterial Activity of Ciprofloxacin and Ofloxacin in Mycobacterium Fortuitum Infected Human Polymorphonuclear Leucocytes
Authors: Nziramasanga P. , Shah P.M. , Stille W.
Published: January 2017

The broadspectrum quinolone antibiotics ciprofloxacin and ofloxacin were tested for activity against the atypical mycobacterium M.fortuitum. In vitro minimal inhibitory concentrations (MIC) were done in Brain Heart Infusion broth and intracellular determinations in Medium 199 cell culture medium. The PMNs with intracellular bacteria and controls with or without drugs were incubated for six hours at 37°C. Hourly, 0.1 ml aliquotes were taken for colony forming units (cfu) assays. In vitro and intracellular MIC's for ciprofloxacin were 0.125mg/l and 0.625 mg/l respectively, while for ofloxacin they were 0.2mg/l and 0.4 mg/l, respectively.
I. Downsizing Psychiatric Hospitals: Needs for Care and Services of Current and Discharged Long-Stay Inpatients
Authors: Lesage Alain D , Morissette Raymond , Fortier Linda , Reinharz Daniel , Contandriopoulos André-Pierre
Published: January 2017

Background:

With the psychiatric deinstitutionalization movement in its fourth decade, questions are being raised concerning its relevance for long-stay inpatients with severe disabilities and the risk that those discharged into the community may be abandoned.

Methods

A random sample taken in 1989 of long-stay inpatients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients. Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized. Pairs were matched for sex, age, length of stay, and level of psychiatric care in 1989. Patients and staff were interviewed using standardized questionnaires, and case notes were reviewed to assess symptoms, daily living skills, residential status, quality of residential setting, and clinical and social problems and needs.

Results

The investigation revealed that discharged patients moved to highly supervised settings, which included professionally supervised group homes, supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patients were lost to follow-up, of whom 2 were probable vagrants. Both those discharged and those remaining as inpatients presented with major clinical problems and daily living skill deficits. The care needs of discharged patients were generally met, and placement in the community was considered appropriate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% required intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing behaviours.

Conclusion

Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient abandonment in the community.
Mental Health Services for American Indians and Alaska Natives: Need, Use, and Barriers to Effective Care
Authors: Manson Spero M
Published: January 2017

This special review summarizes and illustrates the state of our knowledge regarding the mental health needs of American Indians and Alaska Natives. These needs are considerable and pervasive. The discussion begins by reflecting on the limits of psychiatric nomenclature and conceptual frameworks for revealing Native constructions of mental health and mental illness. The experience and manifestation of psychopathology can be both different and the same across cultures, hinging upon the extent to which such basic assumptions as the relationship of mind to body—and spirit in the case of Native people—or the primacy of the individual or social collective are shared. Having set the stage, this paper moves to recent empirical evidence regarding the mental health needs of American Indians and Alaska Natives: we review that evidence and consider it within the broader context of available services. The report closes with a brief overview of the most pressing issues and forces for change afoot in Indian country in the US. Most have to do with the structure and financing of care as tribes and other Native community-based organizations seek to balance self-determination and resource management to arrive at effective, fiscally responsible, culturally informed prevention, treatment, and aftercare options for their members. These changes may herald similar trends among First Nations people to the immediate north.
Who Uses Bibliotherapy and Why? A Survey from an Underserviced Area
Authors: Adams Susan J , Pitre Nancy L
Published: January 2017

Objective:

To assess which mental health therapists use bibliotherapy, their reasons for doing so, and rationale for recommending specific titles. To review the book selected most often in several categories, using prepublished criteria for reviewers of self-help books.

Method

We sent a survey to all therapists in a Northern Ontario community requesting information on therapist demographics, the respondent's practice, the use of bibliotherapy, and details of the book most often prescribed in various categories.

Results

Of 112 surveys, 62 were returned, for a response rate of 55%. Sixty-eight percent of respondents indicated that they used bibliotherapy. The most common reason for recommending books was to encourage self-help. There was a significant relation between greater counselling experience and increased use of bibliotherapy. Three of the 5 books reviewed were based on empirical theory; only 1 met all the guidelines.

Conclusion

Most therapists recommend books to their clients, but there is little empirical evidence of efficacy. Counsellors should review the books recommended and discuss them with the client. Client opinion should be solicited and effectiveness measured.
Child Maltreatment: What We Know in the Year 2000
Authors: MacMillan Harriet L
Published: January 2017

This paper provides an overview of child maltreatment within a public health framework, based on the Closing Plenary Address presented at the 1999 Joint Meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child Psychiatry. A brief historical perspective is followed by a discussion of the burden of suffering associated with child maltreatment. Evidence about the prevention and treatment of child abuse and neglect is reviewed.

Evidence supports a program of nurse home visits as effective in preventing abuse and neglect among first-time, at-risk mothers. Sexual abuse education programs improve children's knowledge and prevention skills; whether such programs reduce the occurrence of child sexual abuse remains to be established. In the area of treatment, therapeutic daycare programs improve cognitive skills among physically abused and neglected children. Abuse-specific cognitive-behaviour therapy has been shown to be effective in reducing symptoms among sexually abused children in both preschool and older age groups. Further research is necessary across all subcategories of child maltreatment, particularly neglect and emotional abuse.
Symptoms of Posttraumatic Stress Disorder in Adolescents with Conduct Disorder: Sex Differences and Onset Patterns
Authors: Reebye Pratibha , Moretti Marlene M , Wiebe Vaneesa J , Lessard Jocelyne C
Published: January 2017

Objective:

To examine sex differences in the rate and symptoms of posttraumatic stress disorder (PTSD), trauma exposure, and onset patterns in youth with conduct disorder (CD).

Method

Youth admitted to a clinical facility for severe behaviour problems completed the Diagnostic Interview for Children and Adolescents – Revised (DICA-R) to assess the presence of CD and PTSD.

Results

Over one-half of CD youth reported exposure to trauma, yet only 17% met criteria for PTSD. PTSD was more frequent in CD girls (28%) than in boys (10%), and girls experienced greater symptom intensity and anhedonia, difficulty feeling love or affection, and disturbance of sleep and concentration. Girls more frequently reported sexual assault, while boys were more likely to report accidents, physical assaults, and witnessing the death of a loved one. Retrospective reports indicated that PTSD tended to develop subsequent to CD.

Conclusions

Exposure to trauma is common among CD youth; however, diagnostic procedures should be adapted for increased sensitivity to PTSD. The development of CD may increase the risk for PTSD, particularly in girls, by exposing youth to situations in which they are traumatized. The role of trauma in CD should be routinely examined by clinicians and warrants further research.
Impact of Risperidone on Seclusion and Restraint at a State Psychiatric Hospital
Authors: Chengappa KN Roy , Levine Joseph , Ulrich Richard , Parepally Haranath , Brar Jaspreet S , Atzert Rebecca , Brienzo Rick , Gopalani Aziz
Published: January 2017

Objective:

To evaluate the impact of risperidone on seclusion and restraint in patients at a state psychiatric facility, shortly after risperidone's release.

Methods

Patients who were in the hospital for at least 3 months prior to receiving risperidone and subsequently received risperidone for at least 3 months formed the cohort. A mirror-image design was used with duration to a maximum of 1 year before and 1 year after initiation of risperidone. The hospital population that did not receive either risperidone or clozapine during the same time period was used for comparison of trends of seclusion and restraint.

Results

Seventy-four patients (most with schizophrenia) met the inclusion criteria of the risperidone group. There were statistically significant decreases in the number of seclusion hours (2.2 [SD 5.5] to 0.26 [SD 0.06]) and of events (0.23 [SD 0.59] to 0.05 [SD 0.14]) per person per month during risperidone treatment, compared with the prerisperidone treatment period (P = 0.01). The comparison group also evidenced decreases on these measures during the same time period, but the risperidone-treated cohort achieved a proportionally greater reduction. There were similar trends toward reduction in the restraint measures during risperidone treatment compared with prerisperidone, but these did not achieve statistical significance. The comparison group also showed slightly decreased use of restraints over the study period.

Conclusions

Risperidone appears to have had a positive impact on seclusion in this state-hospital psychiatric population. These data support the positive impact of risperidone on violence found in other studies. Violence and aggression are major factors that affect morale among psychiatric patients and staff. So, any benefit in this regard as a result of antipsychotic drug treatment is salutary for patients, families, and health care providers.
Developmental Disability Training in Canadian Psychiatry Residency Programs
Authors: Lunsky Yona , Bradley Elspeth
Published: January 2017

Objective:

To examine current training in developmental disabilities in Canadian psychiatry residency programs and to determine, from the programs' perspectives, how provinces across Canada are responding to the needs of persons with developmental disabilities and comorbid mental health disturbances (persons with a “dual diagnosis”).

Method:

A survey was completed by residency directors, or their designate, for all 16 psychiatry residency programs in Canada.

Results:

Persons with developmental disabilities require psychiatric services throughout their lives, but inadequate training opportunities exist in many of the residency programs, particularly those involving adults and adolescents. While some didactic opportunities are usually available, supervised clinical opportunities are rare, and many of those reported are optional.

Conclusions:

Across Canada, there have been insufficient advances in clinical training and service developments to meet the needs of individuals with developmental disabilities and comorbid mental health disturbances.
Posttraumatic Stress Disorder, Trauma Exposure, and the Current Health of Canadian Bus Drivers
Authors: Vedantham Kumar , Brunet Alain , Boyer Richard , Weiss Daniel S , Metzler Thomas J , Marmar Charles R
Published: January 2017

Objective:

Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non–treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems.

Methods:

Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures.

Results:

The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings.

Conclusions:

Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health.
Alcoholism: Beliefs and Attitudes among Canadian Alcoholism Treatment Practitioners
Authors: Meza Eduardo E , Cunningham John A , el-Guebaly Nady , Couper Linda
Published: January 2017

Objectives:

To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism.

Methods:

A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons.

Results:

Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication.

Conclusions:

Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.
Canadian Geriatric Psychiatrists: Why Do They Do it? A Delphi Study
Authors: Lieff Susan , Clarke Diana
Published: January 2017

Objective:

To generate hypotheses regarding influential factors that have contributed to the practice of geriatric psychiatry by geriatric psychiatrists.

Method:

Using the Delphi technique, designed to generate ideas and consensus, a sample of members of the Canadian Academy of Geriatric Psychiatry (CAGP) were asked to provide ideas on what factors were influential in their decision to devote a significant part of their practice to geriatric patients. These items were then synthesized into a questionnaire and rated for their degree of influence by the same group of psychiatrists.

Results:

A total of 41 items were rated according to their degree of influence. The most influential items were related to geriatric psychiatry residency training experiences that were perceived to be positive or adequate. Supervision characteristics and interest in the medical psychiatric nature of the field were also deemed influential.

Conclusions:

This study generates the hypothesis that the nature of the educational experience during psychiatry residency has a significant influence on the practice of geriatric psychiatry.
Relation of Blood Counts during Clozapine Treatment to Serum Concentrations of Clozapine and Nor-Clozapine
Authors: Oyewumi L Kola , Cernovsky Zack Z , Freeman David J , Streiner David L
Published: January 2017

Objective:

To determine the relation between serum clozapine and nor-clozapine levels and blood cell counts during clozapine treatment.

Method:

We undertook a prospective longitudinal study of 37 consecutive patients with a diagnosis of schizophrenia treated with clozapine. We obtained informed consent and then determined serum concentrations of clozapine and nor-clozapine weekly. Clozapine was administered daily in divided doses given every 12 hours and adjusted according to clinical guidelines for its use. Samples for serum concentrations were taken at steady state, immediately before the next morning's dose, for 4 to 8 weeks. Complete blood counts (CBC), weight, and vital signs (that is, blood pressure, pulse, and temperature) were also monitored weekly before the morning's dose of clozapine was administered.

Results:

Analyses of variance showed no significant changes over the 8-week treatment course in the observed mean white blood count (WBC), red blood count (RBC), neutrophils, and lymphocytes counts, or in the hemoglobin and hematocrit. Only a few weak correlations (r < 0.21) were found between these hematological parameters and the measures of serum clozapine and nor-clozapine.

Conclusions:

The mechanism of clozapine-induced hematotoxicity at the therapeutic dosage range is probably not by direct toxicity of clozapine or nor-clozapine to the blood cells or their precursors. The formation of the cytotoxic nitrenium compound from clozapine by neutrophils may be necessary.
Treatment Resistance in Anorexia Nervosa and the Pervasiveness of Ethics in Clinical Decision Making
Authors: MacDonald Chris
Published: January 2017

Clinical efforts to treat anorexia nervosa (AN) are constantly resisted by patients. Although the primacy of patient autonomy is a cornerstone of modern medical ethics, clinicians will nonetheless often be justified in pursuing particular interventions despite such resistance, given the reduced competency of patients suffering from this multifactorial psychiatric illness. While a literature exists on the ethical justification for imposing treatment, that literature has focused exclusively on situations in which patients refuse treatment outright. When patients resist rather than refuse treatment, clinicians are faced with the ethical challenge of deciding whether particular interventions constitute justified infringements upon patient autonomy. Given the fact that treatment resistance is endemic to AN, we see that ethical decision making must also be a continual part of the disorder's treatment. This paper argues that the treatment of AN merely constitutes a particularly clear example of what is in fact a general phenomenon: ethical decision making pervades all clinical practice.
Identifying and Targeting Risk for Involvement in Bullying and Victimization
Authors: Craig Wendy M , Pepler Debra J
Published: January 2017

Bullying is a relationship problem in which power and aggression are used to cause distress to a vulnerable person. To assess and address bullying and victimization, we need to understand the nature of the problem, how the problem changes with age and differs for boys and girls, the relevant risk factors (those individual or environmental indicators that may lead to bullying and victimization), and the protective factors that buffer the impact of risk. For children involved in bullying, we need to assess its extent and the associated social, emotional, psychological, educational, and physical problems. Bullying is a systemic problem; therefore, assessments of bullying need to extend beyond the individual child to encompass the family, peer group, school, and community. We recommend that assessments at each of these levels reflect the scientific research on bullying and victimization. With attention to the problems associated with bullying, we can work collectively to make schools and communities safer for children and youth.
Behaviour in Children with Language Development Disorders
Authors: Willinger Ulrike , Brunner Esther , Diendorfer-Radner Gabriele , Sams Judith , Sirsch Ulrike , Eisenwort Brigitte
Published: January 2017

Objective:

The objective of the study was to explore the univariate and multivariate differences in behavioural problems among children with disorders in expressive or mixed receptive–expressive language development and children with unimpaired language development.

Method:

Ninety-four children with language development disorders (LDD) between the ages of 4 and 6 years and 94 children (matched by age and sex) without disorders of language development were compared concerning behavioural problems, as measured by the German version of the Child Behavior Checklist/4–18.

Results:

Thirty-two children (34%) with LDD showed behavioural problems in the clinical range, whereas only 6 control subjects (6%) had scores in this range. Univariate group comparisons between patients and control subjects showed significant differences in all 8 syndromes and the scale “other problems,” with patients having higher scores. Multivariate stepwise discriminant analysis showed a significant discriminant function by the scales “other problems,” “social problems,” “anxious–depressed,” “thought problems,” “attention problems,” and “delinquent problems.”

Conclusions:

In general, our results agree with several studies that report that children with speech and language disorders are at special risk for developing behavioural problems. Neurodevelopmental immaturity may be one factor underlying both the disorder in language development and the behavioural problems.
Pilot Study: Access to Fitness Facility and Exercise Levels in Olanzapine-Treated Patients
Authors: Archie Suzanne , Wilson Jane Hamilton , Osborne Shelley , Hobbs Heather , McNiven Jean
Published: January 2017

Background:

Increasingly alarmed by the health risks (that is, weight gain, elevated lipids, and poor glucose tolerance) posed by novel antipsychotic medications, clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors. Unfortunately, schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia.

Objective:

To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility.

Methods:

Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men's Christian Association (YMCA) fitness facility, based on random allocation. The intervention included a free membership to the YMCA for 6 months, with access to all the fitness amenities and equipment. The mean dosage of olanzapine was 11.5 mg daily for the YMCA group.

Results:

Of the 10 subjects, 2 did not attend at all. One subject met criteria for full attendance for each of the 6 months and lost 15 kg. Dropout rates were as follows: 90% at 6 months, 70% at 5 months, and 40% at 4 months. The main reason they gave for poor attendance was lack of motivation. The mean weight gain was 2 kg in the YMCA group.

Conclusion:

Most subjects did not regularly exercise or attend. They cited poor motivation as the main reason. The subject who exercised regularly lost a significant amount of weight.
Influence of Family Therapy on Bullying Behaviour, Cortisol Secretion, Anger, and Quality of Life in Bullying Male Adolescents: A Randomized, Prospective, Controlled Study
Authors: Nickel Marius K , Muehlbacher Moritz , Kaplan Patrick , Krawczyk Jakub , Buschmann Wiebke , Kettler Christian , Rother Nadine , Egger Christoph , Rother Wolfhardt K , Loew Thomas K , Nickel Cerstin
Published: January 2017

Objective:

To determine the influence of brief strategic family therapy (BSFT) on salivary cortisol, anger, and health-related quality of life (QoL) in adolescent boys with bullying behaviour.

Method:

We selected a sample of 72 boys demonstrating bullying behaviour from the general population and treated 36 with BSFT for 12 weeks. The other 36 boys formed the control group. Primary outcome measures were salivary cortisol concentration 15 to 30 minutes after awakening and changes on the subscales of the State-Trait Anger Expression Inventory (STAXI) and the Health Survey (SF-36).

Results:

After 12 weeks' treatment, we observed a significant reduction in bullying behaviour in the BSFT group ( P = 0.017) and in the mean values (according to the intent-to-treat principle) for salivary cortisol concentration ( P < 0.001). The BSFT group also showed significantly greater change on the STAXI subscales State-Anger ( P < 0.001), Trait-Anger ( P < 0.001), Anger-Out ( P < 0.001), and Anger-Control ( P < 0.001). Treatment with BSFT also resulted in significant improvement on the SF-36 subscales for Vitality ( P < 0.001), Social Functioning ( P < 0.001), Role-Emotional ( P < 0.001), and Mental Health ( P < 0.001).

Conclusions:

BSFT effectively influenced bullying behaviour, salivary cortisol concentration, anger, and health-related QoL in adolescent bullying boys.
Characterization and Treatment Response of Anxious Children with Asthma
Authors: Papneja Tripti , Manassis Katharina
Published: January 2017

Objectives:

To compare children with Axis I anxiety disorders and asthma with a matched group of anxious children without asthma on questionnaire measures and response to cognitive-behavioural treatment (CBT) for anxiety.

Method:

A sample of 36 children with comorbid anxiety and asthma, aged 8 to 12 years, were matched for age, sex, and specific anxiety disorder with 36 children with an Axis I anxiety disorder but no asthma. Parents and children completed standardized questionnaires.

Results:

Children with comorbid anxiety and asthma had significantly more perinatal complications ( P = 0.001), and higher total ( P = 0.000) and psychological stressors ( P = 0.02), especially parent–child problems ( P = 0.01), but lower levels of depression ( P = 0.03) and anxiety ( P = 0.05), compared with anxious, nonasthmatic children. All children reported decreased anxiety ( P = 0.001) and depression ( P = 0.000) posttreatment, with a trend toward less improvement in anxiety in anxious children with asthma.

Conclusions:

Although replication is needed, addressing psychosocial stress and parent–child problems may increase CBT efficacy in children with comorbid anxiety and asthma.
Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)
Authors: Fischer Benedikt , Cruz Michelle Firestone , Rehm Jürgen
Published: January 2017

Objectives:

To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study).

Method:

We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample ( n = 679) was collected in 2002.

Results:

Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine–crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime.

Conclusions:

Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.
Phenotypes, Endophenotypes, and Genotypes in Bulimia Spectrum Eating Disorders
Authors: Steiger Howard , Bruce Kenneth R
Published: January 2017

Objectives:

To review the main phenomenological variants observed among bulimia spectrum syndromes and the factors believed to act etiologically for them and also to generate an etiologic model that accommodates known heterogeneities within the population suffering bulimic syndromes.

Method:

Defining bulimic syndromes broadly, we address threshold and subthreshold forms of bulimia nervosa (BN) and also the provisional or newly proposed diagnoses of binge eating disorder (BED) and purging disorder (PD). We review evidence bearing on the validity of these diagnostic entities and on the place of sociocultural, family-developmental, neurobiological, and genetic factors in a multidimensional etiologic model for these classifications.

Results:

Available data validate certain bulimic phenotypes and subphenotypes that are characterized by such traits as impulsivity or affective instability. Findings associate subphenotypic, or trait-based, variations with putative endophenotypes, such as reduced serotonin transporter activity, and with candidate genotypes affecting the serotonin system; the data also indicate intriguing correspondences between gene–environment interactions and subphenotypic variations along such dimensions as novelty seeking.

Conclusions:

Bulimic syndromes sometimes reflect a primary disruption of controls over mood, impulses, and appetite in individuals showing marked psychopathology; at other times, they reflect a more circumscribed erosion of appetitive controls in relatively intact individuals, following prolonged dieting. We argue that dimensional perspectives involving careful attention to comorbid personality traits and symptoms are needed to accommodate existing heterogeneities within the population suffering from bulimia and to characterize the etiologic roles of familial-developmental, neurobiological, and genetic variables (and of interactions among these variables) in bulimic syndromes.
The Social Causes of Psychosis in North American Psychiatry: A Review of a Disappearing Literature
Authors: Jarvis G Eric
Published: January 2017

Objective:

To review the North American literature with respect to the role of social factors in the etiology of psychosis, including schizophrenia.

Method:

Relevant publications were identified through a search of MEDLINE from 1966 to 2006. Identified studies and articles had to originate in Canada or the United States to be included in the review. Articles written prior to 1966 were identified by cross-referencing bibliographies and reference lists. Articles were considered relevant if they discussed ethnoracial or other social factors as being causal or contributing to the development of psychosis or schizophrenia.

Results:

The relation between the etiology of psychosis and such social factors as poverty, migration, and racial discrimination has been neglected in the North American psychiatric literature for the last 40 years. In Canada and the United States, there is a dearth of research on these issues: the study of social causes of psychosis has been replaced by a focus on the clinical encounter, in which clinician bias is presumed to be responsible for widespread misdiagnosis of psychosis in minority (mainly African-American) populations. The reasons for neglecting social causes of psychosis in the North American psychiatric literature are obscure but may have to do with the rise of genetic–biological paradigms in recent decades.

Conclusions:

The neglect of social causes of psychosis in the North American psychiatric literature has been coincident with an increase in scholarly concern among European clinicians and researchers. Careful reading of the European literature may reveal helpful avenues for future investigation in the North American context. In addition, drawing on social science literature and methods may help to clarify mechanisms underlying poverty, migration, and racial discrimination that contribute to psychosis in vulnerable individuals and groups.