bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward Benchmarks for Tertiary Care for Adults with Severe and Persistent Mental Disorders
Authors: Lesage Alain D , Gélinas Daniel , Robitaille David , Dion Éric , Frezza Diane , Morissette Raymond
Published: January 2017

Background:

Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities.

Objectives:

To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks.

Methods:

Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients.

Results:

The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100 000 inhabitants. The ideal ratio, according to estimated needs, is 171:100 000. The figure breakdown is as follows: 20:100 000 for long-stay hospital units, 20:100 000 for nursing homes, 40:100 000 for group homes, 40:100 000 for private hostels or foster families, and 51:100 000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces.

Discussion:

Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges.

Conclusions:

It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.
Stigma and the Daily News: Evaluation of a Newspaper Intervention
Authors: Stuart Heather
Published: January 2017

Objective:

To evaluate a media intervention designed to improve one newspaper's portrayal of mental illnesses, specifically, schizophrenia. The project was part of an international antistigma program, Open the Doors, organized by the World Psychiatric Association.

Methods:

The media intervention attempted to influence news content directly by providing reporters with more accurate background information and helping them develop more positive story lines. The evaluation compared story content and length over a 24-month period: 8 months prior to the antistigma intervention and 16 months postintervention.

Results:

Positive stories outnumbered negative stories by a factor of 2 in both pre- and postperiods. Positive mental health stories increased by 33% in the postintervention period and their word count increased by an average of 25%. Stories about schizophrenia also increased by 33%, but their word count declined by 10%. At the same time, negative stories about mental illness increased by 25% and their word count by 100%. The greatest increase was in negative news about schizophrenia. Stigmatizing stories about schizophrenia increased by 46%, and their length increased from 300 to 1000 words per story per month.

Conclusion:

The immediate effects of the media intervention were positive, resulting in more and longer positive news stories about mental illness and more positive news stories about schizophrenia. However, when considered from a broader perspective, locally focused efforts yielded meager results in light of the larger increases in negative news, particularly in negative news concerning people with schizophrenia—the target group for the program.
Psychiatric Distress among Road Rage Victims and Perpetrators
Authors: Smart Reginald G , Asbridge Mark , Mann Robert E , Adlaf Edward M
Published: January 2017

Objective:

To investigate the relation between psychiatric distress and road rage, paying particular attention to the potential link between psychiatric illness and frequent involvement in serious forms of road rage.

Method:

This study reports data on road rage involvement, demographic characteristics, and mental health for a representative sample of 2610 adults in Ontario. The mental health indicator was the 12-item General Health Questionnaire.

Results:

A cluster analysis revealed 5 distinct groups of people affected by road rage. The most serious offenders (referred to hereafter as the hard core road rage group), representing 5.5% of those affected, exhibited frequent involvement in the most severe forms of road rage and were the most likely (27.5%) to report psychiatric distress.

Conclusions:

Road rage, particularly experiences of victimization, is related to psychiatric distress. Evidence of psychiatric distress was highest among hard core road rage perpetrators, individuals noted for frequent involvement in serious aggressive and violent conduct. Further research is needed on violence and road rage and its link to mental health.
Medicated Anxious Children: Characteristics and Cognitive-Behavioural Treatment Response
Authors: Liashko Vitaly , Manassis Katharina
Published: January 2017

Objective:

To determine whether individual and family characteristics of children with anxiety disorders who take psychotropic medications differ from those that are unmedicated and whether there is a differential response to cognitive-behavioural therapy (CBT).

Method:

Children ages 8 to 12 years ( n = 102: 18 medicated, 84 unmedicated) were recruited in a specialized outpatient clinic over a 3-year period. All had a primary diagnosis of an anxiety disorder. Comparisons were done using t-tests for continuous measures and chi-square tests for discrete measures. Treatment-related changes were assessed using repeated measures analyses of variance.

Results:

Medicated and unmedicated groups did not differ by age, sex, socioeconomic status, or diagnostic profile. Initial ratings of anxiety symptoms, depressive symptoms, and global functioning were comparable. Greater family dysfunction and family frustration were reported in medicated children. With treatment, both groups improved symptomatically and showed improved family functioning. Families of medicated children showed a greater reduction in frustration than families of unmedicated children, whereas unmedicated children showed greater gains in global functioning.

Conclusions:

Initial family functioning of medicated children seems to show more disturbances. Both medicated and unmedicated children can benefit from CBT. Further studies of differential treatment effects for medicated and unmedicated children are indicated.
Unicorns Do Exist: A Tutorial on “Proving” the Null Hypothesis
Authors: Streiner David L
Published: January 2017

Introductory statistics classes teach us that we can never prove the null hypothesis; all we can do is reject or fail to reject it. However, there are times when it is necessary to try to prove the nonexistence of a difference between groups. This most often happens within the context of comparing a new treatment against an established one and showing that the new intervention is not inferior to the standard. This article first outlines the logic of “noninferiority” testing by differentiating between the null hypothesis (that which we are trying to nullify) and the “nill” hypothesis (there is no difference), reversing the role of the null and alternate hypotheses, and defining an interval within which groups are said to be equivalent. We then work through an example and show how to calculate sample sizes for noninferiority studies.
Psychosocial and Clinical Predictors of Symptom Persistence vs Remission in Major Depressive Disorder
Authors: Enns Murray W , Cox Brian J
Published: January 2017

Objective:

The present study evaluates the impact of a range of psychosocial factors on the outcome of major depression while controlling for the effect of clinical variables.

Method:

Patients ( n = 171) seen in consultation at a mood disorders clinic completed measures of neuroticism, rumination, coping style, sexual abuse history, and parental bonding experiences at Time 1 and completed measures of interpersonal and achievement life events and depression 12 months later.

Results:

In univariate analyses, neuroticism, rumination, interpersonal and achievement life events, and sexual abuse history were associated with nonremission, whereas avoidance coping was associated with remission at Time 2. Interpersonal and achievement life events and sexual abuse history were associated with nonimprovement, whereas avoidance coping was associated with improvement at Time 2. Significant predictors of both remission and improvement in logistic regression analyses controlling for clinical variables (depression and anxiety severity, duration of illness, and age) included avoidance, interpersonal life events, and the interaction between avoidance and interpersonal life events.

Conclusions:

Interpersonal events and responses to depression (that is, coping) play an important role in the outcome of major depression. Further attention to coping style and interactions between psychological factors and life events is warranted in future research on depression persistence.
Construct Validity of an Instrument to Assess Major Depression in Parents in Epidemiologic Studies
Authors: Roy Carmella A , Zoccolillo Mark , Gruber Reut , Boivin Michel , Pérusse Daniel , Tremblay Richard E
Published: January 2017

Objective:

The Longitudinal Study of Child Development in Quebec (LSCDQ) is a community study of children that examines the risk factors, such as parental depression, linked to childhood psychopathology and maladaptive functioning. Our goal was to test the construct validity of an instrument to assess major depression in the parents.

Method:

Parents of a representative sample of 2120 infants born in the province of Quebec in 1998 were selected. The major depression instrument was administered to the parents when the infants were aged 29 months. We tested the construct validity of the instrument by examining 1) sex differences in symptoms and prevalence, 2) the rank order of the prevalence of symptoms, 3) the clustering of symptoms, and 4) the association of depression with functional impairment and treatment-seeking behaviour.

Results:

Depression was twice as common in mothers as in fathers. Most mothers and fathers who reported ever being depressed for 2 or more weeks had also experienced at least 4 additional depression symptoms. The rank order of symptom prevalence was comparable to that found in other studies. At least 50% of parents reported having talked to a professional and that suffering from depression had interfered with their functioning.

Conclusions:

The expected sex differences, the rank order of symptom prevalence, the symptom clustering, and the associations with functional impairment and treatment-seeking behaviour support the construct validity of a brief questionnaire on parental major depression.
Polysomnographic and Symptomatological Analyses of Major Depressive Disorder Patients Treated with Mirtazapine
Authors: Shen Jianhua , Chung Sharon A , Kayumov Leonid , Moller Henry , Hossain Naheed , Wang Xuehua , Deb Prativa , Sun Frank , Huang Xin , Novak Marta , Appleton Darryl , Shapiro Colin M
Published: January 2017

Objective:

This study aimed to characterize the effects of mirtazapine on polysomnographic sleep, especially slow wave sleep (SWS) and rapid eye movement (REM) sleep, as well as its effects on clinical symptoms in patients with major depressive disorder (MDD).

Method:

Sixteen MDD patients were treated with mirtazapine 30 mg taken 30 minutes before bedtime. Polysomnographic and subjective sleep, as well as other clinical data, were collected at baseline and on Days or Nights 2, 9, 16, 30, and 58 during treatment. We used repeated measures analysis of variance, including pairwise comparison, to analyze data statistically.

Results:

Mirtazapine administration increased total SWS and the SWS in the first sleep cycle, but not SWS in the second sleep cycle. The medication increased REM latency and the duration of the first REM episode; it also decreased the number of REM episodes. Simultaneously, mirtazapine significantly reduced wake-after-sleep onset and scores on the Athens Insomnia Scale. After patients took the medication, scores on the Hamilton Depression Rating Scale-17 (HDRS-17) decreased rapidly and continuously. The changes on the Beck Depression Inventory-II were consistent with those on the HDRS-17. The medication has a tendency to increase weight.

Conclusions:

Mirtazapine significantly improved sleep quality, reversed sleep markers of depression, and reduced depressive symptoms in this group of MDD patients.
Status of First-Episode Psychosis Patients Presenting for Routine Care in a Defined Catchment Area
Authors: Payne Jennifer , Malla Ashok , Norman Ross , Windell Deborah , Brown Nicole
Published: January 2017

Objective:

To examine the clinical and behavioural status of all first-episode psychosis (FEP) patients admitted to hospital within a defined catchment area.

Method:

We used a structured format to review clinical records of all first admissions to hospitals from a catchment area (population 390 000) with diagnosis of a first episode of nonaffective psychosis over a 3-year period.

Results:

Patients were somewhat older than usually reported for FEP (mean age 31.3 years). They were mostly male (63.7%), single (80.8%), unemployed (87.4%), with a primary diagnosis of schizophrenia spectrum psychoses (85%), and had spent a mean of 31 days in an open inpatient unit and 2.93 days in an intensive care psychiatric unit during their first admission. Most (60.3%) were admitted involuntarily; 34.2% had a history of legal involvement; 18.8% had attempted suicide prior to admission; 31.5% had demonstrated violence toward people, property, or animals; 14.4% had suffered injuries; and 15.9% had shown aggressive behaviour during the hospital admission.

Conclusions:

These results identify some of the potential needs of FEP patients, toward whom early intervention services should be directed.
Agreement between Staff and Service Users concerning the Clientele's Mental Health Needs: A Quebec Study
Authors: Fleury Marie-Josée , Grenier Guy , Lesage Alain
Published: January 2017

Objectives:

This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas.

Method:

We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared.

Results:

The sites with the greatest degree of user–staff agreement in identifying problems were also the ones where users considered that local services best met their needs.

Conclusions:

The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.

Objectifs:

Cet article examine les différences décelées entre la clientèle souffrant de graves problèmes mentaux et ses principaux travailleurs de la santé, pour ce qui est de l'évaluation des besoins des utilisateurs de services, dans 6 réseaux de services du Québec.

Méthode:

Nous avons interrogé 165 paires d'utilisateurs et d'employés, à l'aide du questionnaire d'évaluation des besoins de Camberwell. Le profil des problèmes sérieux et généraux éprouvés par la clientèle de chaque site a été comparé.

Résultats:

Les sites ayant le niveau d'entente le plus élevé entre utilisateurs et employés dans l'identification des problèmes étaient aussi ceux où les utilisateurs estimaient que les services locaux répondaient au mieux à leurs besoins.

Conclusions:

L'étude a démontré qu'en matière d'évaluation des besoins, il existe des différences majeures entre les perceptions des utilisateurs et celles de leurs principaux travailleurs, à divers sites. Ces différences peuvent s'expliquer en partie par les caractéristiques individuelles des utilisateurs, par les types de besoins, par les particularités locales et par l'utilisation des services.
Psychopathy Checklist Score Predicts Negative Events during the Sentences of Prisoners with Hare Psychopathy: A Prospective Study at a German Prison
Authors: Huchzermeier Christian , Bruß Emelie , Geiger Friedemann , Godt Nils , von Nettelbladt Frederic , Aldenhoff Josef
Published: January 2017

Objective:

This study examined the predictive validity of the German translation of the Psychopathy Checklist-Screening Version (PCL-SV) for negative events during the course of the prison sentence of German prisoners.

Method:

Using the PCL-SV, we investigated 145 offenders in a German prison at the start of their sentences. We then compared the extreme groups identified by the PCL-SV—the high and low scorers—using a prospective design with respect to negative events and factors during the course of the sentences. This involved the standardized collection of data on both objective records of disciplinary incidents and subjective impressions from prison staff on the basis of operationalized criteria.

Results:

The high scorers were involved in significantly more disciplinary incidents and were also rated significantly less favourably by prison staff than the low scorers.

Conclusion:

Until now, the PCL has only been shown to predict recidivism following release from prison. The results of our study show that the PCL also has predictive validity for problems during the course of the sentence. It is therefore recommended that the PCL be used routinely at the start of the prison sentence to estimate the likelihood of subsequent difficulties.
One-Year Stability of Diagnosis in First-Episode Nonaffective Psychosis: Influence of Sex
Authors: Chaves Ana Cristina , Addington Jean , Seeman Mary , Addington Donald
Published: January 2017

Objective:

To determine whether sex influences the frequency and direction of diagnostic change 1 year after a first episode of nonaffective psychosis.

Method:

The subjects ( n = 228) were individuals diagnosed with schizophrenia and other psychoses according to DSM-IV criteria at baseline and at 1 year.

Results:

When diagnostic shifts occurred, men mainly shifted toward schizophrenia (84.6%), which was associated with more severe symptoms. In contrast, 72% of women in whom a diagnostic shift occurred shifted away from a schizophrenia spectrum disorder toward mood disorder. A shift to mood disorder in women was associated with an early age of illness onset.

Conclusions:

At initial presentation, nonaffective first-episode psychosis studies may underestimate the number of men and overestimate the number of women who will eventually receive a schizophrenia diagnosis.
Sadism, Sadomasochism, Sex, and Violence
Authors: Fedoroff J Paul
Published: January 2017

The true prevalence of sexual sadism (and its variants) is unknown. However, all clinicians will knowingly or unknowingly encounter patients with this disorder. Regretfully, few programs offer adequate education in normal sexuality and even less provide training in the assessment and treatment of pathologic sexual interests. This review synthesizes current theories about possible etiologies of criminal sexual sadism and the resulting implications for diagnosis and treatment of this sexual disorder. Included is a review of theories of criminally sadistic sexual motivations, response patterns, and physiology, including possible neurophysiologic factors and more complex interactions. This review focuses primarily on published English-language scientific studies of sexual sadism. It should be noted that my use of the term sadism refers to nonconsensual sexual aggression.
Comparing Interventions for Selective Mutism: A Pilot Study
Authors: Manassis Katharina , Tannock Rosemary
Published: January 2017

Objective:

To examine the outcome within 6 to 8 months of medical and nonmedical intervention for children with severe selective mutism (SM).

Method:

Children with SM ( n = 17) and their mothers, seen in a previous study, attended follow-up appointments with a clinician. Obtained by maternal report were: treatment received, current diagnosis (based on semi-structured interview), speech in various environments, and global improvement. An independent clinician also rated global functioning.

Results:

The diagnosis of SM persisted in 16 children, but significant symptomatic improvement was evident in the sample. All children had received school consultations. Children who had been treated with selective serotonin reuptake inhibitors (SSRI) ( n = 10) showed greater global improvement, improvement in functioning, and improvement in speech outside the family than children who were unmedicated ( n = 7). No differences were evident for children receiving and not receiving additional nonmedical intervention.

Conclusions:

The findings suggest the potential benefit of SSRI treatment in severe SM, but randomized comparative treatment studies are indicated.
Trends in Antidepressant Prescriptions among the Elderly in Alberta during 1997 to 2004
Authors: Newman Stephen C , Schopflocher Don
Published: January 2017

Objective:

To analyze trends in antidepressant (AD) prescription rates among the elderly (aged 65 years and older) in Alberta during 1997 to 2004.

Method:

Numerical data on AD prescriptions were obtained from Alberta Blue Cross. Age-standardized prescription rates were calculated according to type of AD.

Results:

The prescription rate for all ADs combined increased by 59% for men and 55% for women. This change was due entirely to serotonin reuptake inhibitors (SSRIs) and other recently-introduced ADs, that by 2004 accounted for 72% of AD prescriptions for men and 69% for women. For each year and type of AD, the prescription rate for women was almost double that for men.

Conclusions:

In the elderly in Alberta, prescription rates for ADs increased markedly during 1997 to 2004, especially for SSRIs and other recently introduced ADs.
Incidence of Major Malformations in Infants following Antidepressant Exposure in Pregnancy: Results of a Large Prospective Cohort Study
Authors: Einarson Adrienne , Choi Jacquelyn , Einarson Thomas R , Koren Gideon
Published: January 2017

Objective:

To ascertain if antidepressants, as a group, increase the risk for major malformations, as well as assessing each individual antidepressant.

Methods:

At The Motherisk Program, we analyzed pregnancy outcomes of women ( n = 1243) from prospectively collected cases in our database, who were exposed to antidepressants during their pregnancy. We then compared them with a matched comparison group of women ( n = 1243) who were not exposed (nonteratogen group).

Results:

Women ( n = 928) who fit the criteria for inclusion, were exposed in the first trimester of pregnancy, and gave birth to a live-born infant were matched to women ( n = 928) in the comparison group. There were 30 (3.2%) major malformations in the antidepressant group and 31 (3.3%) in the comparison group (OR 0.9; 95% CI 0.5 to 1.61). The antidepressants included in the analysis were: bupropion (113), citalopram (184), escitalopram (21), fluvoxamine (52), nefazodone (49), paroxetine (148), mirtazepine (68), fluoxetine (61), trazodone (17), venlafaxine (154), and sertraline (61).

Conclusions:

As a group, antidepressant use in the first trimester of pregnancy is not associated with an increased risk for major malformation above the baseline. In addition, no individual antidepressant was associated with an increased risk of a specific malformation.
Gatekeeper Training as a Preventative Intervention for Suicide: A Systematic Review
Authors: Isaac Michael , Elias Brenda , Katz Laurence Y , Belik Shay-Lee , Deane Frank P , Enns Murray W , Sareen Jitender ,   The Swampy Cree Suicide Prevention Team (12 members)8
Published: January 2017

Objective:

Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research.

Method:

Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken.

Results:

Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide.

Conclusions:

Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated.
Improvement of Metabolic Risk Profile under Second-Generation Antipsychotics: A Pilot Intervention Study
Authors: Blouin Mélissa , Binet Mario , Bouchard Roch-Hugo , Roy Marc-André , Després Jean-Pierre , Alméras Natalie
Published: January 2017

Objective:

To assess the impact of a weight management program on metabolic health of second-generation antipsychotic (SGA)-treated patients.

Methods:

A prospective 12-week intervention program including individual exercise training and nutritional group sessions was performed as a pilot study. An intervention group of 6 SGA-treated patients (5 men and 1 woman; mean 15.0, SD 11.8 months) was compared with 10 reference patients under SGAs (8 men and 2 women; mean 14.0, SD 14.2 months), presenting similar age and baseline weekly levels of physical activity. For patients of both groups, anthropometric measurements and basic fasting lipid profile were assessed. For patients in the intervention group, an adapted Rockport Test was performed to evaluate their aerobic fitness and compliance to training sessions, and was recorded.

Results:

After the 12-week period, reference patients significantly gained weight ( P = 0.001), whereas intervention patients showed significant weight loss and decreased body mass index ( P = 0.02); interaction between groups: P < 0.01. This weight loss was accompanied by a decreased cholesterol–high-density lipoprotein cholesterol ratio ( P = 0.04). Overall, the intervention patients' adherence to exercise prescription was 95.1 %, and this adherence induced a significant improvement of their aerobic fitness ( P = 0.05).

Conclusion:

This pilot study suggests that patients under SGAs may benefit from a weight management program and improve their metabolic health, as well as their aerobic fitness.
First- Generation Immigrants and Hospital Admission Rates for Psychosis and Affective Disorders: An Ecological Study in Ontario
Authors: Durbin Anna , Lin Elizabeth , Taylor Lawren , Callaghan Russell C
Published: January 2017

Objective:

The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas—Forward Sortation Areas (FSAs)—in Ontario.

Methods:

Ontario's inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income.

Results:

Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders.

Discussion:

Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.
Electrocortical Features of Depression and Their Clinical Utility in Assessing Antidepressant Treatment Outcome
Authors: Jaworska Natalia , Protzner Andrea
Published: January 2017

Major depressive disorder (MDD) is primarily characterized by decreased affect and accompanying behavioural consequences, but it is also associated with cognitive dysfunction. Assessment of electroencephalographic (EEG) activity and associated event-related potentials (ERPs; derived from averaged EEG activity in response to a stimulus) in the context of MDD has provided insights into the electrocortical abnormalities associated with the disorder. Importantly, EEG and ERPs also have emerged as candidates for predicting and optimizing antidepressant (AD) treatment outcome. This is critical in light of relatively low remission rates or a limited response to initial AD interventions. In contrast to other neuroimaging approaches, EEG and ERPs may be superior for predicting and monitoring AD response, as electrocortical measures are relatively inexpensive, easy to use, and have excellent temporal (that is, millisecond) resolution, enabling fine-grained assessment of basic cognitive and emotive processes. This review aims to highlight the most consistently noted EEG and ERP features in MDD, which may one day assist with diagnostic confirmation, as well as the potential clinical utility of specific electrocortical measures in aiding with response prediction.
Validation de la traduction française de la SURPS pour une population d'adolescents québécois
Authors: Castonguay-Jolin Laura , Perrier-Ménard Eveline , Castellanos-Ryan Natalie , Parent Sophie , Vitaro Frank , Tremblay Richard E , Garel Patricia , Séguin Jean R , Conrod Patricia J
Published: January 2017

Objectif:

La Substance Use Risk Profile Scale (SURPS) est un instrument de dépistage des caractéristiques de personnalité qui représentent un risque pour le développement d'une consommation problématique de substances. La SURPS comporte 23 items évaluant 4 dimensions et permet aux intervenants en santé mentale de mieux cibler la prévention. La SURPS a été validée au Canada anglais, au Royaume-Uni, en Chine et au Sri Lanka; l'objectif de cette étude est de valider une traduction française de la SURPS pour des adolescents francophones québécois, en plus d'en tester la sensibilité dans une population clinique.

Méthode:

Deux cent deux jeunes de 15 ans d'un échantillon communautaire ont répondu à la SURPS et à des mesures de la personnalité et de l'utilisation de substances. La cohérence interne, la solution factorielle et la validité concomitante de l'échelle ont été évaluées. Quarante adolescents (âge moyen de 15,7 ans) présentant un diagnostic psychiatrique ont également répondu à la SURPS et les scores ont été comparés aux normes de l'échantillon communautaire.

Résultats:

La traduction française de la SURPS démontre une bonne cohérence interne ainsi qu'une solution factorielle à 4 facteurs semblable à la version originale. Ses 4 sous-échelles ont une bonne validité concomitante. De plus, 3 de ses sous-échelles sont corrélées avec des mesures relatives à la consommation de substances psychoactives. Finalement, 95 % des participants de l'échantillon clinique ont été identifiés à risque selon les scores limites de la SURPS.

Conclusion:

La version française de la SURPS paraît être une mesure valide et sensible pouvant être utilisée auprès d'une population adolescente, québécoise et francophone.
Why are Patients Discharged by Review Boards?
Authors: O'Reilly Richard L , Komer William , Dunbar Sandra
Published: January 2017

Objective:

To identify why Review Boards revoked certificates for involuntary hospitalization.

Method:

The outcome of all applications for a Review Board hearing at 2 psychiatric hospitals in Ontario were recorded from the beginning of 1987 to the end of 1996. All cases where a certificate of involuntary hospitalization was revoked were identified. For each of these cases, the clinical record, including the Review Board's written reasons for its decision, was reviewed.

Results:

During the study period, 2644 patients applied for a review of their involuntary hospitalization. Only 42% of applications reached a hearing. Of these, 9% were revoked. Several recurring reasons for overturning certificates were identified. These included the physician relying too much on hearsay evidence, relatives supporting discharge at the hearings, and the patient clearly having recovered by the time the hearing took place.

Conclusions:

Relatives or staff who observe dangerous behaviour should be encouraged to give evidence at hearings. The treatment team should take careful note of the views of patients 'families and friends and review the patients 'progress before hearings.
Séquelles neurologiques secondaires à une intoxication aiguë au lithium
Authors: Roy Mario , Stip Emmanuel , Black Deborah N , Lew Vivianne , Langlois Robert
Published: January 2017

Objectif:

Analyse de la documentation sur les séquelles neurologiques permanentes secondaires à une intoxication aiguë au lithium.

Méthode:

Soixante-six articles en langue française et anglaise ont été passés en revue de 1968 à 1997 en utilisant Medline.

Résultats:

Cinquante-neuf cas ont été examinés dans la documentation et classifiés selon trois registres: le premier concerne les cas d'intoxication au lithium sans neuroleptique ayant entraîné un syndrome cérébelleux; le deuxième regroupe les cas où le lithium a été associé à un neuroleptique; et le troisième groupe présente des cas de séquelles neurologiques diverses, qu 'il y ait eu ou non association avec un neuroleptique.

Conclusions:

Le lithium présente une toxicité intrinsèque pour le système nerveux central et un tropisme particulier pour le cervelet. L'association avec des neuroleptiques semble augmenter sa toxicité ainsi que certains facteurs associés dont les états infectieux et la correction rapide de la lithémie. Nous discutons des mécanismes physiopathologiques actuellement invoqués pour expliquer la neurotoxicité du lithium.
Quality of Life in the Elderly: Comparisons Between Nursing Home and Community Residents
Authors: Pearlman Robert A. , Uhlmann Richard F.
Published: January 2017

Quality of life of older persons is important as a consideration in medical decisions and as a clinical outcome measure. To compare quality of life between elderly nursing home and community residents, we interviewed 47 pairs of age- and sex-matched, nondemented nursing home and community persons. Global quality of life ratings were similar among nursing home and community residents, with ratings suggesting a self-perceived acceptable quality of life. Housing (the nursing home), finances, health, and interpersonal relationships were associated with global quality of life for nursing home residents; for community participants, health, disability, finances, anxiety, and interpersonal relationships were associated with quality of life. Results suggest that health care providers cannot assume that their older nursing home residents perceive their quality of life to be worse than other elderly persons and that some people report that nursing homes improve their quality of life.
Immunologic Aspects of Transplant Management: Pharmacotherapy and Rejection
Authors: Power Michael , Rosenbloom Alan J.
Published: January 2017

The intensivist caring for the critically ill transplant patient must be knowledgeable in the management of immunosuppression or have expert help. Critical illness often has a major impact on the absorption and metabolism of immunosuppressive drugs, increasing or decreasing net immunosuppression. Too little immunosuppression brings the risk of graft loss, while too much increases the morbidity and mortality of serious infection. Optimum management often requires the skillful manipulation of dosage and/or routes of drug delivery. In many cases of life-threatening infection, immunosuppression must be discontinued altogether and restarted prior to significant graft injury. The cost of miscalculation is very high. Loss of a renal, pancreas, or small bowel transplant is tragic, while loss of a heart, lung, or liver is usually fatal. Unfortunately the management of immunosuppression is becoming more complex. As the field of transplantation matures, new immunosuppressants are being introduced. Also, more experience and growing numbers of clinical trials are making the required knowledge base ever larger. Each type of transplant has its own set of evolving immunosuppression strategies. This review presents the basic mechanisms of the most widely used drugs and the dangers of immunosuppression. The drugs are then discussed in the context of liver, small bowel, kidney, pancreas, heart, and lung transplantation. Finally, a brief section on the practical pharmacokinetics of the drugs is presented.
Disseminated Intravascular Coagulopathy (DIC): Pathophysiology, Laboratory Diagnosis, and Management
Authors: Senno Sandra L. , Pechet Liberto , Bick Rodger L.
Published: January 2017

Disease entities such as sepsis, shock, obstetric complications, and neoplasms share the process of disseminated intravascular coagulopathy (DIC) as a secondary complication. Regardless of the initiating event, DIC results from the activation of the virtually unregulated coagulation cascade, characterized by the generation of thrombin with fibrin deposition within the micro- and macrovascular systems (i.e., multiple thrombi), combined with a hemorrhagic diathesis. The counteraction by the fibrinolytic cascade is variable and is characterized by the conversion of plasminogen to plasmin, the latter functioning as a potent proteolytic enzyme, capable of degrading fibrinogen, fibrin, and several clotting factors. The kinin and complement cascades also partake in the promotion of DIC. In addition, antithrombin (AT), proteins C and S, antiplasmin, and plasminogen activator inhibitor 1, play a functional role in curtailing the activation of the coagulation and fibrinolytic mechanisms, but they too may be affected by the DIC process, particularly because a marked decrease in AT takes place in severe cases.

The laboratory findings of DIC are as variable as the underlying clinical presentation and usually include elevation of D-dimer (a product of lysed fibrin), fibrinogen degradation products (FDP), as well as prolongation of prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time, accompanied by thrombocytopenia and hypofibrinogenemia (noted mostly in obstetrical cases). Because some of these assays are not specific for the diagnosis of DIC, we propose the use of a new, simple, and cost effective panel: D-dimer, FDP, and AT. Elevations in FDP and D-dimer are sensitive for the diagnosis of DIC and a marked drop in AT establishes a poor prognosis.

Aside from the treatment of the underlying triggering event, a consensus with regard to the most effective management of DIC has not been established. Herein we summarize the rationale for the use of conventional therapeutic modalities such as fresh frozen plasma, cryoprecipitate, platelet and clotting factor concentrates, as well as the use of new alternatives. The use of AT infusions to maintain plasma levels of 150% of normal shows great promise in severe cases.

A fundamental understanding of the pathophysiology of DIC combined with an appreciation for efficient laboratory testing will allow for the most comprehensive diagnostic and therapeutic alternatives.
Cholesterol Embolism in Intensive Care Patients
Authors: Kirkland Lisa L.
Published: January 2017

Four case reports are presented, followed by a discussion of the acute, potentially life-threatening manifestations of the cholesterol embolism syndromes. Every major organ system except the lungs may be directly affected by cholesterol emboli; devastating consequences encompass cerebral, myocardial, spinal cord, intestinal, renal, and other visceral organ infarction, as well as peripheral and perineal gangrene. Additional complications include severe hypertension, gastrointestinal bleeding, and hemodynamic instability. Anticoagulants and thrombolytic therapy may exacerbate atheromatous embolism and are relatively contraindicated. Aggressive supportive therapy may improve chances of survival, but long-term prognosis is poor. Prevention remains the most important aspect in this devastating disorder.
Our Health Is in Our Hands
Authors: George Kimberly S. , Roberts Calpurnyia B. , Beasley Stephen , Fox Margaretta , Rashied-Henry Kweli ,   Brooklyn Partnership to Drive Down Diabetes (BP3D)
Published: January 2017

Purpose:

Design, implement, and evaluate a 6-week social marketing campaign (SMC) to raise awareness of obesity and increase involvement in type 2 diabetes prevention, nutrition, and fitness programs offered by the Brooklyn Partnership to Drive Down Diabetes (BP3D) in two low-income, urban communities.

Design:

This was a nonexperimental, formative research, mixed-methods study.

Setting:

The study took place in Central Brooklyn and East New York, two of the most impoverished, high-need communities in New York City.

Subjects:

Participants were black and Hispanic adults, who were 18+ years of age and residing in the priority communities.

Intervention:

Advertisements in English and Spanish encouraging healthier eating habits and advocating for better food options were displayed on New York City bus shelters, buses, and subway cars operating in the priority communities. Social media, Web sites, and print material were used to promote the campaign message.

Measures:

Social media metrics and a street intercept postsurvey informed the campaign’s success.

Analysis:

Quantitative data were analyzed using descriptive statistics.

Results:

One hundred advertisements in English and Spanish were posted. After an 18-month followup, there were over 11,000 visits to the Facebook page. Results from the postsurvey (n = 171) suggest the SMC motivated participants who recognized the advertisements to improve their health behaviors.

Conclusion:

A multifaceted SMC that coincides with prevention programs can effectively raise attention to health issues and activities in a high-risk population at a relatively low cost.
Differentiation Between Dementia and Depression Among Older Persons: Can the Difference Between Actual and Premorbid Intelligence Be Useful?
Authors: Dierckx Eva , Engelborghs Sebastiaan , De Raedt Rudi , Van Buggenhout Michael , De Deyn Peter Paul , Verleye Gino , Verte Dominique , Ponjaert-Kristoffersen Ingrid
Published: January 2017

We wanted to investigate whether the difference between actual and premorbid intelligence can be useful to make an early differentiation between Alzheimer's disease (AD) and depression among elderly. A Dutch version of the National Adult Reading Test (NLV), a measure of premorbid IQ and the Raven Coloured Progressive Matrices (RCPM), a measure of actual intelligence were administered to patients with mild (34) and moderate (27) AD, depressed elderly (36) and healthy control subjects (51). Logistic regression analyses revealed that intellectual decline (i.e. subtracting NLV percentile score from RCPM percentile score) was only able to predict group membership when moderate AD patients were compared to depressed and healthy individuals. Our results indicate that intellectual decline may not be a concomitant of elderly depression. However, the differentiation between mild AD and elderly depression can not be made by means of the difference between premorbid (NLV) and actual (RCPM) intelligence scores.
Presenilin-1 Gene Intronic Polymorphism and Late-onset Alzheimer's Disease
Authors: Dursun Erdinç , Gezen- Ak Duygu , Eker Engin , Ertan Turan , Engin Funda , Hanağasi Haşmet , Gürvit Hakan , Emre Murat , Yilmazer Selma
Published: January 2017

Presenilin-1 is known to contribute to the pathogenesis of Alzheimer's disease. The association of an intronic polymorphism (rs165932) of the presenilin-1 gene with late-onset Alzheimer's disease has been documented. However, contradicting results have been shown in different populations. The aim of the current study is to determine whether there is an association between the intronic polymorphism of the presenilin-1 gene and late-onset Alzheimer's disease in a cohort of Turkish patients. One hundred and seven participants with dementia of the Alzheimer type and 106 age-matched controls were genotyped according to BamH I restriction site in intron 8 of the presenilin-1 gene. The distribution of genotypes and alleles did not significantly differ according to χ 2 test (P = .52, P = .32, respectively), when the control and patients were compared. Consequently, our results showed that the 1/1 genotype does not increase the risk of developing late-onset Alzheimer's disease in the Turkish population.