bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytokine Levels in Serum and Cerebrospinal Fluid during Tetanus: Possible Immune Activation
Authors: Perrella O. , Liguori G. , Martinelli M. , Finelli L. , Guarnaccia D. , Caiazzo A.L. , Buonanno L. , Guerriero M. , Soscia M. , Marinelli P.
Published: January 2017

Because of the possible involvement of cytokines in tetanus, we investigated the cerebrospinal fluid (CSF) and serum levels of granulocyte-macrophage-CSF (GM-CSF), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-1 alpha (IL-1 alpha), and interferon-gamma (IFN-gamma) in eight patients affected by uncomplicated tetanus before intrathecal therapy with immunoglobulins. We observed a significant increase of cytokines levels in CSF respect to controls (p<0.001). In particular IFN-gamma, followed by GM-CSF, IL-6 and TNF-alpha, while IL-1 alpha was not detectable in either serum or CSF. Moreover, no correlation was found between serum and CSF cytokine levels. These results could indicate an intrathecal production of these cytokines and a possible immunologic activation occuring in the central nervous system (CNS). Since this study is preliminary, we do not conclude that the measurement of cerebrospinal fluid cytokine levels could represent a useful marker in the course of tetanus.
Cytokines and Thyroid Autoimmunity
Authors: Mariotti S. , Del Prete G.F. , Chiovato L. , Mastromauro C. , Marcocci C. , De Carli M. , Romagnani S. , Ricci M. , Pinchera A.
Published: January 2017

Cytokines may play important roles in the development and perpetuation of autoimmunity. In this paper are briefly reviewed selected data on the relationship between cytokines and thyroid autoimmune diseases (AITD), which represent a typical example of organ-specific autoimmune endocrinopathy. The availability of high efficiency T-cell cloning techniques recently allowed the phenotipic and functional characterization of T lymphocytes derived from thyroid infiltrates of patients with Graves' disease and Hashimoto's thyroiditis. A high prevalence of T cell clones with cytolytic potential and displaying increased γ-interferon production was observed in both diseases; in contrast, high tumor necrosis factor-α secretion was a peculiar characteristic of T-cell clones derived only from Hashimoto's infiltrates. The production of IL-4 by CD4 + T cell clones from AITD infiltrates was remarkably low, suggesting a quite homogeneous populations of Thl-type «inflammatory» T cells. This pattern of cytokine production by thyroid infiltrates may be important not only in triggering and/or maintaining thyroid autoimmune reaction, but could also modulate the expression of AITD by exerting direct functional effects on thyroid epithelial cells, as suggested by recent in vitro studies.
The Interleukin-1 System: Physiopathology and New Insights for its Therapeutical Potential
Authors: Ghiara P. , Scapigliati G. , Censini S. , Bossù Paola , Tagliabue A. , Boraschi Diana
Published: January 2017

Interleukin-1 (IL-1) is a family of polypeptides that is thought to play an important role in the regulation of the systemic response to invasive stimuli such as infection, trauma or antigenic challenge, exerting both immunopotentiating and inflammatory actions on a wide variety of cellular targets. Binding studies with radiolabeled IL-Is showed that structurally distinct receptors are present on different cell types, suggesting that the different biological activities might be the consequence of IL-1 binding to distinct receptor subtypes.

The highly detrimental activities of IL-1 represent a major drawback for its therapeutic application. Studies with IL-1 fragments have shown that the nonapeptide corresponding to the 163–171 sequence of human IL-1β is able to mimic the immunopotentiating activities of IL-1 while being devoid of its pro-inflammatory potentials, thus it might find clinical application as an immunostimulating agent. Since IL-1 is involved in some pathological conditions, strategies for anti-IL-1 therapy should also be developed. In this regard a recently characterized naturally occurring IL-1 receptor antagonist might play an important role and its structural relationships with IL-1β are hereafter discussed.
Intraperitoneal Administration of Adjuvant Inhibits the Development of Adjuvant Arthritis in Rats
Authors: Conforti A. , Lussignoli S. , Bertani S. , Ortolani R. , Verlato G. , Bellavite P.
Published: January 2017

In recent years, considerable efforts have been made to develop effective therapy for autoimmune diseases by specific suppression of the autoreactive immune process without affecting the remainder of the immune system. In our study we evaluated the protective effects and therapeutic potential of Mycobacterium butyricum (Mb), the causative antigen inducing adjuvant arthritis (AA), an experimental model of autoimmune disease in the rat. The antigen was administered to rats by a different route and at concentrations 10 and 100 times lower than the inducing one. Arthritis was induced by injection of 0.6 mg of Mb in paraffin oil into the hindpaw, and the severity of disease was assessed by measurement of contralateral paw swelling every three days and primary and secondary lesions were scored on an arbitrary scale after 14, 21, and 28 days. Animals were assigned to different groups and treated intraperitoneally with different doses and schedules of Mb. The administration of 60 μg of Mb every two days, starting 6 days before arthritogenic injection until the second day after, led to a significant inhibition of the arthritic process (p< 0.001 of the arthritic index). Treatment of animals with 60 μg of Mb every two days, from day 2 to day 21 after arthritis induction caused almost total suppression of lesions. However, in both treatment schedules, animals showed important signs of peritoneal inflammation. The administration of single injection of 60 or 6 μg of Mb 10 days after arthritis induction led to an inhibition of arthritic index reaching the maximum percentage on day 14 (26% and 24% with 60 and 6 μg respectively) and was able to delay the development of oedema foot volume, without signs of local inflammation. These results confirm the ability to modulate the autoimmune process even when the immunological response is far advanced, suggesting new strategies in the therapy of human autoimmune diseases.
Phenotypic Characterization of Kidney Infiltrating Cell Subsets in Idiopathic Acute Interstitial Nephritis Associated with Uveitis: Evidence for a Cell-Mediated Immune Disease
Authors: Bonomini M. , Settefrati N. , D'Antuono T. , Palmieri P.F. , Albertazzi A.
Published: January 2017

The association of acute interstitial nephritis (AIN) and anterior uveitis without determined cause is quite rare. This disease entity is manifested by uveitis which may precede, occur concomitantly with, or follow AIN. Renal involvement is characterized by acute renal failure which is usually associated with a diffuse interstitial infiltration mainly by mononuclear cells. We report here the clinicopathological features in two cases of this association showing a different time course evolution of the renal disease. Repeat kidney biopsy allowed to study in different points of the disease process both the histological picture and the phenotypic characterization (by an immunohistochemical method) of cells infiltrating the renal interstitium. Immunohistochemical analysis of renal tissue revealed that interstitial infiltrate was primarily composed of T lymphocytes (mainly helper-inducer T cells) and monocytes/macrophages. A clear predominance of memory T lymphocytes (CD45RO+) in the interstitial infiltration was found. These cells persisted in the renal interstitium of the patient in whom renal function remained persistently impaired. The cellular profile of immunocompetent cells in renal lesions suggests a major role for cell-mediated immunity in the development of idiopathic AIN associated with uveitis.
Serum Fcεrii Receptor (SCD23) as an Evaluating Factor for Grass Pollen Immunotherapy
Authors: Fleva A. , Daniilidis M. , Kyriakopoulou G. , Chatzaki E. , Nikolaou A. , Andreopoulos K. , Daniilidis J. , Tourkantonis A. , Hatzipetrou L.
Published: January 2017

CD23 is a protein on the surface of certain hemopoietic cells and it is considered to be the low affinity receptor for immunoglobulin IgE, (FcεRll/CD23). The regulation of the expression of CD23 depends on the type of cell on which it is found. Like most of the FcR receptors, it is released in a soluble form (sCD23) in the extracellular fluid. This form is found in increased levels in the serum of allergic patients and in neoplastic diseases. We studied total IgE and sCD23 in the serum of 30 allergic patients undergoing immunotherapy, 15 allergic patients treated only symptomatically for grass pollen (GP) allergy, 15 healthy and subjects. We found that the mean values of total IgE and sCD23 after the course of hyposensitization were decreased compared to those before treatment as well as to those GP allergic patients under conventional therapy and to healthy adults. However, only the CD23 decrease was statistically significant. Therefore, we speculate that determination of sCD23 may be useful for (a) the general evaluation of allergic patients and (b) the immunological monitoring of patients under immunotherapy.
On the Pharmacotherapy of Obsessive—Compulsive Disorder: Is a Consensus Possible?
Authors: Todorov Christo , Freeston Mark H , Borgeat Francois
Published: January 2017

Objective:

To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive–compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials.

Method:

The literature on the pharmacotherapy of OCD was critically examined.

Results:

The available research evidence is not conclusive but suggests that clomipramine possesses greater antiobsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs.

Conclusion:

Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.
Perceptions of Parental Bonding and Symptom Severity in Adults with Depression: Mediation by Personality Dimensions
Authors: Enns Murray W , Cox Brian J , Larsen Derrick K
Published: January 2017

Objective:

An association between anomalous parental bonding experiences (lack of parental care, overprotection, or both) and depression during adulthood has been observed in several studies. The objective of the present study was to evaluate several different personality dimensions as possible mediators of the relationship between perceptions of parental bonding and depressive symptoms in adulthood.

Methods:

Outpatients with depression (n = 138) completed the Parental Bonding Instrument (PBI), the Beck Depression Inventory (BDI), and several measures of proposed personality vulnerabilities to depression. The conceptual and methodological criteria of Baron and Kenny (1986) were used to assess possible mediating effects of personality variables.

Results:

In men, overprotection by their fathers was significantly associated with depression; neuroticism, socially prescribed perfectionism, and concern over mistakes acted as mediators of this relationship. In women, lack of care by their mothers was significantly associated with depression; self-criticism, socially prescribed perfectionism, and concern over mistakes mediated this relationship.

Conclusions:

The present study provides evidence that personality factors may mediate the observed relationship between parental rearing style and depression. These potential causal mechanisms warrant longitudinal evaluation.
Psychiatric Disorders in an Arctic Community
Authors: Haggarty Jack , Cernovsky Zack , Kermeen Patricia , Merskey Harold
Published: January 2017

Objective:

To determine the rates of depression, anxiety, and alcohol abuse, using modern nosology, in a random sample of residents aged 14 to 85 years living in an Arctic community.

Method:

A cross-sectional 2-step survey of randomly selected households was undertaken, using a self-report questionnaire to screen for anxiety, depression, and alcohol abuse. The survey included the Hospital Anxiety and Depression Scale (HADS) and Ewing and Roose's 4-question alcohol screening instrument (the CAGE questionnaire). Cut-off scores for the HADS and CAGE were found by comparing HADS and CAGE scores with scores on the Structured Clinical Interview for the DSM-III-R (SCID) in a stratified subs ample.

Results:

Estimated rates of depression and anxiety were 26.5% and 19.0% respectively within the past week, and estimated rates of lifetime alcohol abuse were 30.5%.

Conclusions:

The estimated prevalence of psychiatric disorders in this Arctic community is higher than that indicated in previous findings on Native mental health.
A Longitudinal Study of Siblings of Children with Chronic Disabilities
Authors: Fisman Sandra , Wolf Lucille , Ellison Deborah , Freeman Tom
Published: January 2017

Objective:

To examine the unaffected siblings of 2 different groups with chronic disabilities, pervasive developmental disorder (PDD) and Down syndrome (DS), over 3 years, comparing their adjustment with each other and with the siblings of a nondisabled group.

Method:

This study examines 137 siblings of children with PDD, children with DS, and developmentally normal children (control group) initially and 127 siblings at follow-up 3 years later. Their adjustment is measured by the Survey Diagnostic Instrument (SDI), completed by caregivers and teachers. Predictor variables include sibling self-perception, social support, and relationship with sibling, as indicated by siblings; caregiver psychosocial factors such as parental stress, caregiver depression, and marital relationship; family systems characteristics as viewed by both caregiver and sibling; and difficulty that disabled child causes as perceived by the primary caregiver.

Results:

Significantly more adjustment problems are found in the siblings of PDD children at both times when compared with siblings of DS and control children. Caregivers of PDD children report the highest levels of distress and depression, and this persists over time. Parent distress was found, at both times, to be related to sibling adjustment problems, regardless of study group.

Conclusion:

These results have implications for preventive intervention for the unaffected siblings of PDD children.
Clinically Significant Differences among Canadian Mental Health Acts
Authors: Gray John E , O'Reilly Richard L
Published: January 2017

Objectives:

First, to highlight the major differences among mental health acts in different Canadian jurisdictions as they relate to involuntary admission criteria, treatment authorization, review and appeal procedures, and conditional leave and community treatment orders. Second, to analyze the impact of these differences on the care that individuals with mental illness receive.

Method:

We examined the mental health act provisions of all Canadian jurisdictions to determine how the clinical management of a typical case would differ among jurisdictions. We used a statement of principles for mental health legislation endorsed by the Canadian Psychiatric Association to guide the analysis. We confirmed interpretation of each act and its implementation through key informant contact in each province and territory.

Results:

We found clinically significant differences among the provinces and territories on all major components of their mental health acts.

Conclusion:

Provisions that prevent patients receiving appropriate clinical care can be found in some Canadian mental health acts. Alternate provisions that support appropriate clinical care, that respect the human rights and personal dignity of patients, and that are consistent with the Canadian Charter of Rights and Freedoms can be found in the legislation of other jurisdictions.
Lithium Revisited
Authors: McIntyre Roger S , Mancini Deborah A , Parikh Sagar , Kennedy Sidney H
Published: January 2017

Objective:

To review lithium's utility in the treatment of mood disorders.

Method:

We reviewed the safety, tolerability, teratogenicity, optimal dosing regimens, and mortality-lowering effects of lithium. Clinical relevance and scientific rigour determined which articles we selected for review.

Results:

Lithium is the paradigmatic treatment for bipolar disorder (BD). In treating BD, optimal maintenance plasma levels may be approximately 0.75 to 0.85 mEq/L. Although nephrogenic diabetes insipidus is not uncommon, irreversible renal failure due to lithium appears to be a rare, idiosyncratic event. Lithium-induced cardiovascular teratology appears to be less common than previously thought. Optimal lithium dosing may be once daily, this agent appears to bestow a robust suicide-lowering effect, and emerging data hint at neurotrophic and neuroprotective effects.

Conclusion:

Lithium remains an effective and integral agent in the treatment of BD. Its ability to lower suicide rates in persons with BD warrants clinical attention.
Clinical Trials in Psychiatry: Do Results Apply to Practice?
Authors: Seeman Mary V
Published: January 2017

Objective:

The purpose of this communication is to alert psychiatrists to the difficulties of translating results of group difference obtained from large, randomized clinical trials to the treatment of individual patients.

Method:

Reported discrepancies between a) clinical trial participants and general psychiatric patients, b) clinical trial investigators and general clinicians, and c) study trial and usual clinic conditions were assessed.

Results:

The results confirm that important differences exist in all 3 areas.

Conclusions:

Recommendations for researchers include more complete assessments of factors that account for individual difference, an appraisal of outcomes more important to patients than symptom scores, and the use of statistical methods that permit the evaluation of individual difference. Recommendations for clinicians include a careful differentiation of results obtained in different phases of clinical trials and a clear appreciation of the different purposes of those trials. Clinicians should also appreciate that short-term effectiveness is not the same as long-term outcome and that aggregate scores may not apply to individual patients.
Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits
Authors: Viguera Adele C , Cohen Lee S , Baldessarini Ross J , Nonacs Ruta
Published: January 2017

Background:

Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring.

Method:

We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers.

Results:

Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs).

Conclusions:

Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits.

Contexte:

Les problèmes liés au traitement clinique du trouble bipolaire (TB) durant la grossesse sont profonds et peuvent entraîner des risques concurrents pour la mère et l'enfant.

Méthode:

Nous avons examiné les résultats récents de la recherche sur le cours du TB durant la grossesse et le post-partum, de même que les données d'innocuité reproductrice des principaux régulateurs de l'humeur.

Résultats:

La grossesse et surtout la période du post-partum comportent des risques élevés de récurrence du TB. Les risques semblent être limités par les traitements aux régulateurs de l'humeur et notablement accrus par la cessation abrupte de ces traitements. Toutefois, les médicaments utilisés pour traiter ou prévenir les récurrences du TB varient beaucoup en ce qui concerne les risques tératogènes: les risques sont faibles pour les neuroleptiques typiques, modérés pour le lithium, élevés pour les anciens anticonvulsivants comme l'acide valproïque et la carbamazépine, et presque inconnus pour les autres anticonvulsivants de la nouvelle génération et les antipsychotiques atypiques (APA).

Conclusions:

Le traitement clinique des femmes souffrant du TB durant la grossesse et le post-partum demande des évaluations équilibrées des risques et des avantages pour la mère et le foetus.
Gender-Role Conflict and Suicidal Behaviour in Adolescent Girls
Authors: Pinhas Leora , Weaver Harriet , Bryden Pier , Ghabbour Nagi , Toner Brenda
Published: January 2017

Objective:

This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent girls.

Method:

We designed a checklist and used it to perform a chart review.

Results:

Gender-role conflict was associated with suicidal behaviour in 26.79% of the adolescent girls, and 2.68% of the adolescent boys, that we studied.

Conclusions:

Gender-role conflict plays an important role in the suicidal behaviour of girls. At present, there is no published research examining the impact of gender-role conflict on suicidal adolescents.

Objectif:

Cette étude examine si le conflit entre sexe et rôle influence le comportement suicidaire des adolescentes.

Méthode:

Nous avons mis au point une liste de vérification et l'avons utilisée pour effectuer une étude de dossiers.

Résultats:

Le conflit sexe-rôle était associé au comportement suicidaire chez 26,79 % des adolescentes et chez 2,68 % des adolescents que nous avons observés.

Conclusions:

Le conflit sexe-rôle joue un rôle important dans le comportement suicidaire des filles. À l'heure actuelle, aucune étude n'a été publiée sur l'effet du conflit sexe-rôle sur le suicide des adolescentes.
Why are Community Treatment Orders Controversial?
Authors: O'Reilly Richard
Published: January 2017

The use of community treatment orders and other forms of mandatory outpatient treatment has been controversial. The debate on the appropriateness of compulsory treatment in the community addresses a volatile mix of clinical, social policy, legal, and philosophical issues. This paper describes the major sources of contention, outlines the position of the protagonists, and where possible, attempts to answer some of the questions raised and identify common ground.
Completed Suicides in a Youth Centres Population
Authors: Renaud Johanne , Chagnon François , Turecki Gustavo , Marquette Claude
Published: January 2017

Objective:

From 1995 to 2000, 422 youths, aged 18 years and under, died as a result of suicide in Quebec. More than one-third had received services from youth centres (YCs) at some point. This study sought to characterize a sample of those youths to improve services for this at-risk population.

Method:

From a retrospective study of YCs and coroner's office files, we investigated the clinical features of youths who had received YC services and died by suicide. We compared them with YC patients matched for age, sex, and geographic area who had reported suicidal behaviour or who had no such symptoms.

Results:

Among those who committed suicide, we found a ratio of 3.8 boys for 1 girl, with a mean age of 16.8 years. Hanging, used by 73.6%, was the most frequent means; 53.6% had a previous suicide attempt. The group that committed suicide had more indicators of major depression, substance abuse, and disruptive behaviours, as well as more adverse events.

Conclusions:

Interventions should focus on screening for mental disorders and suicidal behaviours on the initial contact with YC services. This screening should be implemented through a medical multidisciplinary team that includes psychoeducational services.
Body Image, Binge Eating, and Bulimia Nervosa in Male Bodybuilders
Authors: Goldfield Gary S , Blouin Arthur G , Woodside D Blake
Published: January 2017

Objective:

Male bodybuilders (MBB) exhibit more severe body dissatisfaction, bulimic eating behaviour, and negative psychological characteristics, compared with male athletic and nonathletic control subjects, but few studies have directly compared MBB and men with eating disorders. This study compared men with bulimia nervosa (MBN), competitive male bodybuilders (CMBB), and recreational male bodybuilders (RMBB) on a broad range of eating attitudes and behaviours and psychological characteristics to more accurately determine similarities and differences among these groups.

Method:

Anonymous questionnaires, designed to assess eating attitudes, body image, weight and shape preoccupation, prevalence of binge eating, weight loss practices, lifetime rates of eating disorders, anabolic androgenic steroid (AAS) use, and general psychological factors, were completed by 22 MBN, 27 CMBB, and 25 RMBB.

Results:

High rates of weight and shape preoccupation, extreme body modification practices, binge eating, and bulimia nervosa (BN) were reported among MBB, especially among those who competed. CMBB reported higher rates of binge eating, BN, and AAS use compared with RMBB, but exhibited less eating-related and general psychopathology compared with MBN. Few psychological differences were found between CMBB and RMBB.

Conclusions:

MBB, especially competitors, and MBN appear to share many eating-related features but few general psychological ones. Longitudinal research is needed to determine whether men with a history of disordered eating or BN disproportionately gravitate to competitive bodybuilding and (or) whether competitive bodybuilding fosters disordered eating, BN, and AAS use.
Metformin for Prevention of Weight Gain and Insulin Resistance with Olanzapine: A Double-Blind Placebo-Controlled Trial
Authors: Baptista Trino , Martínez Jessan , Lacruz Anny , Rangel Nairy , Beaulieu Serge , Serrano Ana , Arapé Yinet , Martinez Maritza , de Mendoza Soaira , Teneud Luis , Hernández Luis
Published: January 2017

Objective:

To assess whether metformin prevents body weight gain (BWG) and metabolic dysfunction in patients with schizophrenia who are treated with olanzapine.

Method:

Forty patients taking olanzapine (10 mg daily) were randomly allocated to a metformin ( n = 20; 850 to 1700 mg daily) or placebo ( n = 20) group in a 14-week double-blind study. Waist circumference (WC), BWG, body mass index (BMI) fasting glucose, insulin, and lipids were evaluated at baseline and at Weeks 7 and 14 of treatment.

Results:

At Week 14, BWG (kg) was similar in the metformin group (5.5 kg) and the placebo group (6.3 kg), P = 0.4. There were no differences between the changes in BMI, WC, glucose, insulin, insulin resistance index (HOMA-IR), and plasma lipid levels observed in the treatment group and the placebo group; however, glucose levels decreased significantly after metformin administration ( P = 0.02). The HOMA-IR decreased significantly in both groups, but 3 subjects from the placebo group developed fasting glucose levels greater than 5 mmol/L. After taking metformin, triglyceride levels increased, but the cholesterol profile improved significantly.

Conclusions:

Metformin did not prevent olanzapine-induced BWG. While some lipid parameters worsened during placebo, the HOMA-IR improved in both the placebo and the metformin groups. Carbohydrate metabolism impairment was not systematically observed during short-term olanzapine administration.
Pharmacologic and Nonpharmacologic Strategies for Weight Gain and Metabolic Disturbance in Patients Treated with Antipsychotic Medications
Authors: Faulkner Guy , Cohn Tony A
Published: January 2017

Objectives:

To provide an overview of pharmacologic and nonpharmacologic strategies for antipsychotic-associated weight gain and metabolic disturbance, to identify important areas for future research, and to make practice recommendations based on current knowledge.

Methods:

We undertook a selective review of interventions for weight gain and metabolic disturbance in the general population and in individuals treated with antipsychotic medications, focusing on randomized controlled trials in schizophrenia.

Results:

Pharmacologic strategies include medication choice, medication dosage and formulation, choice of concomitant psychotropic medications, medication switching, medication addition to effect weight loss or prevent weight gain, and medications to increase insulin sensitivity. Medication choice and medication switching may have the most potent influence on weight and metabolic parameters. Modest short-term weight loss can occur with the addition of selective medications and (or) lifestyle interventions. However, more rigorous and longer-term studies are needed.

Conclusions:

Although difficult, the prevention of weight gain and the promotion of weight loss are possible for individuals treated with antipsychotic medications. Further research, including diabetes prevention studies, is required. We suggest a pathway for the management of weight gain and emerging metabolic disturbance.
Cornerstones of Career Satisfaction in Medicine
Authors: Lepnurm Rein , Danielson Danton , Dobson Roy , Keegan David
Published: January 2017

Objectives:

To establish a reliable and concise measure of career satisfaction that covers all 4 of its dimensions and to document higher dimensions of satisfaction among the major medical specialties and across varying patterns of clinical practice.

Methods:

In 2004, we conducted a stratified, cross-sectional survey of physicians in Canada. Of the eligible population, 2810 physicians (56.7%) responded. We checked response bias and found it was negligible. Responding physicians completed a 17-item measure of career satisfaction along with a detailed breakdown of clinical, academic, and administrative duties. We used confirmatory factor analysis to verify the existence of the hypothesized dimensions of higher-order satisfaction. We then used Scheffe's tests to document differences in the levels of all satisfaction dimensions, both among specializations and by clinical practice profile.

Results:

Factor analysis revealed 4 reliable dimensions of satisfaction: personal (α = 0.85), professional (α = 0.78), inherent (α = 0.70), and performance (α = 0.75). Inherent satisfaction with medicine as a career was the most important dimension for all specializations and for all patterns of practice. The addition of administrative duties without a reduction of clinical duties compromised personal, professional, and performance dimensions of career satisfaction. Academic duties contributed significantly to most physicians' overall, inherent, and performance satisfaction.

Conclusion:

Distinguishing higher-order dimensions of satisfaction from basic ones is a groundbreaking finding because addressing higher-order dimensions supports self-actualization and superior performance of duties.
Add-on Quetiapine for Bipolar Depression: A 12-Month Open-Label Trial
Authors: Milev Roumen , Abraham Gebrehiwot , Zaheer Juveria
Published: January 2017

Objectives:

Bipolar disorder (BD) is a disabling and often chronic condition. Patients with BD suffer from depression at least one-third of the time, but they do not always respond well to conventional mood stabilizers. Attempts to treat them with antidepressants can provoke a switch to mania or increased cycling. Our open-label trial aimed to assess the long-term response of patients with bipolar depression to the addition of quetiapine to their usual treatment. Our study also sought to assess the safety and tolerability of quetiapine in patients with BD.

Method:

To meet inclusion criteria for the study, patients had a DSM-IV diagnosis of type I or II BD, were aged 18 years and older, currently suffered from depression with a score of > 18 on the Hamilton Depression Rating Scale (HDRS), and had no change in antidepressant use for at least 3 weeks prior to the study. We added quetiapine to patients' medication and attempted to increase the dosage to at least 400 mg daily. Outcome was measured at baseline and once monthly for 12 months on the HDRS, the Young Mania Rating Scale, the Clinical Global Impression Scale (CGI), and the Abnormal Involuntary Movement Scale.

Results:

There were 19 patients enrolled in the study (6 men and 13 women), 2 of whom dropped out because they could not tolerate the drug. Seventeen completed at least 2 assessments, and 7 patients completed the full 12-month trial. Data for the 17 patients (that is, last observation carried forward) at 12 months shows HDRS scores reduced from 27.2 to 12.1 and CGI scores reduced from 4.7 to 2.6.

Conclusions:

Quetiapine seems to be helpful to and relatively well tolerated by patients with bipolar depression when it is added to their usual treatment. There is, however, a need for controlled trials.
French Adaptation and Validation of the Helping Alliance Questionnaires for Child, Parents, and Therapist
Authors: Kermarrec Solenn , Kabuth Bernard , Bursztejn Claude , Guillemin Francis
Published: January 2017

Objectives:

To adapt the Helping Alliance Questionnaires for Child and Parents (HAQ-CP) into French and to assess their validity and reproducibility for use with the child, parent, and therapist.

Method:

First, the 3 US versions of the questionnaires were translated into French by 3 French-English bilingual translators (who were native speakers), and the translations were then discussed by an expert committee to ensure that the concept explored within the French context was efficiently targeted. Second, the psychometric properties of the French version were investigated in a cross-sectional, multicentre study. The questionnaires were completed by 148 children and adolescents, aged 9 years or older and with various conditions, who were followed in 3 university hospital outpatient clinics and 2 ambulatory psychiatry units, and also by their parents and therapists.

Results:

The instruments were quick and easy to administer, and acceptability was good. All 3 versions proved unidimensional in factorial analysis (80% of variance was explained) with high internal construct validity (Cronbach's α = 0.8). Reproducibility was satisfactory (intraclass correlation coefficients were as follows: child, 0.84; parent, 0.84; and therapist, 0.87). Concordance of the 3 alliance assessments was moderate.

Conclusion:

This work provides child psychiatrists with a valid measure of the therapeutic alliance. Its predictive value, while recognized in adults, remains to be demonstrated in children.
Adverse Cardiovascular Events in Antidepressant Trials Involving High-Risk Patients: A Systematic Review of Randomized Trials
Authors: Swenson J Robert , Doucette Steve , Fergusson Dean
Published: January 2017

Objective:

To examine whether selective serotonin reuptake inhibitor (SSRI) antidepressants were associated with an increased or decreased risk of cardiovascular adverse events (AEs).

Methods:

We conducted a systematic review of randomized controlled trials published between 1967 and May 2005 that treated patients with cardiac disease, diabetes mellitus, stroke, geriatric age, nicotine dependence, alcoholism, HIV infection, and obesity. We defined serious AEs as death due to a cardiovascular cause, heart failure, stroke, transient ischemic attack, and myocardial infarction. Nonserious AEs were defined as palpitations, chest pain, angina, arrhythmia, hypertension, hypotension–syncope, and unspecified cardiovascular or neurologic events. Adverse event rates were calculated in 4 groups: SSRIs, tricyclic antidepressants (TCAs), other active therapies, and placebo.

Results:

Stroke and cardiac patients were the highest-risk groups for cardiovascular AEs. We were unable to detect differences in odds between SSRI and placebo for both serious (odds ratio [OR] 0.69; 95% confidence interval [CI], 0.39 to 1.21) and nonserious (OR 1.18; 95%CI, 0.90 to 1.57) cardiovascular AEs. There was a significant decrease in the odds of nonserious cardiovascular AEs (OR 0.46; 95%CI, 0.24 to 0.86, P = 0.02) for patients receiving SSRIs, compared with TCAs. Over one-half of the selected trials did not report the presence or absence of cardiovascular events.

Conclusions:

This systematic review of antidepressant trials in high-risk patients did not determine whether SSRIs are associated with a greater or lesser risk of cardiovascular AEs. Reasons for this conclusion include the rarity of serious AEs, the lack of large trials in these patients, and a lack of adequate reporting of AEs in published trials. Further trials assessing the risk of cardiovascular AEs and better trial reporting are needed.
Long-Term Treatment of Depression with Antidepressants: A Systematic Narrative Review
Authors: Furukawa Toshi A , Cipriani Andrea , Barbui Corrado , Geddes John R
Published: January 2017

Objective:

To examine the available scientific evidence for answers to clinically relevant questions on the effectiveness and tolerability of antidepressant drugs (ADs) for the long-term treatment of depression.

Method:

The Cochrane Library was searched up to July 2006. When no complete Cochrane review was available, we looked in PubMed for relevant systematic reviews or individual randomized controlled trials.

Results:

There was no good evidence that increasing the dosage of the initial AD is an effective strategy for patients with no, or partial, response to acute-phase treatment. There was no good evidence that switching between chemical classes of antidepressant was more effective than switching within a class. There was limited support from randomized trials for several augmentation strategies. There was good evidence for the effectiveness of long-term therapy to prevent relapse in patients who remitted after acute-phase treatment. The application of principles of evidence-based medicine suggested that thoughtful, individualized application of evidence is more appropriate than general statements.

Conclusions:

Available evidence provides some support for the effectiveness of several augmentation strategies in the management of patients with no, or partial, response to acute-phase treatment and for the individualized application of groupwise robust evidence for maintenance treatment with ADs to prevent relapses. However, side effects of these long-term treatments with ADs are poorly studied and reported.
A Multisite Canadian Study of Outcome of First-Episode Psychosis Treated in Publicly Funded Early Intervention Services
Authors: Malla Ashok , Schmitz Norbert , Norman Ross , Archie Suzanne , Windell Deborah , Roy Paul , Zipursky Robert B
Published: January 2017

Objective:

The aim of this study was to determine 1-year symptomatic outcome and its predictors in patients with first-episode psychosis (FEP) treated at 3 different publicly funded sites.

Method:

We evaluated FEP patients ( n = 172) treated in specialized programs in 2 medium-sized centres and 1 large urban centre with an identical protocol for demographic variables, diagnosis, and duration of untreated psychosis (DUP) at entry, and positive, negative, and general psychopathology symptoms at entry, 6 months, and 1 year. We used a mixed model analysis of variance, with time and centre and interaction between time and centre as fixed effects and sex and DUP as covariates, to analyze data.

Results:

A significant effect of time and time x centre interaction on positive, negative, and general symptom outcome was shown after controlling for ethnicity, education, and diagnosis. Patients showed significantly better outcome on all dimensions of symptoms in the 2 medium-sized centres, compared with the 1 large urban centre. Sex had a significant effect on negative and general symptoms, while DUP had no effect on any outcome measure.

Conclusions:

Similarly enriched early intervention services may produce different outcomes, even within a relatively homogeneous mental health system.
Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in First Episode Psychosis
Authors: Cassidy Clifford M , Schmitz Norbert , Malla Ashok
Published: January 2017

Objective:

To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP).

Method:

Subjects with FEP completed the AUDIT and DAST and were divided into groups according to the presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis.

Results:

Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis ( P < 0.001 in both cases). The AUDIT functioned best with a problem drinking cut-off score of 10 (sensitivity, 85%; specificity, 91%). The DAST functioned best with a problem drug use cut-off score of 3 (sensitivity, 85%; specificity, 73%). The area under the receiver operating characteristic curve was 0.86 for the AUDIT and 0.83 for the DAST.

Conclusion:

The DAST and AUDIT may reliably identify FEP patients with substance abuse.
Collaborative Mental Health Care for the Homeless: The Role of Psychiatry in Positive Housing and Mental Health Outcomes
Authors: Stergiopoulos Vicky , Dewa Carolyn S , Rouleau Katherine , Yoder Shawn , Chau Nancy
Published: January 2017

Objective:

Factors associated with positive outcomes for homeless men referred to a shelter-based collaborative mental health care team were examined.

Method:

A chart review of 73 clients referred over 12 months was completed. Two outcome measures were examined, clinical status and housing status, 6 months after their referral to the program.

Result:

Among the referred clients, the prevalence of severe and persistent mental illness and substance use disorders was 76.5% and 48.5%, respectively. At 6 months, 24 clients (35.3%) had improved clinically, and 33 (48.5%) were housed. Logistic regression identified 2 factors associated with clinical improvement: the number of visits with a psychiatrist and treatment adherence. The same 2 factors were associated with higher odds of housing, and presence of substance use disorder was associated with lower odds of housing at 6-month follow-up.

Conclusion:

Care by a mental health specialist is positively associated with improved outcomes. Strategies to improve treatment adherence, access to mental health specialists, and innovative approaches to treatment of substance use disorders should be considered for this population. Having a psychiatrist as a member of a shelter-based collaborative care team is one possible way of addressing the complex physical and mental health needs of homeless individuals.
Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder: A Review
Authors: Daskalakis Z Jeff , Levinson Andrea J , Fitzgerald Paul B
Published: January 2017

Several studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for treatment-resistant major depressive disorder (TRD). Recent metaanalyses and more recent large multicentre studies provided evidence suggesting that rTMS is indeed a promising treatment; however, its efficacy has often been shown to be modest, compared with sham stimulation. We review these lines of evidence and discuss several reasons that may explain the modest therapeutic efficacy in most of these studies, including: most involved left-sided treatment alone to the dorsolateral prefrontal cortex (DLPFC) only, which may be less optimal than applying bilateral stimulation; suboptimal methods were used to target the DLPFC (that is, the 5-cm anterior method), limiting the treatment potential of inherently a targeted form of treatment; some treatment durations were short (that is, 2 to 4 weeks); and stimulation intensity might have been insufficient by not considering coil-to-cortex distance, which has been linked to rTMS-induced antidepressant response. Future studies attempting to address the above-mentioned limitations are necessary to potentially optimize the efficacy of this already promising treatment option in TRD. Finally, it is also essential that research investigate the mechanisms of therapeutic efficacy, thus increases in understanding can be translated into enhanced treatment. For several reasons that will be reviewed, cortical excitability may represent an important mechanism, linked to the therapeutic efficacy of this disorder.
Excess Cancer Mortality in Psychiatric Patients
Authors: Kisely Stephen , Sadek Joseph , MacKenzie Adrian , Lawrence David , Campbell Leslie Anne
Published: January 2017

Objectives:

There are conflicting data on cancer incidence and mortality in psychiatric patients, although most studies suggest that while cancer mortality is higher, incidence is no different from that in the general population. Different methodologies and outcomes may account for some of the conflicting results. We investigated the association between mental illness and cancer incidence, first admission rates, and mortality in Nova Scotia using a standard methodology.

Method:

A population-based record-linkage study of 247 344 patients in contact with primary care or specialist mental health services during 1995 to 2001 was used. Records were linked with cancer registrations and death records.

Results:

Cancer mortality was 72% higher in males (95%CI, 63% to 82%) and 59% higher in females (95%CI, 49% to 69%) among patients in contact with mental health services. This was reflected in similarly elevated first admission rates. However, there was weaker and less consistent evidence for increased incidence. For several cancer sites, incidence rate ratios were lower than might be expected given the mortality and first admission rate ratios, and no higher than that of the general population. These were melanoma, prostate, bladder, and colorectal cancers in males.

Conclusion:

People with mental illness in Nova Scotia have increased mortality from cancer, which cannot always be explained by increased incidence. Possible explanations for further study include delays in detection or initial presentation leading to more advanced staging at diagnosis, and difficulties in communication or access to health care.