bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic Monitoring for Patients Treated with Antipsychotic Medications
Authors: Cohn Tony A , Sernyak Michael J
Published: January 2017

Objectives:

Metabolic side effects of antipsychotic treatment include weight gain, dyslipidemia and increased susceptibility to diabetes. Patients with schizophrenia have increased coronary heart disease mortality and reduced life expectancy. There is an urgent clinical need to monitor antipsychotic-treated patients for metabolic disturbance. Our objectives were to review published international monitoring guidelines, establish goals for metabolic monitoring, and make recommendations for practice.

Method:

We reviewed the major published consensus guidelines for metabolic monitoring of patients treated with antipsychotic medications and selectively reviewed practice guidelines for the management of diabetes, dyslipidemia, and hypertension.

Results:

Patients with serious mental illness have markedly elevated rates of metabolic disturbance and limited access to general medical care. Monitoring, but not necessarily medical treatment of metabolic disorder, falls within the scope of psychiatric practice and should include screening for metabolic disturbance as well as tracking the effects of antipsychotic treatment. In addition, psychiatrists and psychiatric services should work toward facilitating patients' access to medical care. There is considerable consensus in the published guidelines. Areas of dissent include which patients to monitor, the utility of glucose tolerance testing, and the point at which to consider switching antipsychotics.

Conclusion:

We encourage clinicians to adopt a structured system for conducting and recording metabolic monitoring and to develop collaborations with family physicians, diabetes specialists, dieticians, and recreation therapists to facilitate appropriate medical care for antipsychotic-treated patients.
Long-Acting Injectable Risperidone Compared with Zuclopenthixol in the Treatment of Schizophrenia with Substance Abuse Comorbidity
Authors: Rubio Gabriel , Martínez Isabel , Ponce Guillermo , Jiménez-Arriero Miguel Angel , López-Muñoz Francisco , Álamo Cecilio
Published: January 2017

Objective:

This study aimed to compare the efficacy of long-acting risperidone and zuclopenthixol in subjects with schizophrenia and substance abuse.

Method:

A total of 115 subjects with schizophrenia and substance use disorders were enrolled for an open, randomized, controlled, 6-month follow-up study. Fifty-seven subjects were selected for treatment with long-acting injectable risperidone, while another 58 were treated with zuclopenthixol-depot.

Results:

Long-acting risperidone patients presented fewer positive urine tests (8.67 compared with 10.36, P = 0.005), showed improved scores on the Positive and Negative Syndrome Scale, and showed better compliance with the Substance Abuse Management program. The use of long-acting risperidone and less severe dependence explained the outcome at the end of the follow-up.

Conclusions:

Long-acting injectable risperidone was more effective than zuclopenthixol-depot in improving substance abuse and schizophrenia symptoms in subjects with dual diagnosis.
Oxcarbazepine in the Treatment of Bipolar Disorder: A Review
Authors: Pratoomsri Wetid , Yatham Lakshmi N , Bond David J , Lam Raymond W , Sohn Chang-Ho
Published: January 2017

Objective:

To review the data on the efficacy of oxcarbazepine (OXC) in bipolar disorder (BD) and to provide recommendations for clinicians on the use of this medication in treating BD.

Method:

Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided search of MEDLINE for the years 1950 to 2005.

Results:

Case reports, retrospective chart reviews, open prospective studies, and double-blind studies reported the efficacy and effectiveness of OXC in treating BD. The data indicate that OXC has efficacy in treating acute mania and may be a useful add-on in treating acute bipolar depression and in BD prophylaxis. OXC is generally well-tolerated.

Conclusion:

We recommend using OXC as monotherapy or as add-on therapy in refractory mania, but we recommend it be used predominantly as an add-on treatment for other phases of BD in patients who have not improved with well-established treatments or in patients who have difficulty tolerating adequate dosages.

Objectifs:

Examiner les données sur l'efficacité de l'oxcarbazépine (OXC) dans le trouble bipolaire (TB) et fournir des recommandations aux cliniciens sur l'utilisation de ce médicament pour traiter le TB.

Méthode:

Nous avons mené une recherche informatique dans MEDLINE recouvrant les années 1950 à 2005, à l'aide des termes oxcarbazépine et trouble bipolaire, oxcarbazépine et manie, ou oxcarbazépine et dépression bipolaire.

Résultats:

Des études de cas, des études de dossiers rétrospectives, des études prospectives ouvertes et des études à double insu portaient sur l'efficacité et l'utilité de l'OXC dans le traitement du TB. Les données indiquent que l'OXC est efficace pour traiter la manie aiguë et peut être un ajout utile pour traiter la dépression bipolaire aiguë et pour la prophylaxie du TB. L'OXC est généralement bien tolérée.

Conclusion:

Nous recommandons l'utilisation de l'OXC comme monothérapie ou comme ajout à la thérapie de la manie réfractaire, mais nous recommandons de l'utiliser principalement comme ajout au traitement d'autres phases du TB, chez des patients qui ne se sont pas améliorés avec les traitements bien établis ou chez les patients qui ont de la difficulté à tolérer les doses adéquates.
The Utility of the DSM Nosology of Mood Disorders
Authors: Goldney Robert D
Published: January 2017

Mood disorders have proven to be a fertile ground for nosological debate. Numerous attempts to classify them phenomenologically have been undertaken, but it is doubtful whether there will ever be widespread agreement until more definitive biological markers emerge. Although some individual classifications may have limited utility, the DSM nosology appears to incorporate most, if not all, of the mood disorders encountered in clinical practice. Indeed, with minor modifications, the DSM and ICD systems could be amalgamated to ensure universal agreement in our conceptualization of mood disorders.
Metareview on Short-Term Effectiveness and Safety of Antidepressants for Depression: An Evidence-Based Approach to Inform Clinical Practice
Authors: Cipriani Andrea , Geddes John R , Furukawa Toshi A , Barbui Corrado
Published: January 2017

Objectives:

To examine the available scientific literature for answers to clinically relevant questions regarding the effectiveness and tolerability of antidepressant drugs (ADs) for the acute phase treatment of depression and to assess the degree to which the literature supports the findings.

Methods:

We used several sources to identify primary reviews: MEDLINE (1955 to April 2006), EMBASE (1980 to April 2006), PsycINFO (1980 to April 2006), and the Cochrane Library 2006 Issue 1. Additional searches were also carried out on the following databases of the National Health Service Centre for Reviews and Dissemination: Abstracts of Reviews of Effects, Health Technology Assessment, and Turning Research into Practice. We also searched the National Institute of Health and Clinical Excellence guidance website. We carried out a metareview of selected high-quality systematic reviews of short-term pharmacologic interventions with ADs for major depression. To assess efficacy, we followed the hierarchy of evidence proposed by the Centre for Evidence Based Medicine (Oxford), including only reviews of randomized controlled trials. To assess tolerability, we also considered observational data when randomized evidence was not available.

Results:

There was randomized evidence that ADs are efficacious in primary care settings and that there may be small, but clinically important, differences in efficacy between ADs. There was no good evidence that an AD combined with an antipsychotic is superior to AD monotherapy in cases of psychotic depression or that intravenous administration leads to more rapid response. There was evidence that monoamine oxidase inhibitors are superior to tricyclic antidepressants, but not to selective serotonin reuptake inhibitors (SSRIs), in treating atypical depression. There is some evidence of harm related to the use of SSRIs in pregnancy but not to their use when breastfeeding. There is evidence that SSRIs may increase suicidal thoughts, but not actual suicide, in early-phase therapy.

Conclusions:

We found a substantial body of evidence regarding the benefits and harms of ADs in the treatment of depressive disorder. Nonetheless, there remains considerable residual uncertainty. The evidence is inadequate for generally applicable recommendations; in most cases, the balance between risks and benefits will need to be considered for individual patients. Clinicians should also be guided by the recommendations and warnings issued by drug regulatory authorities.
Psychosocial Outcomes following Electroconvulsive Therapy in a Community Setting: Retrospective Chart Review with 2-Year Follow-up
Authors: Mathew Biju , Dawson Marliese Y , Kozanitis Chris , Bright Britt , Gopinath HV , Raffa Jesse D , Yatham Lakshmi N , Lam Raymond W
Published: January 2017

Objective:

Electroconvulsive therapy (ECT) continues to be one of the most effective biological therapies for patients with mood disorders. Numerous studies address clinical response; however, few have examined psychosocial or occupational outcomes following ECT, especially in community settings. This study aimed to examine these outcomes in short- and long-term naturalistic follow-up of ECT conducted in a community hospital.

Methods:

A retrospective chart review was conducted of all patients who received ECT at Ridge Meadows Hospital in Maple Ridge, British Columbia, between January 1997 and December 2003. Charts were evaluated with the Clinical Global Impression (CGI), Global Assessment of Functioning, and Social and Occupational Functioning Assessment Scales prior to ECT and at 6 months, 1 year, and 2 years post-ECT.

Results:

A total of 90 patients with mood disorders underwent ECT; 86.5% were rated on the CGI as “markedly ill” to “among the most extremely ill” at baseline. All clinical ratings improved at every follow-up point, and by the end of 24 months, 56.6% of patients were rated as “much improved” or “very much improved” on the CGI. Similarly, the measures of psychosocial functioning also showed significant improvement throughout the follow-up period.

Conclusions:

These findings show that substantial and meaningful improvement occurred in clinical and psychosocial outcomes after ECT conducted in a community hospital. These changes were robust and stable over the 2-year follow-up period. Limitations of the study include the retrospective ratings, the open-label use of ECT, and the naturalistic treatment in follow-up.
The Association between Pathological Gambling and Attempted Suicide: Findings from a National Survey in Canada
Authors: Newman Stephen C , Thompson Angus H
Published: January 2017

Objective:

To examine the association between pathological gambling (PG) and attempted suicide in a nationally representative sample of Canadians.

Methods:

Data came from the Canadian Community Health Survey, Cycle 1.2, conducted in 2002, in which 36 984 subjects, aged 15 years or older, were interviewed. Logistic regression was performed with attempted suicide (in the past year) as the dependent variable. The independent variables were PG, major depression, alcohol dependence, drug dependence, and mental health care (in the past year), as well as a range of sociodemographic variables. Survey weights and bootstrap methods were used to account for the complex survey design.

Results:

In the final logistic regression model, which included terms for PG, major depression, alcohol dependence, and mental health care, as well as age, sex, education, and income, the odds ratio for PG and attempted suicide was 3.43 (95% confidence interval, 1.37 to 8.60).

Conclusions:

PG (in the past year) and attempted suicide (in the past year) are associated in a nationally representative sample of Canadians. However, it is not possible to say from these data whether this represents a causal relation.
Symptomatologie et adaptation psychosociale des adolescents ayant un trouble dépressif cooccurrent à un trouble de comportement perturbateur
Authors: Toupin Jean , Le Corff Yann , Pauzé Robert
Published: January 2017

Objectif:

Décrire la symptomatologie ainsi que l'adaptation psychologique, sociale et scolaire spécifique des adolescents qui présentent un trouble dépressif cooccurrent à un trouble de comportement perturbateur, de même que leur situation familiale.

Méthode:

Cette étude compare, à l'aide de régressions logistiques binomiales, des adolescents ayant un trouble dépressif cooccurrent à un trouble de comportement perturbateur ( n = 25) avec des adolescents ayant les mêmes difficultés de comportement, sans trouble dépressif cooccurrent ( n = 99). Les effets d'interactions en fonction du sexe sont étudiés.

Résultats:

Bien que les deux groupes aient plusieurs caractéristiques similaires, les jeunes ayant un double diagnostic ont plus de symptômes d'opposition et une estime de soi plus faible. Les analyses ne révelent aucun effet d'interaction selon la variable sexe.

Conclusions:

Les adolescents des deux groupes profiteraient d'interventions similaires relativement aux troubles de comportement perturbateurs et de certaines difficultés associées, soit la consommation de substances psychoactives, la fréquentation de pairs déviants et le fonctionnement scolaire problématique. Une attention particuliere doit être portée aux adolescents ayant un trouble dépressif surajouté, vu la symptomatologie oppositionnelle plus marquée et l'estime de soi plus faible.
Disordered Eating in Jewish Adolescent Girls
Authors: Pinhas Leora , Heinmaa Margus , Bryden Pier , Bradley Susan , Toner Brenda
Published: January 2017

Objectives:

To examine the presence and nature of disordered eating attitudes and behaviours among Jewish Canadian adolescents, as compared with non-Jewish Canadian adolescents in an urban community. A secondary goal was to examine whether rates of eating-disordered behaviour differed among the adolescents based on the degree of Jewish religious observance.

Method:

High school students ( n = 868) from the Toronto area completed a demographic and religious practice questionnaire together with the Eating Attitudes Test (EAT), a self-report test that discriminated adolescents with syndromal eating disorders from normal adolescents.

Results:

Jewish females aged 13 to 20 years, but not males, reported significantly more disordered eating behaviours and attitudes, compared with their non-Jewish female counterparts. Twenty-five percent of Jewish females, as compared with 18% of non-Jewish females, scored above the clinical cut-off for the EAT. No differences in vulnerability to disordered eating were found within the group of Jewish females or males related to their degree of religious observance.

Conclusions:

Adolescent Jewish females, but not males, appear to be at greater risk for abnormal attitudes and behaviours related to eating, compared with their non-Jewish female peers. While the reasons for this finding are unclear, this study is a step toward improving understanding of the relations between sex, culture, religion, and the development of eating disorders. Culturally sensitive and sex-specific prevention strategies and treatment interventions are indicated.
Medication Use and Nonadherence to Psychoactive Medication for Mental Health Problems by Community-Living Canadian Seniors with Depression
Authors: Sewitch Maida J , Cole Martin , McCusker Jane , Ciampi Antonio , Dyachenko Alina
Published: January 2017

Objectives:

To determine the relation between level of depression and psychoactive medication use and nonadherence in Canadian seniors, given that late-life depression is a common, serious mental health problem in Canada.

Methods:

Canadian Community Health Survey—Mental Health and Well-Being respondents aged 65 years and older ( n = 7736) comprised the study sample. Using the Composite International Diagnostic Interview to assess depressive symptoms, we created 4 depression levels to capture a spectrum of depressive disorders and (or) symptoms: major depression, comorbid major depression, depressive symptoms, and no depressive symptoms. Psychoactive medications assessed included sleep aids, anxiolytics, and mood stabilizers and (or) antidepressants (AD). Nonadherence was defined as either not taking medication as recommended or taking medication at a lower dosage than prescribed.

Results:

In total, 22.5% of respondents took psychoactive medication for a mental health problem in the previous 12 months. Psychoactive medication use was 46.8% for major depression, 43.1% for comorbid major depression, 34.0% for depressive symptoms, and 17.6% for no depressive symptoms. Rates of psychoactive medication use ranged from 46.5% of those with major depression, to 17.6% of those with no depressive symptoms. Overall, the rate of nonadherence to psychoactive medication was 31%; rates were highest among those with depressive symptoms (37.4%) and lowest among those with no depressive symptoms (27.4%). All 3 depressive categories were associated with greater odds of use and nonadherence.

Conclusion:

All 3 depression categories were associated with increased use of and nonadherence to psychoactive medication; however, rates of AD and (or) mood stabilizer use for clinically significant depression were low.
Objective and Subjective Measures in Recovery from a 35% Carbon Dioxide Challenge
Authors: Niccolai Valentina , van Duinen Marlies A , Griez Eric J
Published: January 2017

Objectives:

Because hyperventilation, dyspnea, and a feeling of choking are often core features of a panic attack, respiration has been one of the most widely studied physiological parameters in panic disorder (PD) patients. A respiratory subgroup of PD, with distinct etiological pathways, has also been suggested. Investigation of the recovery phase following a respiratory challenge may be a reliable way to establish respiratory impairment in PD patients. The objective of the present study was to investigate the recovery phase from a 35% carbon dioxide challenge in PD patients and in healthy controls, and to test the hypothesis of a different respiratory pattern in patients, compared to control subjects.

Methods:

Eleven nonmedicated PD patients with or without agoraphobia, 11 medicated PD patients, and 11 control subjects took part in a 35% carbon dioxide and 65% oxygen inhalation challenge. Respiratory rate, partial pressure of carbon dioxide, heart rate, and blood pressure were recorded during the baseline phase (10 minutes) and the recovery phase (10 minutes). Visual Analogue Scale of Anxiety and Panic Symptom List scores were collected pre- and post-challenge.

Results:

Nonmedicated patients had increased variability in respiratory rate and partial pressure of carbon dioxide during recovery, compared with control subjects and medicated PD patients. Also, PD patients tended to have higher heart rates and to need more time to recover from the challenge than control subjects.

Conclusions:

Results suggest that PD patients have less effective homeostatic control after their physiological equilibrium has been disrupted by a respiratory stressor.
The Bipolar Spectrum—A Bridge Too Far?
Authors: Patten Scott B , Paris Joel
Published: January 2017

Objectives:

To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies.

Methods:

The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified.

Results:

In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category.

Conclusions:

Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.
Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System
Authors: Rush Brian , Koegl Christopher J
Published: January 2017

Objective:

To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.

Method:

Data were collected on cases ( n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.

Results:

Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm.

Conclusion:

The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems.
Structure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Obsessive—Compulsive Personality Disorder in Patients with Binge Eating Disorder
Authors: Ansell Emily B , Pinto Anthony , Edelen Maria Orlando , Grilo Carlos M
Published: January 2017

Objective:

To examine 1–, 2–, and 3-factor model structures through confirmatory analytic procedures for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) obsessive–compulsive personality disorder (OCPD) criteria in patients with binge eating disorder (BED).

Method:

Participants were consecutive outpatients ( n = 263) with binge eating disorder and were assessed with semi-structured interviews. The 8 OCPD criteria were submitted to confirmatory factor analyses in Mplus Version 4.2 (Los Angeles, CA) in which previously identified factor models of OCPD were compared for fit, theoretical relevance, and parsimony. Nested models were compared for significant improvements in model fit.

Results:

Evaluation of indices of fit in combination with theoretical considerations suggest a multifactorial model is a significant improvement in fit over the current DSM-IV single-factor model of OCPD. Though the data support both 2-and 3-factor models, the 3-factor model is hindered by an underspecified third factor.

Conclusion:

A multifactorial model of OCPD incorporating the factors perfectionism and rigidity represents the best compromise of fit and theory in modelling the structure of OCPD in patients with BED. A third factor representing miserliness may be relevant in BED populations but needs further development. The perfectionism and rigidity factors may represent distinct intrapersonal and interpersonal attempts at control and may have implications for the assessment of OCPD.
Neural Substrates of Self-Regulatory Control in Children and Adults with Tourette Syndrome
Authors: Raz Amir , Zhu Hongtu , Yu Shan , Bansal Ravi , Wang Zhishun , Alexander Gerianne M , Royal Jason , Peterson Bradley S
Published: January 2017

Objective:

To identify the neural substrate of self-regulatory control in children and adults with Tourette syndrome (TS).

Method:

We used event-related functional magnetic resonance imaging (fMRI) to study the neural correlates of cognitive self-regulation during the Simon task. Forty-two people from The Tic Disorder Specialty Clinic who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for diagnosis with TS (24 children; 18 adults) were compared with 37 control subjects (19 children; 18 adults). Patients with TS were excluded from participation if they had any Axis I psychiatric disorder other than obsessive–compulsive disorder (OCD) or attention-deficit hyperactivity disorder (ADHD) prior to the onset of TS. Control participants were excluded if they reported a history of tic disorder, OCD, ADHD, or if they met diagnostic criteria for any Axis I disorder at the time of interview.

Results:

We detected greater overall fMRI activation in adults than in children across both diagnostic groups, primarily in frontal and striatal regions. In both groups we also detected an age-related shift away from more general cortical activation toward a more specific reliance on frontostriatal activity, a developmental correlate that was exaggerated in the TS group despite behavioural performances similar to those of control subjects. Moreover, the severity of tics correlated positively with frontal activations across age groups.

Conclusion:

Frontostriatal circuits support cognitive and behavioural control. These circuits likely contribute both to optimal performance in this self-regulatory task and to the regulation of the severity of tics. Adults with persistent TS likely possess deficient activity in these circuits, attributable to either a failure of prefrontal plasticity or to disturbances in striatal functioning.
Impulsivity and Hopelessness as Predictors of Suicide-Related Ideation among Older Adults
Authors: Neufeld Eva , O'Rourke Norm
Published: January 2017

Objective:

Research has demonstrated that impulsivity is strongly associated with suicide-related ideation and behaviour among young adults. However, to date, the potential importance of impulsivity as a predictor of suicide-related ideation in later life has yet to be determined. Our study examined impulsivity, hopelessness, depressive symptomatology, and sociodemographic factors vis-à-vis suicide-related ideation among older adults at risk of self-harm.

Method:

A sample ( n = 117) of older adults was recruited from multiple sources for this study over a 1-year period. Suicide-related ideation was measured with the Geriatric Suicide Ideation Scale, a multidimensional measure of suicide-related ideation developed for use with older adults.

Results:

Canonical correlation identified 2 pairings of linear composites in which impulsivity emerged along both as significantly associated with facets of suicide-related ideation. Of note, the greater proportion of variance in impulsivity was subsumed along the second set of vectors with somatic depressive symptoms.

Conclusion:

Our findings suggest that the impulse to self-harm may be even more pronounced among older adults less likely to present as typically depressed. It is further suggested that impulsivity is more broadly associated with suicide-related ideation than hopelessness, and that screening for impulsivity as well as hopelessness may increase clinicians' ability to identify older adults at greatest risk of self-harm.
Effects on Knowledge and Attitudes of Using Stages of Change to Train General Practitioners on Management of Depression: A Randomized Controlled Study
Authors: Shirazi Mandana , Parikh Sagar V , Alaeddini Farshid , Lonka Kirsti , Zeinaloo Ali Akbar , Sadeghi Majid , Arbabi Mohammad , Nejatisafa Ali Akbar , Shahrivar Zahra , Wahlström Rolf
Published: January 2017

Objective:

To assess the impact on knowledge and attitudes of a tailored educational intervention on depression using a modified version of the Prochaska stages of change model, compared with standard continuing medical education, for general practitioners (GPs) in primary care in Iran.

Method:

Using a randomized controlled trial, a total of 192 GPs were evenly randomized to intervention or control arm. The topic for the educational intervention was depressive disorders. The participants were divided in to small and large groups, depending on their initial stage of change. The GPs' knowledge and skills regarding management of depressive disorders were assessed through a questionnaire with 7 multiple choice questions, 11 Likert statements, 3 case vignettes, and 1 essay question. Attitudes toward management of depressive disorders were also assessed. Both questionnaires were validated.

Results:

There was a significant improvement in knowledge mean scores regarding multiple choice and Likert questions (intervention effect 6%; P = 0.002), as well as for the case vignettes and essay question (intervention effect 12%; P = 0.011) in the intervention arm, in comparison with the control arm. There were significant changes in mean attitude scores in both study arms, but no difference between them.

Conclusions:

A theoretical model of medical learning and behavioural change can be used to devise educational formats that suit different stages of learning. Such tailored educational formats can improve GPs' knowledge and skills regarding management of depressive disorders.
Predictors of Adherence to Cognitive-Behavioural Therapy in First-Episode Psychosis
Authors: Álvarez-Jiménez Mario , Gleeson John F , Cotton Sue , Wade Darryl , Gee Donna , Pearce Tracey , Crisp Kingsley , Spiliotacopoulos Daniela , Newman Belinda , McGorry Patrick D
Published: January 2017

Objective:

To investigate predictors of adherence with a cognitive-behavioural intervention in first-episode psychosis (FEP) patients.

Method:

Predictors of adherence to cognitive-behavioural therapy (CBT) were longitudinally investigated in the experimental arm of a randomized controlled trial designed to evaluate the effectiveness of a CBT intervention for relapse prevention early in the course of psychosis when compared with treatment as usual within 2 high quality, youth oriented, specialist FEP programs (the EPISODE II trial).

Results:

Longer duration of untreated psychosis (DUP) and poorer level of insight predicted poor adherence to CBT. This association remained significant after controlling for potential confounders.

Conclusions:

Treatment delay may decrease adherence with CBT in FEP patients. Reducing DUP and promoting insight early in the course of psychosis are likely to enhance adherence with CBT.
Extending the Construct of Psychopathy to Youth: Implications for Understanding, Diagnosing, and Treating Antisocial Children and Adolescents
Authors: Frick Paul J
Published: January 2017

This paper reviews several attempts to extend the construct of psychopathy to children and adolescents. The research suggests that the presence of callous-unemotional (CU) traits may be particularly important. Specifically, the presence of these traits designates a clinically important subgroup of youth with childhood-onset conduct problems who show a particularly severe, aggressive, and stable pattern of antisocial behaviour. Also, children with CU traits show numerous emotional, cognitive, and personality features that are distinct from other antisocial youth that are similar to features found in adults with psychopathy. The research on CU traits has important implications for understanding the different causal pathways through which children develop severe antisocial and aggressive behaviour, as well as implications for diagnosing and intervening with antisocial youth.
Incidence and Course of Suicidal Ideation and Suicide Attempts in the General Population
Authors: Have Margreet ten , de Graaf Ron , van Dorsselaer Saskia , Verdurmen Jacqueline , van't Land Hedda , Vollebergh Wilma , Beekman Aartjan
Published: January 2017

Objective:

Suicidal ideation and suicide attempts are important indicators of extreme emotional distress. However, little is known about predictors of onset and course of suicidality in the general population. Our study tried to fill this gap by analyzing data from a prospectively followed community sample.

Method:

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a 3-wave cohort study in a representative sample ( n = 4848) of the Dutch adult general population.

Results:

The 3-year incidence of suicidal ideation and suicide attempts was 2.7% and 0.9%, respectively. Predictors of first-onset suicidal ideation and suicide attempts were sociodemographic variables (especially the negative change in situation variables), life events, personal vulnerability indicators, and emotional (mood and anxiety) disorders. Comparison of the corresponding odds ratios and confidence intervals revealed that predictors for first-onset suicidal ideation and suicide attempts did not differ significantly. One of the strongest predictors of incident suicide attempts was previous suicidal ideation. Regarding the course of suicidal ideation, it was found that 31.3% still endorsed these thoughts and 7.4% reported having made a suicide attempt 2 years later.

Conclusions:

Similar predictors were found for first-onset suicidal ideation and suicide attempts. This suggests that suicidal behaviours may be ordered on a continuum and have shared risk factors. While suicidal thoughts may be necessary for, they are not sufficient predictors of, suicidal acts. The course of suicidality in the general population can be characterized by a minority of people having suicidal experiences that develop over time with progressively increasing severity.
Prospective Evaluation of the Effect of Major Depression on Working Status in a Population Sample
Authors: Patten Scott B , Wang Jian Li , Williams Jeanne VA , Lavorato Dina H , Bulloch Andrew , Eliasziw Michael
Published: January 2017

Objective:

Numerous surveys have reported associations between major depressive episodes (MDEs) and occupational status, but cross-sectional studies cannot quantify the risks of employment transitions nor clarify their temporal direction. The goal of our study was to estimate the impact of MDE on subsequent employment status in a longitudinal community cohort.

Methods:

Data from the National Population Health Survey (NPHS) were used. Proportional hazard models and logistic regression were employed to evaluate the effect of MDE on working status during the 1994 to 2004 interval among respondents who reported working at a job or business at baseline.

Results:

MDE was associated with an increased risk of movement to nonworking status. People aged 26 to 45 years with MDEs have more than double the risk of this transition (HR = 2.6; 95% CI 1.8 to 3.6, P < 0.001). The probability of transition to nonworking status was higher, but the relative effect was smaller in people aged 46 to 65 years (HR = 1.2; 95% CI 0.7 to 2.0, P = 0.47). Retirement or perceived lack of availability of work did not contribute to the association.

Conclusions:

MDE is associated with an elevated risk of transition from working to nonworking status, especially in people aged 26 to 45 years.
Advancing Bipolar Disorder: Key Lessons from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Authors: Parikh Sagar V , LeBlanc Serge R , Ovanessian Melina M
Published: January 2017

Objective:

To review the overall clinical research findings from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), the world's largest study of BD.

Methods:

STEP-BD was conducted from 1998 to 2005, enrolling participants ( n = 4361) across 22 clinical sites in the United States. Each individual was followed for up to 2 years in naturalistic practice with blinded research assessments, while subgroups participated in randomized controlled trials (RCTs) for bipolar depression. The naturalistic database was used to examine the course of BD, comorbidity with other psychiatric disorders, and suicidality. Relevant studies in English, published from January 1, 1994, to May 31, 2009, were identified using computerized searches of electronic databases (PubMed, PsycINFO, and Cochrane Register of Clinical Trials), inspection of bibliographies, and review of other major reports.

Results:

One large RCT involving the addition of either paroxetine or bupropion to mood stabilizers in acute depression found neither more effective than placebo in achieving sustained recovery (8 weeks of euthymia). A second large RCT found intensive psychosocial interventions superior to a brief psychosocial intervention as an adjunct to medication in acute depression. A third small RCT found minimal effects of lamotrigine, risperidone, or inositol in refractory depression. Recovery was difficult to achieve, with subsyndromal symptoms or full relapse very common. Anxiety disorders and smoking in particular were treatable conditions that adversely affected the course of BD.

Conclusions:

STEP-BD yielded numerous clinical and systems observations that provide fresh direction for research and treatment of BD, including setting new benchmarks for outcome and demonstrating the viability of large BD networks.
Housing Histories of Assertive Community Treatment Clients: Program Impacts and Factors Associated with Residential Stability
Authors: Kreindler Sara A , Coodin Shalom
Published: January 2017

Objective:

Although housing is widely recognized as a crucial issue for people with severe and persistent mental illness, there is much to learn about the ongoing housing experiences of this group of people. Using secondary data, this study examined the housing histories of 65 assertive community treatment (ACT) clients from 2 years prior until up to 7 years after intake, totalling 407 addresses.

Method:

We used statistical process control to assess the significance and longevity of pre-and post-ACT changes in residential tenure and independent living. We used multivariate survival analysis to explore participant and residence characteristics associated with residential stability.

Results:

After 6 months in ACT, the client population showed a significant, sustained improvement in housing stability. Similarly, shortly after ACT entry, there was a marked increase in the proportion of participants living independently. At the participant level, substance abuse was the strongest predictor of residential instability; other predictors included age (30 years or younger) and sex (female). Residence characteristics also proved important; independent housing, neighbourhood income (a proxy for housing quality), and receipt of a rental subsidy were associated with significantly longer tenure, controlling for client characteristics.

Conclusions:

The timing and magnitude of the observed changes imply that ACT was effective in helping clients to achieve stable housing and to live independently. The results also underscore the importance of high-quality housing in promoting residential stability.
Mental Health Care Use in Later Life: Results from a National Survey of Canadians
Authors: Cairney John , Corna Laurie M , Streiner David L
Published: January 2017

Objective:

To estimate the proportion of older adults who have used mental health services in the past 12 months among those who meet the criteria for one or more Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, 12-month psychiatric disorders. We also examine the factors associated with mental health care use in this population.

Method:

We used secondary data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). We first estimated the proportion of adults aged 55 years and older who used a range of mental health services. Next, using logistic regression, we examined the relative contribution of predisposing, enabling, and need characteristics in predicting any service use in this population.

Results:

Among the 12 792 adults aged 55 years and older in the CCHS 1.2, 513 (4.23%, 95% CI 3.89% to 4.95%) met the criteria for at least one 12-month DSM-IV disorder. Among these respondents, 37% (95% CI 31% to 43%) saw at least one type of mental health care provider in the past 12 months. Visits to a general health care provider for mental health reasons were most common, followed by specialist care. Only psychological distress was significantly and positively associated with using mental health care services.

Conclusions:

Over 60% of the older adults who met the criteria for a DSM-IV disorder were not using mental health care services. Social and demographic factors did not predict service use in this population.
The Association of Suicide and Bullying in Childhood to Young Adulthood: A Review of Cross-Sectional and Longitudinal Research Findings
Authors: Klomek Anat Brunstein , Sourander Andre , Gould Madelyn
Published: January 2017

Objective:

To review the research addressing the association of suicide and bullying, from childhood to young adulthood, including cross-sectional and longitudinal research findings.

Method:

Relevant publications were identified via electronic searches of PsycNet and MEDLINE without date specification, in addition to perusing the reference lists of relevant articles.

Results:

Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying. The few longitudinal findings available indicate that bullying and peer victimization lead tosuicidality but that this association varies by sex. Discrepancies between the studies available may be due to differences in the studies' participants and methods.

Conclusions:

Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up should continue to identify specific causal paths between bullying and suicide.
Étude contrôlée randomisée des effets de la pharmaco-éducation sur une population française de patients souffrant de troubles schizophréniques et schizoaffectifs
Authors: Maurel Murièle , Drai Delphine , Kaladjian Arthur , Pauly Vanessa , Azorin Jean-Michel
Published: January 2017

Objectif:

L'objectif de l'étude était d'évaluer l'effet d'un module de pharmaco-éducation sur les durées d'hospitalisation ainsi que l'état clinique et fonctionnel d'une population française de patients souffrant de troubles schizophréniques et schizoaffectifs.

Méthodes:

Après inclusion, 82 patients ont été répartis par tirage au sort en deux groupes, l'un recevant le module de pharmaco-éducation, l'autre un programme contrôle. Les durées d'hospitalisation, le nombre de recours aux urgences et de médicaments reçus ont été comptabilisés. Les patients ont été évalués à l'aide de l'échelle des syndromes positif et négatif (PANSS), de l'échelle d'Impression clinique globale (CGI), de l'échelle d'akathisie de Barnes (BAS), de l'échelle de Simpson-Angus (SAS), de l'échelle de qualité de vie (QOL), et et de l'échelle globale du fonctionnement (GAF); les données étaient recueillies initialement, puis chaque année pendant deux ans.

Résultats:

Parmi les 72 patients analysés, ceux bénéficiant de la pharmaco-éducation ont une durée totale d'hospitalisation, une durée d'hospitalisation forcée et un nombre de recours aux urgences significativement moindres que les patients du groupe contrôle, et une amélioration plus marquée de leur symptomatologie, de leur autonomie et de leur qualité de vie. Ils présentent également moins d'akathisie et ont une consommation inférieure de médicaments.

Conclusions:

La pharmaco-éducation permet de réduire les durées d'hospitalisation des patients souffrant de troubles schizophréniques et schizoaffectifs ainsi que d'améliorer leur état clinique et fonctionnel, probablement par l'intermédiaire d'une meilleure observance.
Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders
Authors: McGorry Patrick D , Nelson Barnaby , Goldstone Sherilyn , Yung Alison R
Published: January 2017

Most mental illnesses emerge during adolescence and early adulthood, with considerable associated distress and functional decline appearing during this critical developmental phase. Our current diagnostic system lacks therapeutic validity, particularly for the early stages of mental disorders when symptoms are still emerging and intensifying and have not yet stabilized sufficiently to fit the existing syndromal criteria. While this is, in part, due to the difficulty of distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness, these factors have contributed to a growing movement for the reform of our current diagnostic system to more adequately inform the choice of therapeutic strategy, particularly in the early stages of a mental illness. The clinical staging model, which defines not only the extent of progression of a disorder at a particular point in time but also where a person lies currently along the continuum of the course of an illness, is particularly useful as it differentiates early, milder clinical phenomena from those that accompany illness progression and chronicity. This will not only enable clinicians to select treatments relevant to earlier stages of an illness, where such interventions are likely to be more effective and less harmful than treatments delivered later in the course of illness, but also allow a more efficient integration of our rapidly expanding knowledge of the biological, social, and psychological vulnerability factors involved in the development of mental illness into a useful diagnostic framework.