bluuebunny/crossref_metadata_2025 huggingface dataset:
Common Mental Disorders in the Workforce: Recent Findings from Descriptive and Social Epidemiology
Authors: Sanderson Kristy , Andrews Gavin
Published: January 2017

Objective:

To review the recent descriptive and social epidemiology of common mental disorders in the workplace, including prevalence, participation, work disability, and impact of quality of work, as well as to discuss the implications for identifying targets for clinical and preventive interventions.

Method:

We conducted a structured review of epidemiologic studies in community settings (that is, in the general population or in workplaces). Evidence was restricted to the peer-reviewed, published, English-language literature up to the end of June 2005. We further restricted evidence to studies that used recent classification systems; then, if evidence was insufficient, we reviewed studies that used standardized psychiatric screening scales. To distinguish this article from recent reviews of health and work quality, we focused on new areas of investigation and new evidence for established areas of investigation: underemployment, organizational justice, job control and demand, effort–reward imbalance, and atypical (nonpermanent) employment.

Results:

Depression and simple phobia were found to be the most prevalent disorders in the working population. The limited data on rates of participation suggested higher participation among people with depression, simple phobia, social phobia, and generalized anxiety disorder. Depression and anxiety were more consistently associated with “presenteeism” (that is, lost productivity while at work) than with absenteeism, whether this was measured by cutback days or by direct questionnaires. Seven longitudinal studies, with an average sample size of 6264, showed a strong association between aspects of low job quality and incident depression and anxiety. There was some evidence that atypical work was associated with poorer mental health, although the findings for fixed-term work were mixed.

Conclusions:

Mental health risk reduction in the workplace is an important complement to clinical interventions for reducing the current and future burden of depression and anxiety in the workplace.
Descriptive Epidemiology of Major Depression in Canada
Authors: Patten Scott B , Wang Jian Li , Williams Jeanne VA , Currie Shawn , Beck Cynthia A , Maxwell Colleen J , el-Guebaly Nady
Published: January 2017

Objective:

The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) is the first national study to use a full version of the Composite International Diagnostic Interview. For this reason, and because of its large sample size, the CCHS 1.2 is capable of providing the best currently available description of major depression epidemiology in Canada. Using the CCHS 1.2 data, our study aimed to describe the epidemiology of major depression in Canada.

Method:

All estimates used appropriate sampling weights and bootstrap variance estimation procedures. The analysis consisted of estimating proportions supplemented by logistic regression modelling.

Results:

The lifetime prevalence of major depressive episode was 12.2%. Past-year episodes were reported by 4.8% of the sample; 1.8% reported an episode in the past 30 days. As expected, major depression was more common in women than in men, but the difference became smaller with advancing age. The peak annual prevalence occurred in the group aged 15 to 25 years. The prevalence of major depression was not related to level of education but was related to having a chronic medical condition, to unemployment, and to income. Married people had the lowest prevalence, but the effect of marital status changed with age. Logistic regression analysis suggested that the annual prevalence may increase with age in men who never married.

Conclusions:

The prevalence of major depression in the CCHS 1.2 was slightly lower than that reported in the US and comparable to pan-European estimates. The pattern of association with demographic and clinical variables, however, is broadly similar. An increasing prevalence with age in single (never-married) men was an unexpected finding.
Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature
Authors: Somers Julian M , Goldner Elliot M , Waraich Paul , Hsu Lorena
Published: January 2017

Objective:

To present the results of a systematic review of literature published between 1980 and 2004 reporting findings of the prevalence and incidence of anxiety disorders in the general population.

Method:

A literature search of epidemiologic studies of anxiety disorders was conducted, using MEDLINE and HealthSTAR databases, canvassing English-language publications. Eligible publications were restricted to studies that examined age ranges covering the adult population. A set of predetermined inclusion and exclusion criteria were used to identify relevant studies. Prevalence and incidence data were extracted and analyzed for heterogeneity.

Results:

A total of 41 prevalence and 5 incidence studies met eligibility criteria. We found heterogeneity across 1-year and lifetime prevalence rates of all anxiety disorder categories. Pooled 1-year and lifetime prevalence rates for total anxiety disorders were 10.6% and 16.6%. Pooled rates for individual disorders varied widely. Women had generally higher prevalence rates across all anxiety disorder categories, compared with men, but the magnitude of this difference varied.

Conclusion:

The international prevalence of anxiety disorders varies greatly between published epidemiologic reports. The variability associated with all anxiety disorders is considerably smaller than the variability associated with individual disorders. Women report higher rates of anxiety disorders than men. Several factors were found to be associated with heterogeneity among rates, including diagnostic criteria, diagnostic instrument, sample size, country studied, and response rate.
An Epidemiologic Study of Posttraumatic Stress Disorder in Flood Victims in Hunan China
Authors: Liu Aizhong , Tan Hongzhuan , Zhou Jia , Li Shuoqi , Yang Tubao , Wang Jieru , Liu Jian , Tang Xuemin , Sun Zhenqiu , Wen Shi Wu
Published: January 2017

Objective:

To estimate the occurrence and to assess the determinants of posttraumatic stress disorder (PTSD) in flood victims.

Method:

We carried out a retrospective study to examine the occurrence and the determinants of PTSD in victims of flood in 1998 and 1999 in Hunan, China. We used multistage sampling to select the subjects from the flood areas, and we ascertained PTSD according to DSM-IV criteria. Data were collected in face-to-face interviews carried out by experienced research assistants using a preconstructed questionnaire. We used a multiple logistic regression model to analyze the data.

Results:

A total of 33 340 subjects (86.0% of the selected subjects, aged 7 years or over) in the study villages were interviewed. Among them, 2875 (8.6%) had symptoms that met the diagnostic criteria for PTSD. Significant risk factors for PTSD included female sex (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.04 to 1.21), older age (age 18 to 59 years OR 2.28; 95%CI, 2.02 to 2.57, and age > 60 years OR 2.42; 95%CI, 2.05 to 2.85), flood type (collapsed embankment OR 1.84; 95%CI, 1.64 to 2.05, and flash flood OR 3.12; 95%CI, 2.76 to 3.52), and flood severity (intermediate OR 4.05; 95%CI, 3.55 to 4.62, and severe OR 2.98; 95%CI, 2.60 to 3.41).

Conclusions:

PTSD is a common mental disorder in flood victims, which implies the need for improved health services, especially mental health services, for this population.
Corrected QT Intervals in Newly Admitted Geriatric Psychiatric Patients: An Examination of Risk Factors
Authors: Dumontet Jane , Malyuk Rhonda , Kiang Gary , Procyshyn Ric M
Published: January 2017

Objectives:

The primary objective of this study was to determine the incidence of prolonged corrected QT (QTc) intervals in a population of geriatric psychiatry inpatients. Our secondary objective was to examine the associations between prolonged QTc intervals and risk factors identified as determinants in prolonging the QTc interval.

Methods:

We identified all geriatric patients (aged 60 years and older) who were admitted to the geriatric program of our facility between May 1, 2003, and December 31, 2003. Those patients with a heart rate QTc interval calculated on the electrocardiogram (ECG) were eligible for the study. We used Bazett's formula to calculate the QTc interval. We defined a priori that a prolonged QTc interval would be 450 ms and 460 ms for men and women, respectively. We collected data on demographic variables such as weight, sex, age, and Axis I and III diagnoses, as well as on recognized risk factors for prolonged QTc interval. We used Student's t tests to conduct parametric analysis on continuous variables, and chi-square to test categorical variables for independence.

Results:

During the study period, 88 patients were admitted to the geriatric division of Riverview Hospital. Of these patients, 34 men and 42 women had calculated QTc intervals on their ECG and therefore made up the study population. Our data show that 29.4% of men and 21.4% of women had prolonged QTc intervals. However, neither diagnostic nor medicinal risk factors were found to be associated with an increased incidence of prolonged QTc interval in this patient population.

Conclusion:

The preliminary findings of this study suggest that in this patient population the QTc interval may not be influenced by recognized risk factors to the same extent as observed in the adult population. These results warrant confirmation by a larger, prospectively designed study.
Insulin Resistance and Adiponectin Levels in Drug-Free Patients with Schizophrenia: A Preliminary Report
Authors: Cohn Tony A , Remington Gary , Zipursky Robert B , Azad Azar , Connolly Philip , Wolever Thomas MS
Published: January 2017

Objective:

To compare the insulin sensitivity and adiponectin levels of medication-free patients suffering from schizophrenia or schizoaffective disorder with that of matched healthy volunteers.

Method:

We evaluated 9 nondiabetic patients aged 26.6 years (median 26 years, range 17 to 41 years) and matched volunteers, using the frequently sampled intravenous glucose tolerance test, minimal model analysis, and fasting adiponectin levels.

Results:

The mean insulin sensitivity index of the patients was 42% lower than that of the healthy volunteers ( P = 0.026), with inadequate compensation in insulin secretion. Patients with schizophrenia tended to have reduced adiponectin levels ( P = 0.055).

Conclusions:

By direct measurement, this study provides evidence of insulin resistance and susceptibility to type 2 diabetes in patients with schizophrenia who are free of antipsychotic drugs.
Detection of Depression in Acute Schizophrenia: Sensitivity and Specificity of 2 Standard Observer Rating Scales
Authors: Müller Matthias J , Müller Kay-Maria , Fellgiebel Andreas
Published: January 2017

Objective:

To compare the psychometric properties of the Calgary Depression Rating Scale (CDRS) and the Hamilton Depression Rating Scale (HDRS) for severity assessment of depression in acute schizophrenia.

Method:

During clinical routine treatment, we investigated 119 inpatients with acute schizophrenia, using the CDRS, the HDRS, and a global 4-point Depression Severity Scale (DEP-SEV). We compared CDRS and HDRS sum scores regarding their diagnostic accuracy, with global severity of depression as the criterion. We estimated sensitivity and specificity on the basis of receiver operating characteristic curves.

Results:

According to global clinical ratings (DEP-SEV), 31% of patients had no depression, 19% had mild, 31% had moderate, and 19% had severe depression. Sensitivity was significantly higher ( P < 0.05) for the CDRS than for the HDRS to assess mild (0.94 vs 0.76, cut-off 3 vs 10 points) or severe depression (1.00 vs 0.78, cut-off 11 vs 22 points); specificity was comparably high (≥ 0.88) for both scales.

Conclusion:

Despite the fact that both scales were effective in separating mild, moderate, and severe depression, significant advantages emerged for the CDRS to detect mild or severe depression in schizophrenia.
Reaching Out to High School Youth: The Effectiveness of a Video-Based Antistigma Program
Authors: Stuart Heather
Published: January 2017

Objective:

To evaluate the impact on high school students of a video-based antistigma program portraying real life experiences of individuals with schizophrenia and lesson plans to guide classroom discussions and active learning.

Method:

We used a pre- and posttest design to measure the short-term impact of the program on student's knowledge of schizophrenia and its treatment as well as students' self-reported socially distancing behaviours. Participants (571 students) were from 8 high schools across Canada.

Results:

Following the Reaching Out antistigma program, high school students were significantly more knowledgeable and less socially distancing. Impact also varied by age group and sex.

Conclusions:

Video-based antistigma programs are comparable to programs that deliver educational messages through direct contact with individuals with mental illnesses. Video-based programs are more easily disseminated on a broad scale.
How Spiritual Values and Worship Attendance Relate to Psychiatric Disorders in the Canadian Population
Authors: Baetz Marilyn , Bowen Rudy , Jones Glenn , Koru-Sengul Tulay
Published: January 2017

Objective:

Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders.

Method:

In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors.

Results:

Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders.

Conclusion:

This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.
Cost-Effectiveness of Cognitive-Behavioural Therapy for Mental Disorders: Implications for Public Health Care Funding Policy in Canada
Authors: Myhr Gail , Payne Krista
Published: January 2017

Objective:

Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy.

Method:

We searched the literature for economic analyses of CBT in the treatment of mental disorders.

Results:

We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use.

Conclusions:

International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

Objectif:

La thérapie cognitivo-comportementale (TCC) financée par l'État pour les troubles mentaux est rare au Canada, malgré son efficacité prouvée et les lignes directrices qui la recommandent. Cet article examine les données publiées sur l'effet économique de la TCC afin d'éclairer les recommandations en vue des politiques canadiennes actuelles de financement des soins de santé mentale.

Méthode:

Dans la documentation, nous avons recherché des analyses économiques de la TCC dans le traitement des troubles mentaux.

Résultats:

Nous avons repéré 22 études économiques de la santé faisant appel à la TCC des troubles de l'humeur, anxieux, psychotiques et somatoformes. Dans les établissements de santé et parmi les populations de patients, la TCC seule ou combinée avec la pharmacothérapie représentait une valeur acceptable pour les fonds de santé dépensés, car les coûts de la TCC sont compensés par une utilisation réduite des soins de santé.

Conclusions:

Les données probantes internationales suggèrent que la TCC est rentable. Un meilleur accès à la TCC améliorerait probablement les résultats et se traduirait par des épargnes. Il faut plus de recherche pour évaluer l'effet économique de la TCC au Canada.
Twelve-Month Psychiatric Disorder among Single and Married Mothers: The Role of Marital History
Authors: Cairney John , Pevalin David J , Wade Terrance J , Veldhuizen Scott , Arboleda-Florez Julio
Published: January 2017

Objective:

To examine differences between single and married mothers in the 12-month prevalence of psychiatric disorders.

Methods:

The analysis uses data from the National Comorbidity Survey, collected in 1992–1993, and focuses on women aged 15 to 55 years with children ( n = 1346). Psychiatric disorders are assessed with the University of Michigan Composite International Diagnostic Interview, a survey instrument based on DSM-III-R criteria.

Results:

Compared with married mothers, previously married mothers have elevated rates of disorders. Prevalences among single mothers who were never married are similar to those among married mothers, but they are generally lower than prevalences among mothers who experience a marital disruption.

Conclusions:

These results indicate that marital separation and divorce may be markers for elevated risk for psychiatric disorder among women with children. It is important to consider the impact of marital history on the relation between family structure and psychiatric outcomes.
Stress and Psychological Distress among SARS Survivors 1 Year after the Outbreak
Authors: Lee Antoinette M , Wong Josephine GWS , McAlonan Grainne M , Cheung Vinci , Cheung Charlton , Sham Pak C , Chu Chung-Ming , Wong Poon-Chuen , Tsang Kenneth WT , Chua Siew E
Published: January 2017

Objective:

Our study examined the stress level and psychological distress of severe acute respiratory syndrome (SARS) survivors 1 year after the outbreak.

Method:

During the SARS outbreak in 2003, we used the 10-item Perceived Stress Scale (PSS-10) to assess SARS survivors treated in 2 major hospitals (non–health care workers, n = 49; health care workers, n = 30). We invited SARS survivors from the same hospitals (non–health care workers, n = 63; health care workers, n = 33) to complete the PSS-10 again in 2004. At that time, they were also asked to complete the General Health Questionnaire (GHQ-12) and measures of depression, anxiety, and posttraumatic symptoms. PSS-10 scores were also obtained from matched community control subjects during the outbreak ( n = 145) and again in 2004 ( n = 112).

Results:

SARS survivors had higher stress levels during the outbreak, compared with control subjects (PSS-10 scores =19.8 and 17.9, respectively; P < 0.01), and this persisted 1 year later (PSS-10 scores =19.9 and 17.3, respectively; P < 0.01) without signs of decrease. In 2004, SARS survivors also showed worrying levels of depression, anxiety, and posttraumatic symptoms. An alarming proportion (64%) scored above the GHQ-12 cut-off that suggests psychiatric morbidity. During the outbreak, health care worker SARS survivors had stress levels similar to those of non–health care workers, but health care workers showed significantly higher stress levels in 2004 (PSS-10 score = 22.8, compared with PSS-10 score = 18.4; P < 0.05) and had higher depression, anxiety, posttraumatic symptoms, and GHQ-12 scores.

Conclusions:

One year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.
Immediate and Sustained Psychological Impact of an Emerging Infectious Disease Outbreak on Health Care Workers
Authors: McAlonan Grainne M , Lee Antoinette M , Cheung Vinci , Cheung Charlton , Tsang Kenneth WT , Sham Pak C , Chua Siew E , Wong Josephine GWS
Published: January 2017

Objective:

To assess the immediate and sustained psychological health of health care workers who were at high risk of exposure during the severe acute respiratory syndrome (SARS) outbreak.

Methods:

At the peak of the 2003 SARS outbreak, we assessed health care workers in 2 acute care Hong Kong general hospitals with the Perceived Stress Scale (PSS-10). One year later, we reassessed these health care workers with the PSS-10, the 21-Item Depression and Anxiety Scale (DASS-21), and the Impact of Events Scale-Revised (IES-R). We recruited high-risk health care workers who practised respiratory medicine and compared them with nonrespiratory medicine workers, who formed the low-risk health care worker control group.

Results:

In 2003, high-risk health care workers had elevated stress levels (PSS-10 score = 17.0) that were not significantly different from levels in low-risk health care worker control subjects (PSS-10 score = 15.9). More high-risk health care workers reported fatigue, poor sleep, worry about health, and fear of social contact, despite their confidence in infection-control measures. By 2004, however, stress levels in the high-risk group were not only higher (PSS-10 score = 18.6) but also significantly higher than scores among low-risk health care worker control subjects (PSS-10 score = 14.8, P < 0.05). In 2004, the perceived stress levels in the high-risk group were associated with higher depression, anxiety, and posttraumatic stress scores ( P < 0.001). Posttraumatic stress scores were a partial mediator of the relation between the high risk of exposure to SARS and higher perceived stress.

Conclusions:

Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for future outbreaks.
Prevalence of Mental Disorders and Associated Service Variables among Ontario Children Who are Permanent Wards
Authors: Burge Philip
Published: January 2017

Objective:

To identify the prevalence rate of mental disorders among Ontario children who are permanent wards and also the key practice and descriptive variables associated with their diagnostic status.

Method:

I reviewed case files from a stratified random sample of 429 Ontario children who were permanent wards with no access to biological parents on December 31, 2003. Data abstracted from files included information on descriptive variables (such as age, sex, and type of permanent ward), all disorders (that is, mental and other current medical diagnoses and disabilities), family history, maltreatment experiences, service history (such as age at admission to care and current residential placement type), and permanency plans.

Results:

The prevalence of mental disorders was 31.7%. A significantly higher proportion of children with mental disorders experienced maltreatment. Children with mental disorders were almost 3 times more likely than those without mental disorders to be placed by Children's Aid Societies in privately operated resources, such as group homes, and almost 10 times less likely to be living in a probationary adoption home. Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables—age on becoming a permanent ward and age at the time of the study—were predictive of children's adoption plans.

Conclusions:

The findings support the need for improved monitoring of the aggregate mental health needs of children who are permanent wards. Numerous implications for service delivery and future research are discussed.
Pharmacologic Management of Neuropsychiatric Symptoms of Alzheimer Disease
Authors: Herrmann Nathan , Lanctôt Krista L
Published: January 2017

Objective:

To systematically review published clinical trials of the pharmacotherapy of neuropsychiatric symptoms of Alzheimer disease (AD).

Method:

We searched MEDLINE and EMBASE for published English-language medical literature. Our review focused on randomized controlled trials (RCTs) and corresponding metaanalyses.

Results:

The pharmacotherapy of neuropsychiatric symptoms of AD has been studied with numerous RCTs. The largest number of studies has focused on antipsychotics. Data are of reasonably high quality and indicate that risperidone and olanzapine are more effective than placebo for institutionalized patients with severe agitation, aggression, and psychosis. The efficacy of antipsychotics is counterbalanced by safety concerns that include cerebrovascular adverse events and mortality. Cholinesterase inhibitors and memantine appear to have modest benefits for patients with mildly to moderately severe symptoms. Antidepressants are effective for treating depression in AD, but more data are required to determine the efficacy of trazodone and citalopram for agitation and aggression. Carbamazepine appears to be efficacious, although side effects and concerns about drug–drug interactions limit its use. The data do not support the use of valproate. Benzodiazepines should only be used for short-term, as-needed use. There are insufficient data on other pharmacologic interventions, such as beta blockers, buspirone, and estrogen preparations.

Conclusions:

Although there have been numerous well-designed studies of the pharmacotherapy of neuropsychiatric symptoms in AD, safer and more effective treatments are urgently needed.
A National Survey of Primary Methamphetamine-Related Admissions to Youth Residential Substance Abuse Treatment Facilities in Canada, 2005 to 2006
Authors: Callaghan Russell C , Tavares Joey , Taylor Lawren , Veldhuizen Scott
Published: January 2017

Objective:

Adolescent methamphetamine use has become a key issue for Canadian media and governments. Empirical studies, however, have not yet established the national scope of adolescent methamphetamine use or its impact on treatment services in Canada. The objective of the current study was to provide results from a national survey of primary methamphetamine-related admissions to Canadian residential substance abuse treatment facilities for youth.

Method:

We developed a comprehensive list of all Canadian residential substance abuse treatment facilities for youth, and then, we asked the executive director (or equivalent) of each facility about the site's annual caseload and the proportion of primary methamphetamine-related admissions during the previous 12 months.

Results:

Responses were received from 46 of the 50 centres on our final master list. About 20% (1109/5169) of all national admissions to youth residential substance abuse treatment facilities were reported to be primarily due to methamphetamine use. A large majority of primary methamphetamine-related admissions occurred in British Columbia and Alberta.

Conclusions:

Adolescent methamphetamine use has had a major impact on entries into residential substance abuse treatment facilities in British Columbia and Alberta, while only a few centres outside these 2 western provinces have experienced elevated rates of primary methamphetamine-related admissions. Given the paucity of studies on adolescent methamphetamine treatment, future research needs to focus on developing effective clinical strategies in this area.
Early Predictors of Nonadherence to Antipsychotic Therapy in First-Episode Psychosis
Authors: Rabinovitch Mark , Béchard-Evans Laura , Schmitz Norbert , Joober Ridha , Malla Ashok
Published: January 2017

Objective:

To examine the hypothesis that poorer social and family support, identifiable at the onset of treatment, is associated with nonadherence in the first 6 months of treatment of patients with first-episode psychosis (FEP), independent of other patient-related factors.

Method:

Consecutive patients ( n = 100) admitted to a specialized early intervention service for FEP who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for either a schizophrenia spectrum disorder or an affective psychosis were evaluated monthly for 6 months regarding their adherence to medications. Using sociodemographic and illness-related factors, including social and family support, as independent variables and adherence as the dependent variable, univariate analyses were followed by logistic regression.

Results:

Fifty-six patients (54.9%) were adherent (76% to 100% of doses taken) and 46 (45.1%) nonadherent (less than 76% of doses taken). Nonadherent patients were less likely to have received a good level of social support (χ2 = 5.89, df = 1, P = 0.02), as rated by their respective case manager, and more likely to be single (Fisher exact test, P = 0.019) and to have refused medication at the first offer of treatment (χ2 = 19.70, df = 1, P = 0.001). Using logistic regression, both the level of social support (OR = 3.552, P = 0.03) and early medication acceptance (OR = 11.092, P < 0.001) were significant as predictors of adherence.

Conclusion:

These results suggest the significance of social and family support in achieving adherence to medications very early in the course of treatment of FEP, in addition to the influence of early acceptance or rejection of medication.
Family and Patient Predictors of Symptomatic Status in Schizophrenia
Authors: Levene Judith E , Lancee William , Seeman Mary V , Skinner Harvey , Freeman Stanley JJ
Published: January 2017

Objective:

To test an interactive hypothesis that, in schizophrenia, a combination of patients' and relatives' characteristics at 1–month postdischarge from hospital (Time 1 [T1]) better predicts the level of psychotic symptoms at follow-up (Time 2 [T2]), than do the characteristics of patients or relatives alone.

Methods:

Male patients ( n = 38) with a diagnosis of schizophrenia, without substance abuse, and in contact with their families, were recruited at the time of hospital discharge. Patients' psychotic symptom levels were monitored every 2 weeks until follow-up, while family measures were administered at T1 and T2. The 4 predictor variables in the regression analysis were T1 symptom levels of the patient and 3 measures of family interaction (expressed emotion, family burden, and family functioning).

Results:

The model based on the family variable, family burden at T1, and the patient variable, patients' remitted levels of psychotic symptoms at T1, was found to significantly predict the level of psychotic symptoms at T2. These 2 T1 variables made independent and additive contributions to the level of psychotic symptoms at T2, predicting 19% of the variance. Neither expressed emotion nor family functioning at T1 added to the prediction.

Conclusion:

This finding suggests a patient–family interactional component to symptomatic relapse in schizophrenia.
Increased Prevalence of Obesity and Glucose Intolerance in Youth Treated with Second—Generation Antipsychotic Medications
Authors: Panagiotopoulos Constadina , Ronsley Rebecca , Davidson Jana
Published: January 2017

Objective:

To compare the rates of obesity, impaired fasting glucose (IFG), and type 2 diabetes between second-generation antipsychotic (SGA)-treated and -naive youth.

Methods:

A retrospective chart review was conducted for all child and adolescent psychiatry emergency admissions over 2.5 years. Data collected included age, sex, psychiatric diagnosis, medications, height, weight, fasting glucose, and lipid profile. Body mass index (BMI) was standardized for age and sex and converted to a z score. Overweight was defined as a BMI between the 85th and 95th percentile and obese as a BMI at the 95th percentile or greater for age and sex. The 2007 American Diabetes Association criteria for IFG and type 2 diabetes were used.

Results:

Among the 432 admissions, 167 (39%) had both height and weight measured, and 145 (34%) had fasting glucose measured. The mean zBMI was higher in the SGA-treated ( n = 68), compared with the SGA-naive group ( n = 99) (mean difference 0.81; 95% CI 0.46 to 1.16). In the SGA-treated group, 31% were obese and 26% were overweight, compared with 15% and 8%, respectively, in the SGA-naive group ( P < 0.01). In the SGA-treated group ( n = 65), 21.5% had IFG or type 2 diabetes, compared with 7.5% in the SGA-naive group ( n = 80) ( P = 0.01).

Conclusions:

Youth treated with SGAs have significantly higher rates of obesity and glucose intolerance than SGA-naive youth. These data emphasize the need for consistent metabolic monitoring of youth with psychiatric disorders who are prescribed SGAs.
Promising Psychotherapies for Personality Disorders
Authors: Hadjipavlou George , Ogrodniczuk John S
Published: January 2017

Objective:

To provide a narrative review of recent research on the psychotherapeutic treatment of patients with personality disorders (PDs).

Method:

We conducted PubMed and PsycINFO searches of recently published articles that reported on the treatment outcomes of psychotherapies for PDs. Our focus was on studies that used randomized controlled trial (RCT) methodology. The search period was from January 2006 to June 2009.

Results:

The effectiveness of various psychotherapy treatment packages for PDs is well supported by favourable results from RCTs. Beneficial effects of psychotherapy included reduced symptomatology, improved social and interpersonal functioning, reduced frequency of maladaptive behaviours, and decreased hospitalization. Equivalent effects among the interventions we compared were common. Many of the treatments studied required only limited training by therapists. Most studies were focused on treating patients with borderline personality disorder (BPD). Some findings were suggestive of psychotherapy being cost-effective; however, few studies actually included formal cost analyses. Only one study included follow-up of treated patients beyond 1-yearposttreatment.

Conclusions:

There is strong support for the use of psychotherapy to treat patients with PDs. However, most of the evidence is limited to BPD. The findings of recent studies hold promise for training and practice. Future research should attend to identification of appropriate patient-treatment matches, elucidation of active treatment ingredients, and illumination of factors that are common among treatments that account for their equivalent effects.
Clinical Factors That Predict Cognitive Function in Patients with Major Depression
Authors: Elgamal Safa , Denburg Susan , Marriott Michael , MacQueen Glenda
Published: January 2017

Objectives:

To compare the performance of depressed patients to healthy control subjects on discrete cognitive domains derived from factor analysis and to examine the factors that may influence the performance of depressed patients on cognitive domains in a large sample.

Methods:

We compared the cognitive performance of 149 patients with major depression to 104 healthy control subjects using multivariate ANCOVA. We used principal component factor analysis to group the cognitive variables into cognitive domains. Finally, we conducted regression analysis to examine the contribution of predictor factors to the cognitive domains that were impaired in the depressed group.

Results:

Verbal memory and speed of processing were impaired in depressed patients, compared with healthy control subjects. Patient IQ, duration of depressive illness, and number of hospitalizations significantly contributed to the performance of patients on verbal memory and speed of processing. The severity of mood symptoms did not correlate with performance on any cognitive domain.

Conclusions:

Understanding the factors that predict cognitive performance of patients with depression may provide an insight into the processes by which depression leads to cognitive dysfunction. Our study showed that premorbid IQ and factors related to burden of illness are strong independent predictors of cognitive dysfunction in patients with major depression.
Resilience following Child Maltreatment: A Review of Protective Factors
Authors: Afifi Tracie O , MacMillan Harriet L
Published: January 2017

Objective:

Child maltreatment is linked with numerous adverse outcomes that can continue throughout the lifespan. However, variability of impairment has been noted following child maltreatment, making it seem that some people are more resilient. Our review includes a brief discussion of how resilience is measured in child maltreatment research; a summary of the evidence for protective factors associated with resilience based on those studies of highest quality; a discussion of how knowledge of protective factors can be applied to promote resilience among people exposed to child maltreatment; and finally, directions for future research.

Method:

The databases MEDLINE and PsycINFO were searched for relevant citations up to July 2010 to identify key studies and evidence syntheses.

Results:

Although comparability across studies is limited, family-level factors of stable family environment and supportive relationships appear to be consistently linked with resilience across studies. There was also evidence for some individual-level factors, such as personality traits, although proxies of intellect were not as strongly related to resilience following child maltreatment.

Conclusions:

Findings from resilience research needs to be applied to determine effective strategies and specific interventions to promote resilience and foster well-being among maltreated children.
Le contre-transfert dans le traitement des troubles alimentaires: Recension systématique des écrits
Authors: Forget Karine , Marussi Daphne Rocha , Le Corff Yann
Published: January 2017

Objectif:

Identifier les manifestations du contre-transfert et leurs causes chez les thérapeutes qui traitent des patients souffrant de troubles alimentaires, et faire état des solutions qui ont été proposées pour surmonter les aspects négatifs du contre-transfert dans le but d'améliorer la qualité du traitement.

Méthode:

À l'aide des principales banques de données en sciences de la santé et psychologie, nous avons repéré les études traitant du contre-transfert dans le traitement des troubles alimentaires.

Résultats:

Une diversité de manifestations du contre-transfert sont recensées. II appert notamment que les thérapeutes ressentent souvent des affects négatifs au cours du traitement des patients souffrant de troubles alimentaires. Le contre-transfert semble influencé par des facteurs en lien tant avec la maladie qu'avec le patient et le thérapeute. De plus, un contre-transfert négatif peut entraîner des conséquences qui entravent le bon déroulement du traitement. Les principales solutions recensées pour y faire face sont la supervision, la consultation auprès de collègues et le travail en équipe.

Conclusions:

Plusieurs des facteurs impliqués dans le contre-transfert semblent difficilement modifiables, d'où l'importance d'appliquer des solutions efficaces permettant d'en surmonter les aspects négatifs. Par ailleurs, peu d'études empiriques se sont penchées sur le contre-transfert dans le traitement des troubles alimentaires. Il y a là un champ de recherche fort pertinent mais très peu exploité qui mérite davantage d'attention de la part de la communauté scientifique.
Evidence-Based Medicine: Opportunities and Challenges in a Diverse Society
Authors: Whitley Rob , Rousseau Cecile , Carpenter-Song Elizabeth , Kirmayer Laurence J
Published: January 2017

In this article we explore the discourse and practice of evidence-based medicine (EBM) in the context of social and cultural diversity. The article consists of 2 parts. First, we begin by defining EBM, describing its historical development and current ascendance in medical practice. We then note its importance in contemporary psychiatry, comparing dynamics between the United States and Canada. Secondly, we offer a constructive critique of the application of EBM and evidence-based practices in the context of ethnocultural diversity, as one consistent reflection on the EBM literature is that it is does not adequately address issues of diversity. In doing so, we use the situation here in Canada as an extended case study, though our observations will likely be applicable in other diverse nations, such as the United States, the United Kingdom, and Australia. We critically examine the following 6 issues related to the practice of EBM in a diverse society: generalizability and transferability of evidence-based interventions; diversifying standards of evidence in EBM; strategies to address diversity in EBM research; cultural adaptations of evidence-based interventions; integrating idiographic knowledge; and, training and health service delivery. Concurrent with our critique, we offer research and practice suggestions that may address outstanding challenges vis-à-vis the practice of EBM in a diverse society. These include a need for more effectiveness research, more openness to diverse sources of knowledge, better integration of idiographic and nomothetic knowledge, and a critical approach to extrapolation and transfer of knowledge.
Long-Term Impact of Residual Symptoms in Treatment-Resistant Depression
Authors: Fekadu Abebaw , Wooderson Sarah C , Rane Lena J , Markopoulou Kalypso , Poon Lucia , Cleare Anthony J
Published: January 2017

Objective:

Although commonly encountered, little work has defined the longitudinal course of treatment-resistant depression (TRD) and the influence of residual posttreatment symptoms on longer-term outcome. The aim of our study was to assess the impact of posttreatment clinical states on longer-term outcome.

Method:

Patients ( n = 118) with TRD received specialist inpatient treatment and were followed-up for a median of 3 years. Longitudinal outcome dichotomized into good and poor outcome was used as the primary outcome and functional measures were used as secondary outcomes.

Results:

Among 118 treated patients, 40 (34%) entered clinical remission, 36 (31%) entered partial remission, and 42 (37%) remained in episode at discharge. At follow-up, 35% had longitudinally defined poor outcome. Posttreatment clinical status was the main predictor of both poor and good outcome. Nearly 50% of patients achieved postdischarge recovery, and subsequently had longer-term outcome, comparable with patients discharged in remission. Patients who remained in episode posttreatment were more symptomatically and functionally impaired.

Conclusion:

Posttreatment clinical states are a useful guide to clinicians for projecting the longer-term outcome of patients with TRD. The persistence of residual or syndromal symptoms predicts a poorer longer-term outcome, whereas treatment to remission is associated with better outcomes.
Cognitive Remediation Therapy for Mood Disorders: Rationale, Early Evidence, and Future Directions
Authors: Bowie Christopher R , Gupta Maya , Holshausen Katherine
Published: January 2017

People with mood disorders experience cognitive impairments that are predictive of functional disability. Cognitive remediation (CR) is an empirically validated intervention that is designed to remediate neurocognitive deficits and improve functioning. Although much of the focus of this treatment during the last decade has centred on attention deficit disorders, brain injury, and schizophrenia spectrum disorders, emerging evidence suggests that CR is an effective intervention for mood disorders and that these treatment effects translate into improvements in cognitive performance and possibly functioning. Our review aims to examine the profile and magnitude of cognitive impairments in mood disorders, review the evidence in support of CR for this population, and discuss future research directions in CR.
Continuing Education to Go: Capacity Building in Psychotherapies for Front-Line Mental Health Workers in Underserviced Communities
Authors: Ravitz Paula , Cooke Robert G , Mitchell Scott , Reeves Scott , Teshima John , Lokuge Bhadra , Lawson Andrea , McNaughton Nancy , Skinner Wayne , Cooper Carolynne , Fefergrad Mark , Zaretsky Ari
Published: January 2017

Objective:

To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers.

Methods:

Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 se mi structured focus groups with 25 participants were also analyzed.

Results:

Significant pre- and postintervention changes in knowledge (P < 0.001) were found in course completers. Counselling self-efficacy improved in participants who took the first course offered (P = 0.001). Dropouts were much less frequent in peer-led, small-group learning than in a self-directed format. Qualitative analysis revealed improved confidence, morale, self-reported practice behaviour changes, and increased comfort in working with difficult clients.

Conclusion:

This work-based, multimodal, interactive, interprofessional curriculum for knowledge translation of psychotherapeutic techniques is feasible and helpful. A peer-led group format is preferred over self-directed learning. Its application can build capacity of front-line health workers in helping patients who suffer from common mental disorders.