bluuebunny/crossref_metadata_2025 huggingface dataset:
Extending Motivational Interviewing to the Treatment of Major Mental Health Problems: Current Directions and Evidence
Authors: Westra Henny A , Aviram Adi , Doell Faye K
Published: January 2017

Motivational interviewing (MI) was originally developed for the treatment of substance abuse but is rapidly expanding to other major mental health populations beyond addictions. This brief review considers the use of MI and related motivational enhancement therapies (METs) in the treatment of anxiety, depression, and eating disorders, and concurrent psychosis and substance use disorders. MI-MET has been added and (or) integrated into treatment for these problems in a wide variety of ways, most commonly as a pretreatment to other therapies (psychosocial treatments and pharmacotherapy) or integrated into standard assessment procedures. In each problem domain, the bulk of the current evidence supports the value of adding MI to existing therapies in increasing engagement with treatment and in improving clinical outcomes. This is particularly encouraging in that many of the populations included in these investigations represent severe and treatment-recalcitrant populations. However, research on the application of MI to other major mental health problems beyond addictions is in the early stages, with existing studies having numerous limitations (for example, small uncontrolled studies or lack of adequate control groups, and failure to establish both MI treatment integrity and the unique contribution of MI in integrated treatments). In short, the substantial body of promising preliminary findings strongly support the continued investigation of MI and related methods for these populations in well-designed clinical trials that examine not only the additive value of MI but also mechanisms underlying these effects and individual differences (moderators) indicating the need for MI.
The Judicious Judicial Dispositions Juggle: Characteristics of Police Interventions Involving People with a Mental Illness
Authors: Charette Yanick , Crocker Anne G , Billette Isabelle
Published: January 2017

Objective:

The number of police interventions with people presenting a mental health problem has been increasing during the past 30 years, and police services are becoming increasingly aware of the human resources and skills these interventions require. Our study addresses the characteristics explaining police time used and outcomes of interventions as police officers interact with people with mental illness.

Method:

Using a police service administrative database from a large Canadian city, and an identification algorithm method, police interventions with people with mental illness were identified on 3 randomly selected days in 1 year. A content analysis of intervention logs was carried out to identify characteristics of those interventions: the call initiator, the location, and the final outcome of the intervention.

Results:

Interventions with people with mental illness represent a small proportion (3%; n = 272) of all police interventions ( n = 8485). General linear models show that the type of outcome is the most important factor in estimating the time required by police interventions. Arrests and hospitalizations are the least time-efficient outcomes, consuming 2.0 and 3.2 times, respectively, more time than informal dispositions. A multiple correspondence analysis shows that police interventions can be depicted in 2 dimensions, representing their main roles concerning people with mental illness, namely, to ensure the public safety and to protect the most vulnerable citizens. The more these services are required, the more police time will be required.

Conclusion:

Education and partnerships between police services and mental health services are essential to a proper management of outcomes.
Smoking, but Not Malnutrition, Influences Promoter-Specific DNA Methylation of the Proopiomelanocortin Gene in Patients with and without Anorexia Nervosa
Authors: Ehrlich Stefan , Walton Esther , Roffman Joshua L , Weiss Deike , Puls Imke , Doehler Nico , Burghardt Roland , Lehmkuhl Ulrike , Hillemacher Thomas , Muschler Marc , Frieling Helge
Published: January 2017

Objective:

Our pilot study evaluates the impact of environmental factors, such as nutrition and smoking status, on epigenetic patterns in a disease-associated gene.

Method:

We measured the effects of malnutrition and cigarette smoking on proopiomelanocortin (POMC) promoter-specific DNA methylation in female patients with and without anorexia nervosa (AN). POMC and its derived peptides (alpha melanocyte stimulating hormone and adrenocorticotropic hormone) are implicated in stress and feeding response. Promoter-specific DNA methylation of the POMC gene was determined in peripheral blood mononuclear cells of 54 healthy female control subjects, 40 underweight patients with AN, and 21 weight-restored patients with AN using bisulfite sequencing. Malnutrition was characterized by plasma leptin.

Results:

POMC promoter-specific DNA methylation was not affected by diagnosis or nutritional status but significantly negatively associated with cigarette smoking.

Conclusions:

Although malnutrition may be expected to reduce DNA methylation through its effects on one-carbon metabolism, our negative results are in line with several in vitro and clinical studies that did not show a direct relation between gene-specific DNA methylation and folate levels. In contrast, smoking has been repeatedly reported to alter DNA methylation of specific genes and should be controlled for in future epigenetic studies.
Disgust Recognition in Obsessive-Compulsive Disorder: Diagnostic Comparisons and Posttreatment Effects
Authors: Rector Neil A , Daros Alexander R , Bradbury Cheryl L , Richter Margaret A
Published: January 2017

Objective:

To examine whether disgust recognition deficits are present and specific to obsessive-compulsive disorder (OCD), and the extent to which this deficit, if present, can be reduced in cognitive-behavioural therapy (CBT).

Method:

Responses to the Pictures of Facial Affect (POFA) were examined in patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosed OCD ( n = 20), panic disorder with agoraphobia (PDA; n = 15), and generalized social phobia (GSP; n = 15) and a second, independent OCD sample of treatment responders to CBT ( n = 11).

Results:

There were signifcant and statistically large disgust recognition differences between the OCD group and comparison PDA and GSP groups. However, patients with OCD treated with CBT showed disgust recognition scores that were equivalent to the PDA and GSP groups, significantly better than the untreated OCD sample, and equivalent to scores from the original POFA nonaffected standardization sample.

Conclusions:

These results provide support for the presence of disgust recognition impairment in OCD, and provide preliminary evidence that disgust recognition impairments may improve with treatment.
Real-World Evaluation of the Resident Assessment Instrument-Mental Health Assessment System
Authors: Urbanoski Karen A , Mulsant Benoit H , Willett Peggie , Ehtesham Sahar , Rush Brian
Published: January 2017

Objective:

We evaluated the Resident Assessment Instrument—Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality.

Method:

Structured interviews with program staff were used for preliminary information-gathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality.

Results:

There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system's ability to support outcome monitoring. There was variability in implementation and performance across clinical programs.

Conclusions:

This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to short-term, highly specialized services. In particular, the suitability of the RAI-MH for hospital-based addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.
A Case for Reprising and Redefining Melancholia
Authors: Parker Gordon
Published: January 2017

Objective:

To identify limitations to severity-based classifications of depression, and to argue for positioning melancholia as a distinct melancholic subtype.

Method:

An overview of relevant literature was conducted.

Results:

First, dimensionalizing depressive disorders effectively aggregates multiple heterogeneous depressive types and syndromes, and thus limits, if not prevents, identification of differential causes and treatments. Second, the melancholic depressive subtype can be defined with some relative precision, and that as it shows quite distinct differential treatment responsiveness, identification should be a clinical priority.

Conclusion:

Melancholia can be positioned and classified as a distinct depressive subtype.
Psychiatric Symptoms Associated with Brief Detention of Adult Asylum Seekers in Canada
Authors: Cleveland Janet , Rousseau Cécile
Published: January 2017

Objectives:

To examine the association between brief detention and psychiatric symptom levels among adult asylum seekers.

Method:

The Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25 were used to assess psychiatric symptoms and premigration trauma exposure in 122 detained and 66 nondetained adult asylum seekers in Montreal and Toronto.

Results:

After a mean detention of 31 days, the proportion of asylum seekers scoring above clinical cutpoints was significantly higher in the detained than the nondetained group for posttraumatic stress (X2 = 4.117, df = 1, P = 0.04), depression (X2 = 13.813, df = 1, P < 0.001), and anxiety (X 2 = 4.567, df = 1, P = 0.03) symptoms. Hierarchical multiple regression models showed that posttraumatic stress, depression, and anxiety symptom levels were significantly higher among detained asylum seekers than among the nondetained comparison group, taking into account previous trauma and demographics. Incremental F was significant for the addition of detention status for all 3 models, indicating that detention contributed to increased symptom levels.

Conclusions:

For asylum seekers, even brief detention is associated with increased psychiatric symptoms. Governments should consider the many viable alternatives to incarceration of asylum seekers, such as temporary placement in a supervised residential facility, to minimize the risks of psychological harm to this vulnerable population.
Symptoms of Posttraumatic Stress Disorder and Depression in Relation to Alcohol-Use and Alcohol-Related Problems among Canadian Forces Veterans
Authors: Fetzner Mathew G , Abrams Murray P , Asmundson Gordon J G
Published: January 2017

Objective:

Alcohol misuse is common among military veterans affected by posttraumatic stress disorder (PTSD) and depression; however, research to date has provided mixed evidence concerning differential associations among PTSD and depressive symptoms in relation to alcohol misuse. Further, most available studies have examined primarily male samples or have dichotomously grouped participants as either having or not having an alcohol use disorder. Our study sought to explore relations among 2 aspects of alcohol misuse (that is, alcohol-related problems, and quantity or frequency of alcohol use) and symptoms of PTSD and depression in independent samples of female and male military veterans.

Method:

Canadian military veterans (1271 men and 72 women) completed a battery of self-report questionnaires as part of a broader health status assessment conducted by Veterans Affairs Canada.

Results:

Linear regression analyses suggested depressive symptoms accounted for unique variance in reported alcohol-related problems and quantity or frequency of alcohol use among male veterans. Additionally, PTSD hyperarousal symptoms accounted for unique variance in reported alcohol-related problems. In contrast, among female veterans neither PTSD nor depressive symptoms were found to account for significant variance in measures of alcohol-related problems or quantity or frequency of alcohol use.

Conclusions:

Findings suggest differing mechanisms are involved in influencing alcohol misuse among male and female veterans. Accordingly, female veterans may benefit from specialized assessment and intervention approaches to prevent and treat alcohol-related disorders, rather than applying the same strategies commonly used with male veterans. Comprehensive results, implications, and directions for future research are discussed.
Sense of Belonging and Suicide: A Systematic Review
Authors: Hatcher Simon , Stubbersfield Olivia
Published: January 2017

Objective:

To systematically review the research on the association between sense of belonging and suicide.

Method:

We systematically reviewed electronic databases for studies that included assessments of suicidality and belonging.

Results:

We found 16 studies that met our eligibility criteria. They all found an association between belonging and suicidality but nearly all of the studies were in nonclinical populations, and the association was weak and could be taken into account by confounding factors.

Conclusions:

Low sense of belonging has a weak association with suicidality. However, current concepts make it hard to distinguish from loneliness or other measures of social support. An alternative view of belongingness, as a sense of connectedness to things other than people and in the past as well as the present, may generate alternative ideas about useful clinical interventions that may be especially relevant to indigenous populations.
Depression Screening in Primary Care: Why the Canadian Task Force on Preventive Health Care Did the Right Thing
Authors: Thombs Brett D , Ziegelstein Roy C
Published: January 2017

Objective:

To review the recent recommendation against routinely screening adults for depression in primary care settings by the Canadian Task Force on Preventive Health Care (CTFPHC).

Methods:

We reviewed the CTFPHC recommendation and discussed it in the context of relevant evidence.

Results:

Depression screening, which involves using depression symptom questionnaires to attempt to identify patients who have unrecognized depression, was previously recommended by the CTFPHC in primary care settings with staff-assisted depression care programs in place to ensure accurate diagnosis, effective treatment, and follow-up, but not in the absence of such programs. The CTFPHC recently updated this guideline and recommended against routinely screening adults for depression in primary care because there have not been any randomized controlled trials (RCTs) that have shown depression screening to be beneficial and because of a concern about the potentially high number of false-positive screens that would occur. Without evidence from RCTs of better health outcomes from screening, there are numerous factors that suggest that depression screening, even with collaborative depression care, may not be beneficial for patients, including the high rate of patients already treated, uncertainty about the ability of depression screening tools to accurately identify previously unrecognized patients, and relatively small treatment effects among patients with less severe depression who would be most likely to be identified through screening. Routine screening would expose some patients to avoidable risks and would pose a significant cost burden.

Conclusion:

The CTFPHC recommendation to not screen for depression in primary care is consistent with available evidence. Clinicians in primary care settings should be alert to signs of depression and attend to symptoms through assessment and, as appropriate, referral or management, as recommended by the CTFPHC.
The Importance and Limits of Harm in Identifying Mental Disorder
Authors: Wakefield Jerome C , First Michael B
Published: January 2017

The In Review articles in this issue on normality and disorder by Dr Rachel Cooper and Dr Derek Bolton explore the importance of a value component of harm in the concept of mental disorder. They focus on the Diagnostic and Statistical Manual of Mental Disorder's clinical significance criterion, requiring that symptoms cause significant distress or role impairment, as the expression of the harm component. As Dr Bolton argues, harm in the form of distress or role impairment has always been intimately tied to the concept of disorder and treatment decisions; as Dr Cooper argues, without the harm requirement, any disliked anomaly may be labelled a disorder. Moreover, as Cooper argues, a harm requirement is not incompatible with a natural kinds approach to distinguishing among disorders or to a categorical approach to disorder; the lack of zones of rarity on the harm continuum does not preclude categorical underlying causal processes. However, neither paper systematically develops arguments regarding the other component of disorder, the requirement that the harm must be caused by underlying dysfunction. The dysfunction component distinguishes disorders from the many other negative conditions in life. Cooper's identification of dysfunction with symptom severity ignores the fact that normal suffering can be severe, and Bolton's attempt to encompass risk of harm within harm yields an implausibly expansive conception of disorder. While the harm component is essential, clarification of the dysfunction component of the concept of disorder, pursued in part 2 of this In Review in the December 2013 issue, is also essential to establishing a coherent and plausibly limited domain of psychiatric disorder within the broader arena of harmful conditions.
What Do People Believe about Memory? Implications for the Science and Pseudoscience of Clinical Practice
Authors: Lynn Steven Jay , Evans James , Laurence Jean-Roch , Lilienfeld Scott O
Published: January 2017

We examine the evidence concerning what people believe about memory. We focus on beliefs regarding the permanence of memory and whether memory can be repressed and accurately recovered. We consider beliefs about memory among the undergraduate and general population, mental health professionals, judges, jurors, and law enforcement officers to provide a broad canvass that extends to the forensic arena, as well as to psychiatry, psychology, and allied disciplines. We discuss the implications of these beliefs for the education of the general public and mental health professionals regarding the science and pseudoscience of memory and the use of suggestive procedures in psychotherapy.
Risk Indicators of Depressed Mood among Sex-Trade Workers and Implications for HIV Risk Behaviour
Authors: Rogers Marla Rochelle , Lemstra Mark Edgar , Moraros John Simeon
Published: January 2017

Objectives:

To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use.

Methods:

Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices.

Results:

The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours.

Conclusions:

Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.
A Canadian Primary Care Sentinel Surveillance Network Study Evaluating Antidepressant Prescribing in Canada from 2006 to 2012
Authors: Morkem Rachael , Barber David , Williamson Tyler , Patten Scott B
Published: January 2017

Objective:

To evaluate the prescribing patterns of antidepressants (ADs) by primary care providers to youth, adults, and seniors, from 2006 to 2012, using data from electronic medical records (EMRs).

Method:

This was a retrospective cross-sectional database study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Data on more than 600 000 Canadian primary care patients were used to determine the prevalence and incidence of AD prescribing to patients 15 years and older who had an encounter in the years of study (from 2006 to 2012). Each study year was evaluated independently.

Results:

The study population consisted of 86 927 patients in 2006 (mean age 48.1 years [SD 18.7], 38% male) and grew to 273 529 (mean age 49.6 years [SD 19.3], 40% male) in 2012. The prevalence of AD prescribing increased from 9.20% in 2006 to 12.80% in 2012 ( P < 0.001). While the incidence rate of AD prescribing dropped from 3.54% in 2006 to 2.72% in 2008 ( P < 0.001) the rate started to significantly rise again, reaching an incidence of 3.07% by 2012 ( P < 0.001).

Conclusions:

The prevalence of AD prescribing by primary care providers in Canada continued to rise from 2006 to 2012. Conversely, incidence has remained stable or declined during the 6-year study period. While many complex factors likely contribute to the observed prevalence and incidence rates, our findings suggest that the guidelines indicating the efficacy of long-term AD therapy for patients with highly recurrent or severe depression are being followed.
The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada
Authors: Duffy Olivia Anne
Published: January 2017

On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who “clearly consents to the termination of life” and has a “grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”1 The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering.
Effects of Nonparental Child Care on Child Development: An Update
Authors: Lamb Michael E
Published: January 2017

Objective:

To review the published literature on the effects of nonparental and out-of-home care on infants, toddlers, and preschoolers.

Method:

Narrative literature review.

Results:

Although substantial controversy persists, the accumulated evidence suggests that nonparental care does not necessarily have either beneficial or detrimental effects on infants and children, although it can have such effects. In some circumstances, careproviders establish relationships with children that have significant effects on development, and this increases the importance of ensuring that careproviders are well trained, behave sensitively, and are stable rather than ephemeral figures in children's lives. Nonparental care is associated with behaviour problems (including aggression and noncompliance) when the care is of poor quality and opportunities for meaningful relationships with stable careproviders are not available, however.

Conclusion:

The effects of out-of-home care vary depending on the quality of care as well as the characteristics of individual children, including their age, temperaments, and individual backgrounds.
Identifying Narcissistic Personality Disorders in Preadolescents
Authors: Guilé Jean-Marc
Published: January 2017

Objective:

To establish whether consensus exists among 3 diagnostic systems that outline criteria for narcissistic personality disorders (NPDs) in children (Kernberg), in adolescents (Bleiberg), and in adults primarily (DSM-IV) and to identify age-related criteria for preadolescents.

Method:

A comparative analysis was used to determine the rate of concordance for the 9 DSM-IV criteria for NPD.

Results:

There is a high concordance among the 3 systems for DSM criteria, suggesting that NPD can be identified among preadolescents.

Conclusion:

Preliminary ways of adapting DSM-IV criteria for NPD in this age group are discussed.
The Mental Health of Children in Foster Care: A Comparison with Community and Clinical Samples
Authors: Stein Eleanor , Evans Barrie , Mazumdar Rupak , Rae-Grant Naomi
Published: January 2017

Objective:

To determine whether the psychiatric profile of children in foster care is more similar to clinical or community profiles.

Method:

Caregiver and teacher ratings of DSM-III-R externalizing and internalizing symptoms were collected for 3 groups of children: children in foster care, children assessed at a children's mental health centre, and a community sample.

Results:

Children in foster care approximated the numbers and types of symptoms of the clinical sample. Coming from a family on social assistance, having a parent with a criminal history, and being of the male gender were correlated with higher externalizing and internalizing symptom scores independent of group membership. Group membership accounted for less than 5% of the variance in psychiatric symptom scores.

Conclusions:

The high symptom burden of children in care is substantially attributable to their high-risk histories, and treatment should be designed with this in mind.
The Effect of Risperidone on Cognition in Patients with Schizophrenia
Authors: Stip Emmanuel , Lussier Isabelle
Published: January 2017

Objective:

To evaluate the effect of risperidone on cognitive functions after both 6 weeks and 6 months of treatment and to determine whether any improvement on neuropsychological function relates to improvement in psychopathology.

Method:

Patients' psychiatric and extrapyramidal symptoms were assessed while they were receiving classical neuroleptic treatment and adjunctive medications. Patients were then reassessed after changing to a new treatment of risperidone.

Results:

During treatment with risperidone, schizophrenic patients displayed improved performance mainly on attentional components, specifically, selective attention and alertness.

Conclusion:

In patients who were given risperidone, there was a positive correlation between improvement in psychopathology and improvement in cognitive tests of explicit memory and alertness.
A Demographic Study of Polydipsia in an Institution for the Intellectually Disabled
Authors: Hayfron-Benjamin Jonathan , Peters Claudia A , Woodhouse Rosamund A
Published: January 2017

Objective:

To measure the prevalence of primary polydipsia in an Ontario institution for residents with developmental disabilities and to explore the associations of polydipsia with age, sex, and level of mental retardation.

Method:

All 798 residents were screened for polydipsia using a behavioural questionnaire completed by caregivers.

Results:

Thirty-three cases were detected: the prevalence among the mobile resident population (n = 660) was 5%. We found no association of polydipsia with age, sex, or level of mental retardation.

Conclusions:

Physicians should be aware of polydipsia because it is common among residents with moderate, severe, and profound mental disability. Unless screened for specifically, polydipsia may go unrecognized and may place the residents with mental handicap at risk for serious acute and chronic complications.
The Nature and Characteristics of Psychiatric Comorbidity in Incarcerated Adolescents
Authors: Ulzen Thaddeus PM , Psych Dip Child , Hamilton Hayley
Published: January 2017

Objectives:

To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted.

Method:

Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined.

Results:

Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder.

Conclusions:

Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.
Efficacy of Divalproex Sodium in Patients with Panic Disorder and Mood Instability Who Have Not Responded to Conventional Therapy
Authors: Baetz Marilyn , Bowen Rudradeo C
Published: January 2017

Objective:

To determine the efficacy of divalproex sodium in the treatment of psychiatric outpatients with treatment refractory panic disorder and comorbid mood instability.

Method:

This was an 8-week, open-trial, flexible-dose outcome study conducted at a tertiary care referral centre. Individuals with panic disorder who failed to respond to a cognitive behavioural treatment program and standard antipanic medication, who also suffered from mood instability, were chosen to participate in the study. Divalproex sodium was administered at a flexible dose to reach serum levels of 300 to 600 umol/L (45 to 90 ug/ml) unless limited by tolerance. Patients were rated by self- and rater-administered questionnaires that measured the number of panic attacks, the degree of agoraphobic avoidance, the levels of depression, anxiety, and mood swings, and the perceived sense of well being.

Results:

Thirteen subjects were enrolled in the study, and 10 subjects completed it. Two dropped out early because of the medication's side effects, and 1 was lost within the first month of follow-up. All 10 subjects showed significant improvement in depressive and anxiety symptoms and mood instability. There was also a statistically and clinically significant improvement in panic attacks and measures of quality of life.

Conclusions:

These findings suggest that divalproex sodium is useful in the treatment of patients with panic disorder and concomitant mood instability, who are refractory to conventional treatment. Double-blind trials will be required to verify these findings.
Prospective Follow-up Study of Borderline Personality Disorder: Prognosis, Prediction of Outcome, and Axis II Comorbidity
Authors: Links Paul S , Heslegrave Ronald , van Reekum Robert
Published: January 2017

Objective:

To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria.

Method:

This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up.

Results:

Of the 5 7 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance.

Conclusions:

This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.
Neuroendocrine Responses to Inhibitors of Steroid Biosynthesis in Patients with Major Depression Resistant to Antidepressant Therapy
Authors: Murphy Beverley E Pearson , Ghadirian A Missagh , Dhar Veena
Published: January 2017

Objective:

Patients with major depression frequently have high Cortisol levels and resistance to dexamethasone. We sought to determine to what extent major depression might be influenced by inhibitors of steroid biosynthesis and to study the endocrine changes produced.

Method:

After drug washout, 20 treatment-resistant patients with major depression were given aminoglutethimide, metyrapone, and/or ketoconazole, along with a small dose of cortisol for 8 weeks. Hamilton Depression Rating Scale (HDRS) ratings, 8:00 AM Cortisol, dehydroepiandrosterone sulfate (DHAS), adrenocorticotropin (ACTH), and testosterone levels were followed weekly or offener. A dexamethasone suppression test (DST) was conducted before and after treatment.

Results:

Seventeen patients (85%) completed the course of treatment, and a significant mean drop (P ≤ 0.0001) of 50% in the HDRS score occurred by 7 weeks of treatment. Cortisol levels fluctuated widely and were often still high after the patient had improved clinically. Dehydroepiandrosterone sulfate levels fell more uniformly and were found to be a useful indicator of compliance and, to some extent, efficacy with aminoglutethimide and ketoconazole therapy. The correlation between DHAS and HDRS (r = 0.94) was significant (P = 0.02). Testosterone levels in men fell with ketoconazole but returned promptly to normal at the end of treatment. Adrenocorticotropin levels were normal or elevated, depending on the assay used, and rose (P = 0.07; n = 13) in most subjects during therapy. Of the 6 responders who had nonsuppressor DSTs before starting therapy, 5 had reverted to normal 1 to 2 weeks following cessation of therapy (P = 0.0006).

Conclusions:

Abnormal metabolism of adrenocortical steroids may perpetuate depression, and alterations of synthesis or metabolism of these steroids may lead to a remission.
Sexual Recidivism in Sex Offenders
Authors: Greenberg David M
Published: January 2017

Objective:

To examine the recidivism rates of the various types of adult sex offenders including incest offenders, extrafamilial child molesters, exhibitionists, and rapists.

Method:

An examination of the literature over the past 4 decades and the data from our own study group.

Results:

Methodological shortfalls and differences across the studies make statistical appraisal of the results difficult. Nevertheless, there is a consensus that incest offenders are less likely to reoffend compared with extrafamilial child molesters. Rapists and exhibitionists are thought to be at a higher risk for recidivism.

Conclusion:

A combined actuarial predictive approach in conjunction with empirically guided clinical assessment is probably the best method to predict recidivism of sex offenders.
Fitness, Responsibility, and Judicially Ordered Assessments
Authors: Ohayon Maurice M , Crocker Anne , St-Onge Bernard , Caulet M
Published: January 2017

Objective:

To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR).

Method:

This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period.

Results:

In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations.

Conclusions:

Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.
Alcohol Consumption and Major Depression in the Canadian Population
Authors: Patten Scott B , Charney Dara A
Published: January 2017

Objective:

Various clinical studies have documented associations between alcohol consumption and depressive disorders. In some circumstances, alcohol ingestion may cause or worsen depression, whereas in other circumstances the direction of causal effect may be reversed. The objective of this study was to evaluate associations between alcohol consumption and major depression in the Canadian population.

Method:

Data from the Canadian National Population Health Survey (NPHS) were analyzed. This survey, conducted by Statistics Canada in 1994, used a probability sample of 17 626 subjects. The NPHS included measures of alcohol ingestion and a diagnostic screen for major depression (Composite International Diagnostic Interview [CIDI] Short Form).

Results:

Subjects reporting any drinking in the year preceding the interview were more likely to have experienced an episode of major depression during that time than subjects reporting no drinking. Subjects reporting maximal ingestions of 5 or more drinks (and especially 10 or more drinks) on at least 1 occasion during the preceding year were also at greater risk of major depression than nondrinking subjects or subjects reporting smaller maximal ingestions. Neither the average amount consumed daily nor the frequency of drinking was associated with major depression.

Conclusions:

In the general population, there is no simple relationship between the quantity or frequency of alcohol consumption and the prevalence of major depression. Any drinking and maximal consumption on I occasion, however, are related to the prevalence of major depression. Further research is needed to delineate causal mechanisms so that clinical and public-health interventions can be formulated.
Confidentiality in Crisis: Part I—The Duty to Inform
Authors: Glancy Graham D , Regehr Cheryl , Bryant Anthony G
Published: January 2017

Objective:

To discuss the ethical and legal imperatives to protect third parties from harm in circumstances often believed to be protected by doctor-patient confidentiality.

Method:

A review of recent legislative changes and legal decisions pertaining to a psychiatrist's duty to warn.

Conclusion:

The current legislative and legal climate presents many risks to the concept of doctor-patient confidentiality. Psychiatrists must carefully consider any guarantees of confidentiality made to patients and must discuss the limits of confidentiality when obtaining consent for treatment.
Confidentiality in Crisis: Part II—Confidentiality of Treatment Records
Authors: Glancy Graham D , Regehr Cheryl , Bryant Anthony G
Published: January 2017

Objective:

To discuss the implications of recent legislative changes and court decisions in Canada that have placed the privacy of psychiatric records information at risk. New areas of exposure include client access to clinical information provided by family members, parental access to children's records, and court access to clinical records in civil, criminal, and family law matters.

Method:

A review of recent legislative changes and court decisions pertaining to access to psychiatric records.

Conclusion:

At present, psychiatric records can no longer be regarded as confidential. Recent changes in the concept of privilege of treatment records necessitates several changes in psychiatric practice regarding informed consent to treatment, content of clinical records, and responses to demands for information.
Phase-IV Multicentre Clinical Study of Risperidone in the Treatment of Outpatients with Schizophrenia
Authors: Chouinard Guy , Kopala Lili , Labelle Alain , Beauclair Linda , Johnson Sunny V , Singh Kulbir I ,   The RIS-CAN-3 Study Group
Published: January 2017

Objective:

Since most clinical trials of atypical antipsychotics have been conducted in hospitalized patients, a Phase-IV, multicentre, 8-week, open-label, flexible-dose study was performed to assess the efficacy and safety of risperidone in outpatients with schizophrenia.

Method:

Three hundred and thirty patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) diagnosis of schizophrenia were enrolled at 61 Canadian sites. Upon trial entry, the patients had their neuroleptic and antiparkinsonian drugs discontinued, and treatment with risperidone was initiated at a dose of 2 mg daily, then increased by 2 mg daily on each of the 2 following days until the initial target dose of 6 mg daily was reached on day 3. No further titration was allowed until day 14, after which the dose could be increased or decreased.

Results:

During the stabilization phase (days 14–56), the dose was unchanged in 44% of the patients, increased in 24%, decreased in 23%, and titrated both up and down in 9% of the patients. In the efficacy-evaluable population (n = 292), treatment with risperidone produced substantial (−26.4) and significant (P = 0.0001) improvement in the total Positive and Negative Syndrome Scale (PANSS) score. At the end of the study (week 8), 85% of patients were classified as clinically improved according to an a priori definition (that is, 20% or more decrease from baseline in total PANSS score). On their last study visit, 75% of patients reported their experience with risperidone as better than their previous neuroleptic therapy. Risperidone was generally well tolerated. The adverse events reported by more than 5% of the patients were insomnia, nausea, headache, somnolence, dizziness, fatigue, anxiety, vomiting, and ejaculation disorder. Seventy-four percent of the reported treatment-related adverse events were recorded during the first 2 weeks of the trial, possibly because of the discontinuation of prior neuroleptic and antiparkinsonian drugs followed by immediate upward titration of risperidone. However, only 8.5% of adverse events were reported to have occurred during week 3, and only 0.8% of adverse events were reported for week 8. Risperidone treatment produced significant improvements over baseline in the incidence and severity of extrapyramidal symptoms (EPS). A slight but statistically significant increase in body weight was observed.

Conclusions:

The results of this open-label, Phase-IV trial in a large population of outpatients with schizophrenia found that risperidone was superior to the neuroleptics that patients had previously taken in terms of efficacy and severity of EPS. Our results suggest the use of risperidone at lower doses in outpatients with schizophrenia.
The Adequacy of Reporting Randomized, Controlled Trials in the Evaluation of Antidepressants
Authors: Streiner David L , Joffe Russell
Published: January 2017

Objective:

To evaluate the adequacy of the reports of methodological and statistical aspects of randomized, controlled trials that evaluate antidepressant medications and the degree to which their results can be used in subsequent metaanalyses.

Data Sources:

Randomized, controlled trials published in English that compared 2 antidepressant drugs with a placebo were reviewed. Papers were located using Medline and reference lists.

Data Extraction:

Each paper was evaluated using a checklist, and 3 summary criteria scores were derived: minimal, ideal, and overall.

Results:

Only 9 of the 69 papers met the minimal criteria to be included in a metaanalysis (which would report the final sample size and an estimate of the mean and of the standard deviation); and 0 met all of the ideal criteria for reporting clinical trials. Out of a possible 100 points, the mean score for the articles was 51, and the highest score was 80. Scores were not related to the citation impact factor of the journal in which they appeared.

Conclusions:

Researchers must become more aware of the criteria for reporting clinical trials, and editors must insist more strenuously that these criteria be satisfied.
The Relationship of Catatonia Symptoms to Symptoms of Schizophrenia
Authors: Cernovsky Zack Z , Landmark Johan A , Merskey Harold , O'Reilly Richard L
Published: January 2017

Objective:

To evaluate the relationships of symptoms of catatonic schizophrenia to 77 symptoms relevant for diagnosing schizophrenia and to socioanamnestic variables.

Method:

Data from a sample of 112 Canadian patients diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) were evaluated via φ correlation coefficients.

Results:

Forty-five (40.2%) of our 112 patients had catatonic symptoms, either at the time of this study or in the past. However, only weak correlations (φ < 0.31) to other symptoms relevant for diagnosing schizophrenia were found, and no significant correlations to socioanamnestic variables were found.

Conclusion:

Symptoms of catatonia appear to be independent of the key symptoms of schizophrenia.