bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatry in the Nazi Era
Authors: Seeman Mary V
Published: January 2017

Objectives:

To update Canadian psychiatrists on recent information from newly discovered Berlin archives about the actions of physicians, especially psychiatrists, during the era of National Socialism in Germany and to encourage introspection about the role of the medical profession, its relationship with government, and its vulnerability to manipulation by ideology and economic pressures.

Method:

This is a selective review of the literature on the collaboration of physicians, especially psychiatrists, in the sterilization, experimentation, and annihilation of patients with mental illness before and during World War II.

Results:

Directed to value the health of the nation over the care of individual patients and convinced that a hierarchy of worth distinguished one person from another, German psychiatrists were enlisted to commit atrocities during the Nazi period.

Conclusions:

The values of care and compassion can be eroded; this knowledge demands constant vigilance.
Prevalence of Pathological Gambling in Quebec in 2002
Authors: Ladouceur Robert , Jacques Christian , Chevalier Serge , Sévigny Serge , Hamel Denis
Published: January 2017

Objective:

To assess gambling behaviours and the problems associated with pathological gambling among the adult population of Quebec in 2002.

Method:

In Phase 1 of this 2-phase study, a total sample of 8842 adults was assessed. We used the South Oaks Gambling Screen (SOGS), adapted for telephone interview, to assess one-half of the sample; the other one-half was evaluated with the Canadian Problem Gambling Index (CPGI). In the study's second phase, we compared the classifications obtained from these screening instruments with classifications obtained by a psychologist using a semistructured clinical telephone interview.

Results:

The results indicate that the prevalence of pathological gambling in 2002 (at which time 0.8% of the adult population were classified as probable pathological gamblers) did not differ from the proportion obtained in 1996 (1.0%), despite the significant decrease in gambling participation in 2002 (81% vs 90% in 1996). The most popular gambling activities were buying lottery tickets (68%), participating in fundraising draws (40%), gambling in casinos (18%), playing cards with family or with friends (10%), playing bingo (9%), and playing video lotteries (8%). The findings obtained from the SOGS and the CPGI revealed that the 2 instruments perform similarly when identifying pathological gambling prevalence. However, the results of the semistructured clinical telephone interviews differed from the results obtained with the screening instruments: 82% of the gamblers initially identified as probable pathological gamblers by the SOGS or the CPGI were not confirmed by a clinical interview.

Conclusion:

The discrepancy between the results of the screening questionnaires and the clinical evaluation is significant, and this difference needs to be addressed before further cross-sectional or longitudinal studies are conducted.
Treatment Response to Olanzapine and Haloperidol and its Association with Dopamine D2 Receptor Occupancy in First-Episode Psychosis
Authors: Zipursky Robert B , Christensen Bruce K , Daskalakis Zafiris , Epstein Irvin , Roy Paul , Furimsky Ivana , Sanger Todd , Kapur Shitij
Published: January 2017

Objective:

Response to typical antipsychotic medication has been associated with achieving a level of striatal dopamine D2 receptor occupancy in the range of 65% to 70%. We undertook this study to determine whether response to the atypical antipsychotic olanzapine occurs at lower levels of D2 receptor occupancy.

Method:

Eighteen patients who presented with a first episode of psychosis were randomized to receive olanzapine 5 mg daily or haloperidol 2 mg daily in a double-blind design. We acquired positron emission tomography (PET) scans using the D2 ligand [11C]raclopride within the first 15 days of treatment to determine the percentage of D2 receptors occupied by the medication. According to response, dosage was then adjusted to a maximum dosage of 20 mg daily of either drug. PET scans were repeated after 10 to 12 weeks of treatment.

Results:

At the first PET scan, the 8 olanzapine-treated patients had significantly lower D2 receptor occupancies (mean 63.4%, SD 7.3) than those observed in the 10 patients treated with haloperidol (mean 73.0%, SD 6.1). When patients were rescanned following dosage adjustment, mean D2 receptor occupancies were greater than 70% in both groups. D2 receptor occupancies did not differ significantly between the olanzapine-treated group (mean 72.0%, SD 5.7) and the haloperidol-treated group (mean 78.7%, SD 7.6).

Conclusions:

These results suggest that, in patients being treated for a first episode of psychosis, olanzapine has its antipsychotic effect at approximately the same levels of D2 receptor occupancy as are achieved with low dosages of haloperidol.
Preventing Suicidal Behaviour in a General Hospital Psychiatric Service: Priorities for Programming
Authors: Links Paul S , Hoffman Brian
Published: January 2017

Purpose:

General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming.

Methods:

Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004.

Results:

We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract ondischarge from hospital, and 2 articles on reducing access to means.

Conclusions:

Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.
Informed Consent and Adolescents
Authors: Schachter Debbie , Kleinman Irwin , Harvey William
Published: January 2017

Objective:

To explore the doctrine of informed consent and the development of capacity in adolescents with psychiatric problems to help clinicians better reflect on the relevant ethical issues.

Method:

We discuss the relevant literature and explore the role of psychiatric impairment in adolescents' ability to consent.

Results:

In common law, there is no minimum age at which individuals are able to consent to medical treatment and no age below which they are unable to consent. Adolescents' right to self-determination is based on their ability to understand and appreciate the information relevant to the medical decision and on their ability to consent voluntarily and freely. There is a consensus in the literature that, around age 14 years, adolescents have the cognitive ability to understand information necessary for consent. However, there are limited empirical data regarding adolescents' ability to appreciate the information and to make a voluntary decision.

Conclusion:

Clinicians need to involve adolescents in the consent process to the extent possible and assess the elements of capacity to consent to treatment on an individual case basis, recognizing that capacity may evolve as adolescents' cognitive capacities and values mature.
Preferential Aggregation of Obsessive—Compulsive Spectrum Disorders in Schizophrenia Patients with Obsessive—Compulsive Disorder
Authors: Poyurovsky Michael , Fuchs Camil , Faragian Sarit , Kriss Victoria , Weisman Gregory , Pashinian Artashez , Weizman Ronit , Weizman Abraham
Published: January 2017

Objective:

To validate a complex association between schizophrenia and obsessive–compulsive disorder (OCD).

Method:

We used the Structured Clinical Interview for DSM-IV Axis I disorders to compare the rate of OCD spectrum and additional Axis I disorders in 100 patients who met criteria for both schizophrenia and OCD, non-OCD schizophrenia ( n = 100), and OCD ( n = 35).

Results:

There was a robust between-group difference in the number of patients with one or more OCD spectrum disorders (schizo-obsessive n = 30, compared with schizophrenia n = 8; P = 0.001), that is, higher rates of body dysmorphic (8% compared with 0%) and tic (16% compared with 4%) disorders. No difference was revealed in affective, anxiety, and substance use disorders. We found comparable rates of OCD spectrum disorders in the schizo-obsessive and OCD groups (30% and 42.8%, respectively; P = 0.32).

Conclusion:

Preferential aggregation of OCD spectrum disorders in the schizo-obsessive group supports this unique clinical association. Whether a schizo-obsessive interface represents comorbidity or a specific subtype of schizophrenia warrants further investigation.
Psychotherapy Research at the Start of the 21st Century: The Persistence of the Art versus Science Controversy
Authors: Joyce Anthony S , Wolfaardt Ulrich , Sribney Christine , Aylwin A Scott
Published: January 2017

This article offers an overview of prominent general trends in the field of psychotherapy research. We consider 3 areas of the literature: metaanalytic reviews addressing the effectiveness of psychotherapy, the movement to identify empirically supported treatments (EST), and research on the “common factor” or “contextual” models of psychotherapy. We present narrative reviews of selected literature associated with each area. The reviews highlight several issues currently confronting the field. Metaanalytic reviews underscore 2 conclusions: psychotherapy is superior to the absence of treatment, and different approaches to psychotherapy yield equivalent effects. In counterpoint to these findings, the EST movement emphasizes the empirical demonstration that specific psychotherapies have efficacy for specific disorders. Misinterpretation of EST findings has led to considerable controversy. Although EST research can identify causal effects of therapy, it has less capacity to explain how these effects come about. We suggest an appropriate perspective on EST findings. Considerable evidence supports the importance of common factors as mechanisms of change; at present, however, this evidence is predominantly correlational. We conclude that a blending of EST studies and research on the common factors represents the greatest potential for advancing the field. Studies to identify specific ESTs are key to validating the efficacy of psychotherapy approaches and need to be undertaken with the psychodynamic and experiential therapies. Greater emphasis on common factors in research, training, and practice can advance understanding about change processes in efficacious therapies, facilitate the development of sensitive clinicians, and increase the effectiveness of mental health services.
The Incidence of Methylphenidate Use by Canadian Children: What is the Impact of Socioeconomic Status and Urban or Rural Residence?
Authors: Brownell Marni D , Mayer Teresa , Chateau Daniel
Published: January 2017

Objective:

To examine socioeconomic, demographic, and behavioural factors that influence the incidence of methylphenidate use among children aged 4 to 13 years.

Method:

A total of 11 316 children, aged 2 through 11 years, from Cycle 1 (1994–95) of the National Longitudinal Survey of Children and Youth were followed up 2 years later in Cycle 2 (1996–97). The outcome measure was methylphenidate use in Cycle 2. Individual-level explanatory variables included sex, age, socioeconomic status (SES), mother's age at birth of child, lone-parent family status, parental working status, and hyperactivity-impulsivity and inattention probabilities. Area-level explanatory variables included income and rural or urban residence. We used hierarchical linear modelling to examine individual- and area-level factors that predicted methylphenidate use.

Results:

The strongest predictors of methylphenidate use were behavioural: children with high hyperactive-impulsive and (or) inattention behaviours in 1994, compared with children low on these behaviours, were 4.5 to 6 times more likely to use methylphenidate 2 years later. SES remained a significant predictor of the incidence of methylphenidate use, even when other significant predictors were held constant, with lower SES being associated with higher use. Area-level income also predicted methylphenidate use.

Conclusion:

Even when children with similar behavioural symptoms and demographic characteristics were compared, socioeconomic factors had a significant impact on incidence of methylphenidate use.
Does Bipolar Disorder Exist in Children? A Selected Review
Authors: Duffy Anne
Published: January 2017

Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence.
Cost-Effectiveness of Memantine Compared with Standard Care in Moderate-to-Severe Alzheimer Disease in Canada
Authors: Gagnon Micheline , Rive Benoît , Hux Margaret , Guilhaume Chantal
Published: January 2017

Objective:

To conduct a cost-effectiveness analysis comparing the addition of memantine to standard care (that is, without acetylcholinesterase inhibitors) with standard care alone in moderate-to-severe Alzheimer disease (AD) in Canada.

Methods:

A 2-year Markov model estimated clinical effects in terms of quality-adjusted life years (QALYs) and time in complete dependence as well as societal costs in four 6-month cycles. Health states were defined by AD severity assessed with the Mini-Mental State Examination (moderate = 10 to 19; severe < 10), by level of dependence in activities of daily living, and by death. Transition probabilities were estimated by combining data of patients with moderate-to-severe AD from all relevant clinical trials. QALYs were estimated from a UK epidemiologic study. The initial distribution and use of medical and support services for each health state was obtained from the Canadian Study on Health and Aging with current estimates of frequency of use and unit prices applied.

Results:

Compared with standard care, the memantine strategy saved more than 1 month of complete dependence and produced 0.03 additional QALYs, with no additional cost. Probabilistic sensitivity analyses give an 83.3% chance that memantine treatment is cost-neutral, an 89.5% chance of its being cost-effective if the decision maker is willing to pay $20 000 for a QALY, and a 96.2% chance with a willingness to pay $100 000 per QALY. Robustness of results was confirmed through 1-way and scenario-based sensitivity analyses.

Conclusions:

Our evaluation found that memantine monotherapy produced relevant health benefit, compared with standard care alone, with no additional costs. Results are consistent with other economic evaluations of memantine conducted in Europe and the United States.
Pathological Gambling and the Psychiatric Emergency Service
Authors: Chaput Yves , Lebel Marie-Josée , Labonté Edith , Beaulieu Lucie , Paradis Michel
Published: January 2017

Objective:

Pathological gambling (PG) has been associated with several negative mental health outcomes. We attempted to assess the impact of PG at the level of the psychiatric emergency service (PES).

Methods:

In a first trial, clinical and demographic data were acquired from patients visiting the PES of a major university teaching hospital in downtown Montreal from July 1, 1996, to December 31, 2000. In a second trial, data were simultaneously acquired for a 2-year period in the above PES and in 3 others, beginning in September 2002.

Results:

In the first trial, from 2000 onward, the number of visits by PG patients to the PES increased by over 50%. In the second trial, the high level of PES use observed from 2000 onward in the first trial was similarly observed at all 4 PESs. The clinical and demographic characteristics of these patients were typical of help-seeking PG patients. They were, however, significantly less likely to be frequent users of the PES or to be hospitalized.

Conclusion:

Although still manageable, the clinical impact of PG on the PES increased significantly during the course of this study.
Psychosocial Rehabilitation and Psychiatry: What are the Boundaries?
Authors: Bachrach Leona L
Published: January 2017

Objectives:

1. To examine the conceptual underpinnings of psychosocial rehabilitation and underscore its essential relationship to the practice of psychiatry. 2. To explore and dispel some misunderstandings and myths that practitioners in each field sometimes carry about the other.

Method:

Literature review and observation.

Results:

Psychiatry and psychosocial rehabilitation's shared emphasis on the biopsychosocial nature of mental illness forms a compelling basis for cooperative enterprise.

Conclusions:

Mentally ill persons are best served when the disciplines of psychiatry and psychosocial rehabilitation come together in a common cause.
Alcohol, Drugs and Gambling in the Ontario Adult Population, 1994
Authors: Smart Reginald G , Ferris Jacqueline
Published: January 2017

Objective:

To demonstrate the link between gambling, alcohol and drug problems among Ontario adults and to present information on the relationship between expenditures on gambling and type of gambling with gambling problems.

Method:

Using data collected in a 1994 telephone survey of 2,016 randomly chosen Ontario adults, gambling problems are related to the CAGE scale of alcohol problems and the ICD-10 measure of alcohol dependence, as well as smoking, other drug use, and demographic variables. Descriptive tables based on crosstabulations and means are provided, as well as a series of 9 logistic regression models.

Results:

The most significant predictor of gambling problems was the amount spent on gambling in the preceding 30 days, with alcohol dependence on the ICD-10 scale and age also important predictors. Lottery players, compared to other gamblers, are more likely to be male, relatively less affluent, older on average, more likely to report alcohol problems (but not dependence) and be currently smoking.

Conclusions:

The results make clear that heavy drinking and drinking problems are associated with higher levels of spending on gambling and reports of gambling problems. This leads to the suggestion that treatment programs for those with gambling, alcohol or other drug problems should assess that possiblity of comorbidity, since the presence of more than one of these problems can significantly affect the success of treatment and contribute to relapse.
Undue Mood Elevation in Unipolar Patients following Cessation of Lithium Augmentation Treatment: Implications for the Understanding of Mood Disorders
Authors: Hoaken Pcs , Hoaken Peter
Published: January 2017

Objective:

The precipitation of hypomania or mania in some patients with apparent unipolar (UP) depression by the use of antidepressants, lithium augmentation, or antidepressant withdrawal has been described in the literature. However, only 4 cases have been reported where undue mood elevation in UP patients followed lithium termination. To add to the literature, we report 2 cases where mood elevation followed cessation of lithium augmentation treatment.

Method:

Observations were continued on 2 patients receiving an antidepressant plus lithium augmentation after cessation of the lithium treatment.

Result:

There was undue mood elevation in these patients immediately following lithium termination.

Conclusion:

This observation supports the view that there is extensive vulnerability to bipolar disorder among patients with multiple depressions.
Ecg Changes in Pediatric Patients on Tricyclic Antidepressants, Desipramine, and Imipramine
Authors: Johnson Amanda , Giuffre R Michael , O'malley Keiran
Published: January 2017

Objective:

To determine if there is an altered pattern of cardiac electrical activity in children treated with tricyclic antidepressants, desipramine, or imipramine, which may predispose these patients to sudden death.

Methods:

All patients in a child psychiatry practice from 1989 to 1993 in Calgary, Alberta, treated with desipramine or imipramine with both pre- and post-treatment electrocardiograms (ECGs) were included in the study (n = 21; ages 8 to 17 years). Thirty-six blinded post-treatment ECGs were analysed for interval measurement and compared to the pretreatment ECGs.

Results:

Drug dosages ranged from 25 mg to 125 mg per day and treatment duration ranged from 1 to 49 months. Seven of 21 patients were concurrently receiving an antipsychotic medication (pericyazine). The maximal increase in PR, and QRS, and QT interval changes were 40 msec and 70 msec, respectively, with most patients demonstrating no significant changes in the ECG intervals. The QT interval was corrected for heart rate (QTC). No significant arrhythmias or tachycardias were observed. ECG interval changes were not related to drug dosage, age, treatment duration or plasma levels.

Conclusions:

No consistent pattern of ECG interval changes including the QTC interval was observed in children on desipramine and imipramine.
Key Features of Maltreatment of the Infirm Elderly in Home Settings
Authors: Mendonca James D , Velamoor Varadaraj R , Sauve Danielle
Published: January 2017

Objective:

To identify contributory factors of elder abuse by caregivers in home settings.

Method:

Using a reliable instrument, visiting nurses rated observations symptomatic of abuse and neglect found in their current caseload of elderly patients. Their observations were also classified as related or unrelated to wilful maltreatment.

Results:

Regression analysis produced the following significant findings: 1. signs of poor physical care were found to be predictors of physical abuse; 2. signs of psychosocial distress and exploitation were identified as predictors of emotional abuse; 3. defensiveness and irritability shown by caregivers and strained family relationships, in general, were also associated with abuse.

Conclusion:

It appears that emotional abuse is more prevalent than, and not a necessary precursor of, physical abuse; however, reliable signs of impending or actual abuse of the elderly can be found in a home during visitation.
“While You're Up, Get Me a Grant”: A Guide to Grant Writing
Authors: Streiner David L
Published: January 2017

Over the past few years, the number of well-trained researchers has increased, but the amount of money available for research has remained the same or even decreased. Consequently, competition for support is keener than it ever was. How a grant is written may tip the balance between getting funded or not. This article provides some guidelines for writing better proposals, touching on the various parts of the protocol and how it should be packaged. It addresses both the overt purpose of the proposal, which is telling the reviewers what you want to do, why, and how; and the covert message, which is convincing them that you have the ability to do what you propose. The article also discusses the review mechanism, who it is who reads the grant, and why this matters.
Physician Resource Variables and Their Impact on the Future Pool of Research Expertise among Psychiatrists: The Canadian Association or Professors of Psychiatry and Canadian Psychiatric Association Survey
Authors: El-Guebaly Nady , Atkinson Mark
Published: January 2017

Objective:

To assess the impact of the increased proportion of female psychiatrists and trainees, the rapid reduction of international medical graduates allowed in the country, and the expanding number of practitioners with subspecialization on the future pool of psychiatrist researchers in Canadian academic departments of psychiatry.

Method:

A questionnaire was adapted to suit the Canadian milieu and distributed to a target population of 2484, including a core of 522 full-time faculty.

Results:

Female psychiatrists responding to the questionnaire reported less research involvement overall than their male counterparts. International medical graduates with both undergraduate and residency training abroad reported more research interests than other graduate categories. Respondents training in a subspecialty showed no difference in research commitment.

Conclusions:

Concerted efforts must be made to recruit, support, and retain female researchers. Particular attention must be paid to developing research expertise among Canadian medical graduates. The trend towards subspecialization influences only the selection of research topic.
A Critical Review of Recovered Memories in Psychotherapy: Part I—Trauma and Memory
Authors: Paris Joel
Published: January 2017

Objective:

The theoretical basis of the use of recovered memories in psychotherapy will be critically examined.

Method:

Literature will be reviewed on the nature of normal memory, and on the relationship of trauma to memory.

Results:

Normal memories are surprisingly inaccurate. There is little evidence that normal memories can be repressed. There is no evidence that trauma makes repression more likely.

Conclusions:

“Recovery” of repressed memories is not consistent with the findings of empirical research.
Syndrome de Capgras: Perspectives ouvertes par la neuropsychologie cognitive
Authors: Debruille Jacques B , Stip Emmanuel
Published: January 2017

Objectif:

Examiner la façon dont certaines idées, émises quant à la Physiopathologie du syndrome de Capgras (1), ont été mises à l'épreuve par des tests neuropsychologiques.

Méthodes:

Les données consistent en une trentaine d'études sélectionnées pour leur pertinence quant aux étapes cérébrales du traitement des visages chez les patients schizophrènes, les patients atteints du syndrome de Capgras, et les sujets normaux.

Résultats:

L'étude de ces travaux montre: a) qu'en ce qui concerne les patients, les auteurs se sont focalisés sur l'étape de traitement correspondant à la reconnaissance des visages per se; b) mais que l'on peut également étudier l'étape correspondant aux connaissances et croyances relatives aux personnes et évaluer l'existence du clivage proposé par de nombreux psychodynamiciens.

Conclusions:

Les vues provenant du champ de la neuropsychologie, comme du champ psychodynamique peuvent donc être mises à l'épreuve. En offrant le moyen d'élaborer des prédictions testables dans des protocoles expérimentaux, les méthodes de la neuropsychologie cognitive permettront, in fine, le rejet des idées erronées et la démonstration des idées justes. Nous militons pour que les méthodes soient appliquées au syndrome de Capgras comme à chacun des symptômes de schizophrénie.
The Varied Outcomes of Schizophrenia
Authors: Davidson Larry , McGlashan Thomas H
Published: January 2017

Objective:

To review variations in outcomes in schizophrenia across individual, historical, and cross-cultural boundaries, as well as within specific domains of functioning.

Method:

Research literature on the outcomes of schizophrenia appearing within the last 8 years was reviewed.

Results:

First, a review of follow-up studies published in the developed world suggests that heterogeneity in outcome across individuals with schizophrenia remains the rule, with affective symptoms, later and acute onset, and responsiveness to biological treatments predictive of good outcome. Negative symptoms are associated with poor outcome, cognitive impairments, and incapacity in social and work domains. Deterioration appears to occur within the first few months of onset if not already in the prodrome, with recent early-course studies finding longer duration of untreated psychosis associated with insidious onset, negative symptoms, social and work incapacity, and poor outcome. Second, a review of recent cross-cultural and historical studies provides evidence that outcome varies across time and place, schizophrenia having a more favourable outcome in the developing world and becoming a more benign disorder over the course of this century. Third, a review of studies of the domains of functioning within individuals identifies 4 relatively independent dimensions of depression and negative, psychotic, and disorganized symptoms. Cognitive deficits, which are associated with negative symptoms, also constitute a relatively stable dimension over time, showing neither marked deterioration nor improvement once established early in the course of disorder.

Conclusions:

The early appearance and stability over time of negative symptoms and cognitive impairments call for assertive intervention efforts early in the course of disorder to prevent chronicity and prolonged disability.
Who Applies to Regional Review Boards and What are the Outcomes?
Authors: Adams Susan J , Pitre Nancy L , Cieszkowski Rosa
Published: January 2017

Objective:

To determine the outcomes for patients following applications to regional review boards at an Ontario provincial psychiatric hospital for 1992 through 1994.

Method:

A retrospective casenote study examined frequency of readmission, time to next admission, status upon readmission, and episodes of dangerous behaviour perpetrated in the community for patients applying to review boards.

Results:

Over 3 years, 116 hearings took place to review various certificates. Only 57% of applications reached a hearing. Of those, 69% were confirmed and 31% rescinded. A small group of patients made multiple applications to the review board. Median time to next admission for patients who had certificates of involuntary admission rescinded by the review board was 14 days, compared with 53 days for those who remained in hospital until the time of planned discharge.

Conclusion:

Review boards consume considerable resources, serve only a small proportion of patients, and contribute to the “revolving door” phenomenon.
Epidemiology of Affective Disorders: A Review
Authors: Bland Roger C
Published: January 2017

Objective:

To review the epidemiology of affective disorders.

Methods:

This paper reviews recent studies, many of which have used standardized methodology and classification systems, and summarizes their major findings. It also presents trends with particular reference to major depression.

Results:

There have been major advances in the last 15 years, with many investigators using standard methods in different countries, cultures, and races. Rates of major depression are probably increasing, and both major depression and bipolar disorder are occurring at younger ages.

Conclusions:

Affective disorders present a major public health problem with poor recognition, diagnosis, and treatment. There is little coordinated action to reduce untreated morbidity despite the availability of reasonably safe, effective, and economical treatments and the established effectiveness of continuing education programs for providers.
Les placebos dans les essais cliniques sur les psychotropes
Authors: Addington Donald , Williams Richard , Lapierre Yvon , el-Guebaly Nady
Published: January 2017

Le présent document exprime la position adoptée par l'Association des psychiatres du Canada sur les questions éthiques et scientifiques que soulève l'utilisation de placebos dans l'évaluation de nouveaux psychotropes. Selon l'Association, il faut démontrer l'efficacité des nouveaux psychotropes et les comparer aux interventions qui sont actuellement plus efficaces. Les groupes témoins placebos peuvent être indiqués dans certaines circonstances, malgré l'efficacité d'une intervention établie, c.-à-d. dans les situations où les taux de réponse au placebo sont élevés, variables, ou proches des taux de réponse aux traitements efficaces. Les groupes témoins placebos sont également indiqués quand les interventions établies comportent un risque élevé d'effets secondaires ou lorsqu'elles sont efficaces seulement contre certains symptômes d'un trouble.
Implications of Genetic Research for Child Psychiatry
Authors: Rutter Michael
Published: January 2017

Objective:

To review implications of genetic research in child psychiatry.

Method:

Key advances in quantitative and molecular genetics are noted and findings are summarized with respect to autism, attention-deficit hyperactivity disorder, oppositional defiant and conduct disorders, depression, schizophrenia, and Tourette's syndrome.

Conclusions:

Genetic findings will be helpful clinically in the elucidation of disordered brain processes, the understanding of nature–nurture interplay, diagnosis, genetic counselling, and pharmacotherapy.
Bipolar Disorder in Children and Adolescents: Current Challenges
Authors: Steele Margaret , Fisman Sandra
Published: January 2017

Objective:

To demonstrate the diagnostic and treatment challenges in juvenile-onset bipolar disorder.

Method:

Three case vignettes are outlined to demonstrate different bipolar presentations in children and adolescents.

Results:

These case examples illustrate important issues in the diagnosis and management of juvenile-onset bipolar disorder. These issues include diagnostic confusion with atypical initial presentation and the effect of developmental factors on symptom expression. The relationship among genetic risk, early affective instability, and the stress generated by affectively ill family members is complex and circular. Comorbidity with disruptive behaviour disorders, as well as anxiety disorders, is demonstrated by the cases discussed. Comorbid disorders may affect outcome and require separate treatment intervention. There is evidence for the prophylactic antimanic effect of lithium carbonate in children and adolescents, but its specificity as an antimanic agent is still uncertain. There is less evidence, at present, for effectiveness of other mood stabilizers in this age group, although sodium valproate may prove more effective in mixed mania and rapid cycling, which are so often seen with early-onset bipolar disorder.

Conclusions:

While the existence of juvenile-onset bipolar disorder is no longer in dispute, several outstanding issues related to diagnosis and long-term management remain. Careful prospective research will be necessary to sort out these issues definitively.
Help-Seeking for Psychiatric Disorders
Authors: Bland Roger C , Newman Stephen C , Orn Helene
Published: January 2017

Objective:

To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care.

Method:

A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview.

Results:

Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, χ2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care.

Conclusion:

Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder.
Risky Business: Making Sense of Estimates of Risk
Authors: Streiner David L
Published: January 2017

This article describes various indices of risk, which is the probability that a person will develop a specific outcome. The risk difference is the absolute difference in risks between 2 groups and can be used either to compare the outcome of 2 groups, one of which was exposed to some genetic or environmental factor, or to see how much of an effect a treatment may have. The reciprocal of the risk difference, the number needed to treat, expresses how many patients must receive the intervention in order for 1 person to derive some benefit. Attributable risk reflects the proportion of cases due to some putative cause and indicates the number of cases that can be averted if the cause were removed. Finally, the relative risk and odds ratio reflect the relative differences between groups in achieving some outcome, either good (a cure) or bad (development of a disorder).
Ethical and Pragmatic Issues in the Use of Psychotropic Agents in Young Children
Authors: Jensen Peter S
Published: January 2017

Objective:

To provide an overview of the knowledge base concerning the prescribing of psychotropic agents in young children with mental disorders and related mental health problems.

Method:

Relevant information is reviewed concerning the knowledge base available to inform pediatric psychopharmacology prescribing practices.

Results:

Very few psychoactive medications have been adequately tested for safety and efficacy in young children, despite relatively high rates of prescribing.

Conclusion:

Behavioural and psychotherapeutic strategies are often the wisest first therapeutic intervention for this age group. Psychotropic medications may be required, but should be used cautiously in young children, while additional studies are being conducted.
Confronting the Confounders: The Meaning, Detection, and Treatment of Confounders in Research
Authors: Rhodes Anne E , Lin Elizabeth , Streiner David L
Published: January 2017

When one variable is studied to try to explain another, the relationship between them may be biased by a third variable. This bias, known as “confounding,” is common and must be minimized in research. This description is deceptively simple, though. Identifying confounding is complex but can be reduced to a stepped procedure. By way of examples, this article describes confounding and how to recognize it.
Measuring Unfitness to Stand Trial: Psychological Analysis of a Legal Issue
Authors: Veiel HOF , Coles EM
Published: January 2017

The structure of the legal concept of unfitness to stand trial and how it corresponds to psychometric concepts is examined. We conclude that psychometric attempts at quantification and measurement are logically flawed, because they inappropriately treat fitness/unfitness as an individual trait rather than as situation-specific conjunctive/disjunctive concepts. It is argued that, whereas psychometric approaches may be suitable for measuring single components of unfitness, an overall “fitness” score is meaningless and that the assessment should focus on elements of unfitness. The determination of unfitness requires the simultaneous consideration of several different individual capabilities in reference to the demands of a specific trial. The quantification of these specific capabilities by psychologists can assist psychiatrists and the court, but the evaluation of their influence on unfitness in the instant case must be left to the court.
Abnormal Involuntary Movements in Neuroleptic-Naive Children and Adolescents
Authors: Magulac Mark , Landsverk John , Golshan Shahrokh , Jeste Dilip V
Published: January 2017

Objective:

To determine the prevalence of and identify risk factors for abnormal involuntary movements in a well-characterized community sample of neuroleptic-naive children and adolescents.

Method:

The Abnormal Involuntary Movement Scale (AIMS) was administered to 390 subjects aged 3–17 years who were in foster care. Additional instruments were used to assess intellect and behaviour problems.

Results:

A total 12.6% of subjects had at least 1 rating of “mild” movements on AIMS; these included 4.1% with at least 2 ratings of “mild” or 2 of “moderate” severity. Significant risk factors for movement disorder were younger age, lower IQ, and more severe behaviour problems. The abnormal movements were usually orofacial, and the affected subjects were generally unaware of these movements.

Conclusion:

The base prevalence of abnormal involuntary movements must be considered in children and adolescents assessed for medication in order to determine the true rate of motor side effects.
Fact versus Fancy concerning the Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder
Authors: Jensen Peter S
Published: January 2017

Findings from the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA, have been much discussed but frequently misinterpreted or mischaracterized. Misinterpretations regarding the specific nature of and rationale for the study design, the effectiveness of the behavioural treatment arm, the possible advantages of combined treatments over single-component (medication management or behavioural therapy) interventions, and the feasibility and applicability of MTA treatments for “real-world”practitioners are addressed.

Careful interpretation of the MTA findings suggests that for ADHD symptoms, carefully crafted medication-management approaches are superior to behavioural treatment and to routine community care that includes medication. For non-ADHD areas of functioning (for example, social skills, academic performance), combined treatments may offer modest advantages over single-component approaches. Longer-term outcomes past 14 months of intensive MTA treatments (as well as their relative effectiveness with respect to each other) remain unknown, pending further MTA analyses.

The MTA treatments by and large consisted of evidence-based “best practices.” Thus, rather than characterizing these treatments as in-feasible, the substantially superior outcomes of these treatments (versus routine clinical care) across diverse settings should help set the standard for future treatment practices in real-world settings. Despite important study limitations, the MTA study, by virtue of its size, scope, and length; parallel-groups design; explicit use of manualized, evidence-based treatments; and comprehensive range of outcome assessments sets an important benchmark for future trials testing new treatments for childhood ADHD and defines a new standard for optimal outcomes that can be achieved with the best of clinical care.
“Usual and Customary Practice” Testimony as a Defense in Medical Malpractice Informed Consent Issues
Authors: Shiffman Melvin A.
Published: January 2017

Because of the lack of adequate information in many physicians' charts, it is sometimes not possible to find that the physician discussed informed consent with risks and complications and alternative treatments. The law in some jurisdictions allows the use of usual and customary practice to establish that the physician has informed the patient.
A New Paradigm of Surgical Management of the Atonic Face
Authors: Schwarcz Robert M. , Goldberg Robert A. , Shorr Norman
Published: January 2017

Introduction:

Consequences of facial paralysis are functionally and cosmetically debilitating. Surgical facial suspension in patients with facial nerve palsy is characterized by inexorable recurrent descent of the atonic tissues. Despite numerous variations on techniques that have been attempted over the years, including muscle and fascia flaps, deep plane or periosteal dissection, and multiple vector fixation, we have been disappointed to note substantial or complete loss of improvement effect over 1–2 years. This experience has allowed us to reassess the basic philosophy of rehabilitation for patients with facial paralysis. If the most robust and invasive surgeries are not adequately permanent to avoid the need for frequent reoperation, then perhaps a rational approach is to accept and anticipate the need for repeat procedures and use minimally invasive procedures that are designed for maintenance reoperations.

Materials and Methods/Results:

We report our experience with a layered multivector cable suture suspension technique to address the atonic descent of the eyebrow, eyelid, midface, and lower face in patients with facial palsy. We describe 2 approaches, a Keith needle with either Gortex or a nylon suture passed from nasolabial fold to deep temporalis fascia and a procedure involving multivector cables. To address the ocular complications in the atonic face, we review upper and lower eyelid adjunctive techniques. For facial paralysis, solutions to address ocular issues include placement of gold weight to upper eyelid, skin graft to upper eyelid, midface-lift, and lower eyelid slings. Finally, to address the lateral oral commissure droop, we discuss a localized technique involving upward positioning of the area by removal of an ellipse of tissue down to the level of the orbicularis oris muscle.

Discussion:

We discuss our experiences in addressing the upper face, midface, and lower face regarding static reanimation surgery of the atonic face with multivector cables and other modalities to provide a systematic approach. Many of these techniques can be used on the cosmetic patient as well.