bluuebunny/crossref_metadata_2025 huggingface dataset:
What Clinical and Symptom Features and Comorbid Disorders Characterize Outpatients with Anxious Major Depressive Disorder: A Replication and Extension
Authors: Fava Maurizio , Rush A John , Alpert Jonathan E , Carmin Cheryl N , Balasubramani GK , Wisniewski Stephen R , Trivedi Madhukar H , Biggs Melanie M , Shores-Wilson Kathy
Published: January 2017

Objective:

We previously found that 46% of the first 1450 outpatients with depression participating in the multicentre Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project qualified for the designation of anxious depression. This study was designed to replicate and extend our initial findings in a subsequent, larger cohort of outpatient STAR*D participants with nonpsychotic major depressive disorder (MDD).

Methods:

Baseline clinical and sociodemographic data were collected on 2337 consecutive STAR*D participants. A baseline 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor score of 7 or higher was designated as anxious depression. We identified concurrent Axis I disorders with the Psychiatric Diagnostic Screening Questionnaire (PDSQ), using a 90% specificity threshold. Depressive symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology–Clinician-Rated (IDS-C30).

Results:

The prevalence of anxious depression in this population was 45.1%. Patients with anxious MDD were significantly more likely to be in primary care settings and to be women, nonsingle, unemployed, Hispanic, less educated, and suffering from severe depression, both before and after adjustment for overall depression severity. Patients with anxious depression were significantly more likely to meet PDSQ thresholds for generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, posttraumatic stress disorder, agoraphobia, hypochondriasis, and somatoform disorder, both before and after adjusting for baseline depression severity. Individuals with anxious depression were also significantly less likely to endorse IDS-C30 items concerning atypical features and were significantly more likely to endorse items concerning melancholic-endogenous depression features, both before and after adjusting for baseline depression severity.

Conclusions:

This study clearly replicates our previous STAR*D findings and supports the notion that anxious depression may be a valid diagnostic subtype of MDD, with distinct psychiatric comorbidities and clinical and sociodemographic features.
Canadian Psychiatrists' Current Attitudes, Practices, and Knowledge regarding Fitness to Drive in Individuals with Mental Illness: A Cross-Canada Survey
Authors: Ménard Ingrid , Korner-Bitensky Nicol , Dobbs Bonnie , Casacalenda Nicola , Beck Philip R , Gélinas Isabelle , Molnar Frank J , Naglie Gary
Published: January 2017

Objectives:

To assess current attitudes, practices, and knowledge of Canadian psychiatrists regarding fitness to drive in individuals with mental illness and to explore variations according to provincial legislation.

Method:

We carried out a national cross-sectional survey, using a random sample of psychiatrists. We used a mail survey to collect data.

Results:

In total, 248 psychiatrists participated; the response rate was 54.2% on traced subjects. The majority (64.1%) reported that they strongly agreed or agreed that addressing patients' fitness to drive is an important issue. However, only 18.0% of respondents were always aware of whether their patients were active drivers. One-fourth strongly agreed or agreed that they were confident in their ability to evaluate fitness to drive. In discretionary provinces, 29.3% of psychiatrists reported not knowing their provincial legislation, as did 14.6% of psychiatrists in mandatory provinces; of those responding, 54.0% from discretionary provinces and 2.8% from mandatory provinces gave incorrect answers.

Discussion:

Psychiatrists' responses demonstrate a broad range of attitudes, practices, and knowledge. There appears to be a large gap between what is expected of psychiatrists and their readiness and self-perceived ability to make informed clinical decisions related to driving safety.

Conclusion:

There is a clear need for education and guidelines to assist psychiatrists in decision making about driving fitness.
Recurrent Depressive Symptomatology and Physical Health: A 10-Year Study of Informal Caregivers of Persons with Dementia
Authors: O'Rourke Norm , Cappeliez Philippe , Neufeld Eva
Published: January 2017

Objective:

To examine the degree to which recurrent depressive symptomatology predicts the decline in the health status of a randomly derived national sample of caregivers of persons with dementia.

Method:

Individuals with dementia and their caregivers were recruited from each Canadian province as part of a national epidemiologic study of dementia prevalence and the health and welfare of care providers. Both patients and caregivers were assessed at 3 points over a 10-year period. Cohabiting family members who shared the same residence as care recipients were selected for the current study ( n = 96 pairs). We computed a repeated measures analysis of variance to compare the health of caregivers who were consistently asymptomatic for depression, of those symptomatic at 1 of 3 points of measurement, and of those symptomatic at 2 of 3 points.

Results:

As hypothesized, caregivers presenting with elevated depressive symptomatology at multiple points of measurement reported poorer and worsening physical health over time.

Conclusions:

The results of this study support the assertion that depressive symptomatology significantly predicts the decline in health status of caregivers of persons with dementia. Concerted effort to treat depression in this population is warranted to forestall this trajectory of decline and premature patient institutionalization.
Depression Literacy in Alberta: Findings from a General Population Sample
Authors: Wang JianLi , Adair Carol , Fick Gordon , Lai Daniel , Evans Beth , Perry Brenda Waye , Jorm Anthony , Addington Donald
Published: January 2017

Objective:

To assess the public's knowledge about depression, attitudes toward treatments for depression, perceived causal factors for depression, and reported prognoses of depression, overall and by sex.

Methods:

We conducted a cross-sectional telephone survey in Alberta between February and June 2006. We used a random phone number selection procedure to identify a sample of adults in the community ( n = 3047). Participants were presented with a vignette describing an individual with depression and then asked questions to assess recognition of depression, attitudes toward mental health treatments, possible causal factors for depression, and prognosis of depression.

Results:

The response rate was 75.2 %. Among the final participants, 75.6% could correctly recognize depression described in a case vignette. General practitioners or family doctors were considered as being the best help for depression. Of the participants, 35% were in complete agreement with health professionals about appropriate interventions for depression, 28% believed in dealing with depression alone, and 43% thought that “weakness of character” was a likely cause of depression. Men had poorer mental health literacy than women and were more likely to endorse the use of alcohol to cope.

Conclusions:

Mental health promotion and education efforts are needed to improve the general public's mental health literacy and to clarify misunderstanding about depression. Men need to be a particular target of these efforts.
Clozapine-Induced Seizures: Recognition and Treatment
Authors: Wong Jason , Delva Nicholas
Published: January 2017

Objectives:

To inform clinicians about the types of seizures that can be induced by clozapine and to provide recommendations for treatment.

Methods:

We identified articles on clozapine-induced seizures from a MEDLINE search of the English-language literature from 1978 to July 2006. The frequency of each type of seizure and the dosages of clozapine associated with seizures were compiled. In addition to this review, we report a new case illustrating the challenge of diagnosing subtle seizure activity.

Results:

The tonic-clonic variety is the most frequently described clozapine-induced seizure. Myoclonic and atonic seizures together constitute about one-quarter of the reported seizures. The mean dosage of clozapine associated with seizures is not high (less than 600 mg daily).

Conclusions:

It may be difficult for clinicians to recognize subtle types of clozapine-induced seizures, such as myoclonic, atonic, or partial seizures. Clinicians should not place excessive reliance on the plasma level of clozapine or electroencephalogram findings to predict the occurrence of seizures. When a first seizure occurs, it is recommended that the dosage of clozapine be reduced or an alternative antipsychotic agent be employed. If a second seizure occurs, an anticonvulsant drug should be started. Special attention should be paid when commencing or discontinuing concurrent medication that may affect the plasma level of clozapine.
Perinatal Depression: Hiding in Plain Sight
Authors: Lusskin Shari I , Pundiak Tara M , Habib Sally M
Published: January 2017

Objective:

To promote prompt identification and treatment of perinatal depression and enhance preventive care for women at risk.

Methods:

Using MEDLINE and PubMed searches, we reviewed the recent research on the origins, course, and consequences of pregnancy-related depression.

Results:

Depressive disorders are more common in pregnancy and postpartum than widely assumed, and there is no predictable protective effect of pregnancy. Relapse rates are high, and the postpartum period represents a time of increased vulnerability to depression.

Conclusion:

Early identification and treatment of perinatal depression will minimize morbidity and mortality for the woman, the child, and the family.
Executive Function Impairments in Children with Attention-Deficit Hyperactivity Disorder: Do They Differ between School and Home Environments?
Authors: Mares Daniela , McLuckie Alan , Schwartz Michael , Saini Michael
Published: January 2017

Objective:

The primary purpose of this study was to compare parent and teacher reports of executive function (EF), as measured by the Behavior Rating Inventory of Executive Function (BRIEF), on a sample of children who had been diagnosed with attention-deficit hyperactivity disorder (ADHD). If differences were found, the secondary purpose was to explore these differences by determining which of the 8 BRIEF scales, each representing a different EF, would best predict symptoms of ADHD by the 2 proxy reporters.

Method:

We performed a secondary data analysis on the assessment information pertaining to 240 children, aged 5 to 15 years, accessing services at an urban Toronto psychiatric program specializing in ADHD. We compared parent and teacher ratings and applied logistical binary regressions to predict the probability of a child's meeting the criteria for clinically significant inattention and hyperactivity–impulsivity on the ADHD Rating Scale-IV.

Results:

As expected, teachers reported more variety and severity of EF impairments than did parents. In addition, teachers used inhibition, organization of materials, and planning and organizing as predictors of ADHD symptoms, whereas parents relied predominantly on inhibition, working memory, and planning and organizing as the risk factors.

Conclusion:

Consistent with the current theory, EF impairments, particularly in inhibition, appear to underlie the behavioural manifestation of ADHD. However, parents and teachers do not always agree when reporting EF impairments at home and in school. Thus information from both types of informants is essential for understanding and treating children with this disorder.
Risperidone-Induced Neuroleptic Malignant Syndrome: A Case Report and Review
Authors: Meterissian Gb
Published: January 2017

Objectives:

1. To report the case of a 53-year-old patient who developed neuroleptic malignant syndrome (NMS) — a rare but potentially life-threatening complication of neuroleptic therapy — 4 days after treatment with risperidone was initiated. 2. To review previously reported cases of NMS associated with risperidone.

Methods:

A computerized search of several databases, including MEDLINE, was conducted to find all previously reported cases of NMS with risperidone.

Results:

Five reported cases of risperidone-induced NMS were found in the literature. All cases including the one reported here displayed typical clinical features of NMS and all 6 patients had a prior history of extrapyramidal side effects and/or NMS. Age and duration of exposure to risperidone did not seem to be of significance.

Conclusions:

These cases illustrate that clinicians should be on the lookout for risperidone-induced NMS.
Impulsivity, Defensive Functioning, and Borderline Personality Disorder
Authors: Van Reekum Robert , Links Paul S , Mitton M Janice E , Fedorov Cecilia , Patrick Jayne
Published: January 2017

Objective:

To replicate previous research suggesting that impulsivity highly predicts current DIB(R) score and social functioning, with the additional inclusion of other measures, including defensive functioning.

Method:

Correlational analyses between impulsivity and other measures, and regression analyses with DIB(R) and SAS-SR as outcome measures, and impulsivity and other measures as predictor variables, were performed on data derived from n = 57 initially borderline personality disorder (BPD) subjects recruited as part of a 7-year follow-up study of BPD.

Results:

Data showed strong correlations between the elements of impulsivity described previously and defensive functioning. The initial study results were repeated, and only a minor contribution from defensive functioning additionally contributed to the regression models. No other variables entered the model, unless anger was dropped from the variables entered into the analysis.

Conclusions:

The results may contribute to a better definition of the term “impulsivity” as related to BPD, and may lead to further, improved research into the cause, treatment, and prognosis of BPD.
The Assessment of Competence to Make a Treatment Decision: An Empirical Approach
Authors: Bean Graham , Nishisato Shizuhiko , Rector Neil A , Glancy Graham
Published: January 2017

Objective:

To compare physicians' judgements of competency in routine clinical practice with the findings obtained from a structured clinical interview.

Methods:

Ninety-six patients referred for electroconvulsive therapy were administered the Competency Interview Schedule (CIS) prior to their first treatment. Cluster analysis was employed to categorize patients to 1 of 5 cluster centres represented by case studies previously judged competent or incompetent by lawyers and health professionals.

Results:

A match-mismatch table revealed 88% (N = 66) of the 75 patients found competent by the attending physician and 90.5% (N = 19) of the 21 patients found incompetent by the attending physician were classified in agreement with the CIS. The 9 misclassified patients found competent by the attending physician but classified incompetent by the CIS had consented to treatment. The 2 misclassified patients found incompetent by the attending physician but classified competent by the CIS had refused treatment. Examination of individual item scores from the CIS indicated that, in some cases, a different standard of competency was applied in routine clinical practice depending upon the patient's treatment decision.

Conclusions:

The CIS is presented as a useful guide for clinicians with an interest in competency evaluations but caution is advised in using the instrument to make formal evaluations of competency owing to the imprecise definition of competency in various jurisdictions.
Les Propriétés Psychométriques De La Version Française Du Modified Mini-Mental State (3Ms) Avec Des Patients âgés Suivis En Psychiatrie Gŕriatrique
Authors: Cappeliez Philippe , Quintal Marie , Blouin Mariette , Gagne Serge , Bourgeois Anne , Finlay Michel , Robillard ET Andree
Published: January 2017

Objectif:

Cette recherche étudie les propriétés psychométriques de la version française du Modified Mini-Mental State (SMS), un instrument de dépistage de la démence, avec un échantillon de patients suivis en psychiatrie gériatrique.

Méthode:

Les sujets (N = 94; 63 ans à 92 ans) sont des patients externes référés à un service hospitalier de psychiatrie gériatrique. Outre le 3MS, une batterie de tests portant sur le fonctionnement cognitif et la Symptomatologie dépressive a été administrée.

Résultats:

Le coefficient de fidélité test-retest s'élève à 0,87 pour un sous-échantillon de 35 sujets. Une analyse factorielle de type exploratoire révèle 4 facteurs qui rendent compte de 63,2 % de la variance. Des scores-seuils de 79 à 80 (avec scolarisation ⩾ 8 ans) et de 71 à 72 (avec scolarisation ⩽ 7 ans) offrent la meilleure combinaison sensibilité/spécificité, soit respectivement 0,80 et 0,96.

Conclusions:

Cette étude soutient les qualités psychométriques de la version française du 3MS pour l'utilisation avec des patients suivis en psychiatrie gériatrique, en proposant des seuils qui tiennent compte du niveau d'éducation. Elle souligne l'influence des variables sociodémographiques sur les performances au test.
Psychiatric Practice for the Coming Decade
Authors: Goldbloom David S , Garfinkel Paul E
Published: January 2017

Objective:

To identify important trends and themes that will affect psychiatric training and practice.

Method:

Selective literature review and reflections by the authors.

Results:

Three principal themes are elucidated relating to empiricism and integration, accountability and collaboration, and training and the public trust.

Conclusions:

There must be debate and action on these and other themes to maintain the relevance of psychiatry to its changing context.
Competency Assessments: Perceptions at Follow-up
Authors: Carlin Kathleen , Silberfeld Michel , Deber Raisa B , Lowy Frederick
Published: January 2017

Objectives:

To report on the perceptions of assessment of competency and its consequences on a group of clients and significant others at follow-up.

Methods:

Ninety-five interviews were conducted using a carefully developed semistructured telephone interview of 24 clients and 71 family/caregivers, representing the perceptions of about 80 clients.

Results:

There was general satisfaction in the competency assessment process. There was a perception that interests and rights were protected. Clients were seen to be less involved in all spheres of decision making rergardless of capacity outcome. Clients and families were satisfied with how decisions were made.

Conclusions:

Follow-up study of competency assessment does not support the conclusions previously drawn based on court record studies that assessments are deleterious and frequently result in violations of rights.
Syndrome De Capgras: ÉVolution Des Hypotheses
Authors: Debruille Jacques B , Stip Et Emmanuel
Published: January 2017

Objectif:

Retracer l'évolution des hypothèses concernant le syndrome de Capgras.

Méthodes:

Les données consistent en un peu plus de 60 études publiées entre 1866 et 1994 qui ont été sélectionnées en fonction de leur caractère novateur et de leur pertinence quant à la description clinique du syndrome, et quant aux interprétations psychodynamiques, neurologiques et neuropsychologiques.

Résultats:

Deux temps principaux, se chevauchant partiellement, peuvent être dégagés dans l'évolution des hypothèses touchant aux mécanismes du syndrome. Le 1er, débutant dès 1923, se caractérise par la prédominance des interprétations psychodynamiques. Le 2e, issu de la constatation de dysfonctionnements organiques dans un pourcentage élevé de cas, s'en différencie par la survenue d'interprétations d'ordre neurologiques, et par quelques hypothèses mixtes.

Conclusions:

Au total cette revue permet de mettre en évidence la grande diversité des points de vue concernant le syndrome. Elle servira de base à l'étude suivante qui vise à montrer que la mise à l'épreuve expérimentale de chacun des points de vue est possible.
Suicide in Old Age: A Tragedy of Neglect
Authors: Duckworth Geoffrey , McBride Hazel
Published: January 2017

Objective:

To investigate the incidence and treatment of depression in geriatric suicide.

Method:

All coroners' records, autopsy and police reports for suicide victims aged 65+ in Ontario (n = 543) over 3 years were examined.

Results:

Over 80% of the elderly who committed suicide received no psychiatric referral. Of the sample, 87% were untreated while only 13% received antidepressants. Tricyclics, which are lethal in overdose, were the drugs of choice. None of the sample was treated with the safer specific serotonin reuptake inhibitors (SSRIs). Females were 3 times as likely to be treated as were males, and those seeing psychiatrists were 4 times more likely to be treated with antidepressants than those seeing general practitioners (GPs). The physically ill were rarely treated.

Conclusions:

These findings suggest that early geropsychiatric assessment and vigorous treatment could prevent many suicides in old age.
Occurrence and Effects of Personality Disorders in Depression: Are They the Same in the Old and Young?
Authors: Agbayewa M Oluwafemi
Published: January 2017

Objectives:

To determine the frequency and effects of personality disorders on episodes of depression in elderly and young inpatients. Personality disorders are common and may affect the prognosis of Axis I disorders.

Methods:

Clinical records of 89 elderly inpatients and a matched comparison group of 119 young inpatients were reviewed to confirm the diagnosis of a major depressive episode according to the DSM-III-R criteria. The frequency of personality disorder diagnoses in the 2 groups was determined. Within each group, severity, functioning, and treatment were compared between those with and without personality disorders.

Results:

Personality disorders were diagnosed more frequently in the young (40.3%) than in the elderly (27%). Both rates were similar to previous reports. Cluster C disorders were the most common personality disorders found in the elderly, compared to cluster B disorders in the young. Personality disorder in the young was associated with longer episodes of depression (P = 0.035) and poorer family relations (P < 0.001); whereas in the elderly, personality disorder was associated with more severe episodes (P = 0.014).

Conclusions:

These findings suggest that the frequency and effects of personality disorders on the depressed patient may differ according to age.
Readiness to Stop Smoking in Schizophrenia
Authors: Addington Jean , el-Guebaly Nady , Addington Donald , Hodgins David
Published: January 2017

Objective:

To assess the motivation and readiness to change of individuals with schizophrenia prior to developing a smoking cessation program.

Method:

Smoking history, nicotine dependence, readiness to stop smoking, and interest in a smoking cessation group were assessed in 60 schizophrenia outpatients who smoked.

Results:

The majority were interested in attending a smoking cessation group and appeared to be appropriately motivated.

Conclusions:

Smoking cessation groups for a schizophrenia population may be a worthwhile endeavour. Current measures of motivation and readiness to change may be useful to identify those who are most likely to succeed.
Childhood Antecedents of Self-Destructiveness in Borderline Personality Disorder
Authors: Dubo Elyse D , Zanarini Mary C , Lewis Ruth E , Williams Amy A
Published: January 2017

Objective:

To assess the relationship between lifetime patterns of self-destructive behaviour and various parameters of childhood abuse and neglect in patients with borderline personality disorder (BPD) compared with other personality disorder (OPD) controls.

Method:

The subjects were 42 inpatients with the diagnosis of BPD and 17 OPD controls. Lifetime patterns of self-destructive behaviour were assessed using the Lifetime Borderline Symptom Index. Childhood experiences were assessed using a semistructured interview by raters who were blind to diagnosis.

Results:

Chronic self-destructive behaviour discriminated patients with BPD from OPD controls. In the borderline group, parental sexual abuse was significantly related to suicidal behaviour and both parental sexual abuse and emotional neglect were significantly related to self-mutilation.

Conclusion:

Both parental sexual abuse and emotional neglect appear to play a role in the etiology of self-destructive behaviour in BPD. The results highlight the importance of considering the effects of sexual abuse within its environmental context and suggest that the etiology of borderline symptoms is likely multifactorial.
Bipolar Disorder: From Families to Genes
Authors: Alda Martin
Published: January 2017

Background:

Genetic factors are known to contribute to the etiology of bipolar illness, but the actual genetic mechanisms remain to be clarified.

Methods:

This paper reviews the research undertaken to establish the genetic basis of bipolar illness and to elucidate the nature of its genetic predisposition.

Results:

The presented findings suggest that bipolar affective disorder is a heterogeneous condition characterized by a complex relationship between the genetic susceptibility and the clinical presentation. Linkage studies have generated promising and replicated findings on chromosomes 18 and 21.

Conclusion:

In spite of the methodological difficulties inherent in the genetic study of psychiatric disorders, recent investigations have made important advances and promise to identify specific susceptibility genes.
Speaking Graphically: An Introduction to Some Newer Graphing Techniques
Authors: Streiner David L
Published: January 2017

The vast majority of graphs appearing in the psychiatric literature consist of the traditional line graphs, histograms, and bar charts. Over the past decade, new graphing techniques have appeared which make the data easier to read and which present much more information than simply group means and confidence intervals. These methods include horizontal bar charts, dot charts, stem-and-leaf plots, box plots, and notched box plots. This paper describes these new techniques, as well as older ones, such as smoothing, and warns against using some of the options found in graphics programs: 3-dimensional (3-D) graphs, stacked graphs, and pie charts.
A Cross-Sectional Study of Private Psychiatric Practices under a Single-Payer Health Care System
Authors: Anderson Keith , Catterson Alistair , Gaudet Michael , Gautam Mamta , Kerr Peter J , Pecher Marina , Waiser David , Kaji Junko , Fava Maurizio
Published: January 2017

Objectives:

To examine current concerns that in the Canadian single-payer mental health care system, the “rich worried well” (that is, wealthy individuals who are worried yet mentally well) may overuse psychiatric services, while low-income, uninsured mentally ill individuals may remain undertreated. The current study focuses on the mental health care in the Canadian region of Ottawa-Carleton, where a single-payer system provides universal access to mental health services, to assess how psychiatric services are provided by psychiatrists in private practice.

Method:

One hundred and seven private psychiatrists working in the region of Ottawa-Carleton completed a questionnaire which contained questions about the sociodemographic characteristics and background of the psychiatrists themselves and which asked the psychiatrists specific questions about the sociodemographic status, diagnosis, and treatment of each patient seen on November 10, 1994.

Results:

Approximately 93% of the patients seen met criteria for one or more Axis I disorders, of which mood and anxiety disorders were the most common. Wealthier patients were relatively underrepresented among the patients treated by the private psychiatrists. In addition, we found no significant differences in the distribution of Axis I, Axis II, and Axis III disorders between patients earning below $30 000 per year compared with patients earning above $60 000 per year.

Conclusions:

Our results suggest that outpatient psychiatric care delivered by private psychiatrists in a Canadian single-payer system targets primarily individuals with major psychiatric disorders and does not seem to favour “the worried well.” Larger epidemiological studies with independent assessments of psychiatric populations are necessary to confirm our findings.
Is Mr Pac Man Eating Our Children? A Review of the Effect of Video Games on Children
Authors: Emes Craig E
Published: January 2017

Objective:

To provide mental health professionals with an up-to-date review of the literature regarding the effects of playing video games on the well-being of children.

Method:

A computerized literature search of MEDLINE and PSYCHINFO of all articles written in English from 1966 to 1996 was performed. The various studies are organized into different sections.

Results:

Playing video games is associated with a variety of physical effects including increased metabolic and heart rate, seizures, and tendinitis. Aggressive behaviour may result from playing video games, especially among younger children. There is no direct relationship between psychopathology or academic performance and playing video games.

Conclusions:

Video games have some adverse effects, but they are also valuable learning tools. Research about the role of video games is inadequate. The data are also limited by the lack of long-term studies and inconsistent findings.
The Relationship of Endogenous Cortisol to Psychiatric Disorder: A Review
Authors: Kiraly Stephen J , Ancill Raymond J , Dimitrova Gergana
Published: January 2017

Objectives:

To focus on hypothalamic-pituitary-adrenal (HPA) axis activity, especially endogenous hypercortisolemia, to study its role in the maintenance of psychiatric illness, and to entertain the probability that the elderly are vulnerable.

Method:

Case presentation, clinical and research literature review, and theoretical discussion.

Results:

Clinical and research evidence overwhelmingly suggest that hypercortisolemia is toxic to the hippocampus. Some research supports the position that it can be a treatable perpetuating factor in a subset of affective disorders and psychoses. Pharmacological treatments to correct hypercortisolemia have been used by endocrinologists. Hypercortisolemic treatment-resistant and nontreatment-resistant psychoses and affective disorders have been successfully treated by a small number of researchers who remain interested in this subject. Data pertaining to geriatric psychoses may be germane but are sparse.

Conclusions:

It behooves us to research diagnostic methods pertaining to psychoses and affective disorders associated with hypercortisolemic states. Very little research is available, but we must be alert to the possibility that the elderly are more susceptible to cortisol endotoxicosis than the younger adult population. Without accurate diagnosis, we cannot take advantage of existing antiglucocorticoid strategies.
A Review of Functional Neuroimaging in Mood Disorders: Positron Emission Tomography and Depression
Authors: Kennedy Sidney H , Javanmard Mahan , Vaccarino Franco J
Published: January 2017

Objective:

To examine the progress of positron emission tomography (PET) as a tool for understanding the psychobiology of mood disorders, particularly major depression and bipolar disorder.

Method:

Review of the literature on functional imaging of mood disorders.

Results:

Functional imaging techniques have been used in psychiatric research as a noninvasive method to study the behaviour and function of the brain. Techniques used so far have involved the manipulation of emotion in healthy volunteers, the evaluation of depressed (unipolar and bipolar as well as secondary depression), manic, and normal subjects under resting and various activation conditions, such as cognitive activation, acute pharmacological challenge, and chronic thymoleptic treatments. As a result, functional imaging studies tend to support abnormalities in specific frontal and limbic regions.

Conclusion:

Different PET methods demonstrate consistent abnormalities in the prefrontal, cingulate, and amygdala regions. These findings are in agreement with past animal and clinical anatomical correlates of mood and emotions.
A Review of Continuation and Maintenance Electroconvulsive Therapy
Authors: Rabheru Kiran , Persad Emmanuel
Published: January 2017

Background:

Many patients with major psychiatric disorders who are severely ill, medication-resistant, or medication-intolerant respond more reliably and quickly to a course of electroconvulsive therapy (ECT). The management of such patients after successful treatment with ECT is of significant importance given the high rate of relapse and recurrence of these disorders. The unmet clinical need to maintain the mental health of these seriously ill patients at an optimal level has revived the interest in ECT as an alternative prophylactic treatment.

Method:

We review the historical background of ECT and the literature that supports its use as a prophylactic treatment in various disorders and special populations. A clinical summary outlining its efficacy, acceptability, risks, cost-effectiveness, and medicolegal aspects is followed by a guide for prescribing ECT for prophylactic reasons.

Results:

Continuation and maintenance ECT (C/MECT) has been found to be efficacious, safe, well tolerated, and cost-effective. Its greatest impact has been in reducing relapse, recurrence, and rehospitalization, particularly in the management of recurrent mood disorders in the elderly. The elderly are usually refractory or intolerant to pharmacotherapy but have a good response to ECT during the index episode. Parkinson's disease (PD), schizophrenia, and obsessive–compulsive disorder (OCD), as well as affective disorders coexisting with dementia, neurological disorder, or mental retardation, have also been reported to respond to C/MECT. The outcome depends greatly on rate of compliance. Cognitive risks of C/MECT need to be further studied because the literature to date consists mostly of case reports and anecdotal evidence. Controlled studies with well-defined outcome measurements are needed.

Conclusions:

When planning a rational approach to the care of patients with major pyschiatric disorders, clinicians should carefully consider ECT along with other alternatives.
Ethical Research with the Mentally Disordered
Authors: Arboleda-Flórez Julio , Weisstub David N
Published: January 2017

Because of concerns about competence and voluntariness, the mentally disordered constitute a vulnerable population in the context of nontherapeutic biomedical research and, as such, are in need of protection. Despite others' concern about protecting the mentally disordered, their decision-making potential should also be respected and maximized, allowing such individuals to consent to participate in experiments subject to an evaluation of their competence to make such a decision. Competent mentally disordered persons who anticipate future incapacity should be able to issue research directives or durable powers of attorney whereby they can provide explicit consent to participate in nontherapeutic research. When he or she becomes incompetent, a substitute decision maker should be able to provide consent on behalf of the mentally disordered person within established parameters. Nontherapeutic experimentation with the mentally disordered should be permitted, but only within the boundaries of ethical permissibility delineated by legislated guidelines. At present, the legal status of substituted consent for nontherapeutic procedures is uncertain and requires legislation, which in addition to legalizing such consent, would provide guidelines for substitute decision makers and for the creation of research directives. These guidelines should include restrictions on the scope of research, obligations of researchers, rights of subjects, and responsibilities of research ethics committees (RECs). In all cases, the voluntary and informed consent of the person or substitute decision maker must be obtained.
Ethical Research with the Developmentally Disabled
Authors: Weisstub David N , Arboleda-Flórez Julio
Published: January 2017

The developmentally disabled constitute a vulnerable population in the context of nontherapeutic experimentation. Their vulnerability is characterized by diminished decision-making capacity and by susceptibility to coercive situations that may bring voluntariness into question. The international consensus is that research involving this population should be permitted, but only if the consent of a legal guardian is obtained and appropriate safeguards are introduced. Therefore, legislation regulating the ethical conduct of research should be enacted, including provision for substituted consent in the research context. Although researchers seeking the participation of a developmentally disabled individual in a protocol must presume the person to be capable of participating in the decision, they must conduct competency assessments if the person's ability to make such a decision is in doubt. Information must be presented in such a way as to maximize the individual's contribution, and capacity must be reevaluated on an ongoing basis. In addition, research on the developmentally disabled presents specific challenges to establish competency, the selection of subjects, the characteristics of the decision maker, and the model to be used in making substituted decisions.
Courts and Torts: The Psychiatrist Preparing for Trial
Authors: Hoffman Brian F
Published: January 2017

Objective:

To outline how a psychiatric expert can do an impartial assessment and medicolegal report and then give an effective presentation in court that can sustain cross-examination.

Methods:

The legal principles of litigating emotional trauma are reviewed, including proving causation, characterizing emotional suffering, assessing disability, and determining a realistic prognosis.

Results:

Psychiatrists must understand the interplay of legal and psychiatric principles when they are asked to assess litigants who are suing for monetary compensation for a widening range of emotional injuries resulting from motor vehicle accidents, slips and falls, incest and sexual abuse of children, discrimination, unlawful dismissal, malpractice, human-made disasters, product liability, and intentional torts, to name a few.

Conclusion:

The psychiatrist can prepare his or her attitude, knowledge, and skills to give a presentation in court that will be credible, trustworthy, and dynamic. With adequate preparation, the psychiatric expert can bring an informed psychiatric perspective to the court that will have a significant impact on the outcome of the judicial deliberations.
Choking Incidents among Psychiatric Patients: Retrospective Analysis of Thirty-one Cases from the West Bologna Psychiatric Wards
Authors: Fioritti Angelo , Giaccotto Lucia , Melega Vittorio
Published: January 2017

Objective:

To determine the rate of choking incidents among the psychiatric population of 4 inpatient facilities, classifying the incidents according to their probable etiology.

Method:

All incidents recorded over 18 months were retrospectively analyzed for demographic variables, psychiatric and medical diagnoses, and drug therapy at the time of incident. Where possible, patients underwent psychiatric, neurological, and medical examination.

Results:

Thirty-one incidents were recorded involving 18 patients at a rate of one incident every 56.32 months' hospitalization per person. One case proved fatal, one patient died several weeks after the incident from aspiration pneumonia, and 5 patients needed reanimation or the Heimlich manoeuvre. Etiological classification showed that incidents due to bradykinetic dysphagia and “fast eating” were the most numerous, even among the fatal or grave cases.

Conclusions:

Various simple, effective preventive measures emerge from the study.
Severe Conduct Disorder—Some Key Issues
Authors: Werry John Scott
Published: January 2017

Objective:

To examine the state of knowledge about clinically severe conduct disorder and identify key issues.

Method:

This paper surveys the literature on conduct disorder and delineates and discusses the critical issues.

Results:

Conduct disorder is the subject of a vast and growing amount of research on taxonomy, correlates, etiology, outcome, management, and prevention. There are 2 distinctive types: childhood and adolescent onset. Comorbidity with other disorders is common. It remains a costly disorder, however, with a generally poor prognosis for the childhood-onset type. The validity of the separation of conduct and antisocial personality disorder is questionable.

Conclusions:

In view of its huge cost, chronicity, and generally poor outcome, childhood-onset or severe conduct disorder should be considered one of if not the major public health problems of our time, and resources for its study and management should reflect this. The disorder is poorly defined and inadequately studied in females.
Are There Injury-Prone Children? A Critical Review of the Literature
Authors: Wazana Ashley
Published: January 2017

Objectives:

To review the evidence of general injury and pedestrian injury studies to determine if there are child behavioural, emotional, developmental, or physical characteristics that put children at higher risk for injury and, if there are such proneness risk factors, to determine their importance relative to other risk factors.

Methods:

This paper critically assesses 11 general child injury studies and 6 child pedestrian injury studies that have examined variables of child proneness. Information on study design, source of data, magnitude and significance of the risk factors identified, and study limitations are presented in separate sections.

Results:

A critical review of the literature suggests that aggression is a consistent risk factor for general injuries but not for pedestrian injuries, hyperactivity is inconsistently associated with all types of injuries, and both a general measure of behaviour problems and a measure of unsafe behaviour were found to be significantly related to pedestrian injuries. A look at the pedestrian injury literature suggests that child risk factors make a consistent but minor contribution to injuries in comparison with environmental and social risk factors.

Conclusions:

We need to address the environmental and social risk factors by educating parents about the roles of home stressors, poor supervision, and high-risk exposure in child injuries and by adding our voice to the efforts to bring into effect engineering and legislative interventions.
The Delusional Parent: Family and Multisystemic Issues
Authors: Ulzen Thaddeus PM , Carpentier Russell
Published: January 2017

Objectives:

To examine the dilemmas for children, family, and mental health professionals posed by the presence of a delusional parent in a family, including someone with induced psychotic disorder (IPD); to identify frequently unrecognized problems; and to propose practical suggestions for professionals.

Method:

The pertinent literature on the effects of delusional parents on children, families, and professionals is reviewed. By way of 3 case vignettes, the dilemmas are identified and discussed.

Results:

Delusional disorders are underdiagnosed, resulting in poor anticipation of their implications. Unanticipated family factors, such as “pursuit of isolation” and the related heightened risk of violence, contribute to the failure of professional interventions, which has been described as “therapeutic systems paralysis.”

Conclusions:

These cases are complex, often requiring multisystemic involvement to reduce the risks of flight, violence, psychosis, posttraumatic stress disorder, and other psychiatric sequelae to children and other family members. The critical features of the innovative collaboration (“therapeutic consensus”) required between professionals for successful therapeutic interventions with these families are described.
Children of Parents with Bipolar Disorder: A Metaanalysis of Risk for Mental Disorders
Authors: Lapalme Micheline , Hodgins Sheilagh , LaRoche Catherine
Published: January 2017

Objective:

To compare the prevalence rates of mental disorders among children of parents with bipolar disorder and of parents with no mental disorders.

Method:

Seventeen studies, meeting specific selection criteria, were included in the metaanalyses. Risks for mental disorders among children were estimated by aggregating raw data from the selected studies.

Results:

Results indicate that in comparison with children of parents with no mental disorders, children of parents with bipolar disorder are 2.7 times more likely to develop any mental disorder and 4.0 times more likely to develop an affective disorder. The metaanalyses indicate that during childhood and adolescence, the risks for any mental disorder and for affective disorders in children are consistently but moderately related to having a parent who suffers from bipolar disorder.

Conclusions:

Risk factors that could account for the psychopathology observed in children of bipolar parents are explored.
Child Psychiatric Consultation Service to Community Agencies: A Collaborative Approach Involving Three Community Agencies
Authors: Froese Arthur , Dwyer-Sepic Patrice , Parker Kevin
Published: January 2017

Objective:

To report the early experience of a multiagency child psychiatric consultation service.

Method:

The program is described, and the demographic characteristics of clients referred to the consultation program over the first 25 months of operation are presented. Referrals were examined for demographics and the questions consultees wanted to have answered.

Results:

In 59 of 100 consultations, physical and/or sexual abuse was proved or highly suspected. In 82 of the 100 cases, consultees had questions pertaining to management issues. Questions related to diagnostic issues numbered 62, and there were 45 questions about safety issues.

Conclusion:

Effective psychiatric consultations services to rural areas can be established. Once established, the questions of consultees can provide an effective training ground for future community-oriented child psychiatrists.
Disability and Family Burden in Obsessive—Compulsive Disorder
Authors: Steketee Gail
Published: January 2017

This paper reviews 2 aspects of obsessive–compulsive disorder (OCD): impairment in functioning and family burden associated with OCD. Impairment is evident from epidemiological and clinical studies in several areas, particularly in occupational and social maladjustment. Clinic outpatients show a range of impairment associated with OCD, while hospitalized patients exhibit consistently severe disabilities that rival those of patients with schizophrenia. Although behaviourally and medication-treated patients improve in adjustment levels, there is some evidence of persistent impairment, particularly in social and work functioning. Several studies support extensive family involvement and accommodation of OCD symptoms, as well as the considerable burden placed on families who reduce their social activities and increase their isolation and distress. Findings are equivocal regarding OCD and marital distress. Predictors of treatment outcome do not include marital dissatisfaction, but may include expressed anger and criticism. With regard to treatment, family support groups are popular but untested interventions, and family-assisted individual and group behaviour therapy have demonstrated good outcomes in limited trials.