bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of a Smoking Cessation Policy on Visits to a Psychiatric Emergency Department
Authors: Kurdyak Paul , Cairney John , Sarnocinska-Hart Anna , Callahan Russell C , Strike Carol
Published: January 2017

Objective:

Smoking cessation policies are increasingly imposed in mental health facilities because of the high prevalence of tobacco smoking and its related adverse health consequences. The objective of this study was to measure the impact of 2 smoking cessation policies—one imposed in a specific psychiatric hospital and the other across the entire province of Ontario—on weekly visit rates to a psychiatric emergency department.

Methods:

Administrative data records from consecutive patient visits to a psychiatric emergency department were grouped by week from March 1, 2002, to December 31, 2005. The patients were grouped into 3 broad diagnostic categories: substance-related disorders, psychotic disorders, and other disorders. The impact of 2 smoking cessation policies—one imposed on September 21, 2005 at the Centre for Addiction and Mental Health (CAMH) and one imposed on May 31, 2006 across the province of Ontario—on psychiatric emergency department visit rates was measured using time series analysis.

Results:

The CAMH-specific smoking cessation policy had no impact on psychiatric emergency department visit rates in any diagnostic category. The province-wide smoking cessation policy resulted in a 15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder.

Conclusions:

The benefits of a smoking cessation policy need to be balanced by the impact of the policy on the likelihood of patients to seek treatment.
The Incidence and Characteristics of Clozapine-Induced Fever in a Local Psychiatric Unit in Hong Kong
Authors: Chung Joseph Pui-Yin , Chong Catherine Shiu-Yin , Chung Ka-Fai , Dunn Eva Lai-Wah , Tang Orlando Wai-Nang , Chan Wah-Fat
Published: January 2017

Objective:

To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit.

Method:

A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever.

Results:

Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 °C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02).

Conclusion:

Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.
Suicidal Ideation: The Role of Economic and Aboriginal Cultural Status after Multivariate Adjustment
Authors: Lemstra Mark , Neudorf Cory , Mackenbach Johan , Kershaw Tanis , Nannapaneni Ushasri , Scott Christina
Published: January 2017

Objective:

To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status.

Methods:

Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems.

Results:

Participants ( n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk–hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone.

Conclusion:

The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.
The Restless Brain: Attention-Deficit Hyperactivity Disorder, Resting—State Functional Connectivity, and Intrasubject Variability
Authors: Castellanos F Xavier , Kelly Clare , Milham Michael P
Published: January 2017

Objectives:

To highlight recent advances in the conceptualization of attention-deficit hyperactivity disorder (ADHD) emerging from neuroimaging and endophenotypic approaches.

Methods:

We selectively reviewed recent published literature on the phenomena of resting-state functional connectivity, intrasubject variability, and diffusion tensor imaging pertaining to ADHD.

Results:

Recent advances based on the novel approach of resting-state functional connectivity appear to be highly promising and likely to link to studies of intrasubject variability.

Conclusions:

Endophenotypic fractionation may offer a means of addressing the complex heterogeneity of ADHD on the path to testable models of pathophysiology. Such models focusing on intrasubject variability, intrinsic brain activity, and reward-related processing are progressing rapidly.
Comorbidity in Adults with Attention-Deficit Hyperactivity Disorder
Authors: Cumyn Lucy , French Lisa , Hechtman Lily
Published: January 2017

Objective:

To examine the prevalence of comorbid Axis I (current and lifetime) and II disorders in adult men and women with attention-deficit hyperactivity disorder (ADHD).

Method:

Adult patients ( n = 447; 266 men, 181 women) received comprehensive assessments for ADHD and Axis I and II disorders. Adults were aged between 17 and 74 years. Among the patients diagnosed with ADHD ( n = 335), there were those with ADHD inattentive subtype (ADHD-I) ( n = 199), hyperactive–impulsive subtype (ADHD-H) ( n = 24), or combined ADHD subtype (ADHD-C) ( n = 112). Chi-square and logistic regression analyses were performed to examine associations between adults with and without ADHD on Axis I and II disorders.

Results:

Adults with ADHD, compared with those without ADHD, had higher rates of Axis I (46.9% and 27.31%) and Axis II (50.7% and 38.2%) disorders. Adults with ADHD-C were more likely to have mood disorder, anxiety, conduct disorder, and substance use disorder as well as obsessive–compulsive personality disorder, passive–aggressive personality disorder, depressive personality disorder, narcissistic personality disorder, and borderline personality disorder (BPD). Men with ADHD were more likely to have antisocial personality disorder and had higher rates of current drug abuse than women with ADHD. Women with ADHD had higher rates of past and current panic disorder, and past anorexia and bulimia. Women with ADHD were more likely to have BPD than men with ADHD.

Conclusions:

Adults with ADHD have very high rates of comorbid Axis I and II disorders, with differences found between men and women on certain comorbid disorders.
Traditional Postpartum Practices and Rituals: Clinical Implications
Authors: Grigoriadis Sophie , Robinson Gail Erlick , Fung Kenneth , Ross Lori E , Chee Cornelia (Yin Ing) , Dennis Cindy-Lee , Romans Sarah
Published: January 2017

Objectives:

In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD.

Methods:

MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included.

Results:

Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors.

Conclusions:

This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.
Antipsychotics and Schizophrenia: From Efficacy and Effectiveness to Clinical Decision-Making
Authors: Foussias George , Remington Gary
Published: January 2017

Objective:

To comprehensively review the 2 recent and large antipsychotic effectiveness trials for treatment of schizophrenia: the United Kingdom's Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), and the National Institute of Mental Health-initiated Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial.

Method:

We present a review of the rationale, methodology, and findings to date from the CUtLASS and CATIE schizophrenia trials, including all primary and secondary outcomes.

Results:

The primary findings from both trials, CUtLASS and CATIE, suggest that first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are equally effective in the treatment of schizophrenia. The exception is in treatment-resistant populations where clozapine exhibits superiority, compared with other SGAs. In the CATIE trial, there is a suggestion that olanzapine is superior in effectiveness, compared with other nonclozapine SGAs, although this seems to be mediated by past history of olanzapine use, and carries with it increased weight gain and metabolic adverse events. From a cost-effectiveness perspective, there is no evidence that SGAs are superior to FGAs, with findings suggesting the possibility that FGAs may be superior.

Conclusion:

Past efficacy trials have strongly supported the position that SGAs are superior to FGAs in the treatment of schizophrenia and in side effect profile. Two large independent effectiveness trials, CUtLASS and CATIE, have offered a strong challenge to these claims. Both suggest that SGAs, except clozapine in the treatment-resistant population, offer little, if any, clinical benefits, and, moreover, harbour their own significant side effects.
Age of Onset of Cannabis Use is Associated with Age of Onset of High-Risk Symptoms for Psychosis
Authors: Dragt Sara , Nieman Dorien H , Becker Hiske E , van de Fliert Reinaud , Dingemans Peter M , de Haan Lieuwe , van Amelsvoort Thérèse A , Linszen Don H
Published: January 2017

Objective:

Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger age.

Method:

People referred to the Academic Medical Centre in Amsterdam, the Netherlands, with an ultra-high risk (UHR) for psychosis were interviewed with the Composite International Diagnostic Interview to assess their cannabis consumption. The Interview for the Retrospective Assessment of the Onset of Schizophrenia was used to collect data about age of onset of high-risk or prodromal symptoms. Nine high-risk symptoms were selected and clustered because of their known relation with cannabis use.

Results:

Among the 68 included participants, 35 had used cannabis (51.5%), of whom 15 had used recently. Twenty-two participants had been cannabis abusers or cannabis-dependent (32.4%) in the past. Younger age at onset of cannabis use was related to younger age of onset of the cluster of symptoms (rho = 0.48, P = 0.003) and also to 6 symptoms individually (rho = 0.47 to 0.90, P < 0.001 to 0.04). Younger age at onset of a cannabis use disorder was related to younger age of onset of the cluster of symptoms (rho = 0.67, P = 0.001) and also to 6 symptoms individually (rho = 0.50 to 0.93, P = 0.007 to 0.03).

Conclusion:

Cannabis use or a cannabis use disorder at a younger age in a group with an UHR for transition to psychosis is related to onset of high-risk symptoms for psychosis at a younger age.
Measure for Measure: New Developments in Measurement and Item Response Theory
Authors: Streiner David L
Published: January 2017

For the past 70 years, test development has been dominated by what is called classical test theory (CTT). However, there are many problems associated with CTT, including: the resulting scales tend to be long; their interpretation is highly dependent on the normative sample; the assumption that each item contributes equally to the total score is often wrong, as is calculating a single index of measurement error for all possible scores; and it is difficult to equate different tests developed using CTT. Recently, a new approach to scale development has appeared, called item response theory (IRT), which overcomes all of these problems and, in certain cases, results in a scale with true interval-level properties. This article is an introduction to IRT. It concludes by discussing why IRT hasn't been adopted more widely, and some of its limitations.
Clinical Response to Methylphenidate in Children Diagnosed with Attention-Deficit Hyperactivity Disorder and Comorbid Psychiatric Disorders
Authors: Ter-Stepanian Mariam , Grizenko Natalie , Zappitelli Michael , Joober Ridha
Published: January 2017

Objective:

To determine to what extent the clinical response to methylphenidate (MPH) is affected by psychiatric comorbidities in children diagnosed with attention-deficit hyperactivity disorder (ADHD).

Methods:

Children ( n = 267) aged 6 to 12 years diagnosed with ADHD participated in a double-blind, placebo-controlled, 2-week medication trial of MPH. Children were assessed using parent and teacher ratings and laboratory measures. Clinical response to MPH was determined by integrating all obtained measures.

Results:

Meeting criteria for conduct disorder (CD) was 27.7% of children, 40.8% for oppositional defiant (ODD), 47.2% for anxiety, and 7.9% for depressive disorders. The presence of CD or ODD was associated with good response to MPH. In contrast, children diagnosed with only comorbid anxiety were more likely to receive poor response rating independent of age, sex, or socioeconomic status. Low family income was found to be predictive of good response to MPH.

Conclusions:

The response to MPH in children with ADHD may be dependent on the type of comorbid disorder present.

Clinical Trial Registration Number:

NCT00483106
Persistence and Remission of Psychiatric Disorders in the Quebec Older Adult Population
Authors: Préville Michel , Boyer Richard , Vasiliadis Helen-Maria , Grenier Sébastien , Streiner David , Cairney John , Brassard Joëlle ,   Scientific Committee of the ESA Study
Published: January 2017

Objective:

To document the remission and persistence of psychiatric disorders in Quebec's older adult population.

Method:

Data came from the Enquěte sur la santé des aînés (ESA) study conducted in 2005–2008 using a representative sample ( n = 2784) of community-dwelling older adults.

Results:

The ESA study results indicate that 12% of respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. The results also indicate that the 12-month rate of patients with a persistent psychiatric condition was 19.4%. Sixty-seven percent of the patients in remission experienced a total recovery of their symptoms during the following year. The probability of presenting a persistent psychiatric condition or a partial remission after 1 year of follow-up, compared with those in total remission, did not vary according to sociodemographic characteristics. The results also showed that social support and the number of chronic health problems did not influence mental health at follow-up. However, results indicated that the use of health services (OR 7.4; 95% CI 3.72 to 14.55) and the change in the number of chronic health problems reported between baseline and the second interview (OR 1.2; 95% CI 1.06 to 1.34) increased the probability of patients with prevalent disorders at Time 1 having persistent disorders at Time 2.

Conclusion:

Results suggest that a deterioration of physical health status was associated with the persistence of DSM-IV disorders in the elderly. These results also suggest that the use of mental health services is associated with severity of the mental illness.
Associations of Risk of Depression with Sexual Risk Taking among Adolescents in Nova Scotia High Schools
Authors: Wilson Kevin , Asbridge Mark , Kisely Steve , Langille Don
Published: January 2017

Objective:

Several interrelated factors, including depression, influence adolescents' chances of risky sexual behaviour. We examined the relation between depression and sexual risk-taking behaviours in adolescents after accounting for the effects of other variables.

Method:

We surveyed male ( n = 1120) and female ( n = 1177) adolescents at 4 high schools in central Nova Scotia, measuring factors known to be associated with sexual risk taking. Risk of depression was assessed using the Center for Epidemiologic Studies Depression Scale. Outcomes were self-reported sexual behaviours. We used logistic regression to assess associations of multiple factors with sexual risk taking.

Results:

In univariate analyses, risk of depression was associated with 3 risk-taking behaviours for females (being sexually active, having unplanned sex when using substances, and not using effective contraception at last intercourse) and 2 for males (having unplanned sex when using substances and having more than 1 partner in the previous year). In full multivariate models, risk of depression in females remained significantly associated with unplanned sex and nonuse of effective contraception at last intercourse, but was no longer associated with being sexually active. For males, both associations remained significant.

Conclusions:

Risk of depression is consistently and independently associated with adolescent sexual risk behaviours after adjusting for other variables. Health care providers working with teenagers should screen for risky sexual behaviours and sexually transmitted infections if depression is apparent in their patients.
Seeking Help for Mental Health Problems outside the Conventional Health Care System: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)
Authors: Sevilla-Dedieu Christine , Kovess-Masféty Viviane , Haro Josep Maria , Fernández Anna , Vilagut Gemma , Alonso Jordi ,   ESEMeD–Mental Health Disability: A European Assessment in Year 2000 Investigators
Published: January 2017

Objective:

In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries.

Method:

A cross-sectional survey was conducted in representative samples of noninstitutionalized adults in 6 European countries. Participants ( n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems.

Results:

Among the respondents ( n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed.

Conclusions:

In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used.
The Prevalence of Mental Disorders in the Working Population over the Period of Global Economic Crisis
Authors: Wang JianLi , Smailes Elizabeth , Sareen Jitender , Fick Gordon H , Schmitz Norbert , Patten Scott B
Published: January 2017

Objectives:

The ongoing global economic crisis may have affected people's mental health. This study aimed to, among a sample of the working population, estimate and compare the prevalence of depressive and anxiety disorders in different time intervals from January 2008 to October 2009 and to examine the demographic and socioeconomic correlates of mental disorders.

Methods:

From January 2008 to October 2009, 3579 employees in Alberta were recruited using the random digit dialing method. Mental disorders were assessed using the World Health Organization's Composite International Diagnostic Interview—Auto 2.1. The lifetime and 12-month prevalence of depressive and anxiety disorders in different time intervals were estimated and compared.

Results:

The 12-month prevalence of major depressive disorder (MDD) before September 1, 2008; between September 1, 2008, and March 1, 2009; and between March 1, 2009, and October 30, 2009, was 5.1%, 6.8%, and 7.6% ( P = 0.03), respectively. The lifetime prevalence of dysthymia reported during the 3 periods was 0.4%, 0.7%, and 1.5% ( P= 0.006), respectively. No changes in the 12-month prevalence of social phobia, panic disorder, and generalized anxiety disorder were found over time.

Conclusions:

The ongoing global economic crisis may have contributed to the increased prevalence of MDD. Future studies are needed to monitor the changes in the prevalence and to describe how the event may affect people's employment status, income, and health.
Paradigm Shifts and the Development of the Diagnostic and Statistical Manual of Mental Disorders: Past Experiences and Future Aspirations
Authors: First Michael B
Published: January 2017

Objective:

Work is currently underway on the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, due to be published by the American Psychiatric Association in 2013. Dissatisfaction with the current categorical descriptive approach has led to aspirations for a paradigm shift for DSM-5.

Method:

A historical review of past revisions of the DSM was performed. Efforts undertaken before the start of the DSM-5 development process to conduct a state-of-the science review and set a research agenda were examined to determine if results supported a paradigm shift for DSM-5. Proposals to supplement DSM-5 categorical diagnosis with dimensional assessments are reviewed and critiqued.

Results:

DSM revisions have alternated between paradigm shifts (the first edition of the DSM in 1952 and DSM-III in 1980) and incremental improvements (DSM-II in 1968, DSM-III-R in 1987, and DSM-IV in 1994). The results of the review of the DSM-5 research planning initiatives suggest that despite the scientific advances that have occurred since the descriptive approach was first introduced in 1980, the field lacks a sufficiently deep understanding of mental disorders to justify abandoning the descriptive approach in favour of a more etiologically based alternative. Proposals to add severity and cross-cutting dimensions throughout DSM-5 are neither paradigm shifting, given that simpler versions of such dimensions are already a component of DSM-IV, nor likely to be used by busy clinicians without evidence that they improve clinical outcomes.

Conclusions:

Despite initial aspirations that DSM would undergo a paradigm shift with this revision, DSM-5 will continue to adopt a descriptive categorical approach, albeit with a greatly expanded dimensional component.
Person-Centred Integrative Diagnosis: Conceptual Bases and Structural Model
Authors: Mezzich Juan E , Salloum Ihsan M , Cloninger C Robert , Salvador-Carulla Luis , Kirmayer Laurence J , Banzato Claudio EM , Wallcraft Jan , Botbol Michel
Published: January 2017

Objectives:

To review the conceptual bases of Person-centred Integrative Diagnosis (PID) as a component and contributor to person-centred psychiatry and medicine and to outline its design and development.

Method:

An analysis was conducted of the historical roots of person-centred psychiatry and medicine, tracing them back to ancient Eastern and Western civilizations, to the vicissitudes of modern medicine, to recent clinical and conceptual developments, and to emerging efforts to reprioritize medicine from disease to patient to person in collaboration with the World Medical Association, the World Health Organization, the World Organization of Family Doctors, the World Federation for Mental Health, and numerous other global health entities, and with the coordinating support of the International Network for Person-centered Medicine.

Results:

One of the prominent endeavours within the broad paradigmatic health development outlined above is the design of PID. This diagnostic model articulates science and humanism to obtain a diagnosis of the person (of the totality of the person's health, both ill and positive aspects), by the person (with clinicians extending themselves as full human beings), for the person (assisting the fulfillment of the person's health aspirations and life project), and with the person (in respectful and empowering relationship with the person who consults). This broader and deeper notion of diagnosis goes beyond the more restricted concepts of nosological and differential diagnoses. The proposed PID model is defined by 3 keys: broad informational domains, covering both ill health and positive health along 3 levels: health status, experience of health, and contributors to health; pluralistic descriptive procedures (categories, dimensions and narratives); and evaluative partnerships among clinicians, patients, and families. An unfolding research program is focused on the construction of a practical guide and its evaluation, followed by efforts to facilitate clinical implementation and training.

Conclusions:

PID is aimed at appraising overall health through pluralistic descriptions and evaluative partnerships, and leading through a research program to more effective, integrative, and person-centred health care.
Are Canadians Providing Advance Directives about Health Care and Research Participation in the Event of Decisional Incapacity?
Authors: Bravo Gina , Dubois Marie-France , Cohen Carole , Wildeman Sheila , Graham Janice , Painter Karen , Bellemare Suzanne
Published: January 2017

Objective:

Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with which Canadians communicate their preferences about health care and research should they become incapacitated.

Method:

We surveyed 5 populations (older adults, informal caregivers, physicians, researchers in aging, and research ethics board members) from Nova Scotia, Ontario, Alberta, and British Columbia. We asked respondents whether they had expressed their preferences regarding a substitute decision maker, health care, and research participation in the event of incapacity.

Results:

Two out of 3 respondents (62.0%; 95% CI 59.1% to 64.8%) had been advised to communicate their health care preferences in advance. Oral expression of wishes was reported by 69.1% of respondents (95% CI 66.8% to 71.3%), and written expression by 46.7% (95% CI 44.3% to 49.2%). Among respondents who had expressed wishes in advance (orally or in writing), 91.2% had chosen a substitute decision maker, 80.9% had voiced health care preferences, and 19.5% had voiced preferences regarding research participation. Having been advised to communicate wishes was a strong predictor of the likelihood of having done so.

Conclusions:

Advance planning has increased over the last 2 decades in Canada. Nonetheless, further efforts are needed to encourage Canadians to voice their health care and research preferences in the event of incapacity. Physicians are well situated to promote advance planning to Canadians.
Concordance of Self- and Proxy-Reported Suicide Ideation in Depressed Adults 50 Years of Age or Older
Authors: Heisel Marnin J , Conwell Yeates , Pisani Anthony R , Duberstein Paul R
Published: January 2017

Objective:

To assess whether social supports (proxies) can detect the presence of suicide ideation in a clinical sample of depressed adults 50 years of age or older, and to additionally assess the potential impact of depression symptom severity on patient–proxy concordance in reports of patient suicide ideation.

Method:

Cross-sectional data were collected regarding Axis I diagnoses, severity of depressive symptoms, and suicide ideation in a clinical sample of 109 patients 50 years of age and older. Patients were administered study measures by trained interviewers. Patients' social supports completed proxy measures of these same variables. We assessed concordance in self- and proxy-reported suicide ideation, employing global suicide ideation items derived from depression scales and more fine-grained suicide ideation items drawn from multi-item suicide ideation measures. We investigated patient–proxy concordance regarding the presence of patient suicide ideation.

Results:

Patients who endorsed suicide ideation and were concordantly seen by their social supports to be suicidal reported significantly greater depressive symptom severity than patients concordantly reported to be nonsuicidal. Patients' social supports reported significantly less depressive symptom severity in patients who endorsed suicide ideation yet who did not appear to be suicidal to them.

Conclusions:

Our findings suggest that family and friends can broadly ascertain the presence of suicide ideation in depressed middle-aged and older adults, yet in doing so may largely be responding to their broad perceptions of depressive symptom severity in patients and not specifically to the presence of suicidal thoughts.
A Critical Review of Dissociative Trance and Possession Disorders: Etiological, Diagnostic, Therapeutic, and Nosological Issues
Authors: During Emmanuel H , Elahi Fanny M , Taieb Olivier , Moro Marie-Rose , Baubet Thierry
Published: January 2017

Objective:

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, acknowledges the existence of dissociative trance and possession disorders, simply named dissociative trance disorder (DTD), it asks for further studies to assess its clinical utility in the DSM-5. To answer this question, we conducted the first review of the medical literature.

Method:

The MEDLINE, CINAHL, and PsycINFO databases were searched from 1988 to 2010, seeking case reports of DTD according to the DSM or the International Classification of Diseases definitions. For each article, we collected epidemiologic and clinical data, explanatory models used by authors, treatments, and information on the outcome.

Results:

We found 28 articles reporting 402 cases of patients with DTD worldwide. The data show an equal proportion of female and male patients, and a predominance of possession (69%), compared with trance (31%). Amnesia is reported by 20% of patients. Conversely, hallucinatory symptoms during possession episodes were found in 56% of patients and thus should feature as an important criterion. Somatic complaints are found in 34% of patients. Multiple explanatory models are simultaneously held and appear to be complementary.

Conclusion:

Data strongly suggest the inclusion of DTD in the DSM-5, provided certain adjustments are implemented. DTD is a widespread disorder that can be understood as a global idiom of distress, probably underdiagnosed in Western countries owing to cultural biases, whose incidence could increase given the rising flow of migration. Accurate diagnosis and appropriate management should result from a comprehensive evaluation both of sociocultural and of idiosyncratic issues, among which acculturation difficulties should systematically be considered, especially in cross-cultural settings.
Synaptosomal- Associated Protein 25 Gene Polymorphisms and Antisocial Personality Disorder: Association with Temperament and Psychopathy
Authors: Basoglu Cengiz , Oner Ozgur , Ates Alpay , Algul Ayhan , Bez Yasin , Cetin Mesut , Herken Hasan , Erdal Mehmet Emin , Munir Kerim M
Published: January 2017

Objective:

The molecular genetic of personality disorders has been investigated in several studies; however, the association of antisocial behaviours with synaptosomal-associated protein 25 (SNAP25) gene polymorphisms has not. This association is of interest as SNAP25 gene polymorphism has been associated with attention-deficit hyperactivity disorder and personality.

Methods:

We compared the distribution of Ddel and Mnll polymorphisms in 91 young male offenders and in 38 sex-matched healthy control subjects. We also investigated the association of SNAP25 gene polymorphisms with severity of psychopathy and with temperament traits: novelty seeking, harm avoidance, and reward dependence.

Results:

The Mnll T/T and Ddel T/T genotypes were more frequently present in male subjects with antisocial personality disorder (APD) than in sex-matched healthy control subjects. The association was stronger when the frequency of both Ddel and Mnll T/T were taken into account. In the APD group, the genotype was not significantly associated with the Psychopathy Checklist–Revised scores, measuring the severity of psychopathy. However, the APD subjects with the Mnll T/T genotype had higher novelty seeking scores; whereas, subjects with the Ddel T/T genotype had lower reward dependence scores. Again, the association between genotype and novelty seeking was stronger when both Ddel and Mnll genotypes were taken into account.

Conclusion:

Ddel and Mnll T/T genotypes may be a risk factor for antisocial behaviours. The association of the SNAP25 Ddel T/T and Mnll T/T genotypes with lower reward dependence and higher novelty seeking suggested that SNAP25 genotype might influence other personality disorders, as well.
Risk Indicators of Depressive Symptomatology among Injection Drug Users and Increased HIV Risk Behaviour
Authors: Lemstra Mark , Rogers Marla , Thompson Adam , Moraros John , Buckingham Robert
Published: January 2017

Objectives:

In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100 000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours.

Methods:

From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR.

Results:

Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10 000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment.

Conclusions:

This study found that depressive symptomatology was strongly associated with injection drug use.
Les antipsychotiques injectables à action prolongée: Avis d'experts de l'Association des médecins psychiatres du Québec
Authors: Stip Emmanuel , Abdel-Baki Amal , Bloom David , Grignon Sylvain , Roy Marc-André
Published: January 2017

Objectif:

Dégager les points d'accord et de divergence relatifs aux antipsychotiques. Depuis l'apparition des antipsychotiques d'action prolongée (APAP) de 2e génération et vu la fréquence élevée de la non-observance aux antipsychotiques dans les troubles psychotiques, les APAP suscitent une recrudescence d'intérêt dans la littérature psychiatrique. Toutefois, leur utilisation, globalement sous-optimale, connaît de plus des disparités nationales significatives. Dans ce contexte, l'Association des médecins psychiatres du Québec (AMPQ) a demandé un examen des données probantes concernant l'efficacité et la tolérance des APAP, et réclamé une réflexion clinique consensuelle concernant leurs avantages et les obstacles à les prescrire ainsi que des pistes de solution, y compris administratives ou judiciaires.

Méthodes:

Un comité d'experts de 4 universités québécoises, responsable de la rédaction de l'article de synthèse, a été réuni par l'AMPQ. L'esprit de la démarche est de bien outiller les cliniciens quant aux divers aspects liés à l'utilisation des APAP. Le comité a produit une revue qualitative et sélective.

Résultats:

Les taux de prescription des APAP constatés en moyenne au Canada sont autour de 6% et les données sont rares pour le confirmer. On pourrait suggérer un taux entre 15 et 25%.

Conclusion:

Le comité a proposé l'algorithme Québec algorithme antipsychotique à action prolongée (communément appelé QAAPAPLE) issu d'un consensus exprimé par les 4 départements de psychiatrie universitaire.
Access to and Waiting Time for Psychiatrist Services in a Canadian Urban Area: A Study in Real Time
Authors: Goldner Elliot M , Jones Wayne , Fang Mei Lan
Published: January 2017

Objective:

To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure.

Method:

An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists ( n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT).

Results:

Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe.

Conclusions:

Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed.
Long-Term Effects of Short-Term Psychodynamic Psychotherapy and Cognitive-Behavioural Therapy in Generalized Anxiety Disorder: 12-Month Follow-up
Authors: Salzer Simone , Winkelbach Christel , Leweke Frank , Leibing Eric , Leichsenring Falk
Published: January 2017

Objective:

In a previous randomized controlled trial (RCT), short-term efficacy of cognitive-behavioural therapy (CBT) and short-term psychodynamic psychotherapy (STPP) in generalized anxiety disorder (GAD) was demonstrated. In this article, long-term stability of these effects will be examined. Effects of CBT and STPP will be compared.

Method:

In the original RCT, patients with GAD were treated with either CBT ( n = 29) or STPP ( n = 28). Treatments were carried out according to manuals and included up to 30 sessions. As the primary outcome measure the Hamilton Anxiety Rating Scale was used. In addition to short-term outcome previously reported, treatment effects were assessed 12 months after termination of treatment.

Results:

Both CBT and STPP yielded large improvements at 12-month follow-up. No significant differences were found between treatments concerning the primary outcome measure. This result was corroborated by 3 self-report measures of anxiety. However, in measures of trait anxiety and worry, CBT was superior. Concerning depression, differences reported at posttreatment were no longer significant at 12-month follow-up.

Conclusions:

In GAD, both CBT and STPP yield large and stable effects 12 months after treatment. Concerning trait anxiety and worry, CBT seems to be superior. For STPP, further studies should be carried out to confirm the results.
Pharmacological Treatment of Alzheimer Disease
Authors: Massoud Fadi , Léger Gabriel C
Published: January 2017

Objective:

To review the different pharmacological approaches to the cognitive, functional, and behavioural manifestations of Alzheimer disease (AD).

Methods:

We searched and critically analyzed the most recent relevant literature on pharmacological treatment of AD.

Results:

The current pharmacological approach to AD treatment is based on vascular prevention and symptomatic therapy with cholinesterase inhibitors (ChEIs) and memantine, an N-methyl-d-aspartic acid antagonist. Clinical trials of 6– to 12–month duration have shown statistically significant benefits with ChEIs and memantine on cognitive, global, functional, and behavioural outcome measures. In general, these benefits are modest. However, they are dose-dependent and reproducible across studies. Most importantly, these benefits are symptomatic as they do not alter disease course. According to the third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, these agents are considered standard treatment options in AD. We will discuss practical issues related to current pharmacological management, such as setting realistic expectations, management of side effects, switching ChEIs, and the decision to discontinue treatment. The results of clinical trials studying potentially disease-modifying approaches in AD will also be reviewed. Unfortunately, although there remains much promise and enthusiasm, none of these agents has shown consistent benefits, and none are available for use in clinical practice.

Conclusion:

Pharmacological options are presently available for the symptomatic treatment of AD. These treatments provide mild but sustained benefits. Before disease-modifying approaches become available, optimizing the use of the available treatment options is crucial.
Suicide Attempts: Prevention of Repetition
Authors: Daigle Marc S , Pouliot Louise , Chagnon François , Greenfield Brian , Mishara Brian
Published: January 2017

Objective:

To present an overview of promising strategies to prevent repetition of suicidal behaviours.

Method:

This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management.

Results:

Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo—a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) ( n = 4), (including dialectical behaviour therapy [ n = 2]); psychodynamic therapy ( n = 2); mixed (CBT plus psychodynamic therapy [ n = 1]); and motivational approach and change in therapist ( n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples.

Conclusions:

There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.