bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexsomnia—A New Parasomnia?
Authors: Shapiro Colin M , Trajanovic Nikola N , Fedoroff J Paul
Published: July 2017

Objective:

To describe a distinct parasomnia involving sexual behaviour, which we have named sexsomnia.

Method:

We have used a case series as a basis for the description of sexsomina.

Results:

Eleven patients with distinct behaviours of the sexual nature during sleep are described. The features in common with other nonrapid eye movement arousal parasomnias, such as sleepwalking are documented. Some patients had simply been referred to a tertiary sleep clinic for investigation of unrelated sleep problems. A small number had been involved in medicolegal issues. Sexsomnia has some distinct features that separate it from sleepwalking. The automatic arousal is more prominent, motor activities are relatively restricted and specific, and some form of dream mentation is often present.

Conclusions:

A significant number of patients with this unusual parasomnic behaviour were identified only after specific questions were asked, suggesting that the behaviour is more common than previously thought.
Suicide Attempts in Turkey: Results of the WHO—EURO Multicentre Study on Suicidal Behaviour
Authors: Devrimci-Ozguven Halise , Sayıl Isık
Published: July 2017

Objective:

To investigate the rate and method of attempted suicides in a catchment area in Turkey as part of the WHO–EURO Multicentre Study on Suicidal Behaviour.

Method:

All hospitals in the catchment area were screened to identify suicide attempts for 4 years between January 1, 1998, and December 31, 2001.

Results:

In the 4-year period, 737 individuals attempted suicide (514 women and 223 men). The mean annual rate per 100 000 was 46.89 for men and 112.89 for women. The parasuicide rate increased by 93.59% between 1998 and 2001. The most frequent method used by both men and women was self-poisoning.

Conclusion:

Compared with the results from other European research centres, attempted suicide rates in Turkey were relatively low. However, the increase in rates was striking. This upward trend may be related to the intense economic difficulties, increasing unemployment, and rapid social change experienced in Turkey in recent years. The risk groups appeared to be younger and female. Information on author affiliations appears at the end of the article.
Adverse Effects Associated with Physical Restraint
Authors: Mohr Wanda K , Petti Theodore A , Mohr Brian D
Published: July 2017

Objective:

Restraint use is not monitored in the US, and only institutions that choose to do so collect statistics. In 1999, investigative journalists reported lethal consequences proximal to restraint use, making it a life-and-death matter that demands attention from professionals. This paper reviews the literature concerning actual and potential causes of deaths proximal to the use of physical restraint.

Method:

Searching the electronic databases Medline, Cinahl, and PsycINFO, we reviewed the areas of forensics and pathology, nursing, cardiology, immunology, psychology, neurosciences, psychiatry, emergency medicine, and sports medicine

Conclusions:

Research is needed to provide clinicians with data on the risk factors and adverse effects associated with restraint use, as well as data on procedures that will lead to reduced use. Research is needed to determine what individual risk factors and combinations thereof contribute to injury and death.
Insight and Neuropsychological Function in Patients with Schizophrenia and Bipolar Disorder with Psychotic Features
Authors: Arduini Luca , Kalyvoka Artemis , Stratta Paolo , Rinaldi Osvaldo , Daneluzzo Enrico , Rossi Alessandro
Published: July 2017

Objectives:

This study investigates the pattern of association between patient unawareness of illness and neuropsychological tests of frontal lobe function in subjects with schizophrenia and bipolar disorder (BD) with psychotic features.

Method:

We administered the Wisconsin Card Sort Test (WCST) and a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD) to a sample of 64 patients with psychosis (42 with schizophrenia and 22 with BD).

Results:

None of the correlations between WCST scores and insight scores were statistically significant, either in the total group or in each group analyzed separately. Further, no differences were seen in insight scores between sexes and between the diagnostic groups.

Conclusions:

The 3 insight dimensions (that is, awareness of mental disorder, awareness of social consequences of mental disorder, and awareness of the benefits of medication) do not appear to be associated with frontal impairment, as measured by the WCST.
Diabetes Mellitus and Impaired Glucose Tolerance in Patients with Schizophrenia
Authors: Subramaniam Mythily , Chong Siow-Ann , Pek Elaine
Published: July 2017

Objectives:

This study aimed to establish the prevalence of diabetes mellitus (DM) and impaired glucose tolerance in patients with schizophrenia and to elucidate some of the factors associated with hyperglycemia.

Methods:

We studied a sample of 194 patients with schizophrenia. We determined fasting blood glucose and insulin levels at the start of the testing period; patients were given an oral glucose tolerance test after an overnight fast.

Results:

The overall prevalence of diabetes and impaired glucose tolerance in these patients was 16.0% and 30.9%, respectively. These rates were higher than those reported in the general population. Patients with disordered glucose homeostasis were significantly older ( P = 0.005, Kruskal–Wallis test). There was no significant effect of sex or ethnicity on diabetes.

Conclusions:

Our findings suggest that patients with schizophrenia are more vulnerable to developing DM. We caution clinicians to be mindful of the increased risk and to be vigilant for such a development.
Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality
Authors: Breitbart William , Gibson Christopher , Poppito Shannon R , Berg Amy
Published: July 2017

Medical and psychological discourse on end-of-life care has steadily shifted over the years from focusing primarily on symptom control and pain management to incorporating more person-centred approaches to patient care. Such approaches underscore the significance of spirituality and meaning making as important resources for coping with emotional and existential suffering as one nears death. Though existential themes are omnipresent in end-of-life care, little has been written about their foundations or import for palliative care practitioners and patients in need. In this article, we explore the existential foundations of meaning and spirituality in light of terminal illness and palliative care. We discuss existential themes in terms of patients' awareness of death and search for meaning and practitioners' promotion of personal agency and responsibility as patients face life-and-death issues. Viktor Frankl's existential logotherapy is discussed in light of emerging psychotherapeutic interventions. Meaning-centred group therapy is one such novel modality that has successfully integrated themes of meaning and spirituality into end-of-life care. We further explore spiritual and existential themes through this meaning-oriented approach that encourages dying patients to find meaning and purpose in living until their death.
Schizophrenia: The Quest for a Minimum Sense of Identity to Ward off Delusional Disorder
Authors: Noël-Jorand Marie-Christine , Reinert Max , Giudicelli Sébastien , Dassa Daniel
Published: July 2017

Objective:

This study was designed to analyze the language of patients with schizophrenia exhibiting negative symptoms during a 3-month period.

Method:

The computer-assisted ALCESTE method was used to simultaneously analyze the subjects' oral behaviour and speech patterns at various levels.

Results:

The tested subjects had very specific speech patterns. Most significantly, analysis of the underlying syntactic processes showed that the patients exhibited a sense of identity, however minimum, based on their own pathologies and on the surrounding world. In our previous study, no such characteristics were observed in the discourse of schizophrenia patients with delusions (exhibiting positive symptoms). This suggests that the minimum sense of identity that develops in patients with schizophrenia allows them to avoid positive symptoms.

Conclusion:

In studies of language production by subjects suffering from schizophrenia, it is necessary to distinguish between patients with positive symptoms and those with negative symptoms. The speech patterns of these 2 groups have to be analyzed separately, which has not been done previously, since the groups differ in too many respects.
Defining Best Practices for Specialty Geriatric Mental Health Outreach Services: Lessons for Implementing Mental Health Reform
Authors: Sullivan Mary Pat , Kessler Linda , Le Clair J Kenneth , Stolee Paul , Berta Whitney
Published: July 2017

Objective:

This paper reviews fundamental areas that inform best practices for outreach services as they relate to shared care, education, and program and systems development and illustrates a framework for defining best practices.

Method:

We examined literature that addresses the needs and characteristics of older persons with mental illness, studies that investigate geriatric mental health outreach services, and relevant theoretical developments. In addition, we synthesized some of the health services field research that we conducted.

Results:

This analysis provided a foundation for understanding the processes required to identify and implement best practices in specialty geriatric mental health outreach. Constructive insights for a comprehensive approach to the development, implementation, and evaluation of these services emerged.

Conclusions:

The needs of an aging population, the articulation of principal functions for specialty services within mental health reform, and the realities of individual communities converged to establish direction for service provision. The use of best practices across a range of health and social services, combined with an effective process that facilitates the exchange of knowledge between sectors, establishes an important mechanism by which shared care, education, and program and systems development can be achieved.
Symptoms Defined by Parents' and Teachers' Ratings in Attention-Deficit Hyperactivity Disorder: Changes with Age
Authors: Öncü Bedriye , Öner Özgür , Öner Pınar , Erol Neşe , Aysev Ayla , Canat Saynur
Published: July 2017

Objective:

To determine whether Child Behavior Checklist/4–18 (CBCL) and Teacher Report Form (TRF) scores of children and adolescents with a first-time diagnosis of attention-deficit hyperactivity disorder (ADHD) are different and whether there is a similar difference in normal control subjects.

Method:

We analyzed the CBCL and TRF scores of 146 patients (124 boys and 22 girls, aged 6 to 18 years; mean age 11.0 years, SD 3.6). We analyzed the same scores for 274 age and sex-matched control subjects recruited from a nationally representative sample.

Results:

Subjects with ADHD had significantly higher CBCL and TRF scores than control subjects. Age was significantly correlated with scores on the CBCL and TRF subscales Social Withdrawal, Somatic Complaints, and Internalization Problems; with scores on the CBCL subscale Attention Problems; and with scores on the TRF subscale Anxiety–Depression. In the group with ADHD, age was negatively correlated with scores on the CBCL and TRF subscale Externalizing Problems and with scores on the TRF subscale Aggressive Behavior. In the control group, the only significant correlation was between age and the CBCL subscale Somatic Complaints score.

Conclusions:

These results indicate that underdiagnosis of ADHD in childhood may cause the emergence of greater internalization problems in adolescence. attention-deficit hyperactivity disorder
Somatization Disorder: A Practical Review
Authors: Mai François
Published: July 2017

Objective:

This paper reviews the present state of knowledge on the etiology, prevalence, diagnosis, and treatment of somatization disorder (SD).

Method:

A comprehensive review of the literature on SD is described under the above headings.

Results:

SD is a common condition that is not well managed by many physicians. Patients with SD get caught between the cracks of the health care system, with expensive consequences. SD is a psychiatric disorder, but patients are reluctant to see and be treated by psychiatrists. They frequently are managed by nonpsychiatric physicians who have limited understanding of the condition. Cognitive-behavioural therapy (CBT) is the most efficacious treatment in SD, although antidepressants and supportive psychotherapy also have a role for some patients.

Conclusions:

A cadre of clinicians with training in the theory and practice of CBT for SD is required. They need to be based both in the community and in tertiary health care centres, where most patients with this condition are located.
Sexual Medicine: Why Psychiatrists Must Talk to Their Patients about Sex
Authors: Stevenson Ronald WD
Published: July 2017

Objective:

To review the prevalence of sexual concerns and the relevance of this area to psychiatrists and to present evidence supporting the need for psychiatrists to routinely include a sex-function inquiry in the assessment of their patients.

Method:

A review of the recent literature was undertaken.

Conclusions:

Sex is a fundamental quality-of-life issue. Sexual problems are extremely prevalent among the general population and even more so among persons with psychiatric or medical illness. There are at least 9 reasons why all physicians, perhaps psychiatrists especially, should make inquiry into sexual behaviours and response a routine part of caring for each patient.
Design and Feasibility of a New Cognitive-Behavioural Therapy Course Using a Longitudinal Interactive Format
Authors: Lau Mark A , Dubord Greg M , Parikh Sagar V
Published: July 2017

Objective:

This report describes the design and feasibility of conducting a unique longitudinal supervision course incorporating both therapist and patient evaluation measures in teaching cognitive-behavioural therapy (CBT) to a group of mental health practitioners.

Method:

We designed a 10-session longitudinal supervision course to teach CBT by applying key continuing medical education (CME) principles. Each session consisted of 30 minutes of didactics and demonstrations followed by 90 minutes of group case supervision. Course participants were mental health practitioners who treated patients from their own practice; most of the patients suffered from a depressive and (or) anxiety disorder. We assessed therapists for CBT skill acquisition at the beginning and at the end of the course, using the Cognitive Therapy Scale (CTS). We assessed patients' symptoms weekly, using the Beck Depression Inventory, the Beck Anxiety Inventory, and the Clinical Global Impression scale.

Results:

A total of 34 participants enrolled in three 10-session courses. Most participants submitted audiotapes for rating at the beginning and end of the course, and most submitted patient symptom information.

Conclusions:

This course shows promise as an effective way to teach complex skills in CBT to mental health providers. In limited samples, the course showed clear improvement in therapist adherence to CBT and in patients' clinical outcomes. Future research is required to validate the potential benefit of this CME intervention for mental health practitioners treating patients with mood and anxiety disorders.
Bipolar Disorder: It's All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Authors: Malhi Gin S , Ivanovski Belinda , Szekeres Viktoria , Olley Amanda
Published: July 2017

Objective:

To compare and contrast the neuropsychological profile of the 3 phases of bipolar disorder (BD) to achieve a better definition of BD and to identify potential state and trait deficits.

Methods:

We conducted a search for English-language papers published in journals from 1965 onward, using the following terms in Medline and Embase: neuropsychology or neuropsychological and BD, depression, mania, and euthymia. We scrutinized suitable subheadings and retrieved familiar papers and literature.

Results:

We initially identified more than 100 articles and then excluded reviews and papers that did not directly administer neuropsychological tests. This left 27 papers, which we further examined and the findings of which we tabulated and discussed. Cognitive and executive functioning deficits were found, including set-shifting, verbal fluency, planning, attention, and memory.

Conclusions:

The neuropsychological deficits found in bipolar depression, mania or hypomania, and euthymia provide important insights into the pathophysiology of BD and may, in future studies, form the basis of clinically meaningful subtypes.
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Authors: Lai Daniel WL
Published: July 2017

Objectives:

The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada.

Method:

Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms.

Results:

Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive.

Conclusions:

The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.
Command Hallucinations among Asian Patients with Schizophrenia
Authors: Lee Theresa MY , Chong Siow Ann , Chan Yiong Huat , Sathyadevan Gangaharan
Published: July 2017

Objectives:

The impact of command hallucinations on patients and the determinants of patients' compliance with them are still poorly understood. The extant literature is also divided on their association with violence. This study aimed to establish the prevalence of command hallucinations and to identify the factors that affect compliance with the commands, together with patients' coping methods.

Methods:

We recruited 50 consecutive male and 50 consecutive female schizophrenia inpatients who reported hearing voices in the 6 months prior to admission. We interviewed these patients, using a semistructured questionnaire. We collected information on the contents of their auditory hallucinations and their coping methods.

Results:

Of the patients, 53 (53%) reported command hallucinations. Of these 53 patients, 58% were women and 48% were men; 62% reported complying with the commands. They were also more likely to comply with nonviolent commands. A history of self-harm predicted compliance. Those patients who did not comply with the commands adopted various methods of coping, of which praying was the most common.

Conclusion:

Command hallucinations are common in patients with schizophrenia. Patients with a history of self-harm need closer monitoring because they may be more likely to comply with these hallucinations. Assessment should also include the patient's own coping strategies, which can be incorporated into the treatment.
Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Authors: Archie Suzanne , Wilson Jane Hamilton , Woodward Kevin , Hobbs Heather , Osborne Shelley , McNiven Jean
Published: July 2017

Background:

There is growing recognition that people presenting with psychotic symptoms for the first time need specialized treatment. The Hamilton Health Sciences Corporation, McMaster Hospital, offers one such program, the Psychotic Disorders Clinic (PDC); it addresses some of the problems posed by long waiting lists, lack of family interventions, and long-term hospitalizations. The PDC is affiliated with the Department of Psychiatry and Behavioural Neurosciences at McMaster University. The program's goals are to provide comprehensive outpatient care and early interventions for persons in the early stages of illness and, consequently, to improve symptom control and functioning and reduce hospitalizations. Key service components include providing low dosages of antipsychotics, offering specialized family education, and supporting return to school and work settings.

Objectives:

This study compared outcomes before and after enrolment in the PDC to determine whether first-episode patients achieved improved symptom control and functioning and fewer hospitalizations.

Method:

For a 12-month period, we followed 40 patients, aged between 16 and 45 years, who experienced their first episode of psychotic illness between 1997 and 2000. Prospective longitudinal data were collected at baseline, 3, 6, and 12 months. Outcome measures included symptoms, global functioning, employment rates, duration of untreated psychosis, and number of bed-days.

Results:

Of the patients, 37 completed the study at 6 months, and 31 at 12 months. Over the 12 months, significant improvements occurred in psychiatric symptoms ( P < 0.001), global functioning ( P < 0.001), and the mean number of hospital bed-days ( P < 0.001).

Conclusions:

It is feasible for small outpatient services to provide early intervention strategies and obtain good outcomes among first-episode patients.
Perceived Quality of Life in Patients with Bipolar Disorder. Does Group Psychoeducation Have an Impact?
Authors: Michalak Erin E , Yatham Lakshmi N , Wan Dante DC , Lam Raymond W
Published: July 2017

Objective:

A large body of research has now accumulated concerning quality of life (QoL) for patients with major depressive disorder, both in terms of describing levels of well-being and in terms of assessing the impact of treatment interventions. However, there is little information concerning QoL for patients with bipolar disorder (BD), and there is relatively little published evidence concerning the effectiveness of psychological interventions for BD. We aimed to assess the impact of a time-limited psychoeducation (PE) group therapy upon perceived QoL among patients with BD.

Method:

Participants were patients ( n = 57) with BD type I or II who were clinically described as euthymic or mildly symptomatic. Treatment intervention was a standardized, 8-week group PE course delivered in a mood disorders program in British Columbia, Canada. Using retrospective chart review and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), we assessed QoL at baseline and at 8 weeks.

Results:

Mean baseline Q-LES-Q scores were 56%, representing moderate impairment in QoL. Group PE was associated with a 5-point increase in Q-LES-Q scores (where higher scores indicate better QoL). Examination of the questionnaire's subscales revealed that 2 domains (that is, physical functioning and general satisfaction) increased significantly following PE, with the remaining domains showing nonsignificant trends toward improved functioning. Multivariate analysis indicated that only one factor (having had a recent episode of depression) significantly predicted pre- and posttreatment Q-LES-Q scores.

Conclusion:

Patients with BD continue to show impaired QoL even when clinically euthymic. Although preliminary, our results show that group PE is associated with improved QoL in this population, both in terms of general satisfaction and in relation to levels of physical functioning. The use of PE as an adjunct to pharmacotherapy in BD should be further studied with particular emphasis on characterizing the effects of treatment intervention on perceived QoL.
Finding Our Way: An Introduction to Path Analysis
Authors: Streiner David L
Published: July 2017

Path analysis is an extension of multiple regression. It goes beyond regression in that it allows for the analysis of more complicated models. In particular, it can examine situations in which there are several final dependent variables and those in which there are “chains” of influence, in that variable A influences variable B, which in turn affects variable C. Despite its previous name of “causal modelling,” path analysis cannot be used to establish causality or even to determine whether a specific model is correct; it can only determine whether the data are consistent with the model. However, it is extremely powerful for examining complex models and for comparing different models to determine which one best fits the data. As with many techniques, path analysis has its own unique nomenclature, assumptions, and conventions, which are discussed in this paper.
Traumatic Memories are Not Necessarily Accurate Memories
Authors: Laney Cara , Loftus Elizabeth F
Published: July 2017

Some therapists, as well as other commentators, have suggested that memories of horrific trauma are buried in the subconscious by some special process, such as repression, and are later reliably recovered. We find that the evidence provided to support this claim is flawed. Where, then, might these memory reports come from? We discuss several research paradigms that have shown that various manipulations can be used to implant false memories—including false memories for traumatic events. These false memories can be quite compelling for those who develop them and can include details that make them seem credible to others. The fact that a memory report describes a traumatic event does not ensure that the memory is authentic.
Difficult-to-Engage Patients: A Specific Target for Time-Limited Assertive Outreach in a Swiss Setting
Authors: Bonsack Charles , Adam Laurence , Haefliger Thomas , Besson Jacques , Conus Philippe
Published: July 2017

Objective:

Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT.

Methods:

We retrospectively assessed social, clinical, and functional outcomes and motivation for treatment in 75 consecutively seen subjects treated between 2000 and 2002.

Results:

With 70% of the interventions lasting less than 6 months, we observed significant improvement in most clinical and social problems, in collaboration, in motivation for treatment, and in social network support, despite high baseline levels of clinical and social problems. The number of hospitalizations decreased significantly.

Conclusions:

Time-limited ACT is a useful treatment for difficult-to-engage patients with severe clinical and social problems, and it facilitates linkage to care. This narrower target for ACT may facilitate its implementation in Europe.
Small Signal, Big Noise: Performance of the CIDI Depression Module
Authors: Kurdyak Paul A , Gnam William H
Published: July 2017

Objectives:

With the release of data from the Canadian Community Health Survey: Mental Health and Weil-Being (Cycle 1.2), researchers have, for the first time, information on several psychiatric disorders from a nationally representative sample of Canadians residing in households. This survey used the Composite International Diagnostic Interview (CIDI) to identify persons with one or more psychiatric disorders. In this paper, our primary purpose was to evaluate the evidence supporting the validity of the CIDI—that is, the extent to which the depression diagnoses generated by the CIDI reflect true cases of depression.

Method:

We conducted a critical review of the CIDI, focusing on the depression module.

Results:

Reliability studies indicate that the CIDI performs reliably, as measured by interrater reliability. However, the use of different versions of the CIDI and the occasional exclusion of the Depression module from studies suggest that the reliability of the CIDI Depression module remains unconfirmed. The most critical issue in regard to the CIDI's performance is that clinical samples are used to test validity. A clinical sample has a higher prevalence of depression than a community sample.

Conclusion:

The results generated by the CIDI in a community setting likely will have a high false-positive rate, resulting in a falsely elevated prevalence rate. Given the widespread application of the CIDI internationally, addressing the outstanding concerns about validity with proper validation studies should become an international priority.
Neural Correlates of Sad Feelings in Schizophrenia with and without Blunted Affect
Authors: Stip Emmanuel , Fahim Cherine , Liddle Peter , Mancini-Marïe Adham , Mensour Boualem , Bentaleb Lahcen Ait , Beauregard Mario
Published: July 2017

Objective:

There have been reports that patients with schizophrenia have decreased activity in the prefrontal cortex during emotion processing. However, findings have been confounded by sample nonspecificity and explicit cognitive task interference with emotion processing. We aimed to further investigate this by examining the ventrolateral prefrontal cortex (VLPFC) activation in response to the passive viewing of sad film excerpts.

Methods:

We presented film excerpts depicting sad and neutral social situations to 25 schizophrenia patients (14 with blunted affect [BA+] and 11 without blunted affect [BA-]) in an implicit perception task to evoke prefronto-limbic activity illustrated by blood oxygenation level–dependent functional magnetic resonance imaging.

Results:

A random-effects analysis (2-sample t test) using statistical parametric mapping indicated that BA+ patients differed from BA–patients at a 0.05 level ( P corrected for multiple comparisons). Consistent with our a priori hypothesis, BA–patients (relative to BA+ patients) showed significant activation in the right VLPFC. An exploratory analysis revealed the following loci of activation: caudate nucleus, VLPFC, middle prefrontal cortex, medial prefrontal cortex, anterior cingulate cortex, and anterior temporal pole in the BA–group; and hippocampus, cerebellum, anterior temporal pole, and midbrain in the BA+ group.

Conclusions:

We observed not only hypofrontality in the BA+ group but also dysfunctional circuitry distributed throughout the brain. The temporal and midbrain activation seen in the BA+ group may indicate that these brain regions were working harder to compensate for inactivation in other regions. These distributed dysfunctional circuits may form the neural basis of blunted affect through impairment of emotion processing in the brain that prevents it from processing input efficiently and producing output effectively, thereby leading to symptoms such as blunted affect.
Unavailable Essential Archival Data: A Major Limitation in the Conduct of Clinical Practice and Research in Violence Risk Assessment
Authors: Padgett Richard , Webster Christopher D , Robb M Kathleen
Published: July 2017

Numerous studies have identified various historical factors strongly associated with violent behaviour in psychiatric patients. We comment herein on some practical reasons for difficulty in obtaining the background documentation necessary for risk assessment.
Childhood Separation Anxiety and Separation Events in Women with Agoraphobia with or without Panic Disorder
Authors: Peter Helmut , Brückner Eva , Hand Iver , Rufer Michael
Published: July 2017

Objective:

This study aimed to investigate the association between separation anxiety and actual separation events during childhood in adult patients with agoraphobia with or without panic disorder (PD).

Method:

Forty-two women with agoraphobia with or without PD participated in long-term follow-ups after exposure-in-vivo treatment. We assessed separation anxiety and separation events from age 0 to 18 years, as well as adult separation from a spouse.

Results:

Childhood separation experiences (55%) and separation anxiety were significantly higher in patients than in healthy subjects, but both conditions were not associated with each other. Childhood separation anxiety was related to adult separation events.

Conclusions:

Retrospective measures of childhood separation anxiety appear to be confounded by adult separation events. Thus the conclusion of whether childhood anxiety is a consequence of actual childhood separation events cannot be drawn, owing to a lacking association between both ratings.
Suicidal Behaviours in a Population-Based Sample of French Youth
Authors: Fedorowicz Valérie J , Fombonne Eric
Published: July 2017

Objectives:

To estimate the prevalence of suicidal ideation and behaviours in a large, representative sample of French youth and to evaluate age and sex correlates.

Method:

We surveyed a large ( n = 1106) cohort of French adolescents and young adults, aged 15 to 26 years and diversified throughout France, using a mailed-in self-report questionnaire.

Results:

Lifetime prevalence rates for suicidal ideation, plans, and attempts were 47.2%, 14.8%, and 5.7%, respectively. Rates for female youth were higher than for male youth across the entire spectrum of suicide-related outcomes. Rates generally increased between the ages of 15 and 20 years and decreased after age 21.

Conclusions:

The findings suggest that suicidal thoughts and behaviours are widespread phenomena among adolescents and constitute a major public health issue.
Strengthening the Status of Psychotherapy for Personality Disorders: An Integrated Perspective on Effects and Costs
Authors: Bartak Anna , Soeteman Djøra I , Verheul Roel , Busschbach Jan JV
Published: July 2017

Objective:

Despite scientific evidence of effectiveness, psychotherapy for personality disorders is not yet fully deployed, nor is its reimbursement self-evident. Both clinicians and health care policy-makers increasingly rely on evidence-based medicine and health economics when determining a treatment of choice and reimbursement. This article aims to contribute to that understanding by applying these criteria on psychotherapy as a treatment for patients with personality disorder.

Method:

We have evaluated the available empirical evidence on effectiveness and cost-effectiveness, and integrated this with necessity of treatment as a moderating factor.

Results:

The effectiveness of psychotherapy for personality disorders is well documented with favourable randomized trial results, 2 metaanalyses, and a Cochrane review. However, the evidence does not yet fully live up to modern standards of evidence-based medicine and is mostly limited to borderline and avoidant personality disorders. Data on cost-effectiveness suggest that psychotherapy for personality disorders may lead to cost-savings. However, state-of-the-art cost-effectiveness data are still scarce. An encouraging factor is that the available studies indicate that patients with personality disorder experience a high burden of disease, stressing the necessity of treatment.

Conclusions:

When applying an integrated vision on outcome, psychotherapy can be considered not only an effective treatment for patients with personality disorder but also most likely a cost-effective and necessary intervention. However, more state-of-the-art research is required before clinicians and health care policy-makers can fully appreciate the benefits of psychotherapy for personality disorders. Considerable progress is possible if researchers focus their efforts on evidence-based medicine and cost-effectiveness research.
The Relevance of Qualitative Research for Clinical Programs in Psychiatry
Authors: Goering Paula , Boydell Katherine M , Pignatiello Antonio
Published: July 2017

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician–researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making.
Disclosure and Social Acknowledgement as Predictors of Recovery from Posttraumatic Stress: A Longitudinal Study in Crime Victims
Authors: Mueller Julia , Moergeli Hanspeter , Maercker Andreas
Published: July 2017

Objective:

To address posttraumatic stress disorder (PTSD) predictors with research focused on the coping styles of traumatized individuals.

Method:

A total of 86 crime victims (mean age 46.1, standard deviation 17.6) were assessed at 5 and 11 months post-crime. Disclosure of trauma, social acknowledgement, dysfunctional posttraumatic cognitions, and PTSD symptom severity were assessed by self-reports.

Results:

Dysfunctional posttraumatic cognitions, disclosure attitudes, and social disapproval correlated positively with PTSD severity. Hierarchical regression analyses revealed the particular value of disclosure attitudes and perceived social disapproval in predicting PTSD symptom severity at 11 months post-crime.

Conclusions:

In addition to known predictors of PTSD, disclosure attitudes and social acknowledgement should also be considered. Future research should focus on broader concepts such as the victim's perception of, and interaction with, their social environment, and on the objective factors of social interaction, in addition to intrapersonal processes of posttraumatic recovery.
Psychological Approaches in the Treatment of Chronic Pain Patients—When Pills, Scalpels, and Needles are Not Enough
Authors: Turk Dennis C , Swanson Kimberly S , Tunks Eldon R
Published: July 2017

Background:

Chronic pain is a prevalent and costly problem that eludes adequate treatment. Persistent pain affects all domains of people's lives and in the absence of cure, success will greatly depend on adaptation to symptoms and self-management.

Method:

We reviewed the psychological models that have been used to conceptualize chronic pain—psychodynamic, behavioural (respondent and operant), and cognitive-behavioural. Treatments based on these models, including insight, external reinforcement, motivational interviewing, relaxation, meditation, biofeedback, guided imagery, and hypnosis are described.

Results:

The cognitive-behavioural perspective has the greatest amount of research supports the effectiveness of this approach with chronic pain patients. Importantly, we differentiate the cognitive-behavioural perspective from cognitive and behavioural techniques and suggest that the perspective on the role of patients' beliefs, attitudes, and expectations in the maintenance and exacerbation of symptoms are more important than the specific techniques. The techniques are all geared to fostering self-control and self-management that will encourage a patient to replace their feelings of passivity, dependence, and hopelessness with activity, independence, and resourcefulness.

Conclusions:

Psychosocial and behavioural factors play a significant role in the experience, maintenance, and exacerbation of pain. Self-management is an important complement to biomedical approaches. Cognitive-behavioural therapy alone or within the context of an interdisciplinary pain rehabilitation program has the greatest empirical evidence for success. As none of the most commonly prescribed treatment regimens are sufficient to eliminate pain, a more realistic approach will likely combine pharmacological, physical, and psychological components tailored to each patient's needs.
A Clinician's Guide to Correct Cost-Effectiveness Analysis: Think Incremental Not Average
Authors: Hoch Jeffrey S , Dewa Carolyn S
Published: July 2017

Objective:

To explain how to correctly report the results from a cost-effectiveness analysis (CEA).

Methods:

Results were used from a hypothetical clinical trial to illustrate how different ways of reporting economic results affect both presentation of findings and formulation of conclusions. To provide context, we reviewed some high-profile exchanges in the scientific literature.

Results:

The critical issue with which decision makers must grapple involves the trade-offs introduced by a new treatment or intervention. Specifically, are decision makers willing to pay the additional cost for the additional outcomes? This question cannot be considered without estimates of the additional cost and additional outcomes. Correct cost-effectiveness measures, such as the incremental cost-effectiveness ratio or the incremental net benefit, address this issue.

Conclusions:

As decision makers face the challenge of balancing increasing health care demand with cost containment, it will be crucial to identify cost-effective ways of providing care. Health care providers and other decision makers should not be misled by the results of improperly reported CEAs. Decisions around adoption of pharmaceuticals or implementation of new programs or interventions may be affected by which cost-effectiveness summary measure is reported. Thus consumers of CEA must have a basic understanding of why different methods give different results, and how the results should be interpreted.
Knowledge Transfer and Improvement of Primary and Ambulatory Care for Patients with Anxiety
Authors: Smolders Mirrian , Laurant Miranda , Roberge Pasquale , van Balkom Anton , van Rijswijk Eric , Bower Peter , Grol Richard
Published: July 2017

Objective:

To summarize current evidence on the effectiveness of different knowledge transfer and change interventions for improving primary and ambulatory anxiety care to provide guidance to professionals and policy-makers in mental health care.

Method:

We searched electronic medical and psychological databases, conducted correspondence with authors, and checked reference lists. Studies examining the effectiveness of knowledge transfer and interventions targeted at improvement of the recognition or management of anxiety in primary and ambulatory health care settings were included. Methodological details and outcomes were independently extracted and checked by 2 reviewers. Where appropriate, data concerning the impact of interventions on symptoms of anxiety were pooled using metaanalytical procedures.

Results:

We identified 24 studies that met our inclusion criteria. Seven professional-directed interventions and 17 organizational interventions (including patient-oriented interventions) were identified. The methodological quality of studies was variable. Professional-directed interventions only impact the process and outcome of care when embedded in some sort of organizational intervention. Metaanalysis ( n = 8 studies) showed no effect of diverse organizational interventions on patients' anxiety symptoms (effect size, −0.08; 95% confidence interval, −0.31 to 0.15; P = 0.50). Collaborative care interventions proved to be the most effective organizational intervention strategies. Six studies reported economic results: 4 studies showed that intervention had a high probability of being cost-effective.

Conclusions:

Collaborative care seems to be very promising for improving primary and ambulatory care for anxiety. At the level of management and policy, the results of this review mandate the need to offer fair and reasonable reimbursement for collaborative care programs.
Organizational Change to Transfer Knowledge and Improve Quality and Outcomes of Care for Patients with Severe Mental Illness: A Systematic Overview of Reviews
Authors: Franx Gerdien , Kroon Hans , Grimshaw Jeremy , Drake Robert , Grol Richard , Wensing Michel
Published: July 2017

Objective:

To provide a comprehensive overview of the research on organizational changes aimed at improving health care for patients with severe mental illness and to learn lessons for mental health practice from the results.

Method:

We searched for systematic literature reviews published in English during 2000 to 2007 in PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Central Register of Systematic Reviews. Three reviewers independently selected and assessed the studies' quality. Studies involving changes of who delivers health care, how care is organized, or where care is delivered were included. We categorized the studies using an existing taxonomy of 6 broad categories of strategies for organizational change.

Results:

A total of 21 reviews were included. Among these, 17 had reasonably good methodological quality. Almost all reviews included or intended to include randomized controlled trials (RCTs), 6 reviews did not identify studies that met eligibility criteria. Multidisciplinary teams and integrated care models had been reviewed most frequently (a total of 15 reviews). In most studies, these types of changes showed better outcomes in terms of symptom severity, functioning, employment, and housing, compared with conventional services. Different results were found on cost savings. Other types of organizational changes, such as changing professional roles or introducing quality management or knowledge management, were much less frequently reviewed. Very few reviews looked at effects of organizational changes on professional performance.

Conclusions:

There is a fairly large body of evidence of the positive impact of multidisciplinary teams and integrated care changes on symptom severity, functioning, employment, and housing of people with severe mental illness, compared with conventional services. Other strategies, such as changes in professional roles, quality or knowledge management, have either not been the subject of systematic reviews or have not been evaluated in RCTs. There is still a lack of insight in the so-called black box of change processes and the impact of change on professional performance.
Adults with Autism Spectrum Disorders
Authors: Howlin Patricia , Moss Philippa
Published: July 2017

In the decades since autism was first formally described in the 1940s, there have been major advances in research relating to diagnosis, causation, and treatment approaches for children with this condition. However, research into prognosis, outcomes, or effective interventions for adults with autism spectrum disorders (ASDs) is much more limited. In this paper, we review studies of outcome in adulthood. The findings indicate that, as adults, many people with ASD, including those of normal IQ, are significantly disadvantaged regarding employment, social relationships, physical and mental health, and quality of life. Support to facilitate integration within the wider society is frequently lacking, and there has been almost no research into ways of developing more effective intervention programs for adults. Moreover, most of the research on outcome has involved relatively young people in their 20s and 30s—much less is known about outcomes for people with ASD as they reach mid-late adulthood. Systematic follow-up studies from childhood through adulthood are needed if we are to gain a better understanding of trajectories of development over the lifespan, to identify the factors that influence prognosis, and to determine how these factors exert their effects and how they may be modified to ensure a better future.