bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Lactobacillus Salivarius LS01 (DSM 22775) Treatment on Adult Atopic Dermatitis: A Randomized Placebo-Controlled Study
Authors: Drago L. , Iemoli E. , Rodighiero V. , Nicola L. , De Vecchi E. , Piconi S.
Published: January 2017

Atopic dermatitis (AD) is a common inflammatory skin disease characterized by xerosis, pruritus and eczema. The role of probiotics in the prevention and the treatment of AD have been extensively studied in children with controversial results while there are few studies on an adult population. The aim of this randomized, double-blind, placebo-controlled study is to evaluate the clinical efficacy of the intake of a probiotic strain ( Lactobacillus salivarius LS01) in the treatment of adult patients with AD. A group of 38 patients was treated with probiotics or placebo (maltodextrin) for 16 weeks. The study was performed from January (T0) to May, 2009 (T16). The assessment of efficacy was based on change in SCORAD (SCORing Atopic Dermatitis) index, dermatology life quality index (DLQI) improvement, cytokine production by PBMCs and ability to modify faecal microbial flora. No significant adverse events were recorded during the study. Patients treated with probiotics showed a statistically improvement of both clinical parameters (SCORAD p< 0.0001 and DLQI p= 0.021) at the end of treatment (T16) compared with the placebo group. Furthermore, after four months of treatment there was a significant reduction of Th1 cytokines (IL-12+IFNγ) (p= 0.03) and Th1/Th2 ratio (IL-12+IFNγ/IL-4+IL-5) (p= 0.019) only in placebo-treated patients. A statistically relevant decrease of staphylococci in faeces of the probiotic-treated group was also observed at the end of treatment. In our study, the administration of L. salivarius LS01 was well tolerated and was associated with a significant improvement of clinical manifestation and QoL. This probiotic strain could have an important role in modulating Th1/Th2 cytokine profiles and could be considered as an important adjunctive therapy in the treatment of adult AD.
A Comparison between IgE and IgG4 as Markers of Allergy in Children: An Experimental Trial in a Model of Natural Antigen Avoidance
Authors: Piacentini G.L. , Guerresi S. , Kantar A. , Lubrano L. , Olivieri F. , Boner A.L. , Peroni D.G.
Published: January 2017

IgG4 have been hypothesized to act as blocking antibodies capable of preventing IgE-mediated effector cell triggering. This study aims to evaluate the changes in IgG4 in children during a period of natural antigen avoidance. Serum IgE and IgG4 were evaluated in a group of asthmatic children, aged between 7 and 17 years, admitted to the residential house Istituto Pio XII (Misurina, BL, Italy), located at 1,756 m, in a natural model of antigen avoidance. All the patients were skin prick test positive to at least two of the following allergens: Dermatophagoides pteronissynus, Dermatophagoides farinae, cat epithelium, timothy grass pollen and Parietaria pollen. During the 180 days of hospitalization, serum specific IgE and IgG4 were measured six times. A significant decrease (p<0.05) in serum specific IgE to house dust mite and pollen allergens was observed; by contrast, no significant variations were shown by IgG4 and IgG4/IgE ratio. No significant relationship was found between serum specific IgE, IgG4 and IgG4/IgE ratio variations and the re-exposure to house dust mite allergens during the Christmas holidays. A positive correlation between specific IgE and specific IgG4 was observed at each considered time (T0: r=0.57, p=0.08; T1: r=0.85, p=0.001; T3: r=0.76, p=0.01). The positive correlation between specific IgE and specific IgG4, enduring throughout the entire time of study, suggests a relationship between these classes of immunoglobulins.
Exhaled Nitric Oxide as a Marker of Lung Involvement in Crohn's Disease
Authors: Malerba M. , Ragnoli B. , Buffoli L. , Radaeli A. , Ricci C. , Lanzarotto F. , Lanzini A.
Published: January 2017

Crohn's Disease is an inflammatory bowel disease associated with a variety of systemic manifestations, including large and small airway involvement. The latter is most often a subclinical one, and requires expensive and invasive diagnostic approaches. Nitric Oxide (NO) can be detected non-invasively in the exhaled air (eNO) and be considered as a surrogate marker of airway inflammation. eNO tested at multiple expiratory flows can be used to distinguish the alveolar concentration of NO (CalvNO) from the total amount of fractional eNO (FeNO). The aim of our study is to compare FeNO and concentration of alveolar nitric oxide (CalvNO) levels and to assess their relationship with pulmonary involvement in Crohn's patients differing in clinical stage and therapeutic regimens versus a group of healthy subjects. Thirty Crohn's patients not showing clinical evidence of pulmonary diseases and 21 non-smoking, non-atopic healthy controls were enrolled. FeNO (14.9±10.2 ppb vs 10.1±6.3 ppb, p=0.049) and CaIvNO (4.4±2.2 ppb vs 2.6±1.9; p=0.006) values were found to be significantly higher in Crohn's patients than in healthy controls. Both FeNO and CaIvNO correlated positively with the Crohn's Disease Activity Index. In conclusion, our results for FeNO and CaIvNO confirm the presence of subclinical pulmonary involvement in Crohn's disease. eNO measurement may be of clinical value in the follow-up of Crohn's patients.
Regulatory T-Cell Modulation by Green Tea in Chronic Lymphocytic Leukemia
Authors: D'arena G. , Simeon V. , De Martino L. , Statuto T. , D'auria F. , Volpe S. , Deaglio S. , Maidecchi A. , Mattoli L. , Mercati V. , Musto P. , De Feo V.
Published: January 2017

Regulatory T cells (Tregs) are considered to be key immunomodulatory cells of the immune system and are increased in chronic lymphocytic leukemia (CLL). Rai stage 0 identifies patients with early stage CLL for which there is no effective intervention at the present time and a “wait and see” policy is usually adopted. Some biological and clinical studies have reported that green tea constituents, such as epigallocatechin-gallate (EGCG), have antitumor effects on hematologic malignancies including CLL. We report data on a clinical trial in which green tea extracts were given orally to 12 patients with stage 0 CLL and 12 healthy subjects. Ten patients and 10 controls completed the 6-month scheduled therapy. Two patients and 2 controls stopped therapy within 1 month because of tachycardia and epigastralgia. Eight out 10 evaluable patients (80%) showed a reduction of lymphocytosis and absolute number of circulating Tregs, as well. One patient (10%) had a stabilization of lymphocytosis and a reduction of Tregs, and 1 patient (10%) showed an increase of both lymphocytosis and Tregs. Only the non-responding patient progressed after 5 months from the end of green tea administration and chemotherapy was given. Interestingly, both IL-10 and TGF-β serum levels declined throughout the green tea intake period, in both patients and controls. These data seem to indicate that green tea is able to modulate circulating Tregs in CLL patients with early stage of the disease. This can result in the control of lymphocytosis as well as in the prevention of disease progression.
The Role of Nasal Cytology in the Management of Inferior Turbinate Hypertrophy
Authors: Cassano M. , Del Giudice A. Maselli , Russo G. , Russo L. , Ciprandi G.
Published: January 2017

Inferior turbinate hypertrophy (ITH) is the main cause of nasal obstruction symptom. This study aimed at investigating whether a particular cellular pattern could be a predictive factor for failure of medical treatment for ITH in patients with rhinitis. Globally, 258 patients with chronic nasal obstruction due to ITH were evaluated by: visual analogue scale assessment of symptoms, skin prick tests, fiber-endoscopy, active anterior rhinomanometry, and nasal cytology. All patients were treated with drugs for 3 months and then re-evaluated. The symptom improvement depended on the different cellular pattern. There was improvement in: 54 (51.4%) patients with allergic rhinitis, 72 (69.2%) with non-allergic rhinitis with neutrophils (NARNE), 15 (42.8%) with non-allergic rhinitis with eosinophils (NARES), and 9 (64.3%) with non-allergic rhinitis with mast cells/non-allergic rhinitis with eosinophils and mast cells (NARMA/NARESMA). The non-responders (108; 41.9%) were therefore directed towards surgical treatment. Both patients with allergic rhinitis and patients affected by NARES had a higher failure rate to medical treatment compared with NARMA and NARESMA groups (p<0.01). In conclusion, elevated number of eosinophils, in the nasal secretion of both allergic (allergic rhinitis) and non-allergic (NARES) patients with ITH, can be associated to a higher medical treatment failure rate.
A Survey of the Use of Community Treatment Orders by Psychiatrists in Saskatchewan
Authors: O'Reilly RL , Keegan DL , Elias JW
Published: January 2017

Objective:

To determine the pattern of use and satisfaction with community treatment orders (CTOs) by psychiatrists in Saskatchewan.

Method:

All psychiatrists who were licensed to practise by the College of Physicians and Surgeons of Saskatchewan were surveyed by mail in July 1998.

Results:

The response rate was 72%. The responding psychiatrists were treating 14 patients on CTOs at the time of the survey. Psychiatrists were generally satisfied with the operation of CTOs, though many felt that commitment of only of 3 months before mandatory renewal was too short a period. Almost one-half expected their use of treatment orders to increase.

Conclusion:

While CTOs are used for only a small number of patients in Saskatchewan, they are a clinically useful tool for dealing with a group of otherwise difficult-to-treat patients.
The Future of Cultural Psychiatry: An International Perspective
Authors: Kirmayer Laurence J , Minas Harry
Published: January 2017

Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.
Effective Interventions for Children and Adolescents with Conduct Disorder
Authors: Frick Paul J
Published: January 2017

Many different types of interventions have been used to treat children and adolescents with conduct disorder (CD). Unfortunately, most have had very limited effectiveness and, in some cases, have even shown iatrogenic effects. A primary reason for this limited effectiveness has been the failure of most treatments to directly address the causal mechanisms implicated in the development of CD. A few exceptions that have based interventions on the available research and that have proven to have some efficacy in reducing the conduct problems in youths with CD are reviewed. More important, a model for intervention is presented. This model emphasizes that interventions for youths with CD need to be comprehensive. That is, they need to take into account the myriad factors both within the child and within his or her social context that can cause and maintain CD symptoms. Further, interventions need to be individualized; they need to take into account the different pathways along which children may develop CD. Two intervention approaches that are consistent with these principles are reviewed, as are important directions for advancing treatment technology for youths with this disorder.
Alcohol Consumption and Major Depression: Findings from a Follow-up Study
Authors: Wang JianLi , Patten Scott B
Published: January 2017

Objective:

To investigate whether alcohol consumption predicts major depressive disorder episodes (MDEs) in the general population.

Method:

The respondents without depression (n = 12 290) in the longitudinal cohort of the Canadian National Population Health Survey (NPHS) were classified into cohorts based on any drinking, frequency of drinking, maximum number of drinks on a maximal drinking occasion, and average daily alcohol consumption, based on data collected in the 1994–1995 survey. Major depression frequency 2 years later, in 1996–1997, was evaluated and compared across drinking categories.

Results:

The respondents who reported any drinking, drinking daily, having more than 5 drinks on a maximal drinking occasion, and having more than 1 drink daily on average, did not have an elevated risk of major depression. A trend in the data suggested that women who reported having more than 5 drinks on a maximal drinking occasion might be at a higher risk of major depression. No evidence of confounding or effect modification by demographic, psychological, and clinical variables was found.

Conclusion:

In a general population sample, alcohol consumption levels were not associated with major depression. Having more than 5 drinks on a maximal drinking occasion, however, may be associated with an increased risk of major depression among women. Extreme patterns of alcohol consumption, which tend to characterize clinical samples, are associated with depression. These patterns of drinking, however, are relatively uncommon in the general population, and the current analysis may have lacked power to detect these associations.
Comorbidity of Major Depression with Substance Use Disorders
Authors: Currie Shawn R , Patten Scott B , Williams Jeanne VA , Wang JianLi , Beck Cynthia A , El-Guebaly Nady , Maxwell Colleen
Published: January 2017

Objectives:

In the Canadian adult population, we aimed to 1) estimate the 12-month prevalence of major depressive disorder (MDD) in persons with a diagnosis of harmful alcohol use, alcohol dependence, and drug dependence; 2) estimate the 12-month prevalence of harmful alcohol use, alcohol dependence, and drug dependence in persons with a 12-month and lifetime diagnosis of MDD; 3) identify socioeconomic correlates of substance use disorder–major depression comorbidity; 4) determine how comorbidity impacts the prevalence of suicidal thoughts; and 5) determine how comorbidity affects mental health care used.

Methods:

We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).

Results:

The 12-month prevalences of MDD in persons with a substance use disorder (SUD) were 6.9% for harmful alcohol use (95% confidence interval [CI], 5.2 to 8.5), 8.8% for alcohol dependence (95%CI, 6.6 to 11.0), and 16.1% for drug dependence (95%CI, 10.3 to 21.9). Conversely, the 12-month prevalences of harmful alcohol use, alcohol dependence, and drug dependence in persons with a 12-month diagnosis of MDD were 12.3% (95%CI, 9.4 to 15.2), 5.8% (95%CI, 4.3 to 7.3), and 3.2% (95%CI, 2.0 to 4.4), respectively. Regression modelling did not identify any socioeconomic predictors of SUD–MDD comorbidity. Substance dependence and MDD independently predicted higher prevalence of suicidal thoughts and mental health treatment use.

Conclusions:

SUDs cooccur with a high frequency in cases of MDD. Clinicians and mental health services should consider routine assessment of SUDs in depression patients.
A Controlled Study of Alexithymia in Adolescent Patients with Persistent Somatoform Pain Disorder
Authors: Burba Benjaminas , Oswald Ronald , Grigaliunien Viktorija , Neverauskiene Simona , Jankuviene Odeta , Chue Pierre
Published: January 2017

Objective:

To study the differences in levels of alexithymia, depression, and anxiety between a sample of adolescents diagnosed with ICD-10 persistent somatoform pain disorder (defined by the DSM-IV as a pain disorder associated with psychological factors) and healthy adolescent control subjects.

Method:

Using the Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale, we investigated the point prevalence of alexithymia, anxiety, and depression among adolescents aged 12 to 17 years, with somatoform disorder, who were hospitalized in Kaunas Medical University Hospital, Lithuania ( n =120), and a healthy control group ( n = 60) of adolescents aged 12 to 17 years, who were randomly selected from 6 schools in Kaunas, Lithuania.

Results:

The rate of alexithymia in adolescents with somatoform disorder was 59%, which was significantly higher than that in healthy control subjects (1%, P < 0.001). Similarly, the rate of anxiety was significantly higher in the patient group (62%), compared with control subjects (15%, P < 0.001). The rate of depression was low in both groups and did not differ significantly between groups.

Conclusions:

Adolescents with somatoform disorder have higher levels of alexithymia and anxiety than healthy adolescent control subjects, but adolescents with somatoform disorder and adolescent control subjects do not have significantly different levels of depression.
Chronic Disease Management for Depression in Primary Care: A Summary of the Current Literature and Implications for Practice
Authors: Kates Nick , Mach Michele
Published: January 2017

Objective:

To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada.

Methods:

We reviewed all RCTs conducted between 1992 and 2006, including other reviews and analyses of pooled data. Using various search terms, we searched PsycINFO, Cinahl (1982 to May 2005), MEDLINE (1995 to 2005), EMBASE, The Cochrane Library, and PubMed.

Results:

There is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care. Most studies have demonstrated improved outcomes in terms of symptom reduction, relapse prevention, functioning in the community, adherence to treatment, community and workplace involvement, and satisfaction with care received.

Conclusions:

Primary care practices need to examine how they can incorporate different concepts and models for managing depression. Components to consider include case registries, care managers or coordinators, treatment algorithms, follow-up and monitoring after a treated episode, care and relapse prevention plans, visits by psychiatrists, and training and ongoing education for all providers.
Health Service Patterns Indicate Potential Benefit of Supported Self-Management for Depression in Primary Care
Authors: Bilsker Dan , Goldner Elliot M , Jones Wayne
Published: January 2017

Objective:

To examine health service delivery in a Canadian province (British Columbia) to consider how Canadian health care services might be developed to best address the large number of individuals with mildly to moderately severe depressive illnesses.

Method:

We used provincial administrative data to describe patterns of medical services provided to individuals suffering from depression during 3 different time periods (1991–1992, 1995–1996, and 2000–2001) and to determine the frequency with which depression patients receive treatment from primary care physicians and psychiatrists. We then used these findings to consider the feasibility and potential applicability of the various approaches that have been described to decrease the burden of disease related to depression.

Results:

In the fiscal year 1991–1992, the “treated prevalence” rate was 7.7%; in 1995–1996, it was 8.7%; and in 2000–2001, it was 9.5%. In each cohort over the 10-year period, the proportion of individuals who received a diagnosis of depression and who were then treated by primary care physicians alone (no psychiatric services were provided) remained constant at 92%.

Conclusions:

Supported self-management is identified as a promising intervention that could be integrated into primary health care within the context of the Canadian health care system. It constitutes a feasible and practical approach to enhance the role of family physicians in the delivery of services to individuals with milder forms of depression and promotes the active engagement of individuals in their recovery and in prevention of future episodes.
Psychiatric Advance Directives and the Right to Refuse Treatment in Canada
Authors: Ambrosini Daniel L , Crocker Anne G
Published: January 2017

Objective:

To provide a Canadian perspective on psychiatric advance directives (PADs) and assess whether these documents can be implemented as an adjunct to mental health services to empower people with mental illness.

Method:

We reviewed Canadian jurisprudence over the past 15 years related to people with mental illness and the right to refuse medical treatment. Provincial mental health legislation is explained to discern PADs' possible effect in Canada.

Results:

Evidence is accumulating that legal and mental health professionals see PADs as useful documents to promote patient autonomy. Canadian jurisprudence, mental health legislation, and psychological research suggest that PADs could be implemented by legal and mental health professionals. Mental health legislation has the power to prohibit or facilitate choices regarding the right to refuse medical treatment.

Conclusions:

This review suggests the need for greater empirical research to be conducted in Canada to determine stakeholders' perceptions of whether PADs could successfully be implemented and their interaction with legislation.
Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy
Authors: Bellino Silvio , Rinaldi Camilla , Bogetto Filippo
Published: January 2017

Objective:

Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD.

Method:

Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant.

Results:

Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P.

Conclusions:

Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.
Efficacy and Tolerability of Antidepressants for Treatment of Depression in Coronary Artery Disease: A Meta-Analysis
Authors: Dowlati Yekta , Herrmann Nathan , Swardfager Walter L , Reim Elyse K , Lanctôt Krista L
Published: January 2017

Objective:

Depression occurs in 18% to 45% of patients with coronary artery disease (CAD) where it is associated with an increased risk of acute coronary events and mortality. Our objective was to quantitatively summarize the data on the efficacy and tolerability of antidepressant (AD) treatment for depression in CAD.

Methods:

We performed a meta-analysis of randomized, placebo-controlled, double-blind trials with a database search of the English literature (to March 2008) and manual search of references.

Results:

Four clinical trials with ADs (mirtazapine, citalopram, fluoxetine, and sertraline) of a 9- to 24-week duration involving 798 subjects (402 ADs, 396 placebo) with documented CAD and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for depression were included. ADs were superior to placebo for decreasing Hamilton Depression Rating Scale (HDRS) scores (402 ADs, 396 placebo; weighted mean difference 1.41, 95% CI 0.53 to 2.29, P = 0.002) and Beck Depression Inventory (BDI) scores (373 ADs, 369 placebo; weighted mean difference 2.27, 95% CI 0.60 to 3.94, P = 0.008). The proportion of patients (216 ADs, 213 placebo) who responded (a 50% or more reduction in HDRS scores, OR 1.72, 95% CI 1.17 to 2.54) and remitted (HDRS of 8 or less at final assessment, OR 1.80, 95% CI 1.18 to 2.74), were also significantly higher with AD, compared with placebo, with no significant differences between the 2 groups for overall dropouts (OR 0.84, 95% CI 0.42 to 1.68) or dropout owing to adverse events (OR 1.30, 95% CI 0.75 to 2.25). The combined studies were homogeneous except for overall dropout rate ( P = 0.01).

Conclusion:

Treatment with ADs for depression in CAD results in significant therapeutic effects without substantially increased rates of discontinuation.
Adults with Mood Disorders Have an Increased Risk Profile for Cardiovascular Disease within the First 2 Years of Treatment
Authors: Taylor Valerie , McKinnon Margaret C , Macdonald Kathryn , Jaswal Gurpreet , MacQueen Glenda M
Published: January 2017

Objectives:

People with bipolar disorder (BD) and major depressive disorder (MDD) are at risk for premature death from various physical illnesses. A large component of this risk may be accounted for by an elevated risk of metabolic syndrome (MeS) and coronary heart disease (CHD). The objective of our study was to examine patients' physical health prior to first treatment and over 2 years of follow-up.

Methods:

Ten-year risk for CHD and incidence of MeS were calculated for newly diagnosed patients with MDD ( n = 30) and BD ( n = 24) at baseline and over a 2-year follow-up. Age and sex-matched control subjects were obtained from the National Health and Nutrition Examination Survey III dataset.

Results:

At baseline, 11.2% of patients met diagnostic criteria for MeS and this increased to 16.8% at follow-up. Women had higher rates of MeS but rates were similar across diagnosis. There was a significant increase within all MeS criteria. The 10-year CHD risk was low for patients at baseline and follow-up but increased across the follow-up period. Changes in CHD and MeS risk were not associated with a specific type of pharmacotherapy, as all medication classes appeared to increase risk.

Conclusion:

Prior to treatment, MeS and CHD risk rates for patients were similar to the general population, but their risk of CHD increased appreciably.
One-Year Incidence of Psychiatric Disorders in Quebec's Older Adult Population
Authors: Préville Michel , Boyer Richard , Vasiliadis Helen-Maria , Grenier Sébastien , Voyer Philippe , Hudon Carol , Streiner David L , Cairney John , Brassard Joëlle ,   Study Scientific Committee of the ESA
Published: January 2017

Objective:

To examine the incidence of psychiatric disorders in the Quebec older adult population.

Method:

Data from the Enquěte sur la Santé des Aînés (ESA) study conducted in 2005 to 2008 using a representative sample (n = 2784) of community-dwelling adults aged 65 years and older were used.

Results:

The ESA study's results indicate that 12.0% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. Our results also indicate that the 12-month rate of incident cases of DSM-IV disorders was 6.2%. The proportion of incident cases was higher for the depression group (3.4%) than for the anxiety disorders group (2.3%). The results showed that the probability to develop an incident psychiatric condition after 1 year of follow-up, compared with the noncases group, varied according to sex (OR 2.18; 95% CI 1.39 to 3.44). Our results also showed that the number of chronic health problems (OR 1.20; 95% CI 1.09 to 1.33) and the change in the number of chronic health problems reported between the baseline and the second interview (OR 1.14; 95% CI 1.01 to 1.30) increased the probability to be an incident case at Time 2. The results indicated that social support did not influence the probability to develop a psychiatric disorder.

Conclusion:

These results indicate that sex and physical health status have an impact on the incidence of DSM-IV disorders in the elderly. This finding underscores the need for improved recognition and treatment of psychiatric disorders associated with physical illness in the older population.
Creativity and Psychopathology: A Shared Vulnerability Model
Authors: Carson Shelley H
Published: January 2017

Creativity is considered a positive personal trait. However, highly creative people have demonstrated elevated risk for certain forms of psychopathology, including mood disorders, schizophrenia spectrum disorders, and alcoholism. A model of shared vulnerability explains the relation between creativity and psychopathology. This model, supported by recent findings from neuroscience and molecular genetics, suggests that the biological determinants conferring risk for psychopathology interact with protective cognitive factors to enhance creative ideation. Elements of shared vulnerability include cognitive disinhibition (which allows more stimuli into conscious awareness), an attentional style driven by novelty salience, and neural hyperconnectivity that may increase associations among disparate stimuli. These vulnerabilities interact with superior meta-cognitive protective factors, such as high IQ, increased working memory capacity, and enhanced cognitive flexibility, to enlarge the range and depth of stimuli available in conscious awareness to be manipulated and combined to form novel and original ideas.
Concept de soi physique et adolescents présentant une déficience intellectuelle: Effets de l'âge, du sexe et de la catégorie de poids
Authors: Bégarie Jérôme , Maïano Christophe , Ninot Grégory
Published: January 2017

Objectif:

Etudier les effets de l'âge, du sexe, du poids et de leurs interactions sur l'estime globale de soi (EGS) et le concept de soi physique d'adolescents présentant une déficience intellectuelle (DI).

Méthode:

Un échantillon de 353 adolescents DI, âgés de 12 à 18 ans, a participé à cette étude. La version très courte de l'inventaire du soi physique pour adolescents DI (communément appelée PSI-VSF-ID) a été utilisée pour évaluer l'EGS et les perceptions du soi physique (la valeur physique perçue [VPP], la compétence sportive [CS], la condition physique, l'apparence physique et la force).

Résultats:

Les analyses de covariances multivariées montrent: (i) des niveaux d'EGS et de soi physique inférieurs (à l'exception de la VPP) chez les filles par rapport aux garçons; (ii) une diminution des scores d'EGS, de VPP, de CS et d'apparence physique perçue (APP) au cours de l'adolescence; (iii) des scores d'EGS, de VPP, et d'APP inférieurs chez les adolescents obèses comparés à leurs pairs en surpoids ou de poids normal; et (iv) que les filles obèses présentent des scores d'APP inférieurs à ceux des autres adolescents.

Conclusion:

Les résultats obtenus pour le sexe et l'âge sont quasiment conformes à ceux de la littérature en population générale. En revanche, ils s'en éloignent pour l'effet principal de la catégorie de poids.
Supported Self-Management: A Simple, Effective Way to Improve Depression Care
Authors: Bilsker Dan , Goldner Elliot M , Anderson Ellen
Published: January 2017

Objectives:

To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system.

Method:

SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients.

Results:

SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers.

Conclusion:

The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.
Stepped Care: A Method to Deliver Increased Access to Psychological Therapies
Authors: Richards David A
Published: January 2017

Objective:

To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation.

Method:

Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing high-volume services for common mental health problems are derived from this experience.

Results:

Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidence-based treatments, access to telephony, and smart patient management informatics systems.

Conclusions:

Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems.
Clinical Course and Personality in Reactive, Compared with Nonreactive, Delusional Disorder
Authors: Pillmann Frank , Wustmann Tobias , Marneros Andreas
Published: January 2017

Objective:

Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases,10thRevision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years.

Method:

As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations.

Results:

Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures.

Conclusions:

Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients.
A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors before and after Introduction of Generic Equivalents
Authors: Bolton James M , Dahl Matthew , Sareen Jitender , Enns Murray W , Leslie William D , Collins David M , Alessi-Severini Silvia
Published: January 2017

Objective:

Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents.

Method:

Administrative health and census data were used to examine the rates of use of all 6 SSRIs from 1996 to 2009 in the province of Manitoba (population of 1.2 million). The primary outcome measure was a comparison of the rates of use in the pre- and post-generic periods, using generalized estimating equations. Secondary analyses were stratified by specialty of physician prescriber.

Results:

Escalating rates of use of branded SSRIs in the pre-generic period significantly decreased after generic versions became available (all Ps < 0.001). Incident use of sertraline and paroxetine continued to decrease throughout the post-generic period (1.5% and 1.9% quarterly decreasing rates, respectively). During the years when generic sertraline, fluoxetine, and fluvoxamine were available, their use declined while branded paroxetine and citalopram use continued to increase. Use of branded citalopram, sertraline, and paroxetine prescribed by general practitioners (GPs) increased at rates significantly higher than when prescribed by psychiatrists (all Ps < 0.001).

Conclusion:

The introduction of cheaper generic alternatives of SSRIs paradoxically resulted in their use diminishing rather than increasing. With the exception of escitalopram, branded SSRIs tended to be preferentially used, compared with available less expensive generic SSRIs. These patterns were more pronounced for prescriptions by GPs.
The Canadian Survey of Standards of Electroconvulsive Therapy Practice: A Call for Accreditation
Authors: Chan Peter , Graf Peter , Enns Murray , Delva Nicholas , Gilron Ian , Lawson J Stuart , Gosselin Caroline , Patry Simon , Milev Roumen , Jewell Mark , Martin Barry
Published: January 2017

Objective:

To report the results of the policies and procedures subsection of a nationwide electroconvulsive therapy (ECT) survey: Canadian Electroconvulsive Therapy Survey/Enquête canadienne sur les electrochocs.

Method:

We contacted 1273 registered health care institutions in Canada and invited the 175 centres identified as providing ECT to complete a comprehensive postal questionnaire. Nonresponding sites were repeatedly reminded and then eventually contacted by telephone.

Results:

Sixty-one per cent (107/175) of the institutions returned survey questionnaires. Most (84%) of the responding sites have a written general policy for the delivery of ECT. Only 27% of respondents indicated having some written policy for managing concurrent medications during ECT, and practice was quite variable regarding individual psychotropics. Informed consent was usually obtained by the attending physician (88%), and most sites indicated conveying information before ECT by using interdisciplinary and multimodal means. Almost all of the sites (93%) discharged outpatients with accompaniment home by a responsible adult.

Conclusions:

It is reassuring to note that general ECT policies and procedures do exist in most Canadian ECT centres. Wider variations in practice were observed in several areas, such as the elements of consent provided to patients and families, the use of concurrent medications, and the degree of supervision on discharge home after outpatient ECT. However, adherence to these policies was not captured by the results of the survey. Based on experiences in other countries, establishing a Canadian ECT accreditation service could further improve standards of practice.
Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay
Authors: Aflalo Marc , Soucy Nathalie , Xue Xiaoqing , Colacone Antoinette , Jourdenais Emmanuelle , Boivin Jean-François
Published: January 2017

Objective:

To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.

Methods:

This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.

Results:

A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%).

Conclusions:

Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
Personality Dimensions and Depression: Review and Commentary
Authors: Enns Murray W , Cox Brian J
Published: January 2017

Objectives

The relationship between dimensionally assessed personality and the onset, features, and course of depressive illness will be critically examined and considered in relation to 4 hypothesized models: predisposition or vulnerability; pathoplasty; complication or scar; and spectrum or continuity.

Method

Studies that have used clinically depressed adult patients to explore the relationship between personality dimensions and depression will be reviewed.

Results

Higher-order personality factors that have shown a significant and consistent association with major depressive illness include neuroticism, extraversion (negative relationship), and the factors of Cloninger's Tridimensional Personality Model. Neuroticism appears to be the most powerful predictor of depression. Lower-order factors showing a significant and consistent relationship with depressive illness include dependency, self-criticism, obsessionality, and perfectionism. The links between depression and dependency and self-criticism have the strongest empirical support.

Conclusions

Several personality dimensions are significantly associated with depressive illness, but the evidence that unequivocally demonstrates a true personality predisposition for depression is modest. Measures of personality may prove to be clinically useful for treatment selection.
Placebos in Clinical Trials of Psychotropic Medication
Authors: Addington Donald , Williams Richard , Lapierre Yvon , El-Guebaly Nady
Published: January 2017

This paper represents the position of the Canadian Psychiatric Association on the ethical and scientific issues related to the use of placebos in the evaluation of new psychotropic drugs. The position taken by the Association is that new psychotropic medications must be shown to be effective and must be weighed against the best current interventions. Placebo controls may be appropriate under certain circumstances, even when an established intervention is effective. These include situations in which placebo response rates are high, variable, or close to response rates for effective therapies. Placebo controls arc also appropriate when established interventions cany a high risk of side effects or are effective against only certain symptoms of the disorder.
Évaluation du potentiel de ressources communautaires en santé mentale
Authors: Wallot H
Published: January 2017

Objectifs:

Dans le cadre d'une réflexion sur l'organisation régionale des services de santé mentale, décrire et évaluer un modèle parallèle de services de santé mentale non professionnels de type centre de jour.

Méthodologie:

Sujets étudiés: 129 d'un échantillon stratifié de 3 organismes communautaires d'une sous-région surtout urbaine du Québec. La collecte des données s'est faite en plusieurs étapes auprès de 3 types de répondants: l'usager, l'équipe clinique et l'organisme communautaire. Outils: le GAS, le MRSS et un questionnaire visant à établir un profil sociodémographique, un profil de santé (diagnostic, médicaments, hospitalisations, suivi externe), et l'EDBES qui évalue la présence ou l'absence du besoin de 25 services de santé mentale et l'utilisation de ceux-ci au cours du dernier mois.

Résultats:

Les usagers sont majoritairement des personnes souffrant de troubles graves et persistants. Les organismes communautaires répondent à 40% des besoins.

Conclusion:

Les 3 organismes jouent un rôle prépondérant au sein des services. On pourrait toutefois améliorer leur apport en accroissant d'une part les subventions allouées, afin de les doter d'un personnel stable et de prolonger les heures d'accueil, et d'autre part, augmenter la coordination, ainsi que la coopération avec les équipes cliniques traitantes.