bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Leptin and Cytokines Involved in Body Weight Gain during Treatment with Antipsychotic Drugs?
Authors: Baptista Trino , Beaulieu Serge
Published: July 2017

Objective:

To critically review published literature on the causal association between leptin, cytokines, and excessive body weight gain (BWG) induced by antipsychotic drugs (APs).

Methods:

We completed a Medline search using the words leptin, cytokines, antipsychotic drugs, neuroleptics, psychotropic drugs, weight gain, and obesity. We also included our empirical research on this topic in the discussion. We examined the relation between leptin, cytokines (mainly tumour necrosis factor alpha [TNF-α] and its soluble receptors), and AP-induced BWG, using the biological sciences' current theories of causality.

Results:

In the general field of weight regulation, there is scarce experimental evidence that leptin or TNF-α by themselves can induce obesity. Serum levels of leptin and TNF-α rather increase simultaneously as BWG occurs. This has also been reported during AP-induced BWG, with the equivocal exception of a study with clozapine. Some researchers have suggested that the absence of the expected correlation between leptin and body mass index (BMI) or serum insulin levels, and the lack of sex-related differences in leptin levels in AP-treated patients, may point to a causal relation. This contention requires more experimental support. In addition, future clinical studies must carefully control for sex and BMI.

Conclusions:

No conclusive evidence has been provided that leptin or TNF-α may induce obesity either in drug-free subjects or in AP-treated patients. In most cases, the elevated serum levels of these hormones appear to be a consequence rather than a cause of obesity. That does not mean that such an elevation is innocuous, since it may impair blood pressure and also carbohydrate and lipid metabolism regulation. Hence, all efforts should be made to prevent or attenuate BWG during treatment with APs.
Progress against Major Depression in Canada
Authors: Patten Scott B
Published: July 2017

Background:

Generally, public health strategies for major depression have focused on case-finding, public and professional education, and disease-management strategies. In principle, increased rates of treatment utilization and improved treatment outcomes should lead to improved mental health at the population level. Progress of this sort, however, has been difficult to confirm.

Methods:

The National Population Health Survey (NPHS) is a large-scale longitudinal study of a representative sample drawn from the Canadian population. To date, Statistics Canada has released data from 3 NPHS cycles: 1994–1995, 1996–1997, and 1998–1999. Treatment utilization and major depression measures were employed in the NPHS survey, providing a unique source of longitudinal Canadian data. In this study, major depression point prevalence (defined using a predictive instrument for annual major depressive episode [MDE] prevalence and responses from a distress scale) and associated treatment utilization were evaluated over time.

Results:

Between 1994–1995 and 1995–1996, the proportion of persons with depression receiving antidepressant treatment increased dramatically, from 18.2% (12.3% to 22.1%) in 1994–1995 to 32.6% (23.0% to 42.2%) in 1998–1999. Point prevalence of major depression was 2.4%, 1.8%, and 1.9% in the 3 NPHS iterations.

Conclusions:

Data from the NPHS suggest public health progress against major depression in Canada. More people with major depression in Canada are receiving treatment, and these changes may have been associated with improved population health status. However, both random variation and extraneous societal factors could account for the observed trends in prevalence. It is impossible to relate changes in utilization directly to population health status using the NPHS data.
Epidemiologic Studies of Trauma, Posttraumatic Stress Disorder, and other Psychiatric Disorders
Authors: Breslau Naomi
Published: July 2017

This paper reviews recent epidemiologic studies of posttraumatic stress disorder (PTSD) in the general population. Estimates of the prevalence of exposure to traumatic events vary with the method used to ascertain trauma exposure and the definition of the stressor criterion. Changes in the DSM-IV definition of “stressor” have increased the number of traumatic events experienced in the community that can be used to diagnose PTSD and thus, the number of PTSD cases. Risk factors for PTSD in adults vary across studies. The 3 factors identified as having relatively uniform effects are 1) preexisting psychiatric disorders, 2) a family history of disorders, and 3) childhood trauma. In civilian populations, women are at a higher risk for PTSD than are men, following exposure to traumatic events. Most community residents have experienced 1 or more PTSD-level traumas in their lifetime, but only a few succumb to PTSD. Trauma victims who do not succumb to PTSD are not at an elevated risk for the subsequent onset of major depression or substance use disorders, compared with unexposed persons.
PTSD and the Experience of Pain: Research and Clinical Implications of Shared Vulnerability and Mutual Maintenance Models
Authors: Asmundson Gordon JG , Coons Michael J , Taylor Steven , Katz Joel
Published: July 2017

It is common for individuals with symptoms of posttraumatic stress disorder (PTSD) to present with co-occurring pain problems, and vice versa. However, the relation between these conditions often goes unrecognized in clinical settings. In this paper, we describe potential relations between PTSD and chronic pain and their implications for assessment and treatment. To accomplish this, we discuss phenomenological similarities of these conditions, the prevalence of chronic pain in patients with PTSD, and the prevalence of PTSD in patients with chronic pain. We also present several possible explanations for the co-occurrence of these disorders, based primarily on the notions of shared vulnerability and mutual maintenance. The paper concludes with an overview of future research directions, as well as practical recommendations for assessing and treating patients who present with co-occurring PTSD or chronic pain symptoms.
Antidepressants and the Risk of Breast Cancer
Authors: Kurdyak Paul A , Gnam William H , Streiner David L
Published: July 2017

Background:

A recent national newspaper article highlighted 2 published research papers that suggest an association between antidepressants and an increased risk of breast cancer. The authors of the 2 papers recommend switching or avoiding the antidepressants implicated in their studies.

Method:

We critically review these papers and, based on our review, consider what clinical practices, if any, should be modified as a result of their findings.

Results:

Both articles are based upon case–control studies. In the first paper, the authors examine the relation between tricyclic antidepressants (TCAs) and an increased risk of breast cancer. The study upon which the paper is based has several design strengths, and the paper presents findings that have biological plausibility. However, the conclusions are weakened by the lack of accounting for potential confounding factors and multiple statistical comparisons. In the second paper, the authors combined survey and administrative data to examine the association between antidepressant use and breast cancer risk. The press article notwithstanding, the second paper does not find a significant association between specific antidepressants and an increased risk of breast cancer, after adjusting for potential confounders. There are significant methodological limitations to the research upon which the paper is based.

Conclusions:

The finding of an association between TCA use and increased risk of breast cancer merits further testing using stronger research designs. However, because of the methodological concerns described, the 2 papers we review provide insufficient evidence to guide practitioners to change clinical practice.
Are There Cognitive and Behavioural Approaches Specific to the Treatment of Pathological Gambling?
Authors: Tavares Hermano , Zilberman Monica L , el-Guebaly Nady
Published: July 2017

Objective:

Treatment approaches for pathological gambling have been modelled after preexisting substance addiction models. This paper reviews cognitive-behavioural models in a search for original insights that are specific to gambling treatment.

Method:

A computerized search of major health care databases (Medline and PsycINFO) was performed.

Results:

New cognitive-behavioural approaches to the treatment of pathological gambling provide 3 original additions to the traditional multimodal treatment of addictions: cognitive restructuring, in vivo exposure, and imaginal desensitization. Other cognitive-behavioural techniques, such as relapse prevention, problem solving, and social skill training, are shared by gambling treatment and addictions treatment.

Conclusions:

When treating pathological gamblers, clinicians must consider introducing techniques to address cognitive distortions related to gambling. Also, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by such cues. The blending of these new techniques into a multimodal addiction treatment potentially balances the rational and external orientation of the cognitive-behavioural approach with interpersonal and introspective components of the traditional addiction treatment.
The Thought Disorder Questionnaire
Authors: Waring Edward M , Neufeld RWJ , Schaefer B
Published: July 2017

Objective:

To describe the development of the Thought Disorder Questionnaire (TDQ), including data on reliability and validity, and to explain the questionnaire's feasibility and diagnostic accuracy.

Methods:

The TDQ has 6 scales, each with 10 items (on a scale from 0 [for never] to 4 [for always]). The 6 scales measure content of thought, control of thought, orientation, perception, fantasy, and symptoms.

Results:

The TDQ is a reliable 60-item, self-report questionnaire that measures the quantity and quality of disordered thinking in patients with mental disorders. It has established reliability and validity.

Conclusion:

The TDQ's clinical and research utility remains to be determined.
Phenomenology and Comorbidity of Dysthymic Disorder in 100 Consecutively Referred Children and Adolescents: Beyond DSM-IV
Authors: Masi Gabriele , Millepiedi Stefania , Mucci Maria , Pascale Rosa Rita , Perugi Giulio , Akiskal Hagop S
Published: July 2017

Objective:

Diagnostic criteria and nosological boundaries of juvenile dysthymic disorder (DD) are underresearched. Two different sets of diagnostic criteria are still discussed in the DSM-IV, the first giving major weight to somatic and vegetative symptoms and the second, included in the appendix, to more affective and cognitive symptoms. The aim of this study was to describe prototypical symptomatology and comorbidity of DD, according to DSM-IV criteria, in a consecutive series of referred children and adolescents, as a function of age and sex.

Method:

One hundred inpatients and outpatients (36 children and 64 adolescents, 57 males, 43 females, age range 7 to 18 years, mean age 13.3 years) received a diagnosis of DD without comorbid major depressive disorder (MDD), using historical information, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and symptoms ratings according to the DSM-IV criteria.

Results:

Irritability, low self-esteem, fatigue or loss of energy, depressed mood, guilt, concentration difficulties, anhedonia, and hopelessness were present in more than 50% of subjects. Differences in symptomatic profile between male and female patients were not significant. Anxiety disorders were commonly comorbid with DD, mainly generalized anxiety disorder, simple phobias, and in prepuberal children, separation anxiety disorder. Externalizing disorders were reported in 35% of the patients, with higher prevalence in male patients. Adolescents showed more suicidal thoughts and anhedonia than children.

Conclusions:

The clinical picture of early-onset DD we found, based entirely on a pure sample without current and past MDD, is not totally congruent with the diagnostic criteria according to DSM-IV. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.
The Effect of Peer Support on Postpartum Depression: A Pilot Randomized Controlled Trial
Authors: Dennis Cindy-Lee
Published: July 2017

Objective:

To evaluate the effect of peer support (mother-to-mother) on depressive symptomatology among mothers identified as high-risk for postpartum depression (PPD).

Method:

Forty-two mothers in British Columbia were identified as high-risk for PPD according to the Edinburgh Postnatal Depression Scale (EPDS) and randomly assigned to either a control group (that is, to standard community postpartum care) or an experimental group. The experimental group received standard care plus telephone-based peer support, initiated within 48 to 72 hours of randomization, from a mother who previously experienced PPD and attended a 4-hour training session. Research assistants blind to group allocation conducted follow-up assessments on diverse outcomes, including depressive symptomatology, at 4 and 8 weeks postrandomization.

Results:

Significant group differences were found in probable major depressive symptomatology (EPDS > 12) at the 4-week (χ2 = 5.18, df = 1; P = 0.02) and 8-week (χ2 = 6.37, df = 1; P = 0.01) assessments. Specifically, at the 4-week assessment 40.9% ( n = 9) of mothers in the control group scored > 12 on the EPDS, compared with only 10% ( n = 2) in the experimental group. Similar findings were found at the 8-week assessment, when 52.4% ( n = 11) of mothers in the control group scored > 12 on the EPDS, compared with 15% ( n = 3) of mothers in the experimental group. Of the 16 mothers in the experimental group who evaluated the intervention, 87.5% were satisfied with their peer-support experience.

Conclusions:

Telephone-based peer support may effectively decrease depressive symptomatology among new mothers. The high maternal satisfaction with, and acceptance of, the intervention suggests that a larger trial is feasible.
Are Mental Health Services for Children Distributed According to Needs?
Authors: Blais Régis , Breton Jean-Jacques , Fournier Mylène , St-Georges Marie , Berthiaume Claude
Published: July 2017

Objectives:

The purpose of this study was twofold: 1) to determine whether publicly funded mental health services and resources available in 4 large regions in the province of Quebec were distributed according to the mental health needs of children aged 6 to 14 years and 2) to assess whether the variations in mental health services and resources across the 4 regions had changed over a 5-year period.

Methods:

Indicators of need according to the child's parent (presence of mental disorder, measure of adaptation, and perception of need for help) from an epidemiologic survey of 2400 noninstitutionalized children were compared with both in-school and community professional resources and with physician and hospital services in 1992–1993. Resource and service data were also collected for 1997–1998. Resource and service data came from professional colleges and government administrative databases.

Results:

No significant regional differences were found for need indicators, but there were large discrepancies in mental health resources and services in 1992–1993. Differences in professional resources were largest for special education teachers in the school system and for psychiatrists in the community. The regional differences in resources and services were as large in 1997–1998 as they were in 1992–1993.

Conclusions:

Despite universal health care in Quebec and a government mental health policy stressing equity of access, the available mental health resources for children aged 6 to 14 years are not distributed across regions according to needs. More evidence-based planning is required, specifically using epidemiologic survey data, to match resources to needs and to monitor changes over time.
Patient Characteristics Associated with Nonprescription Drug Use in Intentional Overdose
Authors: Lo Andre , Shalansky Stephen , Leung Marianna , Hollander Yitzchak , Raboud Janet
Published: July 2017

Objective:

Over-the-counter (OTC) medications remain freely available to suicidal patients, despite their potential lethality and common use in suicide. The study's main objective was to identify patient characteristics, particularly psychiatric diagnosis associated with the use of OTC medications in intentional overdose.

Methods:

We retrospectively reviewed 95 charts from patients who presented to St Paul's Hospital from August 1, 1997, to July 31, 1998, with a discharge diagnosis of intentional drug overdose. Univariate analysis was carried out to identify potential risk markers for OTC medication use, and logistic regression was performed using these variables.

Results:

When the variables age, sex, and concurrent psychiatric diagnoses were controlled, use of OTC medications in overdose was significantly lower in patients with a DSM-IV diagnosis of substance abuse (OR 0.11, P = 0.005) and in those who possessed prescription medications at the time of overdose (OR 0.18, P = 0.007). Most patients in this cohort (82%) had at least 1 of these 2 traits. Although not statistically significant, younger patients appeared more likely to choose OTC medications for overdose.

Conclusion:

Suicide-prone patients with a diagnosis of substance abuse and who possess prescription medications are unlikely to use OTC medications in overdose. For this cohort, this represents a relatively small proportion of patients whom clinicians should consider to be at greater risk for attempting suicide when using OTC medication, especially acetaminophen.
The Canadian Psychiatric Association Practice Profile Survey: II. General Description of Results
Authors: Woodside D Blake , Lin Elizabeth
Published: July 2017

Objective:

To provide an overview of the results of the Canadian Psychiatric Association (CPA) practice profile survey (PPS), a national survey of psychiatrists and psychiatric practice.

Method:

Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information—including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition—was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day.

Results:

Psychiatrists work 10 hours daily on average and take calls for 5 hours. Sixty percent of the overall work time is in the provision of direct patient care, and fee-for-service payments account for 55% of hours worked. Forty percent of the clinical work is provided in a hospital setting, and 34% is in a private office. Agency work accounted for only 6% of clinical hours worked. Relatively few practitioners provide services to children, older, or forensic patients. The average patient seen is female, aged 40 years, unmarried or with a marital disruption, significantly impaired in multiple areas of functioning, and likely to suffer from depression (21%), schizophrenia (14%), an anxiety disorder (13%), or bipolar disorder (12%). Comorbid Axis I and Axis II disorders are common (each over 30%) and fairly high rates of suicidal (15% to 30%) and homicidal (10% to 20%) risk are present.

Conclusions:

This paper suggests a wide diversity of practice in psychiatry in Canada, with services being provided to a wide range of individuals with many different conditions.
Acceptability and Disintegration Rates of Orally Disintegrating Risperidone Tablets in Patients with Schizophrenia or Schizoaffective Disorder
Authors: Chue Pierre , Welch Ron , Binder Carin
Published: July 2017

Objective:

To investigate the disintegration profile, acceptability, and tolerability of orally disintegrating risperidone tablets in patients with schizophrenia or schizoaffective disorder.

Method:

Ten patients stable for at least 10 days on monotherapy with oral risperidone 2 mg to 4 mg taken once daily were switched for 7 days to an equivalent dosage of orally disintegrating risperidone. Visual assessments for time to initial and complete disintegration were collected at each visit. Clinical Global Impression of Severity scores were collected at baseline and at the last visit. Patient acceptance of the new formulation, rated according to a visual analog scale, was obtained at the last visit.

Results:

All patients maintained stable clinical status. Mean time to initial disintegration was 5.1 seconds, SD 0.8, and mean time to complete disintegration was 29.4 seconds, SD 18.4. The formulation was rated as very acceptable. Adverse events were reported by 5 patients; all were mild.

Conclusion:

The orally disintegrating risperidone tablets were well tolerated and rated as very acceptable by all patients.
Neurobiological Findings in Bipolar II Disorder Compared with Findings in Bipolar I Disorder
Authors: McGrath Brent M , Wessels Phillip H , Bell Emily C , Ulrich Michele , Silverstone Peter H
Published: July 2017

Objective:

To determine there are consistent neurobiological differences between patients with bipolar I disorder (BD I) and those with bipolar II disorder (BD II).

Method:

We reviewed the literature in areas where the most consistent neurobiological findings have been reported for bipolar disorder, specifically, neuroimaging and brain metabolism. The imaging studies reviewed, examined structure, using magnetic resonance imaging (MRI), and function, using functional MRI, positron emission tomography, and single photon emission computed tomography. We used magnetic resonance spectroscopy to examine brain chemistry. We reviewed those metabolic studies that examined cell calcium, 3-methoxy-4-hydroxyphenylglycol, and protein kinase C.

Results:

Some genetic studies suggest that there may be differences between BD II and BD I patients. However, our review of the imaging and metabolic studies identified few studies directly comparing these 2 groups. In those studies, there were few differences, if any, and these were not consistent.

Conclusions:

While genetic data suggest there may be differences between BD II patients and BD I patients, the neurobiological findings to date do not provide support. However, this may be owing to the small number of studies directly comparing the 2 groups and also to the fact that those carried out have not been adequately powered to detect possible small true differences. This is an important issue because, if there are no neurobiological differences, it would be anticipated that similar treatments would be similarly effective in both groups. Given the importance of understanding whether there are neurochemical differences between these groups, further research in this area is clearly needed.
Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Authors: Smolla Nicole , Valla Jean-Pierre , Bergeron Lise , Berthiaume Claude , St-Georges Ma rie
Published: July 2017

Objective:

To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders.

Methods:

We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test–retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient.

Results:

For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76.

Conclusions:

Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Authors: Bloom Hy , Webster Christopher , Hucker Stephen , De Freitas Karen
Published: July 2017

Over the past quarter-century, Canadian researchers, clinical practitioners, and policy specialists have made several notable contributions to the broad field of violence risk assessment and management. In part, these contributions have been fostered by major changes in law over this period; in part, they have been spurred by findings from large-scale Canadian prediction–outcome studies. This paper offers references for a range of Canadian-inspired assessment schemes designed to evaluate psychopathy and potential for violence against others.
The Clinical Use of Risk Assessment
Authors: Glancy Graham D , Chaimowitz Gary
Published: July 2017

In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry.
The Relation between Perceived Need for Mental Health Treatment, DSM Diagnosis, and Quality of Life: A Canadian Population-Based Survey
Authors: Sareen Jitender , Stein Murray B , Campbell Darren W , Hassard Thomas , Menec Verena
Published: July 2017

Objectives:

Prevalence estimates of mental disorders were designed to provide an indirect estimate of the need for mental health services in the community. However, recent studies have demonstrated that meeting criteria for a DSM-based disorder does not necessarily equate with need for treatment. The current investigation examined the relation between self-perceived need for mental health treatment and DSM diagnosis, with respect to quality of life (QoL) and suicidal ideation.

Methods:

Data came from an Ontario population-based sample of 8116 residents (aged 15 to 64 years). The University of Michigan Composite International Diagnostic Interview was used to diagnose mood, anxiety, substance use, and bulimia disorder according to DSM-III-R criteria. We categorized past-year help seeking for emotional symptoms and (or) perceiving a need for treatment without seeking care as self-perceived need for treatment. We used a range of variables to measure QoL: self-perception of mental health status, a validated instrument that measured well-being, and restriction of activities (current, past 30 days, and long-term).

Results:

Independent of subjects' meeting criteria for a DSM-III-R diagnosis, self-perceived need for treatment was significantly associated with poor QoL (on all measures) and past-year suicidal ideation.

Conclusions:

Self-perceived need for mental health treatment, in addition to DSM diagnosis, may provide valuable information for estimating the number of people in the population who need mental health services. The relation between self-perceived need for treatment and objective measures of treatment need requires future study.
Troubles dépressifs majeurs et urgences psychiatriques: Une étude naturaliste concernant la place des interventions de crise
Authors: Damsa Cristian , Lazignac Coralie , Cailhol Lionel , Di Clémente Thierry , Haupert Joëlle , Pull Charles
Published: July 2017

Objectif:

Le but de cette étude rétrospective a été de mesurer l'effet de l'introduction du modèle d'intervention de crise dans le service d'urgences d'un hôpital général, sur le nombre d'hospitalisations et de suivis ambulatoires des patients souffrant d'un trouble dépressif majeur.

Méthode:

L'étude porte sur l'ensemble des patients présentant un trouble dépressif majeur (critères du DSM IV) qui ont consulté le service d'urgences psychiatriques d'un hôpital général durant 2 périodes de 8 mois: avant (425 patients) et après (436 patients) l'introduction des interventions de crise.

Résultats:

Après l'introduction des interventions de crise, on constate une diminution significative du taux d'hospitalisations volontaires (de 17,9 % à 12,4 %), ainsi qu'une augmentation du nombre des suivis psychiatriques ambulatoires (de 82,1 % à 86,2 %). La présence d'un trouble de personnalité limite (borderline) a été associée avec une plus grande diminution du taux d'hospitalisations (27,8 % contre 38,2 %), tandis que le nombre d'hospitalisations des patients souffrant d'un trouble dépressif avec des caractéristiques psychotiques n'a pas diminué après l'introduction des interventions de crise. Les interventions de crise ont été plus efficaces pour les femmes.

Conclusions:

Ces résultats suggèrent l'intérêt des interventions de crise aux urgences psychiatriques pour améliorer la prise en charge des patients souffrant d'un trouble dépressif majeur, en favorisant la solution de rechange du suivi ambulatoire multimodal plutôt qu'une hospitalisation en milieu psychiatrique.
Frequency and Adequacy of Depression Treatment in a Canadian Population Sample
Authors: Esposito Eleonora , Wang Jian Li , Adair Carol E , Williams Jeanne VA , Dobson Keith , Schopflocher Donald , Mitton Craig , Newman Stephen , Beck Cynthia , Barbui Corrado , Patten Scott B
Published: July 2017

Objective:

Population-based data about depression treatment are largely restricted to estimates of the frequency of antidepressant (AD) use. Such frequencies are difficult to interpret in the absence of information about dosages, reasons for taking the medications, and participation in nonpharmacologic treatment. The objective of this study was to describe the pattern of treatment for major depression (MD) in Alberta.

Method:

Telephone survey methods were employed. Random digit dialing was used to select a sample of 3345 household residents aged 18 to 64 years in Alberta. A computer-assisted telephone interview that included the Mini Neuropsychiatric Diagnostic Interview and questions about pharmacotherapy and psychotherapy was administered. Estimates were weighted for design features and population demographics.

Results:

The point prevalence of MD was 4.4% (95% confidence interval [CI], 3.4% to 5.5%), and the overall prevalence of current AD use was 7.4% (95%CI, 6.2% to 8.6%). The ADs taken most commonly, serotonin-specific reuptake inhibitors, were taken at therapeutic dosages 87.4% of the time. Most (80.7%) of those taking ADs reported taking them for more than 1 year. The frequency of receiving counselling, psychotherapy, or talk therapy was 3.9% overall and 14.3% in respondents with MD. However, most of these subjects were unable to name the type of counselling they were receiving.

Conclusions:

When compared with previous estimates, these results suggest continued progress in the delivery of evidence-based care to the population. There is room for additional improvement, especially in the provision of nonpharmacologic treatment.
Using Qualitative Research to Inform Mental Health Policy
Authors: Davidson Larry , Ridgway Priscilla , Kidd Sean , Topor Alain , Borg Marit
Published: July 2017

This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community.
Epidemiology of Chronic Pain with Psychological Comorbidity: Prevalence, Risk, Course, and Prognosis
Authors: Tunks Eldon R , Crook Joan , Weir Robin
Published: July 2017

Objective:

To review the relation between chronic pain and psychological comorbidities, and the influence on course and prognosis, based on epidemiologic and population studies.

Method:

We present a narrative overview of studies dealing with the epidemiology of chronic pain associated with mental health and psychiatric factors. Studies were selected that were of good quality, preferably large studies, and those that dealt with prevalences, course and prognosis of chronic pain, risk factors predicting new pain and comorbid disorders, and factors that affect health outcomes.

Results:

Chronic pain is a prevalent condition, and psychological comorbidity is a frequent complication that significantly changes the prognosis and course of chronic pain. In follow-up studies, chronic pain significantly predicts onset of new depressions, and depression significantly predicts onset of new chronic pain and other medical complaints. Age, sex, severity of pain, psychosocial problems, unemployment, and compensation are mediating factors in course and prognosis.

Conclusion:

In assessment of chronic pain, the evidence from epidemiologic studies makes it clear that chronic pain can best be understood in the context of psychosocial factors.
Lifestyle Characteristics of Psychiatric Outpatients
Authors: Chuang Henry T , Mansell Craig , Patten Scott B
Published: July 2017

Objective:

To describe lifestyle characteristics and associated health issues among psychiatric outpatients in 3 diagnostic categories: schizophrenia, bipolar disorder, and anxiety and (or) depression.

Method:

A series of patients ( n = 182) attending 3 outpatient mental health clinics in Calgary were administered a set of items and instruments to assess: social support, dietary habits, substance use, exercise, and recreational pursuits. In addition, clinical and laboratory parameters including body mass index (BMI) and lipid and glucose levels were compared when available.

Results:

Satisfaction with social support was comparable across the 3 diagnostic categories. About two-thirds reported predominantly sedentary routine daily activities. No significant differences in fatty food intake were identified, or for other dietary habits. There were no significant differences between diagnostic groups and total cholesterol, and high-density lipoprotein or low-density lipoprotein levels. According to their BMI, 74% of the entire sample could be described as overweight and 38% as obese; again, differences between the 3 diagnostic categories were not observed.

Conclusion:

Unhealthy lifestyle issues are not restricted to any specific diagnostic group. These data identify a compelling need to develop ameliorative intervention strategies for psychiatric outpatients; however, we could not identify a basis for targeting such interventions specifically in relation to diagnosis.
The Effect of Study Design on the Reporting of Mortality Due to Colorectal Cancer in Adults with Mental Illness in Nova Scotia
Authors: Kisely Stephen , Campbell Leslie Anne , Cox Martha
Published: July 2017

Objective:

Some studies suggest a higher case fatality from colorectal cancer (CRC) in psychiatric patients even though the incidence is no greater than in the general population. However, this finding is not universal and may be confounded by study design (for example, inception, compared with historical, cohort), mean cohort age, or delays in presentation with more advanced staging at diagnosis. We assessed how study design and cancer stage at presentation affected outcomes in psychiatric patients.

Methods:

A retrospective historical cohort of CRC presentations was used comparing psychiatric patients with control subjects. Psychiatric status was defined by either health service use or psychotropic prescription, and outcomes by logistic or Cox proportional hazards regression.

Results:

There were 3501 new presentations of CRC from 2001 to 2005. Psychiatric cases, as defned by in- or outpatient contacts, made up 15.9% ( n = 558) of patients with CRC. There was no association between psychiatric status and stage at presentation, surgical intervention, or mortality after adjusting for confounders. There was a reduced likelihood of resection, an indicator of curative treatment, when on a selective serotonin reuptake inhibitor or serotonin noradrenergic reuptake inhibitor ( n = 194; AOR 0.54; 95% CI 0.30 to 0.97) or antipsychotics ( n = 28; AOR 0.27; 95% CI 0.08 to 0.92).

Conclusions:

The association between psychiatric status and CRC may vary by study design and how psychiatric status is defined. These factors should be considered when interpreting any association between mental illness and cancer. As in studies of all-cause and cardiac mortality, historical cohorts of prevalent psychiatric cases may be less sensitive than inception cohorts of new patients, possibly because the excess of deaths is greatest within 7 years of initial presentation for a psychiatric disorder.
Diagnostic Criteria as Dysfunction Indicators: Bridging the Chasm between the Definition of Mental Disorder and Diagnostic Criteria for Specific Disorders
Authors: First Michael B , Wakefield Jerome C
Published: July 2017

According to the introduction to the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, each disorder must satisfy the definition of mental disorder, which requires the presence of both harm and dysfunction. Constructing criteria sets to require harm is relatively straightforward. However, establishing the presence of dysfunction is necessarily inferential because of the lack of knowledge of internal psychological and biological processes and their functions and dysfunctions. Given that virtually every psychiatric symptom characteristic of a DSM disorder can occur under some circumstances in a normally functioning person, diagnostic criteria based on symptoms must be constructed so that the symptoms indicate an internal dysfunction, and are thus inherently pathosuggestive.

In this paper, we review strategies used in DSM criteria sets for increasing the pathosuggestiveness of symptoms to ensure that the disorder meets the requirements of the definition of mental disorder. Strategies include the following: requiring a minimum duration and persistence; requiring that the frequency or intensity of a symptom exceed that seen in normal people; requiring disproportionality of symptoms, given the context; requiring pervasiveness of symptom expression across contexts; adding specific exclusions for contextual scenarios in which symptoms are best understood as normal reactions; combining symptoms to increase cumulative pathosuggestiveness; and requiring enough symptoms from an overall syndrome to meet a minimum threshold of pathosuggestiveness. We propose that future revisions of the DSM consider systematic implementation of these strategies in the construction and revision of criteria sets, with the goal of maximizing the pathosuggestiveness of diagnostic criteria to reduce the potential for diagnostic false positives.

Selon l'introduction du Manuel diagnostique et statistique des troubles mentaux (DSM), 5e édition, chaque trouble doit satisfaire à la définition d'un trouble mental, qui exige la présence de préjudice et de dysfonctionnement. Construire des ensembles de critères requérant un dommage est relativement simple. Cependant, établir la présence d'une dysfonction est nécessairement inférentiel en raison du manque de connaissances des processus psychologique et biologique internes ainsi que de leurs fonctions et dysfonctions. Étant donné qu'à peu près chaque caractéristique d'un symptôme psychiatrique d'un trouble du DSM peut se manifester dans certaines circonstances chez une personne fonctionnant normalement, les critères diagnostiques basés sur les symptômes doivent être construits de manière à ce que les symptômes indiquent une dysfonction interne, et qu'ils soient donc intrinsèquement pathosuggestifs.
Implementing a Continuum of Evidence-Based Psychosocial Interventions for People with Severe Mental Illness: Part 2—Review of Critical Implementation Issues
Authors: Briand Catherine , Menear Matthew
Published: July 2017

Objective:

In North America and internationally, efforts have been made to reduce the gaps between knowledge of psychosocial evidence-based practices (EBPs) and the delivery of such services in routine mental health practice. Part 2 of this review identifies key issues for stakeholders to consider when implementing comprehensive psychosocial EBPs for people with severe mental illness (SMI).

Method:

A rapid review of the literature was conducted. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, and psychosocial practices and implementation. The Consolidated Framework for Implementation Research (CFIR) was used to structure findings according to key domains and constructs known to influence the implementation process.

Results:

The CFIR allowed us to identify 17 issues reflecting more than 30 constructs of the framework that were viewed as influential to the process of implementing evidence-based psychosocial interventions for people with SMI. Issues arising at different levels of influence (intervention, individual, organizational, and system) and at all phases of the implementation process (planning, engagement, execution, and evaluation) were found to play important roles in implementation.

Conclusion:

The issues identified in this review should be taken into consideration by stakeholders when engaging in efforts to promote uptake of new psychosocial EBPs and to widen the range of effective psychosocial services available in routine mental health care.
Trauma Reactivation Plus Propranolol is Associated with Durably Low Physiological Responding during Subsequent Script-Driven Traumatic Imagery
Authors: Brunet Alain , Thomas Émilie , Saumier Daniel , Ashbaugh Andrea R , Azzoug Abdelmadjid , Pitman Roger K , Orr Scott P , Tremblay Jacques
Published: July 2017

Objective:

In a previous, double-blind, placebo-controlled study, patients with posttraumatic stress disorder (PTSD) showed lower physiological response during script-driven traumatic imagery 1 week after receiving a single dose of propranolol given after the retrieval of a traumatic memory. We hypothesized that this effect would extend beyond 1 week using a modified treatment approach.

Method:

Twenty-eight participants with PTSD read an account of their traumatic event once weekly for 6 consecutive weeks under the influence of open-label propranolol. One week and 4-months later, skin conductance, heart rate, and left corrugator electromyogram responses were measured while participants engaged in script-driven mental imagery of their traumatic event. Results from the 22 study participants were compared with results from treated and untreated participants in a previously published trial.

Results:

Most participants in our study were classified as non-PTSD cases at posttreatment and follow-up according to a psychophysiological discriminant function analysis. Posttreatment skin conductance and heart rate responses of the current (propranolol-treated) participants were lower than those of placebo participants from the previous study. No difference was observed between physiological responding measured posttreatment and at follow-up.

Conclusions:

Low physiological responding during script-driven traumatic imagery after treatment extends up to 4 months, demonstrating the durability of the treatment effect's. Limitations include the absence of a placebo-controlled group and lack of physiological baseline measures. Despite these limitations, results point to the need for future trials examining the clinical efficacy of trauma reactivation plus propranolol, as it has the potential to become a novel, cost- and time-effective treatment for PTSD.
Research-Track Programs for Residents in Psychiatry: A Review of Literature and a Report of 3 Canadian Experiences
Authors: Bhat Venkat , Leong KaWai , Lee Jonathan , Voineskos Daphne , Daskalakis Zafiris J , Lam Raymond W , Jollant Fabrice
Published: July 2017

Objectives:

Clinician-scientists occupy an interesting position at the interface between science and care, and have a role to play in bridging the 2 valleys between fundamental and clinical research, and between clinical research and clinical practice. However, research training during medical residency for future clinician scientists is an important but challenging process. Our article, written by residents and directors of research-track (RT) programs, aimed at reviewing literature on RT programs for residents, and describing the organization of RT programs at 3 Canadian universities (the University of British Columbia, the University of Toronto, and McGill University).

Methods:

A systematic MEDLINE search was conducted for the review section. Psychiatry program directors in Canada were also contacted to provide information about potential RT programs.

Results:

Twenty articles were related to resident RT programs in medicine, including 6 in psychiatry. Moreover, 5 out of 16 Canadian programs were found to offer a formal RT program, of which 3 are described here. Most reviewed articles described the program organization, while only one provided an outcome assessment with evidence of increased scholarly activity following RT implementation.

Conclusions:

Our article sheds light on postgraduate programs aiming at facilitating the dual training of future clinician-scientists, and developed during the last 10 years. It also highlights the lack of outcome assessment, and the paucity of guidelines to organize these programs in relation to the national requirements.