bluuebunny/crossref_metadata_2025 huggingface dataset:
Disciplining Greece: Crisis Management and Its Discontents
Authors: Panageotou Steven
Published: July 2017

The strategy intended to resolve the Greek financial crisis is not a resolution strategy at all—it is more accurately conceptualized as a crisis management strategy, which is insufficient to reduce the public debt and instead fuels a deflationary spiral. Consequently, power is wielded by unelected, international political and financial institutions and actors, the crisis management regime, who have engendered a wave of discipline, surveillance, and control alongside a neoliberal restructuring of the Greek economy.

JEL Classification: G01, E62, P16
Intra-eurozone Payments Imbalances: Implications for the TARGET2 Payments System
Authors: Lucarelli Bill
Published: July 2017

In the wake of the recent European debt crisis, there have emerged serious payments imbalances between the core/surplus countries and the peripheral/deficit countries, which threaten the internal cohesion of the eurozone. In the absence of political union or fiscal federalism, these centrifugal dynamics appear to be irreversible. This article examines the role performed by the TARGET2 (Trans-European Automated Real Time Gross Settlement Express Transfer System) payments system and the very real possibility of default by the indebted, peripheral countries as a result of the imposition of austerity policies by the European Central Bank (ECB)/European Union (EU)/International Monetary Fund (IMF) (Troika). It is proposed that the current, neoliberal path toward austerity and wage repression (or internal devaluation) is ultimately unsustainable and, indeed, self-defeating.

JEL Classification: B5, B14, B16, B23
The Use of Electroconvulsive Therapy in Special Patient Populations
Authors: Rabheru Kiran
Published: July 2017

Background:

Despite its well-established efficacy and its increasing use, electroconvulsive therapy (ECT) remains a controversial treatment. Lack of clarity in the issues related to its use in special patient populations (for example, in children, in adolescents, in pregnant women, in the elderly, and in the medically ill) often contributes to the debate about the use of ECT.

Method:

The literature on ECT use in special patient populations is reviewed, together with the commonly associated high-risk medical conditions in clinical practice. Specific reference is made in each case to the safety, tolerability, and efficacy of the procedure.

Results:

Much of the literature surveyed consists of case studies, although a few controlled trials are available. In general, ECT use in special populations is relatively safe and extremely effective. In small case series, ECT use in children and adolescents is effective but requires further systematic study. In pregnant women, ECT is very effective, and with proper medical care, it is relatively safe in all trimesters of pregnancy, as well as in the postpartum period. The frail elderly are particularly good candidates for ECT because they are often unresponsive to or intolerant of psychotropic medication. Medical conditions that should receive particular attention during a course of ECT are disorders of the central nervous system (CNS), cardiovascular, and respiratory system. With modern anesthesia techniques and careful medical management of each high-risk patient, most can successfully complete a course of ECT. The process of obtaining informed consent also requires special consideration in this group of patients because their capacity to consent to treatment may be compromised.

Conclusions:

With careful attention to each patient's medical and anesthesia needs, ECT is an effective and relatively safe procedure in high-risk special patient populations.
Comorbidity of Phobic Disorders with Alcoholism in a Canadian Community Sample
Authors: Sareen Jitender , Chartier Mariette , Kjernisted Kevin D , Stein Murray B
Published: July 2017

Objectives:

To examine the relation between phobic disorders and alcoholism in a Canadian community sample.

Method:

Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, “hazardous alcohol use.” Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses.

Results:

Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalence of approximately 10%).

Conclusions:

Given the early onset of most phobic disorders, the findings suggest that these are a risk factor for hazardous patterns of alcohol use.

Objectifs:

Examiner la relation entre les troubles phobiques et l'alcoolisme dans un échantillon communautaire canadien.
Atypical Antipsychotic Use in Treating Adolescents and Young Adults with Developmental Disabilities
Authors: Friedlander Robin , Lazar Susan , Klancnik Joseph
Published: July 2017

Objective:

To study the usage, efficacy, and side effects patterns of atypical neuroleptics (atypicals) in adolescents and young adults with developmental disabilities (DDs) (mental retardation).

Method:

We undertook a chart review of adolescents and young adults (under age 25 years) seen by our specialized mental health team.

Results:

Risperidone and olanzapine were by far the most frequently prescribed atypicals. Robust clinical effects were noted for both psychotic and nonpsychotic disorders. Most patients tolerated atypicals well, although a significant minority did experience neuroleptic induced movement disorders (NIMDs), particularly dystonias and dyskinesias. Female patients with DDs appear to be at particular risk of NIMDs.

Conclusions:

Atypicals are useful in treating various conditions associated with DDs. This population, however, seems particularly sensitive to NIMDs, hence caution and close monitoring are required.
Social Functioning in First- and Multiepisode Schizophrenia
Authors: Grant Christina , Addington Jean , Addington Donald , Konnert Candace
Published: July 2017

Objective:

To compare the social functioning of individuals experiencing their first episode of schizophrenia with those who have experienced multiple episodes and with nonpsychiatrically ill control subjects.

Method:

Subjects included 40 patients with first-episode (FE) schizophrenia, 40 patients with multiepisode (ME) schizophrenia, and a control group of 40 nonpsychiatrically ill individuals. Three social-functioning measures were used: the Social Functioning Scale (SFS), the Quality of Life Scale (QOL), and the Assessment of Interpersonal Problem-Solving Skills (AIPSS).

Results:

Control subjects significantly outperformed FE and ME participants on all social-functioning measures. FE and ME samples did not differ in their performance on the SFS and the AIPSS. On the QLS, ME participants outperformed FE participants.

Conclusions:

This study demonstrated that deficits in social functioning are present near the onset of schizophrenia.
Anxiety Disorders in Children and Adolescents with Bipolar Disorder: A Neglected Comorbidity
Authors: Masi Gabriele , Toni Cristina , Perugi Giulio , Mucci Maria , Millepiedi Stefania , Akiskal Hagop S
Published: July 2017

Objective:

We describe a consecutive clinical sample of children and adolescents with bipolar disorder to define the pattern of comorbid anxiety and externalizing disorders (attention-deficit hyperactivity disorder [ADHD] and conduct disorder [CD]) and to explore the possible influence of such a comorbidity on their cross-sectional and longitudinal clinical characteristics.

Methods:

The sample comprised 43 outpatients, 26 boys and 17 girls, (mean age 14.9 years, SD 3.1; range 7 to 18), with bipolar disorder type I or II, according to DSM-IV diagnostic criteria. All patients were screened for psychiatric disorders using historical information and a clinical interview, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). To shed light on the possible influence of age at onset, we compared clinical features of subjects whose bipolar onset was prepubertal or in childhood (< 12 years) with those having adolescent onset. We also compared different subgroups with and without comorbid externalizing and anxiety disorders.

Results:

Bipolar disorder type I was slightly more represented than type II (55.8% vs 44.2%). Only 11.6% of patients did not have any other psychiatric disorder; importantly, 10 subjects (23.5%) did not show any comorbid anxiety disorder. Comorbid externalizing disorders were present in 12 (27.9%) patients; such comorbidity was related to the childhood onset of bipolar disorder type II. Compared with other subjects, patients with comorbid anxiety disorders more often reported pharmacologic (hypo)mania.
The Pharmacologic Treatment of the Early Phase of First-Episode Psychosis in Youths
Authors: Walter Garry , Wiltshire Catherine , Anderson Josephine , Storm Victor
Published: July 2017

Objectives:

To summarize available knowledge about pharmacologic treatments that are used for first-onset (or early) psychosis in youths, with particular consideration of the prodromal stage and the effectiveness and safety of novel antipsychotic drugs and mood stabilizers.

Method:

A computerized search of medical databases (for example, Medline and Embase), a manual searching of articles and textbooks, and the use of vignettes to highlight treatment issues.

Results:

There are limited data about the effectiveness and safety of psychotropic agents for youths with psychosis and scarce information about the drug treatment of the prodromal stage of early psychosis in all age groups. The available data are encouraging, although the newer agents are not without safety concerns.

Conclusions:

Despite the paucity of studies, there is a range of psychotropics that may be used in the early stages of psychotic illness in youths. Drug choice is influenced by several factors, including the clinical picture, side effect profile, and patient preference. In certain situations, the decision may be not to use medication.
Psychosocial Risk Factors in Poststroke Depression: A Systematic Review
Authors: Ouimet MA , Primeau F , Cole MG
Published: July 2017

Objective:

To review systematically the psychosocial risk factors for poststroke depression.

Methods:

Medline was searched using the key words “poststroke depression” (PSD) for the period January 1, 1966, to June 30, 2000; using the key words “cerebrovascular disease” and “depression” it was searched from June 1, 1996, to June 30, 2000. Corollary articles were obtained from the bibliographies. Inclusion criteria were as follows: original research in French or English; prospective, case-control or cross-sectional study design; assessment of PSD in the first 6 months following the stroke; an acceptable definition of depression; an acceptable definition of stroke; and at least one psychosocial risk factor. Interrater reliability was tested for the selection and quality of the articles. A qualitative risk factor analysis was conducted.

Results:

The risk factors most consistently associated with PSD are a past history of depression, past personal psychiatric history, dysphasia, functional impairments, living alone, and poststroke social isolation. Risk factors not associated with PSD are dementia and cognitive impairment. Controversial risk factors are age, socioeconomic status (SES), prior social distress, dependency in regard to activities of daily living (ADL), and sex.

Conclusions:

Over approximately 30 years, some 25 qualitative studies have addressed psychosocial risk factors for PSD. Further studies should aim for quantitative analysis. The results suggest that identifying psychiatric history and preventing social deterioration and impairment should be part of multidisciplinary efforts to care for poststroke patients.
Antipsychotic Drugs and Obesity: Is Prolactin Involved?
Authors: Baptista Trino , Lacruz Anny , Meza Teraiza , Contreras Quilianio , Delgado Carlos , Mejìas Maria A , Hernàndez Luis
Published: July 2017

Objectives:

To correlate the anthropometric indexes (Body Mass Index [BMI] and Waist–Hip ratio [WHR]) with the serum prolactin levels in a heterogeneous population of patients treated with typical antipsychotic (AP) drugs.

Methods:

We evaluated BMI, WHR, and fasting serum prolactin of inpatients ( n = 105) and outpatients ( n = 122) treated with APs, in outpatients receiving other psychotropic drugs (OPDs) ( n = 77), and in drug-free subjects (n = 33). Outpatients had free access to food, whereas the inpatient sample comprised people with a monotonous diet of approximately 2000 Kcal daily.

Results:

Prolactin correlated positively with the BMI in the whole group of AP-treated outpatient men ( P = 0.03) and with the WHR in AP-treated inpatient men ( P = 0.053). Regarding treatment duration, prolactin and BMI correlated positively in men consecutively treated for more than 1 year ( P = 0.023). By contrast, a trend toward a negative correlation between prolactin and BMI was observed in AP-treated outpatient women ( P = 0.08). No significant correlation, or even a trend, was observed in the other groups.

Conclusions:

Prolactin may be involved in AP-induced weight gain, particularly in men. Future studies should characterize the period of maximal prolactin impact on body weight during AP treatment. Specific populations particularly sensitive to hyperprolactinemia might be identified as well. The negative correlation between prolactin and BMI detected in AP-treated women resembles the dampened prolactin response observed in severe primary obesity.
Factorial Structure of the Sensation-Seeking Scale-Form V: Confirmatory Factorial Analyses in Nonclinical and Clinical Samples
Authors: Loas Gwenolé , Verrier Annie , Flament Martine F , Perez-Diaz Fernando , Corcos Maurice , Halfon Olivier , Lang François , Bizouard Paul , Venisse Jean Luc , Guelfi Julien Daniel , Jeammet Philippe
Published: July 2017

Objective:

The factor structure of the Sensation-Seeking Scale (SSS)-Form V was studied in 2 large French samples, using confirmatory factorial analyses (CFA) to test the 4-dimensional model of sensation seeking postulated by Zuckerman.

Method:

The study included 769 healthy subjects and 659 patients who met the DSM-IV criteria for substance use disorders or eating disorders and completed the SSS. The correlation matrices for each of the samples were analyzed using CFA.

Results:

In each sample, we found the 4-factor model to be replicable.

Conclusion:

The multidimensionality of sensation seeking is supported by the results, and the 4-dimensional model of sensation seeking identified by Zuckerman can be explored in French-speaking people.
Mental Retardation in Teenagers: Prevalence Data from the Niagara Region, Ontario
Authors: Bradley Elspeth A , Thompson Ann , Bryson Susan E
Published: July 2017

Objectives:

There are few Canadian prevalence studies of mental retardation (MR); those that do exist were conducted prior to the era of community integration. We undertook a population-based study to explore mental health disturbances in young persons with MR. The first requirement was to identify a population with MR and to establish its prevalence. Here, we report data on the prevalence of MR in a population aged 14 to 20 years.

Method:

We conducted the study in the Niagara Region of Ontario, which has a population base of around 400 000. Researchers worked closely with schools and with agencies providing services to persons with MR to identify the study group. We confirmed the functioning level of participants through standard tests of nonverbal intelligence and receptive language; teachers and other service personnel provided information relevant to the estimation of nonparticipants' functioning level.

Results:

We identified 255 individuals as having MR (IQ ≤ 75). Of these, 171 chose to participate (defined as “participants with MR”; the remaining 84 were “nonparticipants with MR”). Thus, the participation rate was 67% (171/255). Participants and nonparticipants with MR did not differ on age, sex, or IQ, although there were more nonparticipants in the lower social strata. Overall prevalence for MR was 7.18/1000. For mild mental retardation (MMR; that is, IQ = 50 to 75), prevalence was 3.54/1000, and for severe mental retardation (SMR; that is, IQ < 50), it was 3.64/1000.

Conclusions:

Our prevalence estimate for SMR is similar to rates from previous studies conducted worldwide. Our estimate for MMR parallels the lower rates found in Scandinavian countries and contrasts with the higher rates generally reported in the US.
Treatment-Seeking Rates and Associated Mediating Factors among Individuals with Depression
Authors: Bristow Kristin , Patten Scott
Published: July 2017

Objective:

To systematically review the literature with respect to treatment-seeking rates for depression and associated mediating factors. This review focuses on adolescents and adults of all ages.

Methods:

A structured literature review using Medline and PsychInfo databases revealed 38 relevant papers. Two trained reviewers independently and blindly assessed each study according to 4 inclusion criteria. A total of 17 papers met all 4 criteria.

Results:

Between 17.0% and 77.8% of individuals with depressive episodes or disorders sought treatment in these studies. We could explain the range in rates by diverse measures of depression, mediating factors that influence treatment-seeking, varied years in which the studies were done, and different time periods over which treatment-seeking was assessed.

Conclusions:

Treatment-seeking rates for major depression appear to have increased over the years. Age, race, social supports, and clinical and psychiatric factors seem to influence treatment-seeking rates most. Public health initiatives can use this information to facilitate service access and delivery.
Risperidone Decreases Craving and Relapses in Individuals with Schizophrenia and Cocaine Dependence
Authors: Smelson David A , Losonczy Miklos F , Davis Craig W , Kaune Maureen , Williams John , Ziedonis Douglas
Published: July 2017

Objective:

To examine the efficacy of atypical neuroleptics for decreasing craving and drug relapses during protracted withdrawal in individuals dually diagnosed with schizophrenia and cocaine dependence.

Method:

We conducted a 6-week, open-label pilot study comparing risperidone with typical neuroleptics in a sample of withdrawn cocaine-dependent schizophrenia patients.

Results:

Preliminary results suggest that individuals treated with risperidone had significantly less cue-elicited craving and substance abuse relapses at study completion. Further, they showed a trend toward a greater reduction in negative and global symptoms of schizophrenia.

Conclusion:

Atypical neuroleptics may help reduce craving and relapses in this population. Future research should include more rigorous double-blind placebo-controlled studies with this class of medications.
Effective Use of Electroconvulsive Therapy in Late-Life Depression
Authors: Flint Alastair J , Gagnon Nadine
Published: July 2017

Objective:

To review literature pertaining to the efficacy, safety, and tolerability of electroconvulsive therapy (ECT) in treating late-life depression.

Method:

We undertook a literature review with an emphasis on research studies published in the last 10 years.

Results:

There is a positive association between advancing age and ECT efficacy. Age per se does not necessarily increase the risk of cognitive side effects from ECT, but this risk is increased by age-associated neurological conditions such as Alzheimer's dementia and cerebrovascular disease. With appropriate evaluation and monitoring, ECT can be used safely in patients of very advanced age and in those with serious medical conditions. Several technical factors, including dose of electricity relative to a patient's seizure threshold, position of electrodes, frequency of administration, and total number of treatments, have an impact on the efficacy and cognitive side effects of ECT and need to be taken into account when administering ECT. Naturalistic studies have found that 50% or more of patients have a relapse of depression within 6 to 12 months of discontinuing acute ECT.

Conclusions:

In recent years, there has been substantial progress in our understanding of the effect of technical factors on the efficacy and cognitive side effects of ECT. When administered in an optimal manner, ECT is a safe, well-tolerated, and effective treatment in older patients. Relapse of depression after response to ECT remains a significant problem, and there is a need for further research into the prediction and prevention of post-ECT relapse.
A Test of the Phase Model of Psychotherapy Change
Authors: Joyce Anthony S , Ogrodniczuk John , Piper William E , McCallum Mary
Published: July 2017

Objective:

A comparative trial of 2 forms (interpretive and supportive) of short-term, time-limited individual (STI) therapy provided data that were used to test the propositions of the Howard and others phase model of psychotherapy change.

Method:

Patients completed the Integra Outpatient Tracking Assessment Form on 5 occasions during the 20-session treatments. The measure assesses 3 dimensions: subjective well-being, current symptoms, and current life dysfunction. Howard and others regard these as dimensions that represent successive phases in the therapy change process (that is, well-being improves first, followed by resolution of symptoms, and finally by change in long-standing life dysfunction). We conducted a test of their model, using their approach to data analysis.

Results:

The comparative trial data provided no support for the phase model.

Conclusions:

Possible explanations for the absence of confirmatory findings are considered.
Sleep Quality in Chronic Pain Patients
Authors: Sayar Kemal , Arikan Meltem , Yontem Tulin
Published: July 2017

Objective:

Chronic pain patients have been reported to complain about poor sleep quality. Research aimed at delineating the predictors of poor sleep has produced conflicting results. Depressive mood and pain severity are the most frequently encountered predictors. This study aimed to find out whether chronic pain patients differed from healthy control subjects who had no pain on subjective sleep quality measures and, if so, which factors contributed most to poorer sleep quality.

Method:

We compared 40 patients with chronic pain who met inclusion criteria with 40 healthy control subjects on the measures of sleep quality, anxiety, and depression. The predictors of sleep quality were investigated with multiple regression in the pain group.

Results:

Chronic pain patients had higher scores than did healthy control subjects on the Beck Anxiety Scale, the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). At the bivariate level, pain intensity, anxiety, and depression correlated significantly with poorer sleep quality. At the multivariate level, depression was found to be the only significant factor correlating with the quality of sleep, and the model explained 34% of the variance.

Conclusions:

Chronic pain patients suffer from poor sleep quality—a function of depressed mood rather than pain intensity, duration, or anxiety. However, it is difficult to draw a causal relation in this relatively small sample size. Besides, our study sample comprised a mostly psychiatric population and may not represent the general group of patients with chronic pain.
Psychiatric Disorders and Use of Mental Health Services by Ontario Women
Authors: Frise Sarah , Steingart Allan , Sloan Margaret , Cotterchio Michelle , Kreiger Nancy
Published: July 2017

Objectives:

To describe the lifetime prevalence of selected psychiatric disorders in Ontario women and to compare these estimates with use of mental health resources.

Methods:

We obtained data from a survey of 3062 Ontario women, aged 25 to 74 years, who participated in the Women's Health Study. A 5-item scale assessed lifetime prevalence of 5 psychiatric disorders (anxiety, depression, posttraumatic stress disorder [PTSD], obsessive–compulsive disorder [OCD], and anorexia [AN] or bulimia [BN]). We assessed use of mental health services by comorbidity. We employed stratified random sampling to select study subjects. Prevalence estimates were weighted and 95%CIs were obtained using Taylor linearization techniques (1).

Results:

Nearly 30% of those surveyed reported at least 1 of the disorders studied. The most common were depression (27%) and anxiety (21%). Lifetime prevalence of PTSD, OCD, and AN or BN were 10.7%, 6.1%, and 3.9%, respectively. Successively younger birth cohorts displayed an increase in prevalence and a decrease in onset-age for all disorders. “Ever” use of mental health services was higher for women with 3 or more comorbid disorders (65%) than for those with no disorder (9.8%), or only 1 disorder (51.4%).

Conclusions:

The results of this study highlight the need to conduct more research into the reasons for the low rates of professional service use, especially for women with high comorbidity. They also highlight the need to understand the phenomenon underlying the possibly increasing rates of disorders in younger birth cohorts, so that outreach strategies can be modified to accommodate differences in younger women.
Homicide in the Canadian Prairies: Elderly and Nonelderly Killings
Authors: Ahmed AG , Menzies Robin PD
Published: July 2017

Objective:

To examine the psychosocial and clinical characteristics of male perpetrators of elderly and nonelderly homicides in the Canadian Prairies.

Method:

We examined data drawn from a study of 901 adult homicide offenders who were incarcerated or on parole between 1988 and 1992 in Alberta, Saskatchewan, and Manitoba.

Results:

Of those studied, 67 men were convicted of homicide involving 79 elderly victims, and 671 were convicted of homicide involving 675 nonelderly victims. Most perpetrators were single and engaged in irregular patterns of employment at the time of their index offence. Fourteen (20.8%) offenders with elderly victims had a history of psychiatric treatment, compared with 98 (14.6%) offenders with nonelderly victims; however, this difference was not statistically significant. Approximately 30% of both groups were diagnosed with personality disorders. A comparison of the index-offence characteristics showed no significant differences between the 2 groups.

Conclusion:

Our findings suggest that elderly individuals are more likely to be killed in their own homes by strangers. Social isolation appears to be a significant risk factor in cases of elderly homicide.
Substance Use Disorders: Sex Differences and Psychiatric Comorbidities
Authors: Zilberman Monica L , Tavares Hermano , Blume Sheila B , el-Guebaly Nady
Published: July 2017

Objective:

This article reviews sex differences in psychiatric comorbidity among individuals with substance use disorders and, in particular, the clinical significance of these differences for treatment outcome among women.

Method:

We undertook a computerized search of major health care databases. To enhance the search, we drew prior relevant articles from the reference list.

Results:

Women with alcohol and other drug use disorders present higher rates of psychiatric comorbidity, particularly mood and anxiety disorders, than do men. Moreover, the comorbid diagnosis, particularly of depression, is more often primary in women, while in men the comorbidity is more often secondary to the substance abuse diagnosis. In addition, there is evidence that psychiatric comorbidity is associated with distinct, sex-specific outcomes for substance use treatment.

Conclusions:

Sex differences in the clinical presentation of substance-dependent individuals with psychiatric comorbidity present specific treatment challenges and opportunities.
Clinical Aspects of Substance Abuse in Persons with Schizophrenia
Authors: Negrete Juan C
Published: July 2017

Objective:

To review the current knowledge on the problem of psychoactive substance abuse by persons with schizophrenia, with particular attention to issues of direct relevance to clinical practice.

Method:

The author examined the literature from the last 2 decades and data from studies in which he was involved.

Results:

Schizophrenia sufferers show an elevated liability for substance abuse. Such comorbidity may derive from self-medication attempts, a common neuropathology for addiction and schizophrenia, the psychotogenic properties of certain drugs, or the influence of environmental factors. Among schizophrenia patients receiving treatment, substance misuse is associated with more severe symptoms and poorer therapeutic response. The presence of a chronic psychosis impedes treatment of the substance problem in traditional, nonpsychiatric addiction programs. Better outcomes are observed in integrated therapy services, where patients receive appropriate care for both conditions.

Conclusion:

Dual-pathology patients need comprehensive care with appropriate pharmacotherapy and psychosocial interventions. This treatment can be best provided within the context of a continuing care psychiatric service.
Effect of a New Casino on Problem Gambling in Treatment-Seeking Substance Abusers
Authors: Toneatto Tony , Ferguson Donna , Brennan Judy
Published: July 2017

Problem gambling rates are frequently found to be higher in those who abuse substances than in the general population, and this group represents a well-established high-risk population for developing the disorder. In this study of 853 residential substance abusers, approximately 10% scored in the problem gambling range on the South Oaks Gambling Screen (SOGS). On most descriptive variables, these subjects appeared to be similar to substance abusers who do not have gambling problems. However, they tended to participate in more gambling behaviours and had more relationships with individuals who also gambled. There is some evidence that the introduction of a new casino in the community increased the SOGS scores for subjects who gambled most frequently on such casinorelated gaming as slot machines, cards, and casino games.
The Index Manic Episode in Juvenile-Onset Bipolar Disorder: The Pattern of Recovery
Authors: Rajeev J , Srinath Shoba , Reddy YCJ , Shashikiran MG , Girimaji Satish Chandra , Seshadri Shekhar P , Subbakrishna DK
Published: July 2017

Objective:

Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample.

Method:

We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them.

Results:

After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes.

Conclusions:

The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.
A Pilot Study of a Parent-Education Group for Families Affected by Depression
Authors: Sanford Mark , Byrne Carolyn , Williams Susan , Atley Sandy , Ridley Ted , Miller Jennifer , Allin Heather
Published: July 2017

Objective:

This study assessed the feasibility and efficacy of a parent-education group for families with young children and a parent with depression. We designed the program to be readily disseminated if shown to be effective.

Method:

We recruited 44 parents with depression from clinics and family doctors in Hamilton, Ontario, and randomly assigned them to receive the parenting program or to a wait-list control group. The outcomes measured included knowledge of depression, parenting, family relationships, depression symptoms, child depressive symptoms, and functioning. We used analysis of covariance to test for posttreatment differences between experimental and control groups.

Results:

Of the treatment group, 27% dropped out at posttreatment, and 43% by follow-up. Those who dropped out had more severe depression at baseline than did those who completed the program, and there was selective loss of parents with more severe depression in the experimental group. In intention-to-treat analyses at posttreatment, probands in the experimental group reported more improvements on family functioning, parenting sense of competence, and family and parent conflict than did control subjects. Standardized effect sizes (ES) were medium (0.4 to 0.6). When baseline depressive symptom scores were controlled in the analyses, the between-group differences were reduced, showing that selective loss of participants may have influenced the findings.

Conclusions:

On balance, the results are encouraging and support the further development and evaluation of the group intervention. However, the study does not provide unequivocal evidence in support of the program. Before it is transferred to other settings, the program needs further modification to improve participation by parents with more severe depression and further evaluation of its effectiveness.
Cultural Consultation: A Model of Mental Health Service for Multicultural Societies
Authors: Kirmayer Laurence J , Groleau Danielle , Guzder Jaswant , Blake Caminee , Jarvis Eric
Published: July 2017

Objectives:

This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers.

Methods:

We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance.

Results:

Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up.

Conclusion:

The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.
Culturally Competent Psychotherapy
Authors: Lo Hung-Tat , Fung Kenneth P
Published: July 2017

To provide effective psychotherapy for culturally different patients, therapists need to attain cultural competence, which can be divided broadly into the 2 intersecting dimensions of generic and specific cultural competencies. Generic cultural competence includes the knowledge and skill set necessary to work effectively in any cross-cultural therapeutic encounter. For each phase of psychotherapy— preengagement, engagement, assessment and feedback, treatment, and termination—we discuss clinically relevant generic cultural issues under the following headings: therapist, patient, family or group, and technique. Specific cultural competence enables therapists to work effectively with a specific ethnocultural community and also affects each phase of psychotherapy. Acomprehensive assessment and treatment approach is required to consider the specific effects of culture on the patient. Cultural analysis (CA) elaborates the DSM-IV cultural formulation, tailoring it for psychotherapy; it is a clinical tool developed to help therapists systematically review and generate hypotheses regarding cultural influences on the patient's psychological world. CA examines issues under 3 domains: self, relations, and treatment. We present a case to illustrate the influence of culture on patient presentation, diagnosis, CA, and psychotherapeutic treatment. Successful therapy requires therapists to employ culturally appropriate treatment goals, process, and content. The case also demonstrates various techniques with reference to culture, including countercultural, cultural reinforcing, or culturally congruent strategies and the use of contradictory cultural beliefs. In summary, developing both generic and specific cultural competencies will enhance clinician effectiveness in psychotherapy, as well as in other cross-cultural therapeutic encounters.
A Random-Assignment, Double-Blind, Clinical Trial of Once- vs Twice-Daily Administration of Quetiapine Fumarate in Patients with Schizophrenia or Schizoaffective Disorder: A Pilot Study
Authors: Chengappa KN Roy , Parepally Haranath , Brar Jaspreet S , Mullen Jamie , Shilling Ann , Goldstein Jeffrey M
Published: July 2017

Objective:

To evaluate the efficacy and safety of administering quetiapine once vs twice daily.

Method:

Utilizing a double-blind design, 21 hospitalized adult men or women with DSM-IV schizophrenia or schizoaffective disorder, who had received unchanged doses (for 2 weeks) of either 400 or 600 mg daily of quetiapine administered in 2 doses, were randomly assigned to once- or twice-daily administration for 4 weeks and then crossed over to the opposite dosing regimen for an additional 4 weeks. Standard psychopathology and safety measures were used in the study.

Results:

Nearly 70% (15/21) of the subjects met the a priori efficacy responder criteria with no statistical differences in response between those assigned to once- or twice-daily quetiapine administration. Statistical analyses confirmed that most subjects maintained efficacy during the switch to once- or twice-daily administration with quetiapine. A minority (15%) did experience worsening of symptoms or orthostatic hypotension during the crossover. Quetiapine was generally well tolerated at either twice- or once-daily administration.

Conclusions:

These pilot data suggest that it is clinically feasible to switch most quetiapine-treated subjects receiving a therapeutic twice-daily dosing schedule to a once-daily regimen. A minority may experience worsening of symptoms or orthostatic hypotension during the switch. This strategy of administering quetiapine entirely at bedtime may promote improved adherence to treatment.
Effect of Depression on Stroke Morbidity and Mortality
Authors: Ramasubbu Rajamannar , Patten Scott B
Published: July 2017

Objectives:

This narrative review examines the evidence and discusses the clinical relevance of depression as a risk factor for stroke morbidity and mortality. It also proposes recommendations for future research.

Methods:

We used the Medline computer database to search the relevant original studies published in English from January 1966 to December 2001. Our key words were as follows: depressive disorder, cerebrovascular disease, stroke, vascular risk factors, and mortality. Articles that investigated the relation between antecedent depression and subsequent stroke morbidity and mortality were collected and reviewed.

Results:

Since 1990, 8 prospective studies have been published. Among these 8 studies, 6 addressed depression and stroke morbidity, 1 investigated the association of depression with stroke morbidity and stroke mortality, and 1 investigated the association with stroke mortality only. Of 7 studies examining the independent effect of depression on stroke morbidity, 6 were positive. With regard to stroke mortality, 2 studies found an independent association between depression and specific stroke mortality. The contributions and methodological limitations of these studies are discussed.

Conclusions:

Emerging data suggest an association between depressive symptoms and increased risk for stroke morbidity and mortality. More methodologically sound studies are needed to elucidate causal pathways that link depression and cerebrovascular disease. They are also needed to determine the effect of depression intervention on reducing the risk of cerebrovascular events.
Switch to Mania upon Discontinuation of Antidepressants in Patients with Mood Disorders: A Review of the Literature
Authors: Ali Sherese , Milev Roumen
Published: July 2017

Objective:

To review the literature for reported cases of mania related to discontinuing antidepressant treatment, as well as for possible explanations of this phenomenon, and to present a case report.

Method:

We undertook a literature review through the PubMed index, using the key words mania, antidepressant withdrawal, and antidepressants in bipolar disorder. We reviewed 11 articles featuring 23 cases. Where available, we noted and tabulated certain parameters for both bipolar disorder (BD) and unipolar depression. We use a case example to illustrate the phenomenon of mania induced by antidepressant withdrawal.

Results:

For patients with unipolar depression, we found 17 reported cases of mania induced by antidepressant withdrawal. Antidepressants implicated included tricyclic antidepressants (TCAs) (12/17), monoamine oxidase inhibitors (MAOIs) (2/17), trazodone (1/17), mirtazapine (1/17), and paroxetine (1/17). For patients with BD, we found 19 reported cases of mania induced by antidepressant withdrawal, including our own case example. Of these, selective serotonin reuptake inhibitors (SSRIs) (10/19), TCAs (4/19), MAOIs (2/19), and serotonin norepinephrine reuptake inhibiors (SNRIs) (2/19) were implicated.

Conclusion:

Our case report supports the observation of antidepressant withdrawal–induced mania in patients with BD. It is distinguishable from antidepressant-induced mania, physiological drug withdrawal, and mania as a natural course of the illness. Many theories have been put forward to explain this occurrence. Noradrenergic hyperactivity and “withdrawal-induced cholinergic overdrive and the cholinergic-monoaminergic system” are the 2 most investigated and supported models. The former is limited by poor clinical correlation and the latter by its applicability only to anticholinergic drugs.
Acute Neuroendocrine Response to Sexual Stimulation in Sexual Offenders
Authors: Haake Philip , Schedlowski Manfred , Exton Michael S , Giepen Christoph , Hartmann Uwe , Osterheider Michael , Flesch Martin , Janssen Onno E , Leygraf Norbert , Krüger Tillmann HC
Published: July 2017

Background:

Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive.

Methods:

From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects.

Results:

Sexual offenders demonstrated higher sexual desire ( P < 0.001) and function ( P < 0.001) and a more positively perceived refractory period ( P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm ( P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm.

Conclusions:

These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.
Influence of Season and Latitude in a Community Sample of Subjects with Bipolar Disorder
Authors: Schaffer Ayal , Levitt Anthony J , Boyle Michael
Published: July 2017

Objective:

To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario.

Method:

This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant.

Results:

Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype.

Conclusions:

We identified a seasonal pattern of illness in a proportion of subjects with BD.
Assessing Suicidal Youth with Antisocial, Borderline, or Narcissistic Personality Disorder
Authors: Links Paul S , Gould Brent , Ratnayake Ruwan
Published: July 2017

Objective:

This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide.

Method:

We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents.

Results:

Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse.

Conclusions:

For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.