bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Care and Adverse Pregnancy Outcomes among Women with Depression: A Nationwide Population-Based Study
Authors: Chen Chia-Hui , Lin Herng-Ching
Published: January 2017

Objective:

To evaluate the quantity of prenatal care as a risk factor for giving birth to low birth weight (LBW), preterm, and small for gestational age (SGA) infants in a sample of women diagnosed with depressive disorder.

Method:

Our study used a population-based dataset, Taiwan's National Health Insurance Research Database, which we linked to Taiwan's birth certificate registry to identify a total of 5283 new mothers with depressive disorder. Multivariate logistic regression analyses were performed to measure the risk of giving birth to LBW, preterm, and SGA infants, relating to the number of prenatal care visits (10 or more, 8 to 9, and 7 or less) made by mothers with depressive disorder.

Results:

After adjusting for a woman's age, monthly income, urbanization level of place of residence, geographic location, marital status, substance abuse, arterial hypertension, diabetes, anemia, coronary heart disease, malpresentation, insufficient or excessive fetal growth, placenta or previa abruption, and infant's sex and parity, regression analyses revealed that mothers with a history of depressive disorder who received prenatal care 7 times or less were 4.21 (95% CI 3.34 to 5.32, P < 0.001), 5.37 (95% CI 4.33 to 6.67, P < 0.001), and 2.41 (95% CI 2.03 to 2.86, P < 0.001) times as likely to have LBW, preterm, and SGA babies, respectively, compared with mothers with depressive disorder who received prenatal care visits 10 times or more.

Conclusions:

Mothers with a history of depressive disorder who make fewer prenatal care visits were at an increased risk of LBW, SGA, and preterm birth, compared with women with a history of depressive disorder who made an adequate number of prenatal visits.
To Detain or to Release? Correlates of Dispositions for Individuals Declared Not Criminally Responsible on Account of Mental Disorder
Authors: Crocker Anne G , Braithwaite Erika , Côté Gilles , Nicholls Tonia L , Seto Michael C
Published: January 2017

Objective:

The extent to which risk assessment advances have influenced release decision-making by review boards (RBs) of individuals found not criminally responsible on account of mental disorder (NCRMD) remains unclear. Our objective is to identify the psychosocial, criminological, and risk measure correlates of RB decision-making.

Method:

Data were collected through structured interviews and file reviews conducted between October 2004 and August 2006 in the sole forensic psychiatric hospital in Quebec and in 2 civil psychiatric hospitals in a large metropolitan area designated to care for people found NCRMD. The final sample consisted of 96 men.

Results:

Dynamic, clinical risk factors are associated with decisions to detain or release people found NCRMD, rather than traditional historical risk factors such as criminal history.

Conclusion:

Dynamic variables seem appropriate for the RBs to consider given the intention of the NCRMD legislation. Further, dynamic variables provide direction for titration of treatment and supervision. Results are discussed regarding enhancing evidence-informed RB dispositions.
Economic Approaches to Improving Access to Evidence-Based and Recovery-Oriented Services for People with Severe Mental Illness
Authors: Latimer Eric A , Bond Gary R , Drake Robert E
Published: January 2017

During the past 3 decades, research has identified several psychosocial evidence-based practices (EBPs) for people with severe mental illness (SMI). Starting from a different origin, the recovery movement has influenced perceptions of how EBPs and other services should be delivered, and also emphasized the value of peer supports. We now know much more than 30 years ago about the kinds of services that help people with SMI live satisfying lives in the community. Evidence-based and recovery-oriented services require additional resources but use them sparingly: they are highly individualized, often result in reductions in costs of other mental health services, such as hospitalizations, and favour reliance on and integration into community settings rather than mental health services. Nevertheless, access to such services remains very limited. During the same period, the place of medications in the services system has become a source of growing concern, and there are several reasons to believe that current spending on medications is excessive. Inadequate housing and community supports that increase lengths of stay unnecessarily and spending on ineffective, nonrecovery-oriented vocational services are only 2 additional forms of misallocation of resources. Devolving control over medication budgets to regional or local health authorities, introducing program budgeting and marginal analysis, and implementing individual budgets to give more control to service users (in addition to promoting shared decision making) merit further investigation as potential strategies to improve outcomes for people with SMI in Canada in the context of limited budgets.
Prevalence of Insomnia and its Treatment in Canada
Authors: Morin Charles M , LeBlanc Mélanie , Bélanger Lynda , Ivers Hans , Mérette Chantal , Savard Joseé
Published: January 2017

Objectives:

To estimate the prevalence of insomnia and examine its correlates (for example, demographics and physical and mental health) and treatments.

Methods:

A sample of 2000 Canadians aged 18 years and older responded to a telephone survey about sleep, health, and the use of sleep-promoting products. Respondents with insomnia were identified using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the International Classification of Diseases, Tenth Edition, criteria.

Results:

Among the sample, 40.2% presented at least 1 symptom of insomnia (that is, trouble falling or staying asleep, or early morning awakening) for a minimum of 3 nights per week in the previous month, 19.8% were dissatisfied with their sleep, and 13.4% met all criteria for insomnia (that is, presence of 1 insomnia symptom 3 nights or more per week for at least 1 month, accompanied by distress or daytime impairment). Insomnia was associated with female sex, older age, and poorer self-rated physical and mental health. Thirteen per cent of respondents had consulted a health care provider for sleep difficulties once in their lifetime. Moreover, 10% had used prescribed medications for sleep in the previous year, 9.0% used natural products, 5.7% used over-the-counter products, and 4.6% used alcohol. There were differences between French- and English-speaking adults, with the former group presenting lower rates of insomnia (9.5%, compared with 14.3%) and consultation (8.7%, compared with 14.4%), but higher rates of prescribed medications (12.9%, compared with 9.3%) and the use of natural products (15.6%, compared with 7.4%).

Conclusions:

Insomnia is a prevalent condition, although few people seek professional consultation for this condition. Despite regional differences in the prevalence and treatments used to manage insomnia, prescribed medications remain the most widely used therapeutic option.
Prevalence of Psychiatric Disorder in Lone Fathers and Mothers: Examining the Intersection of Gender and Family Structure on Mental Health
Authors: Wade Terrance J , Veldhuizen Scott , Cairney John
Published: January 2017

Objective:

While mothers head the majority of single-parent households, the percentage of father-headed, lone-parent households has increased in recent years. However, current mental health research on single parents focuses almost exclusively on single mothers. In this analysis, we disaggregate the unique and combined effects of gender and family structure on the mental health of fathers and mothers.

Methods:

We used the Canadian Community Health Survey: Mental Health and Well-Being, a nationally representative population health survey. In this survey, 769 and 1964 lone fathers and mothers, respectively, and 5340 and 5505 married or cohabitating fathers and mothers, respectively, with at least 1 child aged 25 years or younger living at home, were identified. We also used the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) to provide diagnoses for various anxiety and mood disorders and a revised version of the WHM-CIDI to identify substance use disorders (SUDs).

Results:

Lone fathers and lone mothers have higher rates of mood disorders and SUDs than their married counterparts. Comparing lone parents, mothers had higher rates of anxiety disorders (10.7%, compared with 4.9%) and mood or anxiety disorders (19.9%, compared with 11.1%) than fathers but were not significantly different across total disorders when SUD was included. Social support significantly moderated effects for single-parent status and gender. Social support appears to be more of a protective factor for lone fathers than among lone mothers.

Conclusions:

Similar to lone mothers, lone fathers are at greater risk of psychiatric disorders than their married counterparts, indicating that this disadvantaged family structure has negative consequences for all parents.
Fetal Serotonin Reuptake Inhibitor Antidepressant Exposure: Maternal and Fetal Factors
Authors: Shea Alison K , Oberlander Tim F , Rurak Dan
Published: January 2017

Prenatal serotonin reuptake inhibitor exposure is common and neonatal outcomes vary greatly, often leading to confusion about whether to use or even continue antenatal use of these antidepressants. Importantly, some but not all infants are affected, which raises questions about how maternal drug metabolism contributes to fetal drug exposure. To address this key question, our paper reviews the role of key maternal, fetal, and placental pharmacokinetic, metabolic, and genetic factors that affect the extent of fetal drug exposure. Considering the role of these factors may further our understanding of variables that may assist in optimizing maternal psychopharmacotherapy during pregnancy and neonatal outcomes.
Characteristics of Older Adults Hospitalized in Acute Psychiatric Units in Ontario: A Population-Based Study
Authors: Seitz Dallas P , Vigod Simone N , Lin Elizabeth , Gruneir Andrea , Newman Alice , Anderson Geoff , Rapoport Mark J , Rochon Paula , Blumberger Daniel M , Herrmann Nathan
Published: January 2017

Objective:

As the numbers of older adults in Canada increases, there will be a growing need for mental health services for this population. Acute psychiatric units (APUs) provide inpatient psychiatric services for the management of serious mental illness. Understanding the characteristics of older adults in APUs is necessary to determine the range of inpatient services required for this population.

Method:

We conducted a population-based study of all adults discharged from APUs in Ontario in a 2-year period, 2008–2010, using administrative databases. We compared the characteristics of older adults (aged 66 years and older) in APUs to those of younger adults (aged 18 to 65 years), including sociodemographics, psychiatric and medical diagnoses, and measures of cognition and functioning.

Results:

There were a total of 79 352 discharges from APUs, with older adults accounting for 8.8% of all discharges. Depressive disorder was the most common diagnosis, both in older and in younger populations (32.1% and 29.9%, respectively), while dementia accounted for 19.5% of discharges for older adults. Older adults, compared with younger adults, were more likely to have 2 or more chronic medical conditions (83.8% and 20.5%, respectively), significant cognitive impairment (47.0% and 14.5%, respectively), and moderate-to-severe functional impairment (21.8% and 3.3%, respectively).

Conclusions:

Older adults in APUs are a complex group, with mental health and medical care needs that differ from younger adults. APUs must be able to provide adequate psychiatric, medical, and interprofessional services to achieve optimal outcomes. Future studies are required to understand the quality of care and outcomes for older adults in APUs.
Gene—Environment Interaction in Panic Disorder and Posttraumatic Stress Disorder
Authors: Battaglia Marco
Published: January 2017

Gene–environment interaction is a form of causal interplay, whereby genetic effects on phenotypic variation change as a function of environmental exposure. While conceptually appealing, there is still much debate on the veracity and the relevance of this form of etiological interdependence for psychiatric disorders.

By focusing on panic disorder (PD) and posttraumatic stress disorder (PTSD), this article outlines why gene–environment interaction is controversial, why it can be important for both researchers and clinicians, and how it is investigated by quantitative genetic, molecular genetic, and genomic strategies.

It is suggested that gene–environment interaction effects are more reliable and meaningful when they can be harnessed to pinpoint specific biological pathways and mechanisms. In psychiatry, this can be guided by phenotypic dissection and realized by adopting intermediate phenotypes of a physiological nature, such as carbon dioxide sensitivity for PD, or gene expression profiling after stress for PTSD. A developmental framework of reference and the possibility of transferring the investigation to animal models are additional key elements in this debate.
Neuroplasticity-Based Brain Stimulation Interventions in the Study and Treatment of Schizophrenia: A Review
Authors: Rajji Tarek K , Rogasch Nigel C , Daskalakis Zafiris J , Fitzgerald Paul B
Published: January 2017

We reviewed novel brain stimulation approaches that modify neuroplasticity and are used in the treatment and study of schizophrenia. We searched PubMed and Scholars Portal using search terms related to schizophrenia, brain stimulation, and neuroplasticity. Various brain stimulation approaches simulating a range of experimental protocols that induce synaptic long-term potentiation or depression have been developed. By far, repetitive transcranial magnetic stimulation (rTMS) has been the most widely used in the field of schizophrenia. Its application has been associated with mixed results in treating treatment-resistant symptoms and cognitive deficits associated with schizophrenia. Compared to the other approaches, rTMS is probably the least similar to plasticity-inducing cellular paradigms. Other approaches, such as paired associative stimulation, theta-burst stimulation, and transcranial direct current stimulation, are in their incipient stages in the study and treatment of schizophrenia, with promising early results. Numerous brain stimulation approaches have been developed to treat resistant dimensions of schizophrenia. Notwithstanding some promising reports, optimization of the methods and large randomized controlled trials are still needed.
Reciprocal Prospective Associations between Depressive Symptoms and Perceived Relationship with Parents in Early Adolescence
Authors: Brière Frédéric N , Archambault Kim , Janosz Michel
Published: January 2017

Objective:

Adolescent depressive symptoms are associated with difficult family relationships. Family systems and interpersonal theories of depression suggest that this association could reflect a circular process in which symptoms and family functioning affect each other over time. Few longitudinal studies have tested this hypothesis, and the results of these studies have been equivocal. In this study, we examine reciprocal prospective associations in early adolescence between depressive symptoms and 2 important aspects of parent–child relationships: communication and conflict.

Methods:

Participants were 3862 students who annually filled out self-reports. Path analysis was used to examine prospective associations between depressive symptoms and perceived communication and conflict with parents from the age of 12 to 13 and 14 to 15 years. Independence of these associations was assessed by controlling for family context (parental separation and family socioeconomic status) and adolescent behaviour problems (delinquent behaviours and substance use). Sex differences were evaluated with multiple group analysis.

Results:

Reciprocal prospective associations were found between depressive symptoms and perceived conflict with parents, but not between depressive symptoms and communication with parents. Depressive symptoms were found to predict poorer communication with parents overtime, but communication was not predictive of lower depressive symptoms in subsequent years. All paths were sex-invariant and independent from family context and behaviour problems.

Conclusion:

This study highlights the importance of considering the potential impact of adolescent symptomatology on parent-child relationships and suggests that reciprocity may characterize the association between depressive symptoms and negative aspects of parent–child relationships. The role of adolescent perceptions in the interplay between depressive symptoms and family relationships remains to be clarified.
Examining the Nature of the Association between Attention-Deficit Hyperactivity Disorder and Nicotine Dependence: A Familial Risk Analysis
Authors: Biederman Joseph , Petty Carter R , Hammerness Paul , Woodworth K Yvonne , Faraone Stephen V
Published: January 2017

Objective:

To use familial risk analysis to examine the association between attention-deficit hyperactivity disorder (ADHD) and nicotine dependence (ND).

Method:

Subjects were children with ( n = 257) and without ( n = 229) ADHD of both sexes ascertained from pediatric and psychiatric referral sources and their first-degree relatives ( N = 1627).

Results:

ND in probands increased the risk for ND in relatives irrespective of ADHD status. There was no evidence of cosegregation or assortative mating between these disorders. Patterns of familial risk analysis suggest that the association between ADHD and ND is most consistent with the hypothesis of independent transmission of these disorders.

Conclusions:

These findings may have important implications for the identification of a subgroup of children with ADHD at high risk for ND based on parental history of ND. Examiner la nature de l'association entre le trouble de déficit de l'attention avec hyperactivité et la dépendance à la nicotine: une analyse de risque familial
A Population-Based Study of Antipsychotic Prescription Trends in Children and Adolescents in British Columbia, from 1996 to 2011
Authors: Ronsley Rebecca , Scott David , Warburton William P , Hamdi Ramsay D , Louie Dianna Clare , Davidson Jana , Panagiotopoulos Constadina
Published: January 2017

Objectives:

To establish prevalence rates of antipsychotic (AP) prescriptions for children 18 years of age or younger in British Columbia (BC) from 1996 to 2011 by age, sex, AP type, and primary diagnosis; and to identify the predominant AP prescribers for children by specialty training.

Methods:

BC Ministry of Health administrative data were used to describe AP prescriptions for youth aged 18 years or younger. Comparisons were made using population prevalence based on sex; age group; AP; International Classification of Diseases, Ninth Revision, diagnosis; and prescriber specialty.

Results:

From 1996 to 2011, overall AP (both first and second generation) prescription prevalence rate increased 3.8-fold (1.66 to 6.37 per 1000 population); second-generation AP (SGA) prescriptions increased 18.1-fold (0.33 to 5.98 per 1000 population). The highest increase in all AP prescriptions occurred in males aged 13 to 18 years (3.3 to 14.4 per 1000 population; 4.4-fold), followed by similar increases in males aged 6 to 12 years (2.3 to 8.6 per 1000 population; 3.7-fold) and in females aged 13 to 18 years (2.8 to 10.7 per 1000 population; 3.8-fold). Overall, the 3 most common diagnoses associated with all AP prescriptions were depressive disorders (12.8%), hyperkinetic syndrome of childhood (11.7%), and neurotic disorders (11.1%); however, variation was observed by prescriber specialty training. Among all new AP prescriptions in 2010/11, 38.6%, 34.3%, and 15.6% were provided by psychiatrists, family physicians, and pediatricians, respectively.

Conclusions:

There has been an exponential rise in SGA prescriptions in BC secondary to extensive off-label use, not only by psychiatrists but also by family physicians and pediatricians. Knowledge translation initiatives promoting evidence-based prescribing and monitoring practices related to SGA treatment need to target all 3 prescriber groups and be tailored for age subgroups.
Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario
Authors: Anderson Kelly K , Flora Nina , Ferrari Manuela , Tuck Andrew , Archie Suzanne , Kidd Sean , Tang Taryn , Kirmayer Laurence J , McKenzie Kwame
Published: January 2017

Objective:

To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP).

Methods:

We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care.

Results:

We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant.

Conclusions:

Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.
A Youth Suicide Prevention Plan for Canada: A Systematic Review of Reviews
Authors: Bennett Kathryn , Rhodes Anne E , Duda Stephanie , Cheung Amy H , Manassis Katharina , Links Paul , Mushquash Christopher , Braunberger Peter , Newton Amanda S , Kutcher Stanley , Bridge Jeffrey A , Santos Robert G , Manion Ian G , McLennan John D , Bagnell Alexa , Lipman Ellen , Rice Maureen , Szatmari Peter
Published: January 2017

Objective:

We conducted an expedited knowledge synthesis (EKS) to facilitate evidence-informed decision making concerning youth suicide prevention, specifically school-based strategies and nonschool-based interventions designed to prevent repeat attempts.

Methods:

Systematic review of review methods were applied. Inclusion criteria were as follows: systematic review or meta-analysis; prevention in youth 0 to 24 years; peer-reviewed English literature. Review quality was determined with AMSTAR (a measurement tool to assess systematic reviews). Nominal group methods quantified consensus on recommendations derived from the findings.

Results:

No included review addressing school-based prevention ( n = 7) reported decreased suicide death rates based on randomized controlled trials (RCTs) or controlled cohort studies (CCSs), but reduced suicide attempts, suicidal ideation, and proxy measures of suicide risk were reported (based on RCTs and CCSs). Included reviews addressing prevention of repeat suicide attempts ( n = 14) found the following: emergency department transition programs may reduce suicide deaths, hospitalizations, and treatment nonadherence (based on RCTs and CCSs); training primary care providers in depression treatment may reduce repeated attempts (based on one RCT); antidepressants may increase short-term suicide risk in some patients (based on RCTs and meta-analyses); this increase is offset by overall population-based reductions in suicide associated with antidepressant treatment of youth depression (based on observational studies); and prevention with psychosocial interventions requires further evaluation. No review addressed sex or gender differences systematically, Aboriginal youth as a special population, harm, or cost-effectiveness. Consensus on 6 recommendations ranged from 73% to 100%.

Conclusions:

Our EKS facilitates decision maker access to what is known about effective youth suicide prevention interventions. A national research-to-practice network that links researchers and decision makers is recommended to implement and evaluate promising interventions; to eliminate the use of ineffective or harmful interventions; and to clarify prevention intervention effects on death by suicide, suicide attempts, and suicidal ideation. Such a network could position Canada as a leader in youth suicide prevention.
Suicide among Inuit: Results from a Large, Epidemiologically Representative Follow-Back Study in Nunavut
Authors: Chachamovich Eduardo , Kirmayer Laurence J , Haggarty John M , Cargo Margaret , McCormick Rod , Turecki Gustavo
Published: January 2017

Objective:

The Inuit population in Canada's North has suffered from high rates of death by suicide. We report on the first large-scale, controlled, epidemiologically representative study of deaths by suicide in an Indigenous population, which investigates risk factors for suicide among all Inuit across Nunavut who died by suicide during a 4-year period.

Methods:

We identified all suicides by Inuit ( n = 120) that occurred between January 1, 2003, and December 31, 2006, in Nunavut. For each subject, we selected a community-matched control subject. We used proxy-based procedures and conducted structured interviews with informants to obtain life histories, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II diagnoses, and measures of impulsive and (or) aggressive traits.

Results:

Compared with control subjects, subjects who died by suicide were more likely to have experienced childhood abuse (OR 2.38; 95% CI 1.39 to 4.08), have family histories of major depressive disorder ( P = 0.002) and suicide completion ( P = 0.02), and have been affected by major depressive disorder (OR 13.00; 95% CI 6.20 to 27.25), alcohol dependence (OR 2.90; 95% CI 1.59 to 5.24), or cannabis dependence (OR 3.96; 95% CI 2.29 to 6.8) in the last 6 months. In addition, subjects who died by suicide were more likely to have been affected with cluster B personality disorders (OR 10.18; 95% CI 3.34 to 30.80) and had higher scores of impulsive and aggressive traits ( P < 0.001).

Conclusions:

At the individual level, clinical risk factors for suicide among Inuit are similar to those observed in studies with the general population, and indicate a need for improved access to mental health services. The high rate of mental health problems among control subjects suggests the need for population-level mental health promotion.
Correlates of Nonsuicidal Self-Injury and Suicide Attempts among Tertiary Care, Emergency Department Patients
Authors: Chartrand Hayley , Bhaskaran Joanna , Sareen Jitender , Katz Laurence Y , Bolton James M
Published: January 2017

Objective:

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the distinction between nonsuicidal self-injury (NSSI) and suicidal behaviour disorder is highlighted in the section Conditions for Further Study. Diagnostic criteria classify NSSI and suicidal behaviour disorder as distinct disorders, with the latter including suicide attempt (SA). This study examined the prevalence and correlates of NSSI in emergency department (ED) settings and compared them to SA.

Methods:

Data came from adult referrals to psychiatric services in 2 EDs between January 2009 and June 2011 ( n = 5336). NSSI was compared with SA, as well as no suicidal behaviour, across a broad range of demographic and diagnostic correlates.

Results:

NSSI was more highly associated with female sex, childhood abuse, anxiety disorders, major depressive disorder (MDD), aggression and impulsivity, age under 45, and substance use disorders (SUDs), compared with presentations without suicidal behaviour. Comparing NSSI and SA, no differences were observed on sex, age, history of child abuse, or presence of anxiety or SUDs. Recent life stressors (OR 1.44; 95% CI 1.05 to 1.99), active suicidal ideation (OR 8.84; 95% CI 5.26 to 14.85), MDD (OR 3.05; 95% CI 2.23 to 4.17), previous psychiatric care or SA (OR 1.89; 95% CI 1.36 to 2.64), and single marital status (OR 1.63; 95% CI 1.20 to 2.22) contributed to a higher SA rate. Among people with NSSI, 83.7% presented only once to an ED. Among people who presented multiple times, only 18.2% re-presented with NSSI.

Conclusions:

NSSI is associated with early life adversity and psychiatric comorbidity. Most people present only once to ED services, and self-harm presentations seemed to change over time. Future studies should continue to clarify whether NSSI and SA have distinct risk profiles.
Moving Out of the Office: Removing Barriers to Access to Psychiatrists
Authors: Paris Joel , Goldbloom David , Kurdyak Paul
Published: January 2017

Our paper offers a perspective on barriers to access to psychiatric care. Research shows that access depends not simply on the total number of trained specialists but also on their kind of practice. In some large cities, some practitioners follow a small number of patients in long-term psychotherapy, a practice supported by government insurance, which places no limits on the number of sessions or treatment duration. The problem is that long-term psychotherapy, despite a rich tradition in psychiatry, is not an evidence-based treatment. This review recommends a model in which psychiatrists spend more time in consultation with primary care professionals, in acute care for patients with severe mental illness, and in briefer, more cost-effective forms of psychotherapy.
Geriatric Psychiatry Subspecialization in Canada: Past, Present, and Future
Authors: Clair JK Le , Sadavoy J
Published: January 2017

Objective:

To describe the development, future challenges, and directions of geriatric psychiatry in Canada.

Method:

This review and description of geriatric psychiatry was developed in the context of the criteria established by the Royal College of Physicians and Surgeons of Canada for subspecialization applications. Information from key informants, both nationally and internationally, was combined with a review of relevant literature in the field.

Results and Conclusions:

Canada has provided important contributions to the field of geriatric psychiatry in Canada and abroad. The increased needs of older persons with severe mental illness and their families, combined with a significant body of knowledge and therapeutic options, provide an important foundation for further development. Subspecialization in geriatric psychiatry as part of the overall development of psychiatry in Canada is proposed as critical to meeting the challenges of our aging population.
The Pharmacologic Treatment of Alzheimer's Disease: A Guide for the General Psychiatrist
Authors: Flint Alastair J , Van Reekum Robert
Published: January 2017

Objective:

To review the drug treatment of Alzheimer's disease (AD) and to provide guidelines for the physician on how to integrate these treatments into the overall management of this disorder.

Method:

A qualitative review of randomized, double-blind, placebo-controlled trials of medications used to treat cognitive deficits, disease progression, agitation, psychosis, or depression in AD. A computerized search of Medline was used to identify relevant literature published during the period 1968–1998. Key words used in the search were 'randomized controlled trials, ' with 'dementia' and with 'Alzheimer's disease'.

Results:

Agents that are currently available in Canada to treat the cognitive deficits of AD include donepezil, ginkgo biloba, selegiline, and ergoloid mesylates. Donepezil and ginkgo biloba are associated with a statistically significant but clinically modest improvement in cognitive function in a substantial minority of patients with mild to moderate AD. Selegiline may have a mild beneficial effect on cognitive function in some patients with AD, but the data are inconclusive. Ergoloid mesylates have questionable efficacy in AD and can only be recommended as a last line of treatment. The results of a single trial suggest that vitamin E or selegiline (both have antioxidant properties) may slow the progression of AD. Antipsychotic medications can result in clinically significant improvement in agitation and psychosis. Carbamazepine also appears to be an effective treatment for agitation in AD, and there is preliminary evidence that the selective serotonin reuptake inhibitor Citalopram reduces irritability in this disorder. There is no evidence that other nonneuroleptic medications are more efficacious than placebo in treating agitation in AD. Limited data indicate that depression in dementia responds to antidepressant medication.

Conclusion:

These data indicate that selected medications can be used to treat cognitive deficits, disease progression, agitation, psychosis, and depression in AD. However, there is considerable heterogeneity in patients' responses to these medications. Pharmacotherapy needs to be considered as a component of a package of care that also includes psychosocial and environmental interventions and support of the caregiver.
Pharmacologic Treatments Effective in Both Generalized Anxiety Disorder and Major Depressive Disorder: Clinical and Theoretical Implications
Authors: Casacalenda Nicola , Boulenger Jean-Philipe
Published: January 2017

Objective:

To review the efficacy of anxiolytics (alprazolam and azapirones) in major depressive disorder (MDD) and that of antidepressants in generalized anxiety disorder (GAD), thereby exploring the possible theoretical and clinical implications of this efficacy.

Method:

A Medline literature search was performed for the period January 1980 to September 1997 of randomized, double-blind comparison studies between anxiolytics and antidepressants in the acute treatment of adult patients with either MDD or GAD.

Results:

Alprazolam, at doses double those generally recommended for anxiety disorders, appears to be as effective as tricyclic antidepressants (TCAs) in the acute treatment of mild to moderate MDD. Alprazolam was also found to have a more rapid onset of action than do TCAs, particularly for the improvement of anxiety, somatization, and insomnia. Two azapirones (buspirone andgepirone) also have demonstrated a modest acute antidepressant effect in preliminary studies, albeit only in a depressed outpatient sample with considerable anxiety at baseline. Finally, various antidepressant drugs (imipramine, trazodone, paroxetine) were shown to have, at the least, comparable efficacy to benzodiazepines (BZDs) in the acute treatment of GAD.

Conclusions:

The nonspecificity of treatment response suggests that GAD and MDD are 1) different expressions of a similar disorder with a common neurobiological substrate, 2) discrete diagnostic entities that respond to independent pharmacological effects of the same drugs, or 3) a combination of the two (heterogeneity hypothesis). The most relevant clinical finding is the efficacy of antidepressants in the acute treatment of GAD.
Psychotherapy and Disclosure: Recent Court Decisions
Authors: Furlong Allannah , Lefebvre Michèle S
Published: January 2017

Objective:

To encourage mental health professionals concerned about the practice of psychotherapy to add their voices to the legal debate on disclosure.

Method:

Analysis of recent court decisions, in particular 2 Supreme Court of Canada judgements, R. v. O'Connor and R. v. Carosella, and 1 United States Supreme Court judgement, Jaffee v. Redmond.

Results:

The lack of a common definition of psychotherapy may, in part, have made it awkward for mental health professionals to mount a concerted defence of psychotherapy dossiers.

Conclusions:

Unless mental health professionals develop a more robust justification and delimitation for privilege, in Canadian courts possible relevance of clinical material is likely to override concern for the patient's privacy interest. Future research might evaluate the impact of loss of privilege upon different types of psychotherapy.
Thinking Small: Research Designs Appropriate for Clinical Practice
Authors: Streiner David L
Published: January 2017

Even though some treatments have been shown to be efficacious in clinical trials, there is no guarantee that they are effective with a specific patient. This article outlines some of the methods clinicians can use to evaluate the effectiveness of therapy with individual patients. These methods include 1) the before-after design, 2) the reversal design, 3) interrupted time series, and 4) multiple baselines. This paper recommends that patients who are being treated, whether privately or in hospital, be seen as experiments with a sample size of 1 and that their progress be monitored using 1 of these methods.
The Meeting of Pain and Depression: Comorbidity in Women
Authors: Meana Marta
Published: January 2017

The higher prevalence of depression in women is coupled with a higher prevalence of pain complaints. Growing evidence suggests that the comorbidity of these conditions is also proportionately higher in women than men. This paper critically reviews the empirical findings relating to gender differences in comorbid pain and depression as well as findings in support of hypothesized etiologic factors that could explain why women may be more susceptible than men to comorbidity. The empirical evidence for biogenic, psychogenic, and sociogenic explanatory models is presented, and an integration of these models is proposed as a guideline to both research and clinical practice. In conclusion, it is argued that gender-differentiated treatment strategies are not clinically indicated at this time.
Developments in Interpersonal Psychotherapy
Authors: Markowitz John C
Published: January 2017

Background:

Interpersonal psychotherapy (IPT), a time-limited psychotherapy, was developed in the 1970s as a treatment for outpatient adults with major depression. It since has grown in its range of research applications and in its clinical accessibility.

Method:

Review of recent research and educational developments on IPT.

Results:

IPT has demonstrated efficacy in randomized controlled trials for major depression in various patient populations and in patients with bulimia. It showed no advantages in treating 2 substance abuse samples. Numerous further studies are underway. Growing numbers of clinicians are learning IPT.

Conclusions:

At a time when both research developments and economic pressures are increasing interest in time-limited psychotherapies, IPT is expanding in both the research and clinical domains.
Refus catégorique de traitement des patients psychiatriques: Bilan, enquête et perspective
Authors: Trudeau Marie-Hélène , Bruneau Marie-Andrée , Stip Emmanuel , Grünberg Fréderic , Boivin Marie
Published: January 2017

Historique:

Le refus du patient d'être traité est une situation à laquelle le psychiatre est confronté couramment dans sa pratique. Au Québec, en 1990, une nouvelle loi est venue changer radicalement la situation, en introduisant au code civil une disposition imposant le recours à l'intervention judiciaire pour traiter contre son gré une personne jugée inapte à consentir. Dans le présent article, nous proposons un bilan accompagné d'une enquête menée auprès des patients et des psychiatres traitants qui ont eu recours à cette disposition du code civil.

Méthode:

Ainsi, 39 sujets refusant catégoriquement un traitement ont été amenés en cours. A un sous-groupe de ces patients, nous avons proposé un entretien basé sur le DAI (questionnaire sur l'attitude à l'égard des médicaments) sur le CGI (impression clinique globale), et sur 2 questionnaires conçus spécifiquement pour répondre à des questions sur l'expérience au tribunal des patients et des psychiatres traitants.

Résultats:

Les résultats de cette enquête montrent que les patients ont un souvenir plutôt désagréable de leur expérience en cour. Cependant, l'alliance thérapeutique est demeurée inchangée même après la procédure. Les médecins sont unanimes à dire que les patients n 'auraient pas pu présenter un état clinique suffisamment amélioré pour quitter l'hôpital s'ils n 'avaient pas reçu de traitement médicamenteux, par suite de ce jugement. L'analyse de la dissociation entre la perception des patients et celle des médecins est comparée à celle des résultats issus d'études antérieures conduites aux États-Unis.

Conclusion:

Tout en étant une recherche modeste, cette étude porte sur une situation délicate, difficile et de plus en plus fréquente. Elle propose d'étudier plus à fond d'autres voies que le recours au tribunal.
Living Arrangement Requirements for Individuals with Developmental Disability and Behavioural Problems
Authors: Fotheringham John B
Published: January 2017

Objective:

To review the need for a wide range of living arrangements and community support services for individuals with developmental disability (DD) and behavioural problems and for their caregivers.

Methods:

An analysis of a 1-year caseload of a consulting psychiatrist to 2 community support agencies for individuals with DD.

Results and Conclusions:

Of the individuals seen with DD and behavioural problems, one-half needed a different living arrangement, immediately in many cases. Living arrangements and support services are extensively deficient. Correcting these deficiencies requires the concerted involvement of local, provincial, and federal governments as well as of community groups and agencies.
Retention Rates in Placebo- and Nonplacebo-Controlled Clinical Trials of Schizophrenia
Authors: Labelle Alain , Boulay Luc Jean , Lapierre Yvon Denis
Published: January 2017

Objective:

To determine if the inclusion of a placebo control in clinical trials of schizophrenia affects retention rates in the first 35 days of inclusion relative to trials that did not have a placebo control.

Method:

This was a retrospective study of 8 double-blind clinical trials, 5 of which had a placebo control while 3 did not. Using survival analysis, retention rates between the placebo-controlled trials (PCTs) and the nonplacebo-controlled trials (NPCTs) were compared. Screening and percentage improvement on Brief Psychiatric Rating Scale and Positive and Negative Syndrome Scale scores were compared.

Results:

Significantly more patients were retained in the 35-day period for NPCTs. Also, the PCT group had significantly more psychopathology at screening than did the NPCT group.

Conclusions:

Differences in retention rates between PCTs and NPCTs cannot be uniquely attributed to placebo itself.
Cumulative Family Stress and Diurnal Cortisol Responses in Midwest Latino Families
Authors: Kwak Yoonyoung , Taylor Zoe E. , Anaya Laura Y. , Feng Yi , Evich Carly D. , Jones Blake L.
Published: January 2017

Latino youth and their families have been shown to experience higher levels of stressors than the general population, as well as additional unique stressors such as racism, poverty, acculturation, and discrimination. Chronic or cumulative stress often disrupts physiological systems and can lead to dysregulation in diurnal cortisol responses. This study examined the associations between family stress and cortisol responses in 57 Latino mother-adolescent dyads ( N = 114) living in the Midwestern United States. Dyads collected saliva 6 times across two consecutive days and completed a survey. Results from repeated measures mixed-effect analysis found that both mothers and adolescents in the high-stress group had flatter cortisol awakening responses than those in the low-stress group, which indicated disruptions in their diurnal cortisol rhythms. These findings suggest that family stress can potentially influence the diurnal cortisol patterns of early Latino adolescents as well as adults, which may, in turn, lead to future health problems.
Effects of hydroxyl-functionalized multiwalled carbon nanotubes on sperm health and testes of Wistar rats
Authors: Nirmal NK , Awasthi KK , John PJ
Published: January 2017

Carbon nanotubes (CNTs) are promising candidates for various applications including biomedical purposes. Owing to their remarkable physical, mechanical, electrical and chemical properties, CNTs have become an area of intense research and industrial activity in recent years. Therefore, toxicity and risk assessment studies are becoming increasingly important. The present study was designed to assess the effects of hydroxyl-functionalized multiwalled CNTs (OH-f MWCNTs) on sperm health and testes of adult Wistar rats. Animals were treated with different doses of OH-f MWCNTs (0.4, 2.0 and 10.0 mg/kg) along with a control group receiving only vehicle. Assessments after 15 alternate intraperitoneal doses revealed dose-related adverse effects on many endpoints tested. Results of the study showed significant impairment of sperm health at 2.0 and 10.0 mg/kg. Histology of testes demonstrated degeneration of germinal epithelium and loss of germ cells in the treatment groups. The exposure resulted in increased oxidative stress in testes in a dose-dependent manner. The findings of the study demonstrate that CNTs are potentially harmful for male reproductive health.
Neurologic Causes of Acute Respiratory Dysfunction
Authors: Nardin Rachel A. , Drislane Frank W.
Published: January 2017

Many neurologic diseases can cause acute respiratory decompensation, therefore a familiarity with these diseases is critical for any clinician managing patients with respiratory dysfunction. In this article, we review the anatomy of the respiratory system, focusing on the neurologic control of respiration. We discuss general mechanisms by which diseases of the peripheral and central nervous systems can cause acute respiratory dysfunction, and review the neurologic diseases which can adversely affect respiration. Lastly, we discuss the diagnosis and general management of acute respiratory impairment due to neurologic disease.