bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Availability on Gambling: A Longitudinal Study
Authors: Jacques Christian , Ladouceur Robert , Ferland Francine
Published: January 2017

Objective:

Legalized gambling opportunities have markedly increased in most industrialized countries. While most authors agree that the rate of pathological gamblers is related to the accessibility of gambling activities, no published studies have yet empirically estimated the impact of the introduction of new gambling activities within a longitudinal study. Thus, we evaluate the impact of the opening of a casino on gambling activities among nearby inhabitants.

Method

A random sample of 457 respondents from the Hull area (experimental group) and 423 respondents from the Quebec City area (control group) completed the South Oaks Gambling Screen and related questions, both before the opening of the Casino de Hull and 1 year later. Within each household contacted, a resident was randomly chosen by selecting the adult whose birthday was next.

Results

The experimental group exposed to the new casino showed a significant increase in 1) gambling on casino games, 2) the maximum amount of money lost in 1 day on gambling, 3) reluctance toward the opening of a local casino, and 4) the number of participants who reported knowing a person who has developed a gambling problem in the last 12 months.

Conclusion

The impact of legalized gambling is discussed in relation to the availability of gambling.
Do You See What I Mean? Indices of Central Tendency
Authors: Streiner David L
Published: January 2017

There are many indices of the middle, or central tendency, of a set of numbers, including the mode, median, and mean. Indeed, there are, several “means,” of which the arithmetic mean is only one. When data are skewed, or when there are outliers at one or both ends of the distribution that may distort the results, “robust” estimators of the mean, such as the trimmed mean or the bisquare weight mean, give better results than does the arithmetic mean. If the data reflect growth over time, the geometric mean is a more accurate reflection of the middle point than are other indices, and in determining sample size when the sample size varies among groups, the harmonic mean is the one of choice. Finally, this paper discusses the difference between the lay and statistical use of the term “average” and how this difference can lead to problems in interpretation.
The “Re-Entry Group”—A Transitional Therapeutic Framework for Mentally Ill Patients Discharged from the Hospital to Community Clinics
Authors: Karniel-Lauer Enav , Szor Henri , Livne Shula , Melamed Yuval , Spiro Shimon , Elizur Avner
Published: January 2017

An effective transition of the psychiatric patient from the hospital to the community clinic is vital to the continuity of care. This study shows a short-term group, the “re-entry group,” to be more effective in this transition than are patients discharged from a psychiatric hospital by the traditional process. We used a psychoeducational approach to facilitate active participation and compliance with outpatient therapy. Outcome variables included absorption of patients into the clinic, continued therapy, compliance with treatment, rehospitalization, level of knowledge regarding illness and medication, quality of rehabilitation, and attitude towards treatment.
Genetic Counselling for Schizophrenia in the Era of Molecular Genetics
Authors: Hodgkinson Kathleen A , Murphy Jillian , O'Neill Sheri , Brzustowicz Linda , Bassett Anne S
Published: January 2017

Objective:

To review the role of genetic counselling for individuals with psychiatric illnesses.

Method:

Using schizophrenia as an example and including updated information about a genetic subtype (22q deletion syndrome), we discuss the value of the genetic counselling process in psychiatry, with support from the literature and our clinical experience.

Results:

Genetic counselling, the process through which knowledge about the genetics of illnesses is shared, provides information on the inheritance of illnesses and their recurrence risks; addresses the concerns of patients, their families, and their health care providers; and supports patients and their families dealing with these illnesses. For comprehensive medical management, this service should be available to all individuals with schizophrenia and their families.

Conclusions:

New findings in the genetics of psychiatric illness may have important clinical implications for patients and their families.
Major Depressive Disorder in Adolescence: A Brief Review of the Recent Treatment Literature
Authors: Milin Robert , Walker Selena , Chow Joy
Published: January 2017

Objective:

Treating adolescents with depression remains a major clinical and public health challenge. Because of the serious morbidity and mortality associated with adolescent major depressive disorder (MDD), there is a need to review the published literature on treatment efficacy to establish effective treatment choices for these adolescents.

Method:

We reviewed the recent literature on the treatment of MDD in adolescents using the Medline and PsycINFO computerized databases.

Results:

Results of open studies of MDD treatment in adolescents suggested therapeutic efficacy; however, later, better-controlled studies are more difficult to interpret, owing to the high rate of improvement with placebo. Currently, there is limited evidence of robust, effective therapeutic interventions in children and in adolescent depressive disorders.

Conclusions:

Despite limitations, current findings from studies investigating selective serotonin reuptake inhibitors (SSRIs), cognitive-behavioural therapy, and interpersonal therapy generally support these treatments as safe and effective for adolescent MDD. Still, further investigations into these treatments for adolescent depression are warranted.
Behavioural and Substance Use Problems in Rural and Urban Delinquent Youths
Authors: Elgar Frank J , Knight John , Worrall Graham J , Sherman Gregory
Published: January 2017

Objective:

To examine rates of behavioural and substance use problems in incarcerated young offenders and to explore rural and urban differences in the expression and severity of these problems.

Method:

We assessed a sample of 68 confined male young offenders (63.3% rural and 35.3% urban), using the Drug Use Screening Inventory (DUSI) and the Youth Self-Report (YSR).

Results:

Based on clinical cut-offs, data showed high rates of externalizing behavioural problems (75.4%) and substance use problems (95.7%). Urban delinquent youths showed higher rates of attention problems, delinquent behaviours, and externalizing behaviours than those in rural communities.

Conclusions:

Incarcerated young offenders show elevated rates of psychological problems that require treatment. Rural and urban differences in the rates of these problems may reflect differences in community service availability in these areas or in environmental influences on the development of child behavioural problems.
Evidence-Based Treatment of Opioid-Dependent Patients
Authors: van den Brink Wim , Haasen Christian
Published: January 2017

Objective:

To provide an overview of treatment options for opioid-dependent patients.

Method:

We screened all published studies on the treatment of opioid dependence, with a special focus on systematic literature reviews, formal metaanalyses, and recent trials.

Results:

Both clinical experience and neurobiological evidence indicate that opioid dependence is a chronic relapsing disorder. Treatment objectives depend on the pursued goals: crisis intervention, abstinence-oriented treatment (detoxification and relapse prevention), or agonist maintenance treatment. The high quality of solid evidence in the literature demonstrates that there are numerous effective interventions available for the treatment of opioid dependence. Crisis intervention, frequently necessary owing to the high overdose rate, can be effectively handled with naloxone. Abstinence-oriented interventions are effective for only a few motivated patients with stable living conditions and adequate social support. Agonist maintenance treatment is considered the first line of treatment for opioid dependence. Numerous studies have shown efficacy for methadone and buprenorphine treatment, while maintenance with other agonists is also becoming available to a greater extent. Maintenance treatment with diamorphine should be made available for the small group of treatment-resistant, severely dependent addicts. Other harm-reduction measures can serve to engage individuals with opioid addiction who are not in treatment.

Conclusion:

Opioid dependence is a chronic relapsing disease that is difficult to cure, but effective treatments are available to stabilize patients and reduce harm, thereby increasing life expectancy and quality of life.
The Contribution of Social Factors to the Development of Schizophrenia: A Review of Recent Findings
Authors: Cantor-Graae Elizabeth
Published: January 2017

Objective:

To investigate recent evidence suggesting that social factors are causally related to the development of schizophrenia.

Method:

I conducted a sytematic review of MEDLINE to identify possibly relevant studies. The search was limited to peer-reviewed studies and review articles appearing in English-language journals since 1996. Studies were included if they used standardized diagnostic criteria for schizophrenia or standardized assessment instruments for psychotic symptoms.

Results:

Studies of migrants to western Europe provide compelling support for the notion that social factors contribute to the development of schizophrenia. Findings such as excessively high risk for schizophrenia in second-generation immigrants are difficult to explain solely in terms of biological or genetic factors. A growing number of studies implicate childhood exposure to social adversity as a risk factor for schizophrenia, although few studies have used prospective designs. The increased incidence of schizophrenia risk associated with urban birth and (or) urban upbringing suggests possible social causation, but these findings are more ambiguous. Thus far, no studies have explored actual mechanisms by which exposure to social factors might generate psychotic symptoms, although animal experiments suggest that social defeat or social exclusion may cause dopamine dysregulation or sensitization.

Conclusions:

The accumulating evidence suggesting a role for social factors in the development of schizophrenia arises primarily from studies of migrants conducted in Europe. The mechanisms by which social factors exert their influence remain unknown. Future investigations of social causation should clarify the temporal relation between exposure to social defeat and (or) social adversity and the development of psychotic symptoms.
An International Perspective on Worker Mental Health Problems: Who Bears the Burden and How are Costs Addressed?
Authors: Dewa Carolyn S , McDaid David , Ettner Susan L
Published: January 2017

Objective:

To discuss the burden of poor mental health in workers, who currently bears it, and how the associated rising costs are being addressed, from an international perspective.

Method:

We identify the stakeholder groups and the costs they incur as a result of problems related to mental health in 6 different domains. In addition, we offer examples of programs, services, and strategies being used to either decrease costs or enhance benefits.

Results:

Mental illness is associated with a wide range of costs distributed across multiple stakeholders including government, employers, workers and their families, and the health care system. The costs incurred by the groups are interrelated; an attempt to decrease the burden for one group of stakeholders will inevitably affect other stakeholders. Thus the answer to the question of who bears the costs of poor mental health is “everyone.”

Conclusions:

Everyone could benefit from investment in improved mental health in the workplace. However, because the benefits associated with improved worker mental health are often distributed among several stakeholders, the incentives for any single stakeholder to pay for additional services for workers may be diluted. As a consequence, no one invests. Nevertheless, there is a role for all stakeholders, just as there are potential benefits for all. Along with government, employers, employees, and the health care system must invest in promoting good workplace health.
Quality of Life in Treatment-Seeking Patients with Obsessive-Compulsive Disorder with and without Major Depressive Disorder
Authors: Cassin Stephanie E , Richter Margaret A , Zhang K Anne , Rector Neil A
Published: January 2017

Objective:

To compare the quality of life of patients with obsessive–compulsive disorder (OCD) with and without depression comorbidity.

Method:

Treatment-seeking outpatients ( n = 56) with OCD ( n = 28) or comorbid OCD and major depressive disorder (MDD) ( n = 28), matched by age, sex, and antidepressant medication use, completed a multidimensional measure of quality of life.

Results:

Patients with comorbid OCD and MDD reported significantly greater decrements in their subjective feelings, social relations, and a composite measure of general activities (for example, overall well-being and life satisfaction) in comparison with patients with OCD without MDD. These differences were not owing to the presence of other Axis I comorbid disorders.

Conclusions:

Treatments addressing depression comorbidity in the context of primary OCD are required to improve the quality of life of this severely affected population of OCD sufferers.
Differences in Prevalence and Treatment of Bipolar Disorder among Immigrants: Results from an Epidemiologic Survey
Authors: Schaffer Ayal , Cairney John , Cheung Amy , Veldhuizen Scott , Kurdyak Paul , Levitt Anthony
Published: January 2017

Objective:

To add to the limited data on the prevalence, clinical characteristics, and treatment of bipolar disorder (BD) among immigrants.

Method:

Data were obtained from a large epidemiologic survey, the Canadian Community Health Survey—Mental Health and Well-Being (CCHS 1.2). Lifetime prevalence rates of BD were compared between immigrant and nonimmigrant respondents. Among BD subjects ( n = 831), sociodemographic, clinical, and mental health treatment use variables were compared based on immigrant status. Logistic regression was used to determine the correlates of lifetime contact with a mental health professional and 12-month psychotropic medication use.

Results:

Lifetime prevalence rate of CCHS 1.2–defined BD was significantly lower among immigrant, compared with nonimmigrant, participants (1.50% and 2.27%, P = 0.01). There were few sociodemographic or clinical differences, yet immigrants with BD were significantly less likely to report any lifetime contact with mental health professionals (OR = 0.25, 95% CI 0.13 to 0.50, P < 0.001). Past-year psychotropic medication use was numerically lower among immigrants with BD (24.5% and 41.0%); however, this did not reach statistical significance when controlling for other factors (OR = 0.49, 95% CI 0.24 to 1.01, P = 0.05).

Conclusions:

Based on the results of this study, there are in the range of 56 000 to 104 000 immigrants with BD in Canada. Further efforts are needed to better understand and address the barriers to mental health treatment use among immigrants who have BD.
A Brief Scale to Assess Hospital Doctors' Attitudes toward Collaborative Care for Mental Health
Authors: Thombs Brett D , Adeponle Ademola B , Kirmayer Laurence J , Morgan John F
Published: January 2017

Objective:

Collaborative care may improve mental health management in hospital settings. However, no scales assess doctors' attitudes toward its 2 core components: mental health management by nonpsychiatric physicians and psychiatric consultation. Our objective was to develop and assess the reliability and validity of the Doctors' Attitudes Toward Collaborative Care for Mental Health (DACC-MH) Scale.

Method:

Fifteen items assessing doctors' attitudes toward management of mental health problems (10 items) and psychiatric consultation (5 items) were administered to 225 physicians and surgeons from a London hospital. Item responses were dichotomous (agree or disagree). Confirmatory factor analysis models were conducted using Mplus for dichotomous data to identify items for inclusion in the DACC-MH and to test the validity of the 2 hypothesized factors. Known-groups validity was tested by comparing scores of surgeons and physicians, as physicians have been shown to view mental health management and psychiatric consultation more favourably.

Results:

The 8-item DACC-MH included a 4-item Attitudes Toward Management of Mental Health Problems factor (Cronbach's α = 0.65) and a 4-item Attitudes Toward Psychiatric Consultation factor (α = 0.67; overall scale α = 0.70). Model fit was good (χ2 = 12.7, df = 11, P= 0.31; Comparative Fit Index = 0.99; Tucker-Lewis Index = 0.99; root mean square error of approximation = 0.03) with all factor loadings of 0.46 or greater. As hypothesized, physician scores were significantly higher than surgeon scores on both subscales, indicating more positive attitudes toward management of mental health problems and psychiatric consultation.

Conclusions:

Preliminary evidence was found for the validity of the DACC-MH, which will facilitate efforts to evaluate readiness of doctors to engage in collaborative mental health care.
Predictors of the Longitudinal Course of Major Depression in a Canadian Population Sample
Authors: Patten Scott B , Wang Jian Li , Williams Jeanne VA , Lavorato Dina H , Khaled Salma M , Bulloch Andrew GM
Published: January 2017

Objective:

Most psychiatric epidemiologic studies have used cross-sectional methods, resulting in a lack of information about the longitudinal course of depressive disorders. The objective of our study was to describe the longitudinal epidemiology of major depressive episodes (MDEs) in a Canadian sample using data from the National Population Health Survey (NPHS).

Methods:

The NPHS started data collection in 1994 and has evaluated past-year MDE using repeat interviews of the same cohort every 2 years since then. In our study, we examined the number of weeks depressed during years when MDEs occurred, the proportion of respondents having MDEs at consecutive cycles, and MDE counts during follow-up.

Results:

A sizable proportion of MDEs were brief: about one-half of respondents with past-year MDE reported 8 or fewer weeks of depression during that year. Less than 10% reported that they were depressed for the entire year. However, a larger proportion (19.1%) fulfilled criteria for MDE on consecutive interview cycles, suggesting either persistence or rapid recurrence. The mean number of detected MDEs among those with at least 1 detected MDE up to 2006 was 2. Positive family history, evidence of comorbidity, negative cognitive style, stress, pain, and smoking were associated with a more negative course.

Conclusions:

The longitudinal course of MDE in the general population is heterogeneous, including a mixture of brief and more protracted MDEs. Many risk factors for MDE are also associated with a negative course, exceptions being (younger) age and sex. These epidemiologic observations may assist with identification of patients requiring more intensive management in clinical practice.
Psychiatric Comorbidities in Adolescents with Attention- Deficit Hyperactivity Disorder and Their Siblings
Authors: Yang Li-Kuang , Shang Chi-Yung , Gau Susan Shur-Fen
Published: January 2017

Objective:

Despite high psychiatric comorbidities in adolescents with clinical diagnosis of attention-deficit hyperactivity disorder (ADHD), little is known about psychiatric comorbidities in their siblings. We investigated the psychiatric comorbid conditions in adolescents with ADHD, their siblings, and healthy control subjects from their school.

Method:

The sample included 136 adolescent probands with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criteria; 136 siblings (47 affected and 89 unaffected) and 136 age- and sex-matched healthy school control subjects. All participants and their parents received the structured psychiatric interviews for current and lifetime DSM-IV psychiatric disorders of the participants.

Results:

The rate of ADHD (34.6%) in the siblings of probands with ADHD was about 7 times higher than in the general population. Probands with ADHD were significantly more likely than unaffected siblings (OR 6.38; 95% CI 3.43 to 11.88) and healthy school control subjects (OR 9.60; 95% CI 5.31 to 17.34) to have a DSM-IV psychiatric disorder, including oppositional defiant disorder (ODD), conduct disorder (CD), tic disorders, major depressive disorder, specific phobia (more than control subjects only), nicotine use disorder, and sleep disorders. The affected siblings were significantly more likely than healthy school control subjects to have ODD, CD, specific phobia, and to have consumed alcohol (ORs ranging from 2.30 to 20.16).

Conclusions:

Our findings suggest that siblings of probands with ADHD have increased risks for ADHD and that the affected siblings have more psychiatric comorbidities than healthy school control subjects. It warrants early identification of ADHD symptoms and other psychiatric comorbid conditions as well in siblings of adolescents with ADHD.
A (Re)-Evaluation of the Symptom Structure of Borderline Personality Disorder
Authors: Chmielewski Michael , Bagby R Michael , Quilty Lena C , Paxton Robin , Ng Sarah A McGee
Published: January 2017

Objective:

Despite evidence of significant symptom heterogeneity and excessive diagnostic comorbidity, many contend that borderline personality disorder (BPD) is unidimensional, an assumption that rests primarily on results from factor analytic investigations of BPD symptom criteria. We note several limitations in the literature and argue that the symptom structure of BPD can be best clarified by using both factor analytic techniques and examining the BPD symptom dimensions in relation to external criteria (that is, personality traits). Our goals were to: examine if the symptoms of BPD are best conceptualized as unidimensional or multidimensional, and determine the extent to which personality traits account for any symptom dimensions that underlie BPD.

Method:

All published structural models of the BPD symptom criteria were identified and tested for statistical fit using confirmatory factor analysis in a sample of 373 patients who had completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Axis II Personality Questionnaire BPD scale. Dimensions from the best fitting model were examined in relation to traits from the Five-Factor Model (FFM) and the Personality Psychopathology Five (PSY-5) using correlational and regression analyses.

Results:

Sanislow's 3-factor model, containing affect dysregulation, behavioural dysregulation, and disturbed relations symptom dimensions, provided the best fit; the unidimensional model produced the worst. The symptom dimensions of the 3-factor model were differentiable from one another and had unique associations with the FFM and PSY-5 personality traits.

Conclusion:

BPD is a multidimensional construct.
A Meta-Analysis of the Efficacy of Pregabalin in the Treatment of Generalized Anxiety Disorder
Authors: Boschen Mark J
Published: January 2017

Objective:

Generalized anxiety disorder (GAD) is a chronic anxiety disorder that leads to significant functional impairment and reduced quality of life. Pregabalin is a novel analogue of the inhibitory neurotransmitter gamma amino butyric acid, which has been proposed as a treatment for a range of conditions including GAD. This study examined the efficacy of pregabalin for GAD across published trials, using a meta-analytic method.

Method:

This study examined the 7 published placebo-controlled trials of GAD using pregabalin, and, using meta-analytic techniques, we calculated the effect size of treatment with pregabalin (compared with placebo) on a total of 1352 people.

Results:

The overall effect size of pregabalin in the treatment of GAD was Hedges' g = 0.364, with an effect size of 0.349 on psychic anxiety symptoms and of 0.239 on somatic anxiety symptoms.

Conclusion:

Pregabalin is an efficacious therapy for GAD, although effect sizes are smaller than those from earlier studies. Limitations and future research directions are discussed.
A Cross-Sectional Study on Posttraumatic Stress Disorder among Elderly Qiang Citizens 3 Years after the Wenchuan Earthquake in China
Authors: Chen Guanghua , Shen Huizhang , Chen Guangming
Published: January 2017

Objective:

To determine the prevalence of posttraumatic stress disorder (PTSD) and to identify the associated risk factors among elderly citizens belonging to the Qiang ethnic minority group 3 years after the Wenchuan earthquake in China.

Methods:

A cross-sectional survey of 287 respondents aged 60 years and older was conducted to collect data in Beichuan County, a heavily damaged area. PTSD was assessed according to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Independent demographic, socioeconomic and trauma exposure variables were also measured. Association between the independent variables and PTSD was analyzed using logistic regression analysis.

Results:

The prevalence of PTSD was 22.65% among elderly Qiang citizens in Beichuan County. Being female, being widowed, having a low level of education, having low monthly income, suffering bodily injury, being bereaved, and having a low level of social support were risk factors significantly related to the development of PTSD.

Conclusion:

The results indicate that PTSD remained at an elevated level among elderly Qiang citizens in the heavily damaged area 3 years after the Wenchuan earthquake. Effective and sustainable mental health services are needed and should be directed particularly to the elderly Qiang citizens who are among the groups most vulnerable to the direct impact of the earthquake.
The French Version of the Family Assessment Device
Authors: Speranza Mario , Guénolé Fabian , Revah-Levy Anne , Egler Pierre-Jean , Negadi Fethi , Falissard Bruno , Baleyte Jean Marc
Published: January 2017

Objective:

To validate a French version of the Family Assessment Device (FAD), a well-known self-report questionnaire assessing family functioning in clinical and research settings.

Methods:

A French adaptation of the FAD was administered to 3 groups of subjects: a nonclinical group ( n = 115), relatives of psychiatric patients ( n = 102), and medical patients and their relatives ( n = 106). Temporal stability was assessed by test–retest intraclass correlations. Internal consistency was measured by Cronbach alpha reliability coefficients. Discriminant validity was explored, comparing the scores of the 3 groups, using a covariance analysis (ANCOVA). The dimensional structure of the instrument was explored using a principal component analysis, with promax oblique rotation, on the entire sample.

Results:

The French FAD showed good temporal stability and good discriminant validity across groups. Internal consistency was satisfactory only for the General Functioning (GF) subscale. Factor analysis yielded a 3-factor model. The GF subscale was highly correlated with all of the other subscales.

Conclusions:

The French version of the FAD provides a valuable tool for assessing family functioning. However, our study failed to identify the theoretical structure of the FAD and suggests that the GF subscale could be used as a better overall indicator of family functioning.
Neuroimaging Findings in the At-Risk Mental State: A Review of Recent Literature
Authors: Wood Stephen J , Reniers Renate L E P , Heinze Kareen
Published: January 2017

The at-risk mental state (ARMS) has been the subject of much interest during the past 15 years. A great deal of effort has been expended to identify neuroimaging markers that can inform our understanding of the risk state and to help predict who will transition to frank psychotic illness. Recently, there has been an explosion of neuroimaging literature from people with an ARMS, which has meant that reviews and meta-analyses lack currency. Here we review papers published in the past 2 years, and contrast their findings with previous reports. While it is clear that people in the ARMS do show brain alterations when compared with healthy control subjects, there is an overall lack of consistency as to which of these alterations predict the development of psychosis. This problem arises because of variations in methodology (in patient recruitment, region of interest, method of analysis, and functional task employed), but there has also been too little effort put into replicating previous research. Nonetheless, there are areas of promise, notably that activation of the stress system and increased striatal dopamine synthesis seem to mark out patients in the ARMS most at risk for later transition. Future studies should focus on these areas, and on network-level analysis, incorporating graph theoretical approaches and intrinsic connectivity networks.
A Review of Evidence Linking Disrupted Neural Plasticity to Schizophrenia
Authors: Voineskos Daphne , Rogasch Nigel C , Rajji Tarek K , Fitzgerald Paul B , Daskalakis Zafiris J
Published: January 2017

The adaptations resulting from neural plasticity lead to changes in cognition and behaviour, which are strengthened through repeated exposure to the novel environment or stimulus. Learning and memory have been hypothesized to occur through modifications of the strength of neural circuits, particularly in the hippocampus and cortex. Cognitive deficits, specifically in executive functioning and negative symptoms, may be a corollary to deficits in neural plasticity. Moreover, the main excitatory and inhibitory neurotransmitters associated with neural plasticity have also been extensively investigated for their role in the cognitive deficits associated with schizophrenia. Transcranial magnetic stimulation (TMS) represents some of the most promising approaches to directly explore the physiological manifestations of neural plasticity in the human brain. Three TMS paradigms (use-dependent plasticity, paired associative stimulation, and repetitive TMS) have been used to evaluate neurophysiological measures of neural plasticity in the healthy brain and in patients with schizophrenia, and to examine the brain's responses to such stimulation. In schizophrenia, deficits in neural plasticity have been consistently shown which parallel the molecular evidence appearing to be entwined with this debilitating disorder. Such pathophysiology may underlie the learning and memory deficits that are key symptoms of this disorder and may even be a key mechanism involved in treatment with antipsychotics.
Prospective Risk Factors for Suicide Attempts in a Treated Sample of Patients with Borderline Personality Disorder
Authors: Links Paul S , Kolla Nathan J , Guimond Tim , McMain Shelley
Published: January 2017

Objective:

People with borderline personality disorder (BPD) are at high risk for attempting suicide. There are some data to suggest that risk factors for suicide attempts change over time. We conducted a prospective cohort study to examine risk factors for suicide attempts in a treated sample of patients with BPD.

Method:

One hundred eighty participants with BPD were followed over a year-long course of dialectical behaviour therapy or general psychiatric management and then for 2 more years in naturalistic follow-up. Participants were assessed for suicidal and self-injurious behaviours at baseline, every 4 months over the 1-year treatment phase, and every 6 months over a 2-year follow-up period. Participants were classified as suicide or nonsuicide attempters based on their behaviour at the end of the 1-year treatment phase and after the 2-year follow-up period. Groups were then compared on baseline clinical and demographic variables.

Results:

Nearly 26% of participants made a suicide attempt during the 1-year treatment phase, while 16.7% reported a suicide attempt over the 2-year follow-up period. Baseline number of suicide attempts during the 4 months prior to study and severity of childhood sexual abuse predicted suicide attempts during the treatment year. Similarly, baseline suicide attempts, severity of childhood sexual abuse, and number of hospitalizations in the 4 months prior to study entry predicted suicide attempts during the 2-year follow-up.

Conclusions:

Risk factors for suicide attempts in this treated sample of patients with BPD were fairly stable, largely nonmodifiable, and unrelated to psychopathology or psychosocial functioning at baseline.
Impact of Age and Sex on QT Prolongation in Patients Receiving Psychotropics
Authors: Rabkin Simon W
Published: January 2017

Objective:

To assess older age and female sex, 2 of the major risk factors for potentially fatal cardiac arrhythmias or sudden cardiac death in patients prescribed psychotropics, within the context of electrocardiographic evidence of time between start of Q wave and end of T wave (QT) interval prolongation, which is an indicator of an increased risk for potentially fatal cardiac arrhythmias.

Method:

The literature on the relation between age, sex, and QT interval with respect to psychotropic drugs was reviewed.

Results:

The QT interval must be corrected (QTc) for heart rate. Because slower heart rates prolong and faster heart rates shorten the QT interval, people with faster heart rates may have a prolonged QT interval that is not apparent until the correction is performed. QTc values for apparently healthy post-pubertal people are less than 450 ms for males and less than 470 ms for females. The longer QT intervals in women may account for their increased risk of potentially fatal cardiac arrhythmias on psychotropics. QTc increases with increasing age. Assessment of QTc in older people is especially important to identify people with a longer QTc who are more likely to attain a serious QT level with drugs that prolong QTc. The age-related increase in QTc is more evident in men than women, suggesting that male sex does not afford protection against potentially fatal arrhythmias at older age.

Conclusion:

The association of increasing age and female sex with greater QT intervals indicates the need to have an increased awareness of the QTc prior to use of these psychotropics and to evaluate the QTc after initiation of therapy.
Employment and Income of People Who Experience Mental Illness and Homelessness in a Large Canadian Sample
Authors: Poremski Daniel , Distasio Jino , Hwang Stephen W , Latimer Eric
Published: January 2017

Objectives:

Research suggests that homeless people with mental illness may have difficulty obtaining employment and disability benefits. Our study provides a comprehensive description of sources of income and employment rates in a large Canadian sample.

Methods:

Participants ( n = 2085) from the 5 sites of the At Home/Chez Soi study were asked about their income, employment, and desire for work during the pre-baseline period. The proportion of participants employed, receiving government support, and relying on income from other activities were compared across sites, as were total income and income from different sources. Generalized linear models were used to identify participant characteristics associated with total income.

Results:

Unemployment ranged from 93% to 98% across 5 sites. The per cent of participants who wanted to work ranged from 61% to 83%. Participants relied predominantly on government assistance, with 29.5% relying exclusively on welfare, and 46.2% receiving disability benefits. Twenty-eight per cent of participants received neither social assistance nor disability income. Among the 2085 participants, 6.8% reported income from panhandling, 2.1% from sex trade, and 1.2% from selling drugs. Regression models showed that income differed significantly among sites and age groups, and was significantly lower for people with psychotic illnesses.

Conclusion:

These results suggest that homeless people with mental illness are predominantly unemployed, despite expressing a desire to work. In Canada, this group relies predominantly on welfare, but has access to disability benefits and employment insurance. These findings highlight the importance of developing effective interventions to support employment goals and facilitate access to benefits.
Urgent Psychiatric Services: A Scoping Review
Authors: Sunderji Nadiya , de Bibiana Jason Tan , Stergiopoulos Vicky
Published: January 2017

Objective:

Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement.

Method:

We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral.

Results:

We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health-related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions.

Conclusions:

Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.
Neurocognitive Impairment in Schizophrenia and how it Affects Treatment Options
Authors: Bilder Robert M
Published: January 2017

Objective

To review the roles played by neurocognitive assessment in the treatment of schizophrenia and in the design of treatment research strategies.

Method

A review of the literature and summaries of clinical and research implications are presented, with directions for future research.

Results

Neurocognitive deficits are now targets of antipsychotic drug treatment and should increasingly be used to refine both theory and clinical practice by considering the effects of treatments at the level of neural systems.

Conclusion

Efforts to bridge the gaps between preclinical and clinical assessments should yield large rewards in drug development and individualized treatment strategies. Functional neuroimaging may play a major role in these developments.
The 15-Year Outcome of Chinese Patients with Schizophrenia in Hong Kong
Authors: Lee Peter WH , Lieh-Mak F , Wong MC , Fung Amy SM , Mak KY , Lam Julia
Published: January 2017

Objective:

To explore the differential outcome of schizophrenia in developed and developing countries. The 15–year outcome of patients with schizophrenia in Hong Kong is reported.

Method:

In a 15-year retrospective outcome study, 100 patients with first-onset schizophrenia in 1977–1978 were randomly selected for outcome assessment from a pool of 797 patient files. The patterns of outcome were assessed by the same set of instruments and methodology as in other centres, since Hong Kong is 1 of the World Health Organization (WHO) centres for the International Study of Schizophrenia (ISoS).

Results:

Nineteen subjects were untraceable, and 10 subjects committed suicide. More than one-half of the subjects had a good symptomatic outcome, while about 20% of the subjects were rated as having a good psychosocial adjustment. Over the entire 15-year period, 96% of the subjects were maintained on medications, and 79% were living with family members.

Conclusion:

Despite Hong Kong's developed economy, its schizophrenia outcome is similar to that in developing countries. The existence of good family support and active follow-up treatment may be important contributory factors to better outcome.
Physician Satisfaction with Review Boards: The Provincial Psychiatric Hospital Perspective
Authors: Persad E , Kazarian SS
Published: January 2017

Objectives:

To assess the level of satisfaction of physicians in provincial psychiatric hospitals with Review Boards (RBs) regarding Civil Commitment Certificates (CCCs), Certificates of Incompetence (COIs), and Treatment Orders (TOs).

Method:

A total of 200 survey questionnaires were distributed to physicians in provincial psychiatric hospitals. Ninety surveys (completed by 25 females, 45 males, and 20 unknown gender) were returned, representing a 45% return rate. Because of their assignments (for example, outpatient department), not all physicians were involved with RBs, and the return rate is likely to have been influenced by this factor.

Results:

Physician satisfaction rates of 58.2% for CCCs, 66.7% for COIs, and 70.0% for TOs were obtained. Stepwise multiple regression analysis showed that the level of physician satisfaction with RBs for CCCs was predicted best (44.7% of variance) by physician level of comfort with certification and years of institutional affiliation. Qualitative physician responses revealed 3 major themes: patient-related issues, physician-related issues, and RB structure- and process-related issues.

Conclusions:

Strategies that increase physician comfort level with RBs and changes in the medicolegal structure and process are discussed. A similar survey of patients and RB members is recommended.
Treatment of the Psychiatric Manifestations of Huntington's Disease: A Review of the Literature
Authors: Leroi Iracema , Michaion Max
Published: January 2017

Objective:

To review the clinical management of the psychiatric aspects of Huntington's disease (HD), namely the mood disorders, psychotic disorders, anxiety symptoms, sleep disorders, disorders of sexuality, and the behavioural changes of apathy, irritability, and aggression. Emphasis is on pharmacologic and psychotherapeutic intervention strategies. In addition, the role of psychiatric intervention in presymptomatic testing is explored.

Method:

English language literature on the pharmacologic and psychotherapeutic management of the psychiatric manifestations of HD between 1976 and 1996 was critically reviewed.

Results:

Few sound studies address the clinical management of the psychiatric aspects of HD; thus, only the broadest conclusions can be drawn. Pharmacologic strategies for the treatment of psychiatric aspects of HD were organized according to the therapeutic agent and class, and psychotherapeutic strategies were discussed.

Conclusion:

The clinical management of the psychiatric manifestations of HD requires much more complete and systematic study before any definite conclusions as to efficacy of various approaches can be drawn.
Mental Health Service Use: A Comparison of Treated and Untreated Individuals with Substance Use Disorders in Ontario
Authors: Ross Helen E , Lin Elizabeth , Cunningham John
Published: January 2017

Objective:

To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults.

Method:

Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15–64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses.

Results:

Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use.

Conclusions:

The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.
Curriculum Renewal in Child Psychiatry
Authors: Hanson Mark , Tiberius Richard , Charach Alice , Ulzen Thaddeus , Sackin David , Jain Umesh , Reiter Sharon , Shomair Gary
Published: January 2017

Objective:

To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement.

Method:

The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students 'perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated.

Results:

The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI).

Conclusions:

Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.