bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescent Use of Prescription Drugs to Get High in Canada
Authors: Currie Cheryl L , Wild T Cameron
Published: January 2017

Objective:

To present epidemiologic information on adolescent use of prescription drugs to get high, and not for medical purposes, in Canada.

Methods:

Data were obtained from 44 344 adolescents in grades 7 to 12 living across Canada's 10 provinces who completed the Youth Smoking Survey in 2008/2009.

Results:

Nationally, 5.9% of adolescents in grades 7 to 12 reported the use of prescription drugs to get high in the past 12 months in 2008/2009. Females were more likely to report use of pain relievers, sedatives, or tranquilizers to get high, while males were more likely to report the use of prescription stimulants for this purpose. The use of prescription drugs to get high was elevated among older youth, those living in British Columbia, and those who identified as First Nations, Métis, or Inuit. School connectedness was associated with a reduction in this form of prescription drug misuse for all adolescents; however, this protective effect was particularly strong for Aboriginal youth, and may be an important preventative factor for this population.

Conclusions:

Use of prescription drugs to get high was prevalent among adolescents in Canada in 2008/2009. Findings highlight the need for clinicians to include questions about prescription drugs when screening adolescents for substance abuse in Canada. Findings also highlight the need for evidence-informed strategies to reduce prescription drug misuse among Aboriginal youth living outside First Nations communities in Canada. The results of this study suggest school connectedness may be a particularly important target for these interventions.
The Influence of Somatic Symptoms on Beck Depression Inventory Scores in Hospitalized Postmyocardial Infarction Patients
Authors: Delisle Vanessa C , Abbey Susan E , Beck Aaron T , Dobson Keith S , Dozois David J A , Grace Sherry L , Stewart Donna E , Ziegelstein Roy C , Thombs Brett D
Published: January 2017

Objective:

The Beck Depression Inventory (BDI) has been used more than any other self-report questionnaire in research on depression in cardiovascular disease. However, no studies have examined whether BDI scores may be influenced by somatic symptoms common after myocardial infarction (Ml) that may overlap with symptoms of depression. The objective of this study was to examine whether BDI scores of post-MI patients may be influenced by somatic symptoms that commonly occur after MI, but may not be related to depression.

Method:

Post-MI patients and psychiatric outpatients were matched on BDI cognitive-affective symptom scores, sex, and age, and their BDI somatic symptom scores were compared using independent samples t tests.

Results:

Somatic symptoms accounted for 57% of BDI total scores for 296 post-MI patients (mean total BDI = 8.8), compared with 50% for 296 matched psychiatric outpatients (mean total BDI = 7.6). Overall, BDI somatic scores of post-MI patients were 1.3 points higher than for psychiatric outpatients (95% CI 0.68 to 1.82; P < 0.001), equivalent to 14% of total scores of post-MI patients.

Conclusions:

The relative influence of somatic symptoms on BDI total scores was higher for post-MI patients than for psychiatric outpatients matched on cognitive-affective scores, sex, and age. This finding stands in contrast to that from a previous study that used similar methods and sample comparisons and found that post-MI and psychiatric outpatients did not differ in their endorsement of somatic symptoms on the BDI-II. The BDI-II may be preferable to the BDI in post-MI patients.
Synthesis through Simulation: Insights on the Epidemiology of Mood and Anxiety Disorders in Canada
Authors: Patten Scott B , Lin Elizabeth , Martens Patricia J , Stiff David , Smetanin Paul , Adair Carol E
Published: January 2017

Objective:

Prevalence estimates for mood and anxiety disorders in Canada are available, but various methodological approaches have produced inconsistent results. Simulation studies involve careful examination of available data by an expert modelling team working together with subject matter experts. Simulation can integrate datasets and literature-based estimates from various sources into a coherent mathematical representation of the underlying total population epidemiology.

Methods:

Supported by the Mental Health Commission of Canada, a simulation modelling project for mental disorders in Canada was recently undertaken. The modelling was carried out by RiskAnalytica using their Life at Risk platform. Specification and calibration of the model occurred in consultation with national and international experts.

Results:

To reconcile estimates of incidence and prevalence, recall bias needed to be represented in the model. This suggests that the population prevalence of mood and anxiety disorders has been underestimated by population surveys and may explain a discrepancy observed in the age-specific prevalence in population surveys as compared with studies using administrative data. The number of Canadians with mood and anxiety disorders is projected to increase in upcoming decades as a result of population growth, but, based on conservative assumptions, an increased prevalence proportion is not anticipated.

Conclusions:

Simulation models can act as a platform for economic analyses and epidemiologic projections and can support the rapid exploration of what-if scenarios, thereby informing policy decisions. This first national-level simulation provides a high level overview of mood and anxiety disorder epidemiology in Canada.
Inégalités de santé des troubles de l'humeur selon la défavorisation matérielle et sociale du quartier de résidence
Authors: Vanasse Alain , Courteau Josiane , Lesage Alain , Fleury Marie-Josée , Grégoire Jean-Pierre , Moisan Jocelyne , Lauzier Sophie , Bergeron Claude
Published: January 2017

Objectif:

Comparer la prévalence des troubles de l'humeur (TH) au Québec en 2006 et, chez les patients souffrant de TH, comparer l'utilisation des services de santé et des médicaments, la mortalité et morbidité selon le sexe et le niveau de défavorisation matérielle et sociale du quartier de résidence. Identifier les sous-groupes de personnes utilisant en plus grande proportion les services de santé et étant plus à risque de morbidité et mortalité.

Méthode:

Analyse secondaire des données médico-administratives gérées par la Régie de l'assurance maladie du Québec. La cohorte est constituée des personnes adultes ayant reçu un diagnostic de TH et résidant au Québec en 2006. Les variables sont: consultation d'un médecin, réclamation d'un médicament, consultation pour abus de substances ou d'alcool, consultation à l'urgence, hospitalisation pour trouble mental et décès. Les types de quartiers de résidence sont définis par le croisement des quintiles de défavorisation matérielle et sociale de Pampalon.

Résultats:

La prévalence de TH en 2006 était de 3,06 % (177 850 patients), celle des femmes étant 1,7 fois celle des hommes. Les résultats démontrent une prévalence de TH ainsi qu'une mortalité et morbidité plus importantes dans les quartiers matériellement et socialement défavorisés. Les jeunes hommes représentent également un sous-groupe particulièrement vulnérable pour plusieurs des variables étudiées.

Conclusion:

Les politiques publiques visant à améliorer les conditions matérielles (revenu, instruction, chômage) et à briser l'isolement social exerceraient une influence importante sur la santé mentale de la population. Une attention particulière devrait être portée à la population des jeunes hommes dans l'élaboration de programmes de santé publique.
The Impact of Memantine and Cholinesterase Inhibitor Initiation for Alzheimer Disease on the Use of Antipsychotic Agents: Analysis Using the Régie de l'Assurance Maladie du Québec Database
Authors: Lachaine Jean , Beauchemin Catherine , Crochard Anne , Bineau Sébastien
Published: January 2017

Objective:

Patients with Alzheimer disease (AD) show a high incidence of behavioural and psychological symptoms of dementia, which often lead to the prescription of antipsychotics. Our study sought to assess the impact of the initiation of memantine or cholinesterase inhibitors (ChEls) on the use of antipsychotics.

Method:

A retrospective cohort study was conducted using data from the Quebec provincial health plan database. Patients included in our study had received a diagnosis of AD and were initial users of memantine or ChEls. The proportion of patients who used antipsychotics was estimated using prescription data dating back to 1 year before and to 1 year after the first prescription of memantine or ChEls. The difference between the slopes corresponding to the periods pre- and postmemantine or ChEls was analyzed using an interrupted time series design.

Results:

The percentage of antipsychotic users increased by 118.3% before and by 68.3% after initiation of a ChEl, and increased by 68.6% before and by 7.0% after initiation of memantine. Antipsychotic trends pre- and post-ChEl initiation were not statistically different ( P = 0.89), while a statistical difference was observed when comparing the antipsychotic trends pre- and postmemantine initiation ( P < 0.001).

Conclusions:

The initiation of memantine, unlike ChEls, has a notable stabilization effect on the prescription of antipsychotics in patients with AD.
The Impact of the Type of Insurance Plan on Adherence and Persistence with Antidepressants: A Matched Cohort Study
Authors: Assayag Jonathan , Forget Amélie , Kettani Fatima-Zohra , Beauchesne Marie-France , Moisan Jocelyne , Blais Lucie
Published: January 2017

Objective:

To compare adherence to, and persistence with, antidepressants (AD) in Quebec patients who are covered by private and public drug insurance.

Method:

A matched cohort study was conducted using prescription claims databases: reMed, a medication data registry for Quebec residents covered by private drug insurance, and Régie de l'assurance maladie du Québec database for Quebec residents with public drug insurance. Patients were aged 18 to 64 years and filled at least 1 prescription for an AD in monotherapy between December 2007 and September 2009 (194 privately and 2055 publicly insured patients). Adherence over 1 year was estimated using the proportion of prescribed days covered (PPDC). The difference in mean PPDC between patients with private and public drug insurance was estimated with linear regression. Persistence was compared between the groups with a Cox regression model.

Results:

The PPDC was 86.4% (95% CI 83.3% to 89.5%) in privately insured and 82.2% (95% CI 78.5% to 85.9%) in publicly insured patients and the adjusted mean difference was 5.1 % (95% CI 1.6% to 8.6%). Persistence was 51.0% in the private group and 19.7% in the public group at 1 year ( P < 0.001); the adjusted hazard ratio was 0.49 (95% CI 0.30 to 0.79).

Conclusion:

Better adherence and persistence were observed in privately insured patients. Adherence difference may be due to lower copayment among privately insured patients. L'effet du type de régime d'assurance sur l'observance des antidépresseurs et la persistance: une étude de cohorte appariée
Trouble bipolaire à début précoce: Validation par les études de mélange et les biomarqueurs
Authors: Geoffroy Pierre Alexis , Etain Bruno , Jamain Stéphane , Bellivier Frank , Leboyer Marion
Published: January 2017

Objectifs:

Le trouble bipolaire (TB) est une maladie multifactorielle de présentation clinique hétérogène, en particulier au niveau de l'âge de début (ADD). La pertinence d'un tel indicateur a été discutée et il est proposé dans les futures classifications nosographiques.

Méthode:

Nous avons effectué la synthèse systématique des études de mélange de distributions (ou dites d'admixture) ainsi que les biomarqueurs du TB à début précoce (TBDP).

Résultats:

Plusieurs arguments cliniques montrent que le TBDP est un sous-groupe cliniquement homogène qui présente des caractéristiques sévères et récurrentes. Huit études de mélange ont démontré l'existence de trois sous-groupes de patients souffrant du TB selon l'ADD (précoce, intermédiaire, et tardif) avec deux valeurs seuils de 21 (21,33 ans [ET 1,41]) et 35 ans (34,67 ans [ET 5,52]). Le sous-groupe du TBDP est caractérisé par: un taux plus élevé de tentatives de suicide, des cycles rapides, des mésusages d'alcool et drogues, des symptômes psychotiques et des comorbidités anxieuses. Des données génétiques, biologiques, d'imagerie et cognitives peuvent être considérées comme étant des marqueurs possibles de validité externe du TBDP. L'ajout de l'ADD dans les algorithmes de décision thérapeutique pourrait être intéressant même si le niveau de preuve est à consolider.

Conclusion:

La fréquence importante du TBDP (44,80 %) devrait pousser les cliniciens à une plus grande vigilance afin qu'ils apportent des stratégies préventives, un diagnostic et un traitement précoce à ces patients au tableau clinique particulièrement sévère. Cette pertinence clinique fait que le prochain DSM-5 devrait inclure l'ADD en tant que caractéristique du TB.
Effects of Age and Subtype on Emotional Recognition in Children with Anxiety Disorders: Implications for Cognitive-Behavioural Therapy
Authors: Lee Trevor Changgun , Dupuis Annie , Jones Emily , Guberman Carly , Herbert Monique , Manassis Katharina
Published: January 2017

Objective:

It remains unclear whether an anxiety diagnosis is associated with children's emotional recognition. We considered children's age and types of primary anxiety diagnosis, which have been neglected, to elucidate this relationship.

Methods:

Sixty-three referred children with anxiety disorder(s) and 59 volunteer children without anxiety disorder(s), aged between 6 and 11 years, were presented with animated characters, displaying a range of simple and complex emotions, for identification. Statistical analyses examined identification accuracy based on presence or absence of anxiety disorder, age, and types of primary diagnoses.

Results:

Children with anxiety disorder(s) as a group performed comparably to children without anxiety disorder(s) in identifying emotions ( z = −0.72, P = 0.47). In both groups, accuracy for disgust increased significantly each year of age ([anxiety group] OR 2.6; 95% CI 1.6 to 4.3, P < 0.001, [control group] OR 2.1; 95% CI 1.3 to 3.3, P = 0.002). When primary anxiety types were considered, while controlling for age, children with separation anxiety disorder (SAD) showed deficits in overall emotional recognition, compared with children with other subtypes or without anxiety ( P = 0.004). Further regression analyses showed that children with generalized anxiety disorder (GAD) presented significantly lower accuracy than children without anxiety disorder(s) at a young age, but the deficit disappeared with increased age.

Conclusion:

Children with anxiety disorder(s) as a group may not appear to be impaired in emotional recognition. However, when age and subtypes are considered, children with SAD and young children with GAD appear to have difficulty, compared with children without anxiety disorder(s).
A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments
Authors: Cuijpers Pim , Berking Matthias , Andersson Gerhard , Quigley Leanne , Kleiboer Annet , Dobson Keith S
Published: January 2017

Objective:

No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis.

Methods:

Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy.

Results:

A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower ( g = 0.53) than for lower-quality studies ( g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone ( g = 0.49).

Conclusions:

There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.
Omega-3 Fatty Acid Supplementation in Adolescents with Borderline Personality Disorder and Ultra-High Risk Criteria for Psychosis: A Post Hoc Subgroup Analysis of a Double—Blind, Randomized Controlled Trial
Authors: Amminger G Paul , Chanen Andrew M , Ohmann Susanne , Klier Claudia M , Mossaheb Nilufar , Bechdolf Andreas , Nelson Barnaby , Thompson Andrew , McGorry Patrick D , Yung Alison R , Schäfer Miriam R
Published: January 2017

Objective:

To investigate whether long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFAs) improve functioning and psychiatric symptoms in young people with borderline personality disorder (BPD) who also meet ultra-high risk criteria for psychosis.

Methods:

We conducted a post hoc subgroup analysis of a double-blind, randomized controlled trial. Fifteen adolescents with BPD (mean age 16.2 years, [SD 2.1]) were randomized to either 1.2 g/day n-3 PUFAs or placebo. The intervention period was 12 weeks. Study measures included the Positive and Negative Syndrome Scale, the Montgomery–Åsberg Depression Rating Scale, and the Global Assessment of Functioning. Side effects were documented with the Udvalg for Kliniske Undersøgelser. Fatty acids in erythrocytes were analyzed using capillary gas chromatography.

Results:

At baseline, erythrocyte n-3 PUFA levels correlated positively with psychosocial functioning and negatively with psychopathology. By the end of the intervention, n-3 PUFAs significantly improved functioning and reduced psychiatric symptoms, compared with placebo. Side effects did not differ between the treatment groups.

Conclusions:

Long-chain n-3 PUFAs should be further explored as a viable treatment strategy with minimal associated risk in young people with BPD.
Why is Psychiatry Prone to Fads?
Authors: Paris Joel
Published: January 2017

Psychiatry has long been prone to fads. The main reason is that mental illness is poorly understood and can be difficult to treat. Most diagnostic fads have involved the extension of well-known categories into broader spectra. The most prominent treatment fads have involved the overuse of pharmacological interventions and a proliferation of methods for psychotherapy. The best antidote to fads is a commitment to evidence-based psychiatry.
Protective Factors for Mental Disorders and Psychological Distress in Female, Compared with Male, Service Members in a Representative Sample
Authors: Mota Natalie P , Medved Maria , Whitney Debbie , Hiebert-Murphy Diane , Sareen Jitender
Published: January 2017

Objective:

Although military interest in promoting psychological resilience is growing, resources protective against psychopathology have been understudied in female service members. Using a representative sample of Canadian Forces personnel, we investigated whether religious attendance, spirituality, coping, and social support were related to mental disorders and psychological distress in female service members, and whether sex differences occurred in these associations.

Method:

Religious attendance and spirituality were self-reported. Coping items were taken from 3 scales and produced 3 factors (active, avoidance, and self-medication). Social support was assessed with the Medical Outcomes Study Social Support Survey. Past-year mental disorders were diagnosed with the World Mental Health Composite International Diagnostic Interview. The Kessler Psychological Distress Scale assessed distress. Multivariate regression models investigated links between correlates and psychological outcomes within each sex. For associations that were statistically significant in only one sex, sex by correlate interactions were computed.

Results:

In female service members, inverse relations were found between social support and MDD, any MDD or anxiety disorder, suicidal ideation, and distress. No associations were found between religious attendance and outcomes, and spirituality was associated with an increased likelihood of some outcomes. Active coping was related to less psychological distress, while avoidance coping and self-medication were linked to a higher likelihood of most outcomes. Although several statistically significant associations were found in only one sex, only one sex by correlate interaction was statistically significant.

Conclusions:

Social support was found to be inversely related to several negative mental health outcomes in female service members. Few differences between men and women reached statistical significance. Future research should identify additional helpful resources for female service members.
Antenatal Depression in a Multi-Ethnic, Community Sample of Canadian Immigrants: Psychosocial Correlates and Hypothalamic-Pituitary-Adrenal Axis Function
Authors: Peer Miki , Soares Claudio N , Levitan Robert D , Streiner David L , Steiner Meir
Published: January 2017

Objectives:

Immigrant women living in Canada present with higher rates of prenatal depressive symptomatology than Canadian-born women; however, the associated psychosocial correlates remain understudied. Antenatal depression and stress negatively affect maternal health and infant development, in part through changes in maternal hypothalamic–pituitary–adrenal (HPA) axis activity. We aimed to examine the factors associated with prenatal depressive symptoms, including altered HPA axis function, in an ethnically diverse community sample of Canadian immigrant women.

Methods:

Seventy-eight pregnant immigrant women were recruited from the community at 19 weeks' gestation and provided information on health, mood, stressful life events (SLEs), and social support. Fifty-seven of these women also provided saliva samples for measurement of the cortisol awakening response and nighttime cortisol levels.

Results:

Seventeen per cent of the sample had a high level of prenatal depressive symptoms, and these women reported more perceived stress, more somatic symptoms, lower social support, and were less often working or attending school during pregnancy. Controlling for wake time, parity, and region of origin, high levels of prenatal depressive symptoms were associated with elevated nighttime cortisol levels, whereas SLEs were not associated with any measures of HPA axis activity.

Conclusions:

High levels of prenatal depressive symptoms are common in immigrant women living in Canada, and are associated with identifiable factors. Preliminary evidence suggests a similar pattern of HPA axis activity characterizing depressive symptomatology in this subpopulation as previously seen in clinically depressed patients.
Diagnostic Stability of First-Episode Psychotic Disorders and Persistence of Comorbid Psychiatric Disorders over 1 Year
Authors: Pope Megan A , Joober Ridha , Malla Ashok K
Published: January 2017

Objective:

Diagnostic stability is an important indicator of the reliability and validity of psychiatric diagnoses and has implications in clinical practice and research. While several studies have investigated the diagnostic stability of first-episode psychosis (FEP) disorders, less is known about psychiatric comorbidity in FEP and the persistence of such comorbid conditions over time. Our study aimed to confirm the diagnostic stability of FEP disorders and determine the variation in persistence of comorbid substance use disorders (SUDs), mood disorders, and anxiety disorders over 1 year.

Method:

The Structured Clinical Interview for DSM-IV-TR Axis I Disorders—Patient Edition was conducted at first presentation and repeated after 1 year (or reconstructed) for 214 FEP patients at the Prevention and Early Intervention Program for Psychoses–Montreal.

Results:

Psychotic disorder diagnoses were retained by 76.2% of patients at 1 year, schizophrenia being the most stable diagnosis (92.1%). Most diagnostic shifts were to schizophrenia and schizophrenia spectrum disorders. Comorbid SUDs, anxiety disorders, and mood disorders persisted for 50.7%, 64.0%, and 16.7% of patients, respectively. Many new cases of each of these disorders also emerged at 1-year follow-up.

Conclusions:

These findings demonstrate the stability of primary psychotic disorder diagnoses and greater fluidity of comorbid psychiatric diagnoses, with anxiety disorders persisting as comorbid conditions more than mood disorders and SUDs. These results highlight the importance of repeating a structured diagnostic assessment longitudinally, especially for consideration of comorbid conditions.
An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection
Authors: Carter Lorie , Zolezzi Monica , Lewczyk Andrea
Published: January 2017

Objective:

Despite several decades of research, there is still uncertainty regarding the optimal lithium dosage regimen associated with a decreased risk of renal effects, such as polyuria, in patients with bipolar affective disorder. We present an updated review of the literature to provide an informed dosing regimen recommendation for prescribers.

Method:

Major databases MEDLINE and Embase were searched using terms, such as lithium, drug administration schedule, dose–response relationship, once daily, twice daily, and sustained release. In addition, the bibliographies of related publications were manually searched.

Results:

A total of 20 trials were included. Some trials showed a reduction in urine volume with single daily dosing (SDD), while others showed no change. The only trial evaluating patients newly started on lithium found a reduction in urinary frequency with SDD after 21 days. Trials examining renal biopsy results found that multiple daily doses were associated with more pathologic damage to the kidneys. SDD regimens were generally well tolerated, and no reduction in efficacy was noted in any of the trials.

Conclusions:

The available evidence is contradictory as to whether SDD of lithium reduces polyuria; however, no trial has demonstrated any downfall of SDD in terms of prophylactic efficacy or adverse effects. Given the added benefits of SDD, such as improved compliance, we recommend patients newly started on lithium should be converted to a SDD of lithium at bedtime once an appropriate daily dose is determined.
Overdiagnosis Problems in the DSM-IV and the New DSM-5: Can They Be Resolved by the Distress—Impairment Criterion?
Authors: Bolton Derek
Published: January 2017

Criticisms of psychiatry for overdiagnosing, for pathologizing normality, are not new, dating at least from the antipsychiatry critiques in the 1960s. Inevitably, revisions of the diagnostic manuals, the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders (DSM), provide an occasion for renewed criticism, and the revision process of the DSM-IV became a focus for further debates on overdiagnosis. The debates are typically not about the presence or absence of a decisive marker of specific illnesses or of illness in general—a complex matter on which there is hardly a consensus—but rather about the relative medical, psychosocial, and financial harms and benefits that may accrue from overdiagnosis on the one side and underdiagnosis on the other. It is proposed in this In Review paper that a useful and valid principle for use in these debates is the tight conceptual linkage between illness and distress and impairment of day-to-day functioning. This linkage is fundamental to the conceptualization of mental disorder in the DSM-IV and can still serve to reduce overdiagnosis by excluding cases where distress and impairment are absent or minimal. The same conceptual linkage provides a way of understanding how conditions may warrant a diagnosis even though they are not associated with current distress or impairment, namely, if they carry risk for such in the future. For these conditions, assessments of costs and benefits of overdiagnosis and underdiagnosis depend crucially on high-quality, replicated data on the sensitivity and specificity of the early diagnostic test.
Social Network Intervention in Patients with Schizophrenia and Marked Social Withdrawal: A Randomized Controlled Study
Authors: Terzian Emanuela , Tognoni Gianni , Bracco Renata , De Ruggieri Edoardo , Ficociello Rita Angela , Mezzina Roberto , Pillo Giuseppe
Published: January 2017

Objective:

To evaluate the efficacy and feasibility of actions intended to implement or improve patients' social network within the Italian National Health Service community mental health services.

Methods:

We conducted a randomized clinical trial through a network of 47 community mental health services on patients with a diagnosis in the schizophrenia spectrum (F20 in the International Classification of Diseases, 10th Revision), who were young (aged younger than 45 years), and with a poor social network (less than 5 relationships). In addition to routine treatments, for the experimental group, the staff identified possible areas of interest for individual patients and proposed social activities taking place outside the services' resources and with members of the community. The main outcome was an improvement in the patients' social network; secondary end points were clinical outcome, abilities of daily living, and work.

Results:

One- and 2-year outcomes of 345 and 327, respectively, of the 357 patients randomized were analyzed by intention-to-treat. A social network improvement was observed at year 1 in 25% of the patients allocated to routine treatment and in 39.9% of those allocated to the experimental arm (OR 2.0, 95% CI 1.3 to 3.1; adjusted OR 2.4, 95% CI 1.4 to 3.9). The difference remained statistically significant at year 2. No significant differences emerged for any of the other end points. However, patients with 1 or more other areas of improvement at year 1 and 2 showed a statistically significant social network improvement.

Conclusions:

The activation of social networks as an activity integrated with standard psychiatric care is practicable, without added economic and organizational costs, and appears to produce an effect persisting well beyond its implementation.
Long-Term Efficacy and Toxicity of Cholinesterase Inhibitors in the Treatment of Alzheimer Disease
Authors: Hogan David B
Published: January 2017

Though the symptoms of Alzheimer disease go on for years, the phase 3 trials of the cholinesterase inhibitors (ChEIs), the current mainstay of symptomatic pharmacotherapy for this condition, were typically of only 3- to 6-months' duration. We have limited data on long-term (that is, a year or more) therapy with these agents. In this review, we explore the available information on the biological and clinical effects of long-term ChEI therapy, what happens when these agents are discontinued, and examine what others have recommended. An individualized approach to deciding on whether to carry on with a ChEI should be taken. If continued, treatment goals should be clarified and patients monitored over time, for both drug-related benefits and adverse effects.
Evidence-Based Practice: Separating Science from Pseudoscience
Authors: Lee Catherine M , Hunsley John
Published: January 2017

Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills.
Nonmedical Use of Prescription Medication among Adolescents Using Drugs in Quebec
Authors: Roy Élise , Nolin Marc-Antoine , Traoré Issouf , Leclerc Pascale , Vasiliadis Helen-Maria
Published: January 2017

Objective:

To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec.

Method:

Secondary data analyses were carried out with data from a 6-month study, namely, the 2010–2011 Quebec Health Survey of High School Students—a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors.

Results:

Among adolescents who had used drugs in the previous 12 months, 5.4% (95% Cl 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM.

Conclusions:

The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.
A Participant's Observations: Preparing DSM-IV
Authors: Shaffer David
Published: January 2017

Objective:

To provide an overview of the process of creating the DSM-IV from a participant's perspective.

Method:

Narrative review.

Results:

In its attempt to address the perceived weaknesses of both the content and development of the DSM-III and DSM-III-R, the DSM-IV development was based on commissioned reviews for sets of diagnoses, especially designed field trials and a transparent decision-making process.

Conclusions:

Nosology is an ambitious and complicated enterprise. Classification systems must evolve as new empirical evidence is presented. Many of the obstacles faced by the DSM-IV work groups, therefore, may be moot for those formulating DSM-V. The DSM-IV development process was carefully planned, and the profession is indebted to the American Psychiatric Association (APA) for its initiative and effort in producing this system.
The Use of Selective Serotonin Reuptake Inhibitors in Young Children with Pervasive Developmental Disorders: Some Clinical Observations
Authors: Awad George A
Published: January 2017

Objective:

To study the effects of a new group of psychotropic medications, the selective serotonin reuptake inhibitors (SSRIs), on some symptoms of young children (under 7 years old) with pervasive developmental disorders (PDD).

Method:

Open clinical trial.

Results:

Medications produced positive results in half the children, particularly those with obsessional, repetitive, and anxiety symptoms. The medication was discontinued in half the children: one-quarter for worsening of symptoms and the other quarter for doubtful side effects.

Conclusions:

SSRIs may have a role to play in ameliorating some symptoms of PDD. Further studies with standardized measurements, however, are needed to elucidate which children and what symptoms could benefit from which medication.
Utilisation de «l'arrêt des pensées» dans le traitement d'un trouble obsessionnel-compulsif chez une fillette de neuf ans
Authors: Frare Paola , Lebel Alain
Published: January 2017

Objectif:

L'utilisation d'une approche pharmacocomportementale, ayant recours aux techniques modifiées d'exposition et prévention de la réponse et d'arrêt des pensées, dans le traitement d'un trouble obsessionnel-compulsif chez une fillette de 9 ans.

Méthode:

Le diagnostic du trouble obsessionnel-compulsif (TOC) a été posé selon les critères du DSM-IV. La patiente a été rencontrée pendant 15 séances durant lesquelles la clomipramine a été introduite et les techniques modifiées d'exposition et prévention de la réponse et d'arrêt des pensées ont été utilisées successivement. Le suivi s'est prolongé sur plus d'un an et demi après la fin de la thérapie.

Résultats:

L'apprentissage et l'utilisation des techniques comportementales ont été faciles pour la patiente et nous avons observé une disparition rapide, complète et soutenue de la symptomatologie obsessionnelle-compulsive.

Conclusion:

L'utilisation de l'approche pharmacocomportementale dans le traitement du TOC chez les jeunes enfants demeure limitée. Des techniques utilisées chez l'adulte légèrement modifiées pour les adapter à l'enfant représentent à notre avis une avenue thérapeutique à explorer.
Psychopathology in Adolescent Mothers and its Effects on Mother—Infant Interactions: A Pilot Study
Authors: Cassidy Beverley , Zoccolillo Mark , Hughes Susan
Published: January 2017

Objective:

This study assessed adolescent maternal psychopathology and its relation to the quality of mother–infant interactions.

Method:

Twenty-one mother-infant pairs recruited from an adolescent medicine clinic were assessed for socio-demographic background, psychosocial adversity, conduct disorder, alcohol or substance dependence, and depression. Dyads were videotaped during free play and their interactions rated using the Crittenden Child–Adult Relational Experimental (CARE) Index.

Results:

A large proportion of mothers exhibited psychopathology. Severity of maternal depression correlated positively with maternal controllingness and infant difficulty. Severity of maternal antisocial history correlated positively with maternal unresponsiveness and infant passivity.

Conclusion:

Though preliminary, this work suggests that adolescent maternal depression and antisocial history have different effects on the quality of mother–infant interactions. Researchers and clinicians interested in adolescent parenting should consider psychopathology as a contributing variable to the quality of mother–infant interactions.
Prevention concerning Mental Health: The Adolescent's Perspective
Authors: Villeneuve Claude , Bérubé Huguette , Ouellet Rejeanne , Delorme André
Published: January 2017

Objective:

To examine several subjective components of adolescents' behaviour concerning mental illness prevention.

Method:

Adolescents' knowledge, their attitudes and subjective norms, as well as their thoughts about how they would concretely handle a psychological problem were measured. A self-administered questionnaire was completed by 438 male and female adolescents in grades 8 and 11.

Results:

Gender and age differences were revealed: girls and older adolescents were more attuned to prevention. Further, the influence on young people of peers and parents was also apparent.

Conclusion:

Adolescents perceive prevention concerning mental health as important.
Building Curriculum for Training in Community Child Psychiatry
Authors: Leverette John , Froese Arthur , DiNicola Vincenzo
Published: January 2017

Objective:

To present a practical approach to curriculum design for community-based care in child psychiatry.

Method:

A design template is presented, steps for a curriculum review are derived from it, and as an example, a small academic division's program is reviewed.

Results:

The division's curriculum was developed according to the template, resulting in an enhanced focus and improved coverage of topics through a combination of experiential and didactic teaching.

Conclusion:

The suggested format is considered applicable to child psychiatric training programs of all sizes and offers an opportunity to review or initiate the teaching of community child psychiatry.
Research Productivity among PhD Faculty Members and Affiliates Responding to the Canadian Association of Professors of Psychiatry and Canadian Psychiatric Association Survey
Authors: Atkinson Mark , el-Guebaly Nady
Published: January 2017

Objective:

This survey endeavours to assess the research productivity of PhD degree holders affiliated with Canadian academic departments of psychiatry.

Method:

A questionnaire was adapted to suit the Canadian milieu and was distributed to a target population of 2484, of whom 345 were nonmedical PhDs.

Results:

Out of 861 respondents, 148 indicated that they held a PhD degree only— a response rate of 42.9% for that subgroup. PhD respondents engaged in significantly more research activities than MDs. Their fields of research activity differed according to amount of time spent in research activities. Few gender differences were observed.

Conclusions:

The recruitment of sole PhD holders is an indicator of the current research needs of departments and of the dearth of candidates for these positions among MDs.
Screening Patients with Mental Retardation for Polydipsia
Authors: Hayfron-Benjamin Jonathan , Peters Claudia A , Woodhouse Rosamund A
Published: January 2017

Objectives:

To determine whether caregiver responses to a screening question are a reliable method of identifying polydipsia (excessive water drinking) in institutionalized residents with mental retardation. To review the etiology, acute and chronic clinical manifestations, and care of polydipsia and water intoxication.

Method:

This paper presents an assessment of interrater reliability for a screening question for polydipsia using responses of primary caregivers of preidentified polydipsia cases (n = 32) and matched controls (n = 33) in a large Canadian institution for developmentally handicapped adults. A chart review of all cases of identified water intoxication is also provided. The behavioural outcomes of preventive measures for water intoxication are described.

Results:

The screening instrument was reliable, having a κ (interrater reliability) of 0.73. Several case descriptions illustrate typical presentations of water intoxication in this population.

Conclusions:

Polydipsia is reliably identified by caregiver responses to a screening question. It should be screened for regularly to ensure appropriate care to prevent important acute and chronic complications.
Psychiatric Morbidity in HIV Patients
Authors: Khouzam Hani Raoul , Donnelly Nancy J , Ibrahim Nabil F
Published: January 2017

Objective:

To provide an accessible source of clinical information related to the diagnosis and treatment of psychiatric morbidity associated with HIV infection.

Method:

A selective MEDLINE literature search was used to identify 225 relevant articles, 67 of which were selected for inclusion based upon the presence of psychiatric morbidity. Psychiatric morbidity was defined by the presence of a DSM-IV diagnostic code reflecting psychiatric illness.

Results:

HIV-infected patients have high rates of psychiatric morbidity.

Conclusion:

The psychiatric evaluation and treatment of psychiatric morbidity improve the quality of life of HIV and AIDS patients.
The Prevalence of Posttraumatic Stress Disorder in an Adolescent Inpatient Unit
Authors: Koltek Mark , Wilkes TCR , Atkinson Mark
Published: January 2017

Objective:

To examine the prevalence and comorbidity of posttraumatic stress disorder (PTSD) in an adolescent inpatient population. A 2-year retrospective chart study was conducted.

Method:

Computer-registered data of discharge records from 1993 and 1994 were recovered. Patients were grouped by diagnosis; frequency and chi-square statistical analyses were performed to ascertain the prevalence and the comorbidity of various diagnoses with PTSD.

Results:

A total of 187patients, 114 females and 73 males, with a mean age of 15 years were reviewed, and 42% (79) of all patients had a diagnosis of PTSD using DSM-III-R criteria. There were 54 females and 25 males with PTSD; however, gender effect was not clinically significant. Associated comorbidity reaching clinical significance included other anxiety disorders (P = 0.008) and depressive disorders (P = 0.003). Asthma was diagnosed as a significant clinical disorder (P = 0.05) comorbid with PTSD. PTSD diagnoses correlated strongly with a history of abuse (P = 0.0001).

Conclusions:

PTSD occurs frequently in adolescent inpatients and is commonly comorbid with other diagnostic presentations. These findings may affect the management of PTSD and prognosis for this population.
Suggestions for a Framework for an Empirically Based Classification of Personality Disorder
Authors: Livesley W John
Published: January 2017

Background:

The classification of personality disorder is one of the least satisfactory sections of contemporary psychiatric classification. Fundamental problems with current classifications include extensive diagnostic overlap, limited evidence of validity, and poor empirical support.

Methods:

Conceptual analysis and the results of empirical studies are used to propose a framework for organizing an empirically based classification.

Results:

First, personality disorder is a form of mental disorder and, therefore, should be classified as a single diagnostic entity on Axis I along with other mental disorders. A preliminary definition of personality disorder as a tripartite failure involving the self system, kinship relationships, and societal relationships is proposed. The evidence suggests that this definition can be translated into a reliable set of items. Second, the diagnosis of personality disorder should be separated from the assessment of clinically relevant personality traits. Given the consistent evidential support for a dimensional model of personality disorder, it is suggested that personality be coded on a set of trait dimensions selected to provide a systematic representation of the domain of behaviours represented by current diagnostic concepts. Third, given that personality traits are hierarchically organized, it is suggested that an axis for coding personality include basic or lower-order dimensions as the primary level of assessment and a few higher-order patterns to summarize information for some purposes.

Conclusion:

A preliminary list of 16 basic dispositional traits is proposed to describe the more specific components of personality disorder based, in part, on the convergence of evidence across studies: anxiousness, affective lability, callousness, cognitive dysregulation, compulsivity, conduct problems, insecure attachment, intimacy avoidance, narcissism, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, submissiveness, and suspiciousness. Three higher-order patterns were proposed: emotional dysregulation, dissocial behaviour, and inhibitedness, which may occur independently or in combination.
Does Childhood Trauma Cause Personality Disorders in Adults?
Authors: Paris Joel
Published: January 2017

Objective:

To examine the relationship between trauma in childhood and personality disorders in adulthood.

Method:

A review of the literature was conducted.

Results:

The reported associations between trauma and personality pathology are illuminated by the following research findings: 1) personality is heritable; 2) only a minority of patients with severe personality disorders report childhood trauma; and 3) children are generally resilient, and traumatic experiences do not consistently lead to psychopathology.

Conclusions:

The role of trauma in the personality disorders is best understood in the context of gene–environment interactions.