bluuebunny/crossref_metadata_2025 huggingface dataset:
Le concept français d'athymhormie de 1922 à nos jours
Authors: Luauté Jean-Pierre , Saladini Olivier
Published: January 2017

Le concept psychiatrique d'athymhormie (perte de l'élan vital et de l'affectivité) a été créé au début du 20e siècle en France, où son usage était resté confiné jusqu'à ce qu'il soit heureusement repris par des neurologues, essentiellement francophones. Pour ses auteurs, M Dide et P Guiraud, il désignait une entité autonome, héritière de la « démence précoce » dont ils n'acceptaient pas le remplacement par une « schizophrénie » aux limites floues. Par la suite, ce terme désignera pour eux et, jusqu'à nos jours pour la majorité des psychiatres français, le noyau fondamental des formes déficitaires de psychoses. Le terme d'athymhormie (ou perte d'auto-activation psychique) est actuellement aussi utilisé en neurologie pour désigner les conséquences comportementales et affectives de lésions acquises des noyaux gris et plus généralement d'un circuit assimilé à la « boucle limbique». Toutefois, la question se pose de la réalité phénoménologique des troubles correspondants et de l'intérêt d'une même appellation. Au terme de cette revue, il est conclu que même si les tableaux dans lesquels l'athymhormie s'insère en clinique psychiatrique et neurologique sont bien différents, le choix d'un même terme se défend dans le cadre d'une approche neuropsychiatrique renouvelée et symptomatique. L'objectif d'une telle approche est de rechercher en quoi certains symptômes, communs ou similaires, pourraient représenter le déficit d'une fonction physiologique que l'on suppose ici être celle de la motivation.
Treating Psychosis: Is There More to Early Intervention Than Intervening Early?
Authors: Malla Ashok M , Norman Ross MG
Published: January 2017

While the possibility of early intervention following the initial onset of psychotic disorders such as schizophrenia is an exciting development, a closer examination of the nature and content, as well as the timing, of treatment is required for this new approach to be successful. Modification and integration of diverse treatments need to be empirically investigated for their potentially greater effectiveness in patients who are, in general, much younger, naive to the mental health system, and possibly capable of full integration into society. Reducing delay in treatment initiation may be complex, may involve adopting early identification strategies, and may pose significant systemic and conceptual challenges. The 2 aspects of early intervention—integration of phase-specific treatments and early case identification—need to go hand in hand to ensure that another opportunity will not be missed in our efforts to improve the outcomes of these most serious of all mental disorders.
Hidden Cardiac Lesions and Psychotropic Drugs as a Possible Cause of Sudden Death in Psychiatric Patients: A Report of 14 Cases and Review of the Literature
Authors: Frassati Dominique , Tabib Alain , Lachaux Bernard , Giloux Natalie , Daléry Jean , Vittori François , Charvet Dorothée , Barel Cécile , Bui-Xuan Bernard , Mégard Rachel , Jenoudet Louis Pierre , Descotes Jacques , Vial Thierry , Timour Quadiri
Published: January 2017

Objective:

To confirm the hypothesis that psychotropic drugs, especially neuroleptics, lithium, and antidepressants, are implicated as a cause of unexpected sudden death in psychiatric patients because of their cardiotoxicity, especially when hidden cardiac lesions are present.

Method:

We performed a full pathological examination of 14 psychiatric patients who unexpectedly and suddenly died between 1980 and 1999.

Results:

Neuroleptics were involved in 13 instances, antidepressants in 9, and anxiolytics in 5. Psychotropic drugs were combined in all but a single patient. In all 14 patients, toxicological analyses discarded drug overdose as cause of death. At postmortem examination, the brain and abdominal organs were normal. In 13 patients, the following lesions were found in the heart and lungs: dilated cardiomyopathy (6 patients), left ventricular hypertrophy (2 patients, 1 of which was associated with mitral prolapse and anomalies of His bundle), arrhythmogenic cardiopathy of the right ventricle (1 patient), pericarditis (1 patient), mitral prolapse (1 patient), muscular bridge on the anterior interventricular artery (1 patient), and Mendelsons syndrome (1 patient). In 1 case, no changes were seen. Most of the drugs that were taken immediately prior to death can induce arrhythmias either by prolonging the QT interval, potentially resulting in torsades de pointes, or by widening QRS complexes, possibly leading to reentry and ventricular fibrillation.

Conclusion:

Our findings suggest that the arrhythmogenic effects of psychotropic drugs can be exacerbated when preexisting hidden cardiac lesions are present and can result in sudden death. Patients should be systematically evaluated for cardiac lesions prior to starting any treatment with psychotropic drugs; the minimal effective dosage should be used.
The 5-Factor Model of Personality and Antidepressant Medication Compliance
Authors: Cohen Nicole L , Ross Erin C , Bagby R Michael , Farvolden Peter , Kennedy Sidney H
Published: January 2017

Objective:

Medication noncompliance is a significant problem for effective pharmacologic treatment of major depressive disorder (MDD). Attempts to explore predictors of compliance have primarily focused on demographic characteristics; for the most part, these have been shown to be unrelated to compliance. Conversely, the relation between personality characteristics and compliance has been relatively understudied. The primary purpose of this study was to explore the relation between personality characteristics and compliance with antidepressant medication in patients with major depressive disorder (MDD).

Method:

Over 14 weeks, we evaluated a sample of outpatients ( n = 65) who were receiving antidepressant treatment. We monitored compliance electronically, using the Medication Event Monitoring System. We assessed personality characteristics with the NEO Five-Factor Inventory–Revised. We also assessed depression severity and the frequency and severity of side effects.

Results:

Extraversion was a significant negative predictor of compliance. This was largely explained by the relation between compliance and the Activity facet within Extraversion. We also found a negative relation between the Feelings facet and compliance, while the Modesty facet was a significant positive predictor of compliance with antidepressant medication. Neither severity of depression nor side effects predicted compliance.

Conclusions:

These results suggest that correlates of personality are important, although frequently ignored, predictors of compliance with antidepressant medication. Identifying predictors of medication compliance may help in the development of individualized treatment regimens and lead to improved therapeutic outcome in the treatment of MDD.
Social, Demographic, and Clinical Factors Related to Disruptive Behaviour in Hospital
Authors: Boggild Andrea K , Heisel Marnin J , Links Paul S
Published: January 2017

Objective:

This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not.

Method:

We completed a case–control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier.

Results:

Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; χ2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model ( R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95%CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital.

Conclusions:

Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.
Psychiatric Comorbidity and Eating Disorder Inventory (EDI) Profiles in Eating Disorder Patients
Authors: Milos Gabriella , Spindler Anja , Schnyder Ulrich
Published: January 2017

Objective:

This study examines potential overlaps between psychiatric comorbidity (Axis I and II) and scores on the subscales of the Eating Disorder Inventory (EDI) in women with eating disorders (EDs).

Method:

In a sample of 248 women (72 with anorexia nervosa, 140 with bulimia nervosa, and 36 with eating disorders not otherwise specified), we determined psychiatric comorbidity using the Structured Clinical Interview for DSM-IV. Behavioural and psychological characteristics of EDs were quantified with the EDI.

Results:

Psychiatric comorbidity was high in both axes (74% for Axis I and 68% for Axis II). While most EDI subscales pertaining to psychological traits showed significant associations with Axis I and II disorders, the subscales concerning eating and perception of weight and shape were much less associated with psychiatric comorbidity. Affective and anxiety disorders, as well as personality disorders of clusters A and C, showed a similar pattern with links to most psychological subscales. The profile for substance-related disorders was different, showing associations with the Ineffectiveness and Interoceptive Awareness scales. Personality disorders of cluster B were related only to the Bulimia subscale and not to any of the psychological subscales.

Conclusions:

The EDI appears to primarily reflect Axis I and II disorders related to affective and anxiety problems. Clinicians and researchers employing the EDI should be aware that it is not sensitive for all forms of comorbidity prevalent in ED patients.
Family Background and Genius
Authors: Rothenberg Albert , Wyshak Grace
Published: January 2017

Objective:

It is widely believed among professionals and laity that genius is born and not made. However, the early and still-influential statistical studies of Frances Galton on the inheritance of genius have neither been supported nor definitively refuted. This study empirically assesses the hereditary transmission hypothesis.

Methods:

We collected family background data on 50 Nobel Prize laureates in literature, 31 Booker Prize awardees, 135 Pulitzer Prize winners, and 20 National Book and National Book Critics Circle awardees. We compared these for incidence of occupational inheritance (that is, same parent–child occupations) with a matching group of 392 eminent persons in noncreative occupations; for predominant occupation type, we also compared subject data with data for 560 high-IQ nonprizewinners, as well as with general population occupational data.

Results:

Incidence of one or both parents in the same occupation was only 1% for literary prizewinners but 16% for eminent noncreative persons ( P < 0.0001). The predominant (76%) family background constellation for prizewinners consisted of parent–child sex congruency either in applied-equivalent occupations requiring language, persuasion, or artisan skills ( P < 0.0001, compared with control subjects) or in unrelated occupations with unfulfilled wishes for creative expression.

Conclusions:

Outstanding literary prizewinners do not manifest direct inheritance of creativity from their parents; instead, parents and children of the same sex are predominantly in applied-equivalent or performance occupations and have unfulfilled creative wishes. We suggest that early developmental influences on child motivation involve identification and competition with the parent of the same sex.
Barriers to Access to Mental Health Services for Ethnic Seniors: The Toronto Study
Authors: Sadavoy Joel , Meier Rosemary , Ong Amoy Yuk Mui
Published: January 2017

Objective:

To identify and describe barriers to access to mental health services encountered by ethnoracial seniors.

Method:

A multiracial, multicultural, and multidisciplinary team including a community workgroup worked in partnership with seniors, families, and service providers in urban Toronto Chinese and Tamil communities to develop a broad, stratified sample of participants and to guide the study. This participatory, action-research project used qualitative methodology based on grounded theory to generate areas of inquiry. Each of 17 focus groups applied the same semistructured format and sequence of inquiry.

Results:

Key barriers to adequate care include inadequate numbers of trained and acceptable mental health workers, especially psychiatrists; limited awareness of mental disorders among all participants; limited understanding and capacity to negotiate the current system because of systemic barriers and lack of information; disturbance of family support structures; decline in individual self-worth; reliance on ethnospecific social agencies that are not designed or funded for formal mental health care; lack of services that combine ethnoracial, geriatric, and psychiatric care; inadequacy and unacceptability of interpreter services; reluctance of seniors and families to acknowledge mental health problems for fear of rejection and stigma; lack of appropriate professional responses; and inappropriate referral patterns.

Conclusions:

There is a clear need for more mental health workers from ethnic backgrounds, especially appropriately trained psychiatrists, and for upgrading the mental health service capacity of frontline agencies through training and core funding. Active community education programs are necessary to counter stigma and improve knowledge of mental disorders and available services. Mainstream services require acceptable and appropriate entry points. Mental health services need to be flexible enough to serve changing populations and to include services specific to ethnic groups, such as providing comprehensive care for seniors.
The Feasibility of a Mental Health Curriculum in Elementary School
Authors: Lauria-Horner Bianca A , Kutcher Stan , Brooks Sarah J
Published: January 2017

Objective:

To establish the feasibility and short-term impact of implementing a novel curriculum in a linguistically and geographically isolated francophone community to enhance elementary schoolchildren's (Grades 1 to 7; n = 158) knowledge and attitudes regarding mental health.

Methods:

The project team developed a curriculum that covered expected emotional development, depression, anxiety disorders, and attention-deficit hyperactivity disorder to be delivered by the school's usual teachers. Committee members led focused discussions (Grades 1 to 7) and administered evaluation questionnaires (Grades 4 to 7) surveying students' knowledge and attitudes before and after implementation.

Results:

Teachers were enthusiastic about the project. Parents were initially skeptical, but post hoc interventions by school staff secured participation consent for 98% of the students. Baseline data (Grades 4 to 7) revealed little knowledge and some negative attitudes regarding mental illnesses; postprogram data indicated improved knowledge and suggested improved attitudes.

Conclusions:

The project was made feasible by the high degree of involvement of local community members. Children's (Grades 4 to 7) mental health awareness and understanding was enhanced by the curriculum. Effects on help-seeking behaviour and case identification have yet to be assessed.
The Canadian Community Health Survey: Mental Health and Well-Being
Authors: Gravel Ronald , Béland Yves
Published: January 2017

As part of the Canadian Community Health Survey (CCHS) biennial strategy, the provincial survey component of the first CCHS cycle (Cycle 1.2) focused on different aspects of the mental health and well-being of Canadians living in private dwellings. Moreover, the survey collected data on prevalences of specific mental disorders and problems, use of mental health services, and economic and personal costs of having a mental illness. Data collection began in May 2002 and extended over 8 months. More than 85% of all interviews were conducted face-to-face and used a computer-assisted application. The survey obtained a national response rate of 77%. This paper describes several key aspects of the questionnaire content, the sample design, interviewer training, and data collection procedures. A brief overview of the CCHS regional component (Cycle 1.1) is also given.
Unmet Need for the Treatment of Depression in Atlantic Canada
Authors: Starkes Jill M , Poulin Christiane C , Kisely Stephen R
Published: January 2017

Objective:

Most people with depression do not receive treatment, even though effective interventions are available. Population-based data can assist health service planners to improve access to mental health services. This study aimed to examine the determinants of untreated depression in Canada's Atlantic provinces.

Method:

This study used data from the Canadian Community Health Survey Cycle 1.1. Logistic regression models explored the prevalence of depression and associated patterns of mental health service use among population subgroups.

Results:

Of the respondents, 7.3% experienced major depression in the previous year, as measured by the Composite International Diagnostic Interview Short Form. Individuals with the following characteristics were at increased risk for depression: female sex; widowed, separated, or divorced marital status; low income; and 2 or more comorbid medical conditions. Only 40% of respondents with probable depression reported any consultation about their condition with a general practitioner or mental health specialist. Less than one-quarter of Atlantic Canadians with depression reported receiving levels of care consistent with practice guidelines. Vulnerable groups, including older individuals, people with low levels of education, and those living in rural areas, were significantly less likely to receive treatment in either primary or specialty care.

Conclusions:

These findings suggest inequitable access to services and the need to target interventions to at-risk populations by raising awareness among the public and health care providers. Health systems in the Atlantic region must work toward achieving consistent longitudinal care for a larger proportion of individuals suffering from depression by studying the underlying factors for service use among underserved groups.
Area Variations in the Prevalence of Substance Use and Gambling Behaviours and Problems in Quebec: A Multilevel Analysis
Authors: Kairouz Sylvia , Nadeau Louise , Siou Géraldine Lo
Published: January 2017

Objectives:

This study aimed to examine whether variations among regions in Quebec existed after we controlled for individual characteristics in the prevalence of 1) alcohol, cannabis, and gambling behaviours and 2) substance-related disorders and pathological gambling.

Methods:

Using data derived from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), we nested 5332 respondents from the province of Quebec within 374 regions equivalent to census subdivisions (CSDs). Outcome variables included 1) drinking status (past 12 months), alcohol consumption (last week), and 12-month diagnosis of alcohol dependence; 2) cannabis use (past 12 months and lifetime) and diagnosis of illicit drug dependence; and 3) gambling status, severity of gambling problems, and number of reported gambling activities (past 12 months). Multilevel regression models with individuals (Level 1) nested in regions (CSDs, Level 2) assessed the variations among regions in the prevalence of various outcomes and disorders when individual characteristics were controlled for.

Results:

Variance component models revealed that all alcohol-related variables, the prevalence of cannabis use (12 months), and problem gambling did not vary among areas. Gambling rates and the average number of reported gambling activities varied among areas, even when individual-level variables were accounted for in the models, whereas for lifetime cannabis use, variations among areas became nonsignificant.

Conclusion:

Intervention programs may need to address the environment as a relevant determinant of health-related behaviours and lifestyles.
Is the Statistical Association between Sex and the Use of Services for Mental Health Reasons Confounded or Modified by Social Anchorage?
Authors: Drapeau Aline , Lesage Alain , Boyer Richard
Published: January 2017

Objective:

Confounding and interaction have differing implications for the interpretation of findings and the design of research, mental health services, and policy. This study aimed to verify whether the association between sex and the use of services for mental health reasons is confounded or modified by social anchorage.

Methods:

We undertook a case–control study nested in Cycle 1.2 of the Canadian Community Health Survey. Cases were defined as users of general medical services for mental health reasons in the previous 12 months, and control subjects were defined as never-users of any services for mental health reasons. The pattern of social anchorage was described by the roles of parent, spouse, worker, and their combination.

Results:

Overall, women are 2.9 times more likely than men to use general services for mental health reasons. However, this inequality between women and men decreases substantially or subsides in individuals who are less anchored to Canadian society. For instance, in single parents and in unemployed parents, the odds of using general services for mental health reasons are similar in women and in men. The pattern of social anchorage tends to modify, but not to confound, the association between sex and the use of services.

Conclusions:

Ignoring the interaction between sex and the pattern of social anchorage distorts the interpretation of the inequality between women and men in the use of general medical services for mental health reasons and may affect the design of comprehensive mental health services and policy.
Correlates of Depressive and Anxiety Disorders among Young Canadians
Authors: Nguyen Cat Tuong , Fournier Louise , Bergeron Lise , Roberge Pasquale , Barrette Geneviève
Published: January 2017

Objective:

The current study presents data on the prevalence of depressive and anxiety disorders in the Canadian population aged between 15 and 24 years and examines their potential correlates.

Methods:

The study is based on the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). This survey was administered to a representative sample of 36 984 Canadians. A subsample of 5673 Canadians aged between 15 and 24 years was available for the analyses. We used descriptive analyses to calculate lifetime and 12-month prevalence of depressive and anxiety disorders, and we used logistic regressions to measure odds ratios.

Results:

Among Canadian youths, 10.2% had suffered from depressive disorders during their lifetime, whereas 12.1% had suffered from anxiety disorders. For 12-month prevalence, the rates were 6.4% and 6.5% for depressive and anxiety disorders, respectively. Depressive disorders were more frequent among youth aged 20 to 24 years and among those no longer in school. Both disorders were more common among women and people under extreme stress.

Conclusions:

The prevalence rates found are comparable with other studies, and most of the correlates are concordant with the literature. Results indicate that there is a turning point for depression between late adolescence and adulthood that could be crucial for intervention planning.
Perceived Need for Mental Health Treatment in a Nationally Representative Canadian Sample
Authors: Sareen Jitender , Cox Brian J , Afifi Tracie O , Clara Ian , Yu Bo Nancy
Published: January 2017

Objective:

The optimal method of determining how many people in the general population need help for emotional problems remains unclear. This study aimed to examine the prevalence and correlates of self-perceived need for mental health services (that is, help seeking and perceived need) in a large, population-based sample.

Methods:

Data came from the Canadian Community Health Survey 1.2 ( n = 36 816, respondent age 15 years and over, and response rate 77%). Respondents were asked whether they had sought help in the past year from any professional for emotional problems and whether they felt they needed help for emotional symptoms but had not sought treatment. The Composite International Diagnostic Interview (CIDI) was used to make DSM-IV mental disorder diagnoses.

Results:

The past-year prevalences of help seeking and perceived need were 8.7% and 2.9%, respectively. After adjusting for the presence of DSM-IV disorders assessed in the survey, sociodemographic factors, illness severity, social supports, and the presence of physical health conditions were associated with help seeking and perceived need. Independent of DSM diagnoses, sociodemographics, and social supports, perceived need and help seeking were associated with increased levels of distress, disability, and suicidal ideation and attempts.

Conclusions:

This study illustrates that, in addition to the presence of a DSM diagnosis, the respondent's self-perceived need for mental health treatment is important in the assessment of need for mental health services in the community.
Predictors of Long-Term Benzodiazepine Abstinence in Participants of a Randomized Controlled Benzodiazepine Withdrawal Program
Authors: Voshaar Richard C Oude , Gorgels Wim J , Mol Audrey J , van Balkom Anton J , Mulder Jan , van de Lisdonk Eloy H , Breteler Marinus H , Zitman Frans G
Published: January 2017

Objective:

To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial.

Method:

We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition, randomized, controlled benzodiazepine discontinuation trial in general practice.

Results:

Of 180 patients, we completed follow-up for 170 (94%). Of these, 50 (29%) achieved long-term success, defined as no use of benzodiazepines during follow-up. Independent predictors of success were as follows: offering a taper-off program with group therapy (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.5 to 3.9) or without group therapy (HR 2.9; 95%CI, 1.8 to 4.8); a lower daily benzodiazepine dosage at the start of tapering off (HR 1.5; 95%CI, 1.2 to 1.9); a substantial dosage reduction by patients themselves just before the start of tapering off (HR 2.1; 95%CI, 1.4 to 3.3); less severe benzodiazepine dependence, as measured by the Benzodiazepine Dependence Self-Report Questionnaire Lack of Compliance subscale (HR 2.4; 95%CI, 1.1 to 5.2); and no use of alcohol (HR 1.7; 95%CI, 1.2 to 2.5). Patients who used over 10 mg of diazepam equivalent, who had a score of 3 or more on the Lack of Compliance subscale, or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence.

Conclusions:

Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality, benzodiazepine dosage, psychopathology, and personality characteristics. An identifiable subgroup needs referral to specialized care.
Mental Health Treatment Seeking by Military Members with Posttraumatic Stress Disorder: Findings on Rates, Characteristics, and Predictors from a Nationally Representative Canadian Military Sample
Authors: Fikretoglu Deniz , Brunet Alain , Guay Stéphane , Pedlar David
Published: January 2017

Objective:

The goal of this study was to identify rates, characteristics, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD).

Method:

Our sample was drawn from the 2002 Canadian Community Health Survey–Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable.

Results:

About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without.

Conclusions:

Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.
Interventions to Improve Employment Outcomes for Workers Who Experience Mental Illness
Authors: Krupa Terry
Published: January 2017

Objective:

To review employment interventions for individuals who experience mental illness.

Method:

I reviewed employment interventions described in the mental health, disability, and rehabilitation literature for the period 1990 to 2005 and organized these interventions into a framework.

Results:

The framework develops 7 distinct individual-level employment interventions as well as interventions directed at the employer and at workplace organization. It also considers factors that will affect access to these interventions. Although there is a sense of optimism about the potential of these interventions, research in the area is limited.

Conclusion:

Physicians who are knowledgeable about the nature and scope of employment interventions for individuals with mental illness are in a good position to effect positive change in the work lives of the individuals they serve.
Longitudinal Diagnostic Efficiency of DSM-IV Criteria for Borderline Personality Disorder: A 2-Year Prospective Study
Authors: Grilo Carlos M , Sanislow Charles A , Skodol Andrew E , Gunderson John G , Stout Robert L , Bender Donna S , Yen Shirley , Shea M Tracie , Morey Les C , Zanarini Mary C , McGlashan Thomas H
Published: January 2017

Objective:

To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for borderline personality disorder (BPD).

Methods:

At baseline, we used semistructured diagnostic interviews to determine criteria and diagnoses; blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (specifically, conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, with the independent BPD diagnosis at follow-up used as the standard.

Results:

Longitudinal diagnostic efficiencies for the BPD criteria varied, with the criteria of suicidality or self-injury and unstable relationships demonstrating the most predictive utility.

Conclusions:

BPD criteria differ in their predictive utility for the diagnosis of BPD when considered longitudinally. These findings have implications both for clinicians who are considering diagnoses and for researchers concerned with forthcoming revisions of our nosological system.
Clozapine-Induced Hypersalivation: A Review of Treatment Strategies
Authors: Sockalingam Sanjeev , Shammi Chekkera , Remington Gary
Published: January 2017

Objective:

Clozapine-induced hypersalivation (CIH) is a significant side effect affecting about one-third of patients treated with clozapine. CIH can be stigmatizing, can affect quality of life, and can result in discontinuation of clozapine treatment. The purpose of this review is to provide an understanding of CIH, specifically, its pathophysiology, measurement, and the evidence for CIH treatment alternatives.

Methods:

We searched MEDLINE from 1980 to June 2006 for all reported pharmacologic treatment studies related to CIH. We identified additional references by a manual search of the bibliographies of retrieved articles.

Results:

Several studies reported improvement of CIH with both selective and nonselective anticholinergic medications. However, with the exception of local anticholinergic agents such as ipratropium bromide and atropine eye drops, potential systemic adverse effects limit the effectiveness of this class of medications. Open-label studies of clonidine, an alpha2 antagonist, suggest that it may be beneficial in managing CIH. Other pharmacologic treatments, such as amisulpride and botulinum toxin, may be useful in refractory CIH cases.

Conclusion:

Although few randomized controlled trials were found in the literature, this review highlights potential treatment alternatives for this common and disabling cause of hypersalivation. Prompt and effective treatment of CIH may assist with treatment tolerability, adherence, and outcomes in patients with treatment-refractory schizophrenia.
Starson v. Swayze: The Supreme Court Speaks out (Not All That Clearly) on the Question of “Capacity”
Authors: Sklar Ronald
Published: January 2017

Objectives:

The decision in Starson v. Swayze interpreting the “understanding” requirement for capacity in the Ontario Health Care Consent Act (HCCA) provoked concern and criticism from psychiatric quarters. This article seeks to explain the decision and its implications for Ontario and other provinces.

Method:

The majority and minority opinions in the Starson case, and 4 cases decided in Ontario since Starson, were closely analyzed. The literature on capacity was examined. The decision's constitutional implications were considered.

Results:

Patients need not be able to understand that their condition constitutes an illness to be found capable of consenting to or refusing treatment. The focus should be on their ability to understand that they are affected by the condition's manifestations. A patient's “best interests” are not relevant to the capacity determination. The majority opinion departed from the traditional role accorded to a patient's denial of illness in determining capacity. Contrary to the views of some commentators, the Court's discussion of the actual benefits and risks of the treatments prescribed for Starson had no bearing on the capacity issue. Three of the post-Starson cases examined complied with the Court's holding; one did not. The majority's distinction regarding what patients must be able to understand about their condition is likely not a “principle of fundamental justice” under the Canadian Charter of Rights and Freedoms (the Charter). The right of the capable patient to refuse treatment and the irrelevance of the patient's best interests likely do constitute such principles.

Conclusions:

Patients in Ontario cannot be found incapable because they deny they are ill. Ability to recognize the manifestations of their condition suffices. This distinction is probably only binding in Ontario. The capable patient's right to refuse treatment and the irrelevance of the patient's best interests likely are binding throughout Canada.
Personality Disorders among Alcoholic Outpatients: Prevalence and Course in Treatment
Authors: Zikos Eugenia , Gill Kathryn J , Charney Dara A
Published: January 2017

Objective:

To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment.

Method:

Patients with alcohol use disorders ( n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks.

Results:

Using the results of the SCID-II ( n = 138), the sample was divided into 3 groups—that is, no PD 41% ( n = 57), Cluster B PD 32% ( n = 44), and other PD 27% ( n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse.

Conclusions:

This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.
Optimizing DSM-IV-TR Classification Accuracy: A Brief Biosocial Screen for Detecting Current Gambling Disorders among Gamblers in the General Household Population
Authors: Gebauer Line , LaBrie Richard , Shaffer Howard J
Published: January 2017

Objective:

To develop a pathological gambling (PG) screen for efficient application to the household population and for clinicians to use with treatment seekers.

Method:

We applied a series of multivariate discriminant functions to past-12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)-based, gambling-related problems; the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) measured and collected this data. The NESARC conducted computer-assisted personal interviews with 43 093 households and identified the largest sample of pathological gamblers drawn from the general household population.

Results:

We created a 3-item, brief biosocial gambling screen (BBGS) with high sensitivity (Sensitivity = 0.96; 76 of 79 pathological gamblers correctly identified) and high specificiy (Specificity = 0.99; 10 892 of 11 027 nonpathological gamblers correctly identified).

Conclusions:

Major US studies reveal extensive comorbidity of PG with other mental illnesses. The BBGS features psychometric advantages for health care providers that should encourage clinicians and epidemiologists to consider current PG along with other problems. The BBGS is practical for clinical application because it uses only 3 items and they are easy to ask, answer, and include in all modes of interviewing, including self-administered surveys. The BBGS has a strong theoretical foundation because it includes 1 item from each of the addiction syndrome 3 domains: neuroadaptation (for example, withdrawal); psychosocial characteristics (for example, lying); and adverse social consequences of gambling (for example, obtaining money from others).
Apathy following Stroke
Authors: Jorge Ricardo E , Starkstein Sergio E , Robinson Robert G
Published: January 2017

Objective:

We will review the available evidence on the frequency, clinical correlates, mechanism, and treatment of apathy following stroke.

Methods:

We have explored relevant databases (that is, PubMed, MEDLINE, and PsycINFO) using the following keywords and their combinations: apathy, motivation, abulia, stroke, cerebrovascular disease, basal ganglia, prefrontal cortex, anterior cerebral infarction, and thalamus.

Results:

The frequency of apathy following stroke has been consistently estimated between 20% and 25%. It appears to be associated with the presence of cognitive impairment, a chronic course characterized by progressive functional decline, and with disruption of neural networks connecting the anterior cingulate gyrus, the dorsomedial frontal cortex, and the frontal pole with the ventral aspects of the caudate nucleus, the anterior and ventral globus pallidus, and the dorsomedian and intralaminar thalamic nuclei. Published treatment studies have been mostly limited to anecdotal case reports, generally using dopamine agonists or stimulant medications. Cholinesterase inhibitors and nefiracetam may significantly reduce apathetic symptoms. However, their efficacy was examined in relatively small clinical trials that require replication.

Conclusion:

Apathy is a frequent neuropsychiatric complication of stroke that, although often associated with depression and cognitive impairment, may occur independently of both. Its presence has been consistently associated with greater functional decline. However, there is no conclusive evidence about which is the best treatment for this condition.
The Frequency, Clinical Correlates, and Mechanism of Anosognosia after Stroke
Authors: Starkstein Sergio E , Jorge Ricardo E , Robinson Robert G
Published: January 2017

Objective:

To review the frequency, clinical correlates, and mechanism of anosognosia after stroke.

Methods:

We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings.

Results:

Anosognosia is present in about 10% of acute stroke patients and its diagnosis is relatively simple. Nevertheless, a valid and reliable standardization of diagnostic instruments and criteria for research purposes is more difficult to achieve. This limitation may partially account for various instruments available to assess anosognosia and the different strategies used to diagnose this phenomenon. Anosognosia is a fleeting phenomenon and chronic cases are infrequent. There is a robust association between anosognosia and right-hemisphere lesions involving cortical (insular, temporal, and parietal lobes) and subcortical structures (thalamus and basal ganglia). The main clinical correlates of anosognosia are the presence of neglect, cognitive deficits, previous strokes, and older age. Anosognosia has a negative impact on the rehabilitation of stroke patients. The mechanism of anosognosia remains unknown but was explained as owing to psychological denial, disconnexion between left and right hemispheres, and dysfunction of a system that monitors the intention to move and actual movements.

Conclusion:

Anosognosia is a relatively frequent complication of acute stroke and may become an excellent model to understand the mechanism of human awareness.
The Relation between Maternal Schizophrenia and Low Birth Weight is Modified by Paternal Age
Authors: Lin Herng-Ching , Lee Hsin-Chien , Tang Chao-Hsiun , Chen Yi-Hua
Published: January 2017

Objective:

Paternal characteristics have never been considered in the relation between maternal schizophrenia and adverse pregnancy outcomes. The aim of our study was to consider different paternal ages while investigating the relation between maternal schizophrenia and low birth weight (LBW), using a nationwide population-based dataset.

Method:

Our study used data from the 2001 to 2003 Taiwan National Health Insurance Research Dataset and birth certificate registry. A total of 543 394 singleton live births were included. We performed multivariate logistic regression analyses to explore the relation between maternal schizophrenia and the risk of LBW, taking different paternal age groups into account (aged 29 years or younger, 30 to 39 years, and 40 years and older), and after adjusting for other characteristics of infant, mother, and father as well as the difference between the parent's ages.

Results:

Mothers with schizophrenia had a higher percentage of LBW infants than mothers who did not (11.8%, compared with 6.8%). For infants whose mothers had schizophrenia, the adjusted odds ratios of LBW were 1.47 (95% CI 1.02 to 2.27, P < 0.05) and 2.80 (95% CI 1.42 to 5.51, P < 0.01) times greater than for infants whose mothers did not have schizophrenia, for paternal age groups of 30 to 39 years and 40 years or older, respectively. However, maternal schizophrenia was not a significant predictor of LBW for infants whose fathers were aged 29 years and younger.

Conclusions:

The relation between LBW and maternal schizophrenia is modified by paternal age. More attention should be paid to the interaction of paternal characteristics and maternal psychiatric disorders in producing adverse pregnancy outcomes.
Utilisation des psychostimulants chez les patients en fin de vie atteints de delirium hypoactif et de troubles cognitifs: Revue de la littérature
Authors: Elie Dominique , Gagnon Pierre , Gagnon Bruno , Giguère Anik
Published: January 2017

Objectif:

Recenser la littérature portant sur l'effet des psychostimulants sur les fonctions cognitives des patients en fin de vie atteints de delirium hypoactif ou de troubles cognitifs.

Méthode:

Une revue de la littérature anglophone et francophone a été réalisée au moyen de mots clés désignant le delirium-cognition, les psychostimulants et les soins palliatifs dans les bases de données MEDLINE (1966-mars 2008), Embase (1974-mars 2008), PsycINFO (1806-mars 2008), IPA (1970-mars 2008), CINAHL (1982-mars 2008), ISI Web of Science (1945-mars 2008), Current Contents (mars 2007-mars 2008), Access Medicine (2001-mars 2008) et ProQuest Dissertations & Theses (1980-mars 2008). Pour ětre retenue, une étude devait avoir été effectuée auprès d'adultes en soins palliatifs présentant des troubles cognitifs non reliés à une démence ou à un delirium hyperactif–mixte. Une évaluation objective des fonctions cognitives devait avoir été réalisée avant et après le début du traitement psychostimulant. Ce dernier devait avoir été instauré après l'apparition des troubles cognitifs.

Résultats:

Au total, 173 résumés d'étude ont été révisés. Cinq études sur le méthylphénidate et une sur la caféine ont été retenues, soit 2 rapports de cas, 2 études prospectives ouvertes et 2 essais croisés randomisés à double insu contrôlés par placebo. Trois études ont été réalisées auprès de patients atteints de delirium hypoactif.

Conclusions:

Les études recensées soutiennent l'utilisation du méthylphénidate pour améliorer les fonctions cognitives des patients en fin de vie, notamment chez les patients en delirium hypoactif. La caféine semble avoir un effet bénéfique sur l'activité psychomotrice chez cette population.

Objective:

To review the research about psychostimulant effects on cognitive functions in end-of-life patients diagnosed with hypoactive delirium or cognitive disorders.