bluuebunny/crossref_metadata_2025 huggingface dataset:
Gene Expression Profile of Human Colon Cancer Cells Treated with Cross-Reacting Material 197, a Diphtheria Toxin Non-Toxic Mutant
Authors: Rivetti S. , Lauriola M. , Voltattorni M. , Bianchini M. , Martini D. , Ceccarelli C. , Palmieri A. , Mattei G. , Franchi M. , Ugolini G. , Rosati G. , Montroni I. , Taffurelli M. , Solmi R.
Published: January 2017

Cross-Reacting Material 197 (CRM197) is a diphtheria toxin non-toxic mutant that has shown antitumor activity in mice and humans. It is still unclear whether this anti-tumorigenic effect depends on its strong inflammatory-immunological property, its ability to inhibit heparin-binding epidermal growth factor (HB-EGF), or even its possible weak toxicity. CRM197 is utilized as a specific inhibitor of HB-EGF that competes for the epidermal growth factor receptor (EGFR), overexpressed in colorectal cancer and implicated in its progression. In this study we evaluate the effects of CRM197 on HT-29 human colon cancer cell line behaviour and, for CRM197 recognized ability to inhibit HB-EGF, its possible influence on EGFR activation. In particular, while HT-29 does not show any reduction of viability after CRM197 treatment (MTT modified assay), or changes in cell cycle distribution (flow cytometry), in EGFR localization, phospho-EGFR detected signals (immunohistochemistry) or in morphology (scanning electron microscopy, SEM) they show a change in the gene expression profile by microarray analysis (cDNA microarray SS-H19k8). The overexpression of genes like protein phosphatase 2, catalytic subunit, alpha isozyme (PPP2CA), guanine nucleotide-binding protein G subunit alpha-1(GNAIl) and butyrophilin, subfamily 2, member A1 (BTN2A1) has been confirmed with real-time-qPCR. This is the first study where the CRM197 treatment on HT-29 shows a possible scarce implication of endogenous HB-EGF on EGFR expression and cancer cell development. At the same time, our results show the alteration of a specific and selected number of genes.
A New Anti-Infective Strategy to Reduce Adhesion-Mediated Virulence in Staphylococcus Aureus Affecting Surface Proteins
Authors: Artini M. , Scoarughi G.L. , Papa R. , Cellini A. , Carpentieri A. , Pucci P. , Amoresano A. , Gazzola S. , Cocconcelli P.S. , Selan L.
Published: January 2017

Staphylococcus aureus is a flexible microbial pathogen frequently isolated from community-acquired and nosocomial infections. The use of indwelling medical devices is associated with a significant risk of infection by this bacterium which possesses a variety of virulence factors, including many toxins, and the ability to invade eukaryotic cells or to form biofilm on biotic and abiotic surfaces. The present study evaluates the anti-infective properties of serratiopeptidase, a secreted protein of Serratia marcescens, in impairing virulence-related staphylococcal properties, such as attachment to inert surfaces and adhesion/invasion on eukaryotic cells. SPEP seems to exert its action by modulating specific proteins. Proteomic studies performed on surface proteins extracted from SPEP-treated S. aureus cultures revealed that a number of proteins are affected by the treatment. Among these we found the adhesin/autolysin Atl, FnBP-A, SecA1, Sbi, EF-Tu, EF-G, and alpha-enolase. EF-Tu, EF-G and alpha-enolase are known to perform a variety of functions, depending on their cytoplasmic or surface localization. All these factors can facilitate bacterial colonization, persistence and invasion of host tissues. Our results suggest that SPEP could be developed as a potential “anti-infective agent” capable to hinder the entry of S. aureus into human tissues, and also impair the ability of this pathogen to form biofilm on prostheses, catheters and medical devices.
Combination Treatment of Flag with Non-Pegylated Liposomal Doxorubicin (MYOCET™) in Elderly Patients with Acute Myeloid Leukemia: A Single Center Experience
Authors: Melillo L. , Valente D. , D'Arena G. , Dell'Olio M. , Falcone A. , Minervini M.M. , Nobile M. , Rossi G. , Sanpaolo G. , Scalzulli P.R. , Cascavilla N.
Published: January 2017

The incidence of acute myeloid leukemia (AML) increases with age, but results of intensive chemotherapy in elderly patients are disappointing. Non-pegylated liposomal formulations of doxorubicin (Myocet™) have been developed with the aim of reducing systemic and cardiac toxicity especially in the elderly. We evaluated the efficacy and toxicity profiles of fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG) regimen given in association with Myocet™ in 35 patients with AML, median age 69 years (range 61–83 years). Nineteen (54.3%) had newly-diagnosed AML, twelve (34.3%) patients had secondary AML (ten with Myelodisplastic Syndrome, two with Primary Myelofibrosis) and 4 (11.4%) patients had had a late relapse (> 12 months) of AML. Complete remission (CR) and partial remission (PR) were obtained in twenty-two (63%) and 3 (8.5%) patients, respectively. Seven (20%) patients showed a resistant disease. There were 3 early deaths (8.5%). Six patients (17%) experienced severe cardiovascular toxicity. The median overall survival (OS) was 12 months (range 1–52 months) with a median disease-free survival (DFS) of 20 months (range 1–48 months). One-year and two-year DFS were 78.9% and 26.7%, respectively. This study demonstrates that in elderly patients with AML, FLAG-Myocet™ combination shows promising efficacy response with acceptable toxicity, enabling most patients to receive further treatments, including transplantation procedures.
Long-Term N-Acetylcysteine Therapy in Systemic Sclerosis Interstitial Lung Disease: A Retrospective Study
Authors: Rosato E. , Rossi C. , Molinaro I. , Giovannetti A. , Pisarri S. , Salsano F.
Published: January 2017

Systemic sclerosis (SSc) is associated with interstitial lung diseases. The primary endpoints of this study were changes between baseline and month 24 in single-breath carbon monoxide diffusing capacity (DLco). The secondary endpoints were: vital capacity (VC), forced expired volume in 1 sec (FEV1), total lung capacity (TLC), scores of high resolution computed tomography (HRCT) of the chest, number of adverse effects. In this study, we retrospectively investigated data from SSc patients who had undergone therapy with high-dose intravenous N-acetylcysteine (NAC) at a dosage of 15 mg/Kg/h for 5 consecutive hours every 14 days. After NAC therapy median values of DLco (69.5% vs 77.7%), VC (99% vs 101.3%) and TLC (93% vs 98.3%) significantly increased. We did not observed any significant changes from baseline in FEV1 value and HRTC score. The improvement in lung function was more evident in SSc patients without radiological signs of pulmonary fibrosis than in patients with pulmonary fibrosis. In SSc patients with mild-moderate pulmonary fibrosis intravenous NAC administration slows the rate of deterioration of DLco, VC and TLC. In conclusion, this retrospective study demonstrates that long-term therapy with intravenous NAC ameliorates pulmonary function tests in SSc patients.
The Protective Role of Catalase against Cerebral Ischemia in Vitro and in Vivo
Authors: Armogida M. , Spalloni A. , Amantea D. , Nutini M. , Petrelli F. , Longone P. , Bagetta G. , Nisticò R. , Mercuri N.B.
Published: January 2017

The present study aims to assess the protective role of the antioxidant enzyme catalase (CAT) with relation to hydrogen peroxide (H2O2) degradation in oxygen plus water on electrophysiological and fluorescence changes induced by in vitro ischemia and on brain damage produced by transient in vivo ischemia. Neuroprotective effects of CAT were determined by means of electrophysiological recordings and confocal fluorescence microscopy in the hippocampal slice preparation. Ischemia was simulated in vitro by oxygen/glucose deprivation (OGD). In vivo ischemia was produced by transient middle cerebral artery occlusion (MCAo). A protection of the rat CA1 field excitatory postsynaptic potential (fEPSP) loss caused by a prolonged OGD (40 min) was observed after exogenous CAT (500 U/mL) bath-applied before a combined exposure to OGD and H2O2 (3 mM). Of note, neither H2O2 nor exogenous CAT alone had a protective action when OGD lasted for 40 min. The CAT-induced neuroprotection was confirmed in a transgenic mouse model over-expressing human CAT [Tg(CAT)]. In the presence of H2O2, the hippocampus of Tg(CAT) showed an increased resistance against OGD compared to that of wild-type (WT) animals. Moreover, CAT treatment reduced for about 50 min fEPSP depression evoked by repeated applications of H2O2 in normoxia. A lower sensitivity to H2O2-induced depression of fEPSPs was also indicated by the rightward shift of concentration-response curve in Tg(CAT) compared to WT mice. Noteworthy, Tg(CAT) mice had a reduced infarct size after MCAo. Our data suggest new strategies to reduce neuronal damage produced by transient brain ischemia through the manipulation of CAT enzyme.
Transcriptional Profile of Denervated Vastus Lateralis Muscle Derived from a Patient 8 Months after Spinal Cord Injury: A Case Report
Authors: Mancinelli R. , Kern H. , Fulle S. , Carraro U. , Zampieri S. , La Rovere R. , Fanò G. , Pietrangelo T.
Published: January 2017

A lack of motor neurons abolishes both neurotrophic factor secretion and contractile activity in muscle, which impairs mass, contractile properties, and fibre-type characteristics of the muscle. However, the molecular pathways that can be stimulated or repressed in the scenario of spinal cord injury remain unknown. We investigated for the first time the transcriptional profile of a young male patient 8 months after spinal cord injury. Adaptive metabolic changes of complete denervated skeletal muscle were revealed. In particular, the main molecular pathways involved include metabolic and proteolitic pathways, mitochondrial and synaptic function, calcium homeostasis, sarcomere and anchorage structures. Our data depict the molecular signalling still present in complete denervated skeletal muscle fibres a few months after spinal cord injury. These data could be of interest also to design a specific therapeutic approach aimed at the electrical-stimulation of severe atrophied skeletal muscle.
The Expression of TSLP Receptor in Chronic Rhinosinusitis with and without Nasal Polyps
Authors: Boita M. , Garzaro M , Raimondo L. , Riva G. , Mazibrada J. , Vizio B. , Bellone G. , Pecorari G. , Bucca C. , Rolla G. , Giordano C.
Published: January 2017

Chronic Rhinosinusitis with or without Nasal Polyps (CRSwNP and CRSsNP) may be characterized by different cytokine profiles. Generally, Th2 cytokines and eosinophilic infiltration have been reported to be more specific of CRSwNP compared to CRSsNP, where neutrophils seem to play a major role. The epithelial cell-derived thymic stromal lymphopoietin (TSLP) has been recently identified as a key factor in Th2-inflammatory response. The aim of this study is to investigate the expression of TSLP Receptor (TSLP R) in surgical specimens obtained from patients affected by CRSwNP (n=10) and CRSsNP (n = 5) by immunohistochemical techniques (immunostaining score, IS). TSLP R expression was significantly higher in the inflammatory infiltrate and in the epithelial cells of CRSwNP, CRSsNP patients compared to the control group (IS 4.5±0.68, 4.4+1.44 and 0.4310.3 respectively, p=0.0024 for inflammatory infiltrate and IS 5.8±0.92, 7.8±2.06 and 0.86±0.55 respectively, p=0.0018 for epithelial cells). No significant difference was observed in IS of inflammatory infiltrate and epithelial cells in CRSwNP compared to CRSsNP. Very low IS for TSLP R was found in connective tissue of all the samples, with no difference among the groups. TSLP receptor is highly expressed in CRS compared to controls and independently from the polyps suggesting an early common inflammatory pathway in the two CRS phenotypes.
Antibacterial Activity of Methyl Aminolevulinate Photodynamic Therapy in the Treatment of a Cutaneous Ulcer
Authors: Devirgiliis V. , Panasiti V. , Fioriti D. , Anzivino E. , Bellizzi A. , Cimillo M. , Curzio M. , Melis L. , Roberti V. , Gobbi S. , Lieto P. , Richetta A.G. , Calvieri S. , Chiarini F. , Nicosia R. , Pietropaolo V.
Published: January 2017

We describe a 79-year-old female with a chronic venous ulceration infected by Staphylococcus aureus and Enterococcus faecalis and not responsive to conventional treatments. The patient was treated with Methyl-Aminolaevulinate Photodynamic Therapy (MAL-PDT). After four weeks the cutaneous swabs become negative and we observed a significant clinical improvement. Therefore we suppose that MAL-PDT could represent a valid therapeutic option in the treatment of infected chronic ulcers.
Clinical and Serological Features of Patients with Suspected Lyme Borreliosis
Authors: Santino I. , Longobardi V.
Published: January 2017

Serology is currently the method of choice for the laboratory diagnosis of Lyme borreliosis, but it must be interpreted with caution. A total of 954 patients with suspected Lyme borreliosis were evaluated on the basis of clinical and serological data. The seroprevalence of Borrelia burgdorferi antibodies was 4.4% (42 of the 954 serum samples). The most frequent clinical manifestation was erythema migrans which occurred in 50% of the seropositive patients, followed by neuroborreliosis (16.6%) and arthritis (11.9%). Carditis was rare. Our findings suggest that for the diagnosis of Lyme borreliosis, serologic tests need to be combined with clinical signs and symptoms.
Using Financial Incentives to Promote Shared Mental Health Care
Authors: Dewa Carolyn S , Hoch Jeffrey S , Goering Paula
Published: January 2017

Objectives:

To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level.

Method:

Three major financial reimbursement models—fee-for-service, capitation, and blended payment mechanisms—are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism.

Results:

The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment.

Conclusions:

Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care.

Objectifs:

Examiner les structures de remboursement les plus répandues dans les soins primaires, trouver les incitatifs inhérents à chacune et présenter comment chacune pourrait servir à stimuler une approche de soins partagés pour le traitement des troubles mentaux dans les soins primaires.

Méthode:

Trois principaux modèles — rémunération à l'acte, capitation et mécanismes de versements confondus — sont examinés, chacun en fonction des éléments de partage des risques et des incitatifs qui s'ensuivent. Nous présentons plusieurs scénarios pour illustrer comment le modèle de la pratique des soins partagés peut être favorisé par chaque mécanisme de financement.

Résultats:

Le système actuel de rémunération à l'acte n'incite pas aux soins partagés. Pour que le modèle de la pratique des soins partagés soit largement adopté, il faut modifier les incitatifs du système de remboursement. Bien qu'aucun mécanisme de financement n'offre de solution parfaite, chacun offre des possibilités, mais doit être soigneusement adapté à son milieu.

Conclusions:

Les considérations financières ne sont qu'un aspect de la réalisation des soins partagés. Néanmoins, en concevant un système qui incite à des soins coopératifs et coordonnés dispensés aux personnes souffrant de maladie mentale, les décideurs doivent prendre garde de créer ou de maintenir des obstacles (financiers ou autres) à la prestation de soins accessibles de grande qualité.
Mild Dementia or Cognitive Impairment: The Modified Mini-Mental State Examination (3MS) as a Screen for Dementia
Authors: Bland Roger C , Newman Stephen C
Published: January 2017

Objective:

To examine the Modified Mini-Mental State Examination (3MS) as a screen for dementia.

Method:

A group of 1092 elderly Edmonton community residents completed the 3MS and the Geriatric Mental State Examination (GMS). 3MS sensitivity and specificity were determined by comparing positive 3MS screens (score ≤77) with those classified as GMS “organic” (severity level 3, equivalent to a clinical diagnosis). In the Canadian Study of Health and Aging (CSHA), 2914 subjects received the 3MS and a clinical examination. A group described as having “cognitive impairment but no dementia (CIND)” was identified.

Results:

In Edmonton, the 3MS showed 88% sensitivity, 90% specificity, 29% positive predictive value (PPV), and 99% negative predictive value (NPV). In the CSHA, 30% of subjects receiving both the 3MS and a clinical examination were classified as CIND. One-half of these were classified as having “age associated memory impairment (AAMI)” or as “unspecified.”

Conclusions:

The 3MS with a cutting score of 77/78 proved a reasonable screening instrument; 1 case in 3 screening “positive” has dementia, but few (0.64%) will be missed by screening “negative.” CIND, accounting for 2 out of 3 cases screened positive by the 3MS in the Edmonton study, is a substantial, heterogeneous group that is not necessarily “predementia” but that in many cases merits further investigation.
Polydipsia, Psychosis, and Familial Psychopathology
Authors: Ahmed AG , Heigh Liana M , Ramachandran KV
Published: January 2017

Objective:

To compare the demographic and clinical factors and familial psychopathology of chronic psychiatric inpatients with, and without, polydipsia.

Method:

We undertook a case-control study of chronic psychiatric inpatients both with, and without, polydipsia. Clinical and demographic data were gathered using a predesigned questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Abnormal Involuntary Movement Scale (AIMS), the Mini-Mental State Examination Scale (MMSE), and the Family History–Research Diagnostic Criteria (FH-RDC).

Results:

The prevalence rate of polydipsia was 20.2%. The group with polydipsia was significantly younger, both at the time of their first-ever psychiatric and current psychiatric admissions, compared with the group without polydipsia. The 2 groups were similar in terms of their illness characteristics and psychiatric diagnoses. In the group with polydipsia, alcohol abuse predated the psychotic illness by a mean of 10.5 (SD 4.4) years, compared with 4.8 (SD 1.6) years for the same period in the unaffected group. The 2 groups did not differ significantly regarding the antipsychotic medication dosage, the proportion on concomitant anticholinergic medicaton, the documented previous response to antipsychotic medication, or past treatment with electroconvulsive therapy (ECT). First-degree relatives of patients with polydipsia were found to have significantly higher rates of alcohol dependence.

Conclusion:

This study provides further evidence for the higher rate of polydipsia among chronic psychiatric patient populations and for high rates of alcohol-related problems among their first-degree relatives.
Alternative Medicine Use by Individuals with Major Depression
Authors: Wang JianLi , Patten Scott B , Russell Margaret L
Published: January 2017

Objective:

To describe the use of alternative medicine (AM) by persons with major depression and to examine the factors associated with AM use among these individuals.

Methods:

We used data from the 1994–1995 and 1996–1997 National Population Health Surveys. We selected subjects who had major depression according to the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). The prevalence of AM and conventional health service use by the subjects was calculated for each survey and was stratified by province. We employed logistic regression to examine the factors associated with AM use.

Results:

There was a temporal trend toward increasing use of AM among persons with major depression. The prevalence of AM use among subjects with major depression was 7.8% in 1994–1995 and 12.9% in 1996–1997. Female sex, having more than 12 years' education, and having 1 or more long-term medical conditions were associated with an increased likelihood of using AM. The sex difference in AM use depended on subjects' age in 1996–1997.

Conclusion:

General practitioners, mental health specialists, and AM providers should be aware of their patients' use of both conventional medical services and AM because there may be interactions between conventional and alternative treatments. Communication and, if possible, cooperation may lead to improved outcomes in the management of depressive disorders.
Assessing and Treating Problem Gambling: Empirical Status and Promising Trends
Authors: Toneatto Tony , Millar Goldie
Published: January 2017

Objective:

Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment.

Methods:

We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment.

Results:

Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak.

Conclusions:

Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.
The Boundary between Borderline Personality Disorder and Bipolar Disorder: Current Concepts and Challenges
Authors: Magill Chandra A
Published: January 2017

Objective:

The boundary between borderline personality disorder (BPD) and bipolar disorder (BD) is a controversial subject. Clinically, it can be difficult to diagnose patients who present with both affective instability and impulsivity. This paper reviews concepts and challenges related to the overlap of these disorders.

Methods:

A Medline search was conducted, using the key words borderline personality disorder, bipolar disorder, affective disorder, and personality disorder. Reference lists from articles generated were also used. Publications from the last 20 years were considered.

Results:

Studies demonstrate a greater cooccurrence between these 2 disorders than between BPD and other Axis I disorders or between BD and other Axis II disorders. Some authors suggest that many patients diagnosed with BPD are better described as having BD, that the bipolar classification is too narrow, or that BPD should be considered a variant of affective disorders. Others present evidence supporting BPD as a valid construct. Hypotheses about the relation between the 2 disorders and suggestions for clinical practice are offered.

Conclusions:

There appears to be sufficient evidence to consider BPD to be a valid diagnosis. Both disorders apply to heterogeneous populations, and their characteristics require further clarification. In diagnostically challenging situations, careful consideration of a patient's longitudinal history is essential. Future research will be important to ensure that our diagnostic classifications reflect clinically useful entities.
Twenty-Year Course of Schizophrenia: The Madras Longitudinal Study
Authors: Thara R
Published: January 2017

Objective:

To follow up 90 first-episode schizophrenia patients after 20 years and to study the course of symptomatology, work, social functioning, and pattern of illness during this period.

Methods:

The Present State Examination and the Psychiatric and Personal History Schedule were administered at fixed points during follow-up. The measures adopted to ensure a good follow-up rate (67%) after 20 years under adverse conditions are described.

Results:

Complete data were obtained from 61 subjects; 16 had died, and 13 could not be traced. After 20 years, 5 patients had recovered completely, and another 5 were continuously ill. Most of the cohort had multiple relapses with or without complete remission between them. The Global Assessment of Functioning Scale showed that symptoms and social functioning in this sample approximated results from developing countries and were much better than those of developed nations. There were not many sex differences. Marriage and occupational rates were higher than those observed in many published reports.

Conclusions:

This is one of the few long-term follow-up studies from the developing world. It reveals a pattern of course and functioning distinctly better than that found in many such studies from the developed nations.
Determinants of Coprescription of Anxiolytics with Antidepressants in General Practice
Authors: Verger Pierre , Saliba Bérengère , Rouillon Frédéric , Kovess-Masféty Viviane , Villani Patrick , Bouvenot Gilles , Lovell Anne
Published: January 2017

Objectives:

Anxiolytics are the most frequently prescribed psychotropic drugs in France. General practitioners (GPs) tend to prescribe anxiolytics and other benzodiazepines to patients with major depressive disorders (MDD). However, the extent to and reasons for which they prescribe these medications together are not well documented. This article assesses how often and why GPs coprescribe an anxiolytic when starting patients on antidepressant (AD) treatment, and which patient- and GP-related factors are associated with this coprescription.

Methods:

We used a survey of 131 GPs practising in southeastern France and of patients seen consecutively during June to October 2004 to whom they prescribed an AD. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis, and symptom detection) and patients (self-administered questionnaires, including the Hospital Anxiety and Depression scale, and social and demographic characteristics). Factors associated with anxiolytic coprescription were analyzed with a multilevel logistic regression.

Results:

GPs completed 438 consultation-questionnaires for patients; 258 patients (58.9%) returned their questionnaires. Sixty percent of the patients received anxiolytics with ADs. Anxiolytics were prescribed more frequently by male GPs who reported feeling ill at ease treating MDD, or detected suicidal ideation or anxiety in their patients, and finally to patients with stable jobs.

Conclusions:

Although some practice guidelines and authors acknowledge that there might be some justification for zcoprescribing anxiolytics with ADs at the beginning of MDD treatment in specific situations, the high percentage of coprescriptions for anxiolytics observed in our study suggests that training and knowledge of GPs about MDD treatment are not optimal.
The Social Epidemiology of Affective and Anxiety Disorders in Later Life in Canada
Authors: Cairney John , Corna Laurie M , Veldhuizen Scott , Kurdyak Paul , Streiner David L
Published: January 2017

Objective:

To examine the association between markers of social position and psychiatric disorder among older adults, and test whether social support mediates the association between social position and psychiatric disorder in this population.

Methods:

We used data from the Canadian Community Health Survey: Mental Health and Well-Being to examine the social patterning of disorder. Using a series of logistic regression analyses, we regressed indicators of mood, anxiety, and any disorder on markers of social position and social support.

Results:

A negative association between age and disorder was evident across all models, and the likelihood of reporting disorder was elevated among separated–divorced and widowed respondents relative to their married counterparts. Social support was statistically significant in all models, and mediated a considerable amount of the effect of marital status on disorder.

Conclusions:

Many of the markers of social position associated with disorder among younger adults continue to be important predictors among older adults, and these variables are mediated to varying degrees by social support. The results support the general notion that social circumstances are important to psychological well-being. We discuss potential explanations for findings related to sex, age, marital status, and education as predictors of disorder in later life.
Three-Year Physician Treated Prevalence Rate of Mental Disorders in Alberta
Authors: Slomp Mel , Bland Roger , Patterson Sandy , Whittaker Lindsay
Published: January 2017

Objective:

To examine the rate at which adults seek services for mental disorders from different categories of physicians.

Method:

The study used billing data from all physicians during a 3-year period for the total adult population of the province of Alberta.

Results:

During the 3-year period, 35% of adults consulted a physician and were given a mental disorder diagnosis. The highest rates of consultation were for anxiety disorders (21%), followed by mood disorders (depression) (16%). Among patients, 84% were seen by primary care physicians only, and 3% were seen solely by psychiatrists. The more serious the diagnosing (for example, psychosis) the more likely patients were to be seen by psychiatrists.

Conclusions:

These results show that the 3-year prevalence rate includes more than one-third of the entire adult population. These figures differ considerably from those derived from population surveys in showing markedly higher prevalence (and treatment) rates. The number of people treated in primary care far exceeds those treated in the specialist sector.
Incidence of Diabetes in Patients with Schizophrenia: A Population-Based Study
Authors: Hsu Jer-Hwa , Chien I-Chia , Lin Ching-Heng , Chou Yiing-Jenq , Chou Pesus
Published: January 2017

Objective:

To detect the incidence of diabetes in patients with schizophrenia in Taiwan.

Methods:

The National Health Research Institute provided a database of 1 million random subjects for study, from which we drew a random sample of 617 068 subjects aged 18 years and older in the year 2000. Subjects who had at least one service claim during this year, with a primary diagnosis of schizophrenia, diabetes, or with a prescription for treatment of diabetes, were identified. We compared initial diagnosis of diabetes between patients with schizophrenia and the general population in 2000. We also followed a cohort of subjects with schizophrenia from 2000 to 2005.

Results:

The incidence of diabetes was higher in patients with schizophrenia than in the general population (1.46% and 1.12%, respectively; OR 1.47; 95% CI 1.09 to 1.97) in 2000. Compared with the general population, patients with schizophrenia showed a higher incidence of diabetes in the group aged 18 to 29 years; among females; among those with insurance of more than US$1281; among those living in the northern region; and among those residing in urban areas. The average annual incidence of diabetes in patients with schizophrenia was 1.84% from 2000 to 2005. Higher incidence of diabetes in patients with schizophrenia was associated with increased age, females, hypertension, and hyperlipidemia.

Conclusions:

Patients with schizophrenia had a higher incidence of diabetes for the youngest adult age group and for females than for the general population. Increased age, females, hypertension, and hyperlipidemia were risk factors of diabetes in patients with schizophrenia.
Sexual Orientation and its Relation to Mental Disorders and Suicide Attempts: Findings from a Nationally Representative Sample
Authors: Bolton Shay-Lee , Sareen Jitender
Published: January 2017

Objective:

To compare the rates of all Axis I and II mental disorders and suicide attempts in sexual orientation minorities with rates in heterosexuals using a nationally representative sample.

Method:

Data used were from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2 ( n = 34 653, response rate = 70.2%). Cross-tabulations and multivariate logistic regression analyses were performed to determine differences in rates of mental disorders and suicide attempts by sexual orientation. All analyses were stratified by sex.

Results:

Compared with their heterosexual counterparts, lesbians and bisexual women demonstrated a 3-fold increased likelihood of substance use disorders, and gay and bisexual men showed twice the rate of anxiety disorders and schizophrenia and (or) psychotic illness, even after accounting for mental disorder comorbidity. Suicide attempts were independently associated with bisexuality, with odds 3 times higher than in heterosexuals.

Conclusion:

Findings from our study emphasize the fact that sexual orientation minorities are vulnerable to poor mental health outcomes, including suicide attempts. Clinicians need to be aware of these specific negative mental health consequences when assessing sexual orientation minorities.
Psychiatric Disorder in Detained Male Adolescents as Risk Factor for Serious Recidivism
Authors: Colins Olivier , Vermeiren Robert , Vahl Pauline , Markus Monica , Broekaert Eric , Doreleijers Theo
Published: January 2017

Objective:

A growing body of research consistently shows that detained minors bear substantial mental health needs. However, the relation between mental disorder and criminal recidivism has largely remained unexplored. Our study examines whether psychiatric disorders increase the likelihood of recidivism after controlling for time at risk, criminal history, and the presence of other disorders.

Method:

Participants ( n = 232) were detained male adolescents from all 3 youth detention centres in Flanders, Belgium, who were interviewed with the Diagnostic Interview Schedule for Children, Version IV. Two to 4 years later, information on serious recidivism was retrieved from the official judicial registration system. Serious recidivism was defined as having at least one arrest charge for violent, severe property crime, or substance-related offences.

Results:

Serious recidivism was high, with 81% ( n = 191) of the participants being rearrested. Psychiatric disorders predicted neither serious recidivism in general nor violent and severe property recidivism. However, other drug use disorder (OR 2.41; 95% CI 1.22 to 4.75) and general comorbidity (OR 2.64; 95% CI 1.40 to 4.99) were significantly predictive of substance-related recidivism.

Conclusion:

Common psychiatric disorders in detained male adolescents do not significantly increase the likelihood of subsequent arrests, with the exception that substance use disorders appear to increase the risk of later substance-related recidivism. Effective treatment of these disorders may prevent detained juveniles to experience the detrimental outcomes associated with substance-related crimes as adults (for example, mental illness).
From Benzos to Berries: Treatment Offered at an Aboriginal Youth Solvent Abuse Treatment Centre Relays the Importance of Culture
Authors: Dell Colleen Anne , Seguin Maureen , Hopkins Carol , Tempier Raymond , Mehl-Madrona Lewis , Dell Debra , Duncan Randy , Mosier Karen
Published: January 2017

First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder–based and Aboriginal culture–based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation—storytelling—experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.
Rethinking Resilience from Indigenous Perspectives
Authors: Kirmayer Laurence J , Dandeneau Stéphane , Marshall Elizabeth , Phillips Morgan Kahentonni , Williamson Karla Jessen
Published: January 2017

The notions of resilience that have emerged in developmental psychology and psychiatry in recent years require systematic rethinking to address the distinctive cultures, geographic and social settings, and histories of adversity of indigenous peoples. In Canada, the overriding social realities of indigenous peoples include their historical rootedness to a specific place (with traditional lands, communities, and transactions with the environment) and the profound displacements caused by colonization and subsequent loss of autonomy, political oppression, and bureaucratic control. We report observations from an ongoing collaborative project on resilience in Inuit, Métis, Mi'kmaq, and Mohawk communities that suggests the value of incorporating indigenous constructs in resilience research. These constructs are expressed through specific stories and metaphors grounded in local culture and language; however, they can be framed more generally in terms of processes that include: regulating emotion and supporting adaptation through relational, ecocentric, and cosmocentric concepts of self and personhood; revisioning collective history in ways that valorize collective identity; revitalizing language and culture as resources for narrative self-fashioning, social positioning, and healing; and renewing individual and collective agency through political activism, empowerment, and reconciliation. Each of these sources of resilience can be understood in dynamic terms as emerging from interactions between individuals, their communities, and the larger regional, national, and global systems that locate and sustain indigenous agency and identity. This social–ecological view of resilience has important implications for mental health promotion, policy, and clinical practice.
Predicting Response to Day Treatment for Personality Disorder
Authors: Ogrodniczuk John S , Lynd Larry D , Joyce Anthony S , Grubisic Maja , Piper William E , Steinberg Paul I
Published: January 2017

Objective:

Efforts to improve the effectiveness of day treatment should attend to factors that influence treatment response. Our prospective study identified predictors of response to day treatment for personality disorder (PD).

Method:

Patients with a PD, consecutively admitted to a day treatment program, were assessed with self-report and interview measures. Predictors included personality characteristic, demographic, initial disturbance, and PD variables. Patients' overall response to treatment was classified as better, same, or worse, based on change in multiple outcome measures. A comprehensive approach to multivariate modelling was used.

Results:

The likelihood of being classified as better significantly increased if the patient was more psychologically minded, used avoidance-oriented coping strategies, and had a high level of baseline symptom severity. Probability of being classified as better decreased if the patient had a substance use disorder and a history of high service use.

Conclusions:

Identifying factors that affect response to day treatment can help clinicians make better selection decisions or take measures to modify treatment.
Emergency Department Assessment of Self-Harm Risk Using Psychometric Questionnaires
Authors: Randall Jason R , Rowe Brian H , Colman Ian
Published: January 2017

Objective:

To examine several potential predictive screening tools for emergency department assessment of risk of self-harm.

Methods:

Adult patients presenting with self-harm or suicidal ideation were enrolled at 2 emergency departments at large teaching hospitals in Edmonton, Alberta. Patients completed a brief interview assessing demographics and psychiatric history and several questionnaires (the Beck Hopelessness Scale, the Barrett Impulsiveness Scale [BIS], and the Brief Symptom Inventory [BSI]) and drug and alcohol abuse screens (Drug Abuse Screening Test [DAST-10] and the Cut down, Annoyed, Guilt, Eye-opener [commonly referred to as CAGE] Questionnaire). At 3 months, patients were followed up via telephone and electronic health records to ascertain self-harm outcome. Questionnaires and their subscales were assessed using logistic regression. Receiver operating characteristic (ROC) analysis was performed on the results.

Results:

Among the 157 patients enrolled, 49% were women and 36% (of the total) were aged 18 to 29 years. Several of the subscales of the BSI and BIS as well as the DAST-10 were significant predictors of self-harm ( P < 0.05). ROC analysis showed that none of the scales in isolation were very strong predictors. Hierarchical regression analysis that combined the significant scales with clinical risk factors that were significantly related to self-harm (that is, age, education level, history of self-harm, and whether they presented with self-harm or only suicidal ideation) indicated that the BIS and DAST-10 questionnaires each added significantly to the predictive ability of a model with these risk factors.

Conclusions:

While many of the questionnaires and their related constructs are related to future self-harm, none of them are particularly strong and their diagnostic usefulness is limited.
Wait Time Impact of Co-Located Primary Care Mental Health Services: The Effect of Adding Collaborative Care in Northern Ontario
Authors: Haggarty John M , Jarva Janelle A , Cernovsky Zack , Karioja Kim , Martin Lynn
Published: January 2017

Objectives:

In the shared care model, psychiatrists and physicians work in the same office areas, write their notes in the same casebooks, and can more rapidly exchange information about referrals and health conditions of their patients. We evaluated the impact of the introduction of a shared mental health care service, co-located with a primary care site, on wait times for mental health services in a northern Ontario city.

Method:

Chart reviews were conducted to examine a total of 3589 referrals for 5 mental health outpatient services (1 shared care and 4 existing services) from January 2001 to the end of June 2004. The shared mental health care service site was started in July 2001. Wait time was measured 6 months prior to and up to 3 years after the introduction of the shared care service.

Results:

The shared care site offered services more than 40 days sooner and also helped to reduce wait time on the nonshared care sites. After shared care began, the pre-existing, nonshared care services had wait times of about 13 days shorter during the 3 subsequent years.

Conclusions:

The shared care service maintained the lowest overall wait times, compared with the existing nonshared care services. The existing services experienced a decrease in the number of days waiting when the baseline wait time was compared with that of the following year.
Waist Circumference is a Sensitive Screening Tool for Assessment of Metabolic Syndrome Risk in Children Treated with Second-Generation Antipsychotics
Authors: Panagiotopoulos Constadina , Ronsley Rebecca , Kuzeljevic Boris , Davidson Jana
Published: January 2017

Objective:

To compare the prevalence of metabolic syndrome (MetS) and its components in second-generation antipsychotic (SGA)-treated and SGA-naive children; and to explore the utility of clinical markers, such as waist circumference (WC) and body mass index (BMI), as screening tools for MetS.

Methods:

Subjects were prospectively recruited from the Psychiatry Emergency Unit at British Columbia Children's Hospital. As part of a quality-assurance project, a metabolic monitoring protocol was implemented, including collection of anthropomorphic and laboratory data.

Results:

From January 2008 to February 2010, there were 117 SGA-treated and 217 SGA-naive children recruited. The overall prevalence of MetS was 19.0% (16/84; median treatment duration = 14 months) in SGA-treated and 0.8% (1/127) in SGA-naive children (OR 29.7; 95% CI 3.85 to 228.40, P < 0.001), with an increased prevalence of all components except high-density lipoprotein cholesterol (HDL-C), respectively: elevated WC (40.7% and 10.1%; P < 0.001); hypertriglyceridemia (33.7% and 18.8%; P = 0.01); impaired fasting glucose (12.5% and 0.7%; P = 0.005); and elevated blood pressure (41.2% and 16.5%; P < 0.001). SGA treatment was the strongest predictor of MetS (OR 19.2; 95% CI 2.30 to 160.44, P = 0.006) followed by male sex (OR 5.7; 95% CI 1.08 to 30.62, P = 0.04). Presence of abdominal obesity was more sensitive (92.9%) than BMI (68.8%), while fasting glucose of 5.6 mmol/L or more and HDL-C of 1.03mmol/L or less were most specific (94.1%) in correctly identifying MetS.

Conclusions:

SGA treatment confers a significantly increased risk for MetS over the long term. WC measurement is a simple and sensitive screening tool for determining MetS risk in SGA-treated children. These data highlight the dangers of SGA treatment and the importance of standardized metabolic monitoring using sex- and age-adjusted tables in this population.
Parental Sexual Abuse and Suicidal Behaviour among Women with Major Depressive Disorder
Authors: Cankaya Banu , Talbot Nancy L , Ward Erin A , Duberstein Paul R
Published: January 2017

Objective:

Women with major depressive disorder (MDD) and childhood sexual abuse histories have an increased risk for suicidal behaviours, but it is unclear whether specific abuse characteristics contribute to risk. We aimed to examine the contributions of abuse characteristics to lifetime history of suicide attempts and multiple suicide attempts, independent of posttraumatic stress disorder and borderline personality disorder.

Method:

Women with MDD and sexual abuse histories ( n = 106) were assessed regarding sexual abuse characteristics, psychiatric diagnoses, and suicide attempts.

Results:

In multivariate logistic regressions, the odds of having multiple suicide attempts increased 12.27-fold when childhood sexual abuse was perpetrated by a parent figure or a parent, compared with a nonparent.

Conclusions:

Parental perpetration of sexual abuse increases the likelihood of multiple suicide attempts among women outpatients. The relationship of the perpetrator to the abused woman is important in suicide risk evaluation and treatment planning. Clinical Trial Registration Number: NCT00843700