bluuebunny/crossref_metadata_2025_split huggingface dataset:
A (Re)-Evaluation of the Symptom Structure of Borderline Personality Disorder
Authors: Chmielewski Michael , Bagby R Michael , Quilty Lena C , Paxton Robin , Ng Sarah A McGee 
Published: January 2017

Objective: Despite evidence of significant symptom heterogeneity and excessive diagnostic comorbidity, many contend that borderline personality disorder (BPD) is unidimensional, an assumption that rests primarily on results from factor analytic investigations of BPD symptom criteria. We note several limitations in the literature and argue that the symptom structure of BPD can be best clarified by using both factor analytic techniques and examining the BPD symptom dimensions in relation to external criteria (that is, personality traits). Our goals were to: examine if the symptoms of BPD are best conceptualized as unidimensional or multidimensional, and determine the extent to which personality traits account for any symptom dimensions that underlie BPD. Method: All published structural models of the BPD symptom criteria were identified and tested for statistical fit using confirmatory factor analysis in a sample of 373 patients who had completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Axis II Personality Questionnaire BPD scale. Dimensions from the best fitting model were examined in relation to traits from the Five-Factor Model (FFM) and the Personality Psychopathology Five (PSY-5) using correlational and regression analyses. Results: Sanislow's 3-factor model, containing affect dysregulation, behavioural dysregulation, and disturbed relations symptom dimensions, provided the best fit; the unidimensional model produced the worst. The symptom dimensions of the 3-factor model were differentiable from one another and had unique associations with the FFM and PSY-5 personality traits. Conclusion: BPD is a multidimensional construct.
A Meta-Analysis of the Efficacy of Pregabalin in the Treatment of Generalized Anxiety Disorder
Authors: Boschen Mark J 
Published: January 2017

Objective: Generalized anxiety disorder (GAD) is a chronic anxiety disorder that leads to significant functional impairment and reduced quality of life. Pregabalin is a novel analogue of the inhibitory neurotransmitter gamma amino butyric acid, which has been proposed as a treatment for a range of conditions including GAD. This study examined the efficacy of pregabalin for GAD across published trials, using a meta-analytic method. Method: This study examined the 7 published placebo-controlled trials of GAD using pregabalin, and, using meta-analytic techniques, we calculated the effect size of treatment with pregabalin (compared with placebo) on a total of 1352 people. Results: The overall effect size of pregabalin in the treatment of GAD was Hedges' g = 0.364, with an effect size of 0.349 on psychic anxiety symptoms and of 0.239 on somatic anxiety symptoms. Conclusion: Pregabalin is an efficacious therapy for GAD, although effect sizes are smaller than those from earlier studies. Limitations and future research directions are discussed.
A Cross-Sectional Study on Posttraumatic Stress Disorder among Elderly Qiang Citizens 3 Years after the Wenchuan Earthquake in China
Authors: Chen Guanghua , Shen Huizhang , Chen Guangming 
Published: January 2017

Objective: To determine the prevalence of posttraumatic stress disorder (PTSD) and to identify the associated risk factors among elderly citizens belonging to the Qiang ethnic minority group 3 years after the Wenchuan earthquake in China. Methods: A cross-sectional survey of 287 respondents aged 60 years and older was conducted to collect data in Beichuan County, a heavily damaged area. PTSD was assessed according to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Independent demographic, socioeconomic and trauma exposure variables were also measured. Association between the independent variables and PTSD was analyzed using logistic regression analysis. Results: The prevalence of PTSD was 22.65% among elderly Qiang citizens in Beichuan County. Being female, being widowed, having a low level of education, having low monthly income, suffering bodily injury, being bereaved, and having a low level of social support were risk factors significantly related to the development of PTSD. Conclusion: The results indicate that PTSD remained at an elevated level among elderly Qiang citizens in the heavily damaged area 3 years after the Wenchuan earthquake. Effective and sustainable mental health services are needed and should be directed particularly to the elderly Qiang citizens who are among the groups most vulnerable to the direct impact of the earthquake.
The French Version of the Family Assessment Device
Authors: Speranza Mario , Guénolé Fabian , Revah-Levy Anne , Egler Pierre-Jean , Negadi Fethi , Falissard Bruno , Baleyte Jean Marc 
Published: January 2017

Objective: To validate a French version of the Family Assessment Device (FAD), a well-known self-report questionnaire assessing family functioning in clinical and research settings. Methods: A French adaptation of the FAD was administered to 3 groups of subjects: a nonclinical group ( n = 115), relatives of psychiatric patients ( n = 102), and medical patients and their relatives ( n = 106). Temporal stability was assessed by test–retest intraclass correlations. Internal consistency was measured by Cronbach alpha reliability coefficients. Discriminant validity was explored, comparing the scores of the 3 groups, using a covariance analysis (ANCOVA). The dimensional structure of the instrument was explored using a principal component analysis, with promax oblique rotation, on the entire sample. Results: The French FAD showed good temporal stability and good discriminant validity across groups. Internal consistency was satisfactory only for the General Functioning (GF) subscale. Factor analysis yielded a 3-factor model. The GF subscale was highly correlated with all of the other subscales. Conclusions: The French version of the FAD provides a valuable tool for assessing family functioning. However, our study failed to identify the theoretical structure of the FAD and suggests that the GF subscale could be used as a better overall indicator of family functioning.
Prospective Risk Factors for Suicide Attempts in a Treated Sample of Patients with Borderline Personality Disorder
Authors: Links Paul S , Kolla Nathan J , Guimond Tim , McMain Shelley 
Published: January 2017

Objective: People with borderline personality disorder (BPD) are at high risk for attempting suicide. There are some data to suggest that risk factors for suicide attempts change over time. We conducted a prospective cohort study to examine risk factors for suicide attempts in a treated sample of patients with BPD. Method: One hundred eighty participants with BPD were followed over a year-long course of dialectical behaviour therapy or general psychiatric management and then for 2 more years in naturalistic follow-up. Participants were assessed for suicidal and self-injurious behaviours at baseline, every 4 months over the 1-year treatment phase, and every 6 months over a 2-year follow-up period. Participants were classified as suicide or nonsuicide attempters based on their behaviour at the end of the 1-year treatment phase and after the 2-year follow-up period. Groups were then compared on baseline clinical and demographic variables. Results: Nearly 26% of participants made a suicide attempt during the 1-year treatment phase, while 16.7% reported a suicide attempt over the 2-year follow-up period. Baseline number of suicide attempts during the 4 months prior to study and severity of childhood sexual abuse predicted suicide attempts during the treatment year. Similarly, baseline suicide attempts, severity of childhood sexual abuse, and number of hospitalizations in the 4 months prior to study entry predicted suicide attempts during the 2-year follow-up. Conclusions: Risk factors for suicide attempts in this treated sample of patients with BPD were fairly stable, largely nonmodifiable, and unrelated to psychopathology or psychosocial functioning at baseline.
Impact of Age and Sex on QT Prolongation in Patients Receiving Psychotropics
Authors: Rabkin Simon W 
Published: January 2017

Objective: To assess older age and female sex, 2 of the major risk factors for potentially fatal cardiac arrhythmias or sudden cardiac death in patients prescribed psychotropics, within the context of electrocardiographic evidence of time between start of Q wave and end of T wave (QT) interval prolongation, which is an indicator of an increased risk for potentially fatal cardiac arrhythmias. Method: The literature on the relation between age, sex, and QT interval with respect to psychotropic drugs was reviewed. Results: The QT interval must be corrected (QTc) for heart rate. Because slower heart rates prolong and faster heart rates shorten the QT interval, people with faster heart rates may have a prolonged QT interval that is not apparent until the correction is performed. QTc values for apparently healthy post-pubertal people are less than 450 ms for males and less than 470 ms for females. The longer QT intervals in women may account for their increased risk of potentially fatal cardiac arrhythmias on psychotropics. QTc increases with increasing age. Assessment of QTc in older people is especially important to identify people with a longer QTc who are more likely to attain a serious QT level with drugs that prolong QTc. The age-related increase in QTc is more evident in men than women, suggesting that male sex does not afford protection against potentially fatal arrhythmias at older age. Conclusion: The association of increasing age and female sex with greater QT intervals indicates the need to have an increased awareness of the QTc prior to use of these psychotropics and to evaluate the QTc after initiation of therapy.
Employment and Income of People Who Experience Mental Illness and Homelessness in a Large Canadian Sample
Authors: Poremski Daniel , Distasio Jino , Hwang Stephen W , Latimer Eric 
Published: January 2017

Objectives: Research suggests that homeless people with mental illness may have difficulty obtaining employment and disability benefits. Our study provides a comprehensive description of sources of income and employment rates in a large Canadian sample. Methods: Participants ( n = 2085) from the 5 sites of the At Home/Chez Soi study were asked about their income, employment, and desire for work during the pre-baseline period. The proportion of participants employed, receiving government support, and relying on income from other activities were compared across sites, as were total income and income from different sources. Generalized linear models were used to identify participant characteristics associated with total income. Results: Unemployment ranged from 93% to 98% across 5 sites. The per cent of participants who wanted to work ranged from 61% to 83%. Participants relied predominantly on government assistance, with 29.5% relying exclusively on welfare, and 46.2% receiving disability benefits. Twenty-eight per cent of participants received neither social assistance nor disability income. Among the 2085 participants, 6.8% reported income from panhandling, 2.1% from sex trade, and 1.2% from selling drugs. Regression models showed that income differed significantly among sites and age groups, and was significantly lower for people with psychotic illnesses. Conclusion: These results suggest that homeless people with mental illness are predominantly unemployed, despite expressing a desire to work. In Canada, this group relies predominantly on welfare, but has access to disability benefits and employment insurance. These findings highlight the importance of developing effective interventions to support employment goals and facilitate access to benefits.
Urgent Psychiatric Services: A Scoping Review
Authors: Sunderji Nadiya , de Bibiana Jason Tan , Stergiopoulos Vicky 
Published: January 2017

Objective: Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement. Method: We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral. Results: We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health-related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions. Conclusions: Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.
Neurocognitive Impairment in Schizophrenia and how it Affects Treatment Options
Authors: Bilder Robert M 
Published: January 2017

Objective To review the roles played by neurocognitive assessment in the treatment of schizophrenia and in the design of treatment research strategies. Method A review of the literature and summaries of clinical and research implications are presented, with directions for future research. Results Neurocognitive deficits are now targets of antipsychotic drug treatment and should increasingly be used to refine both theory and clinical practice by considering the effects of treatments at the level of neural systems. Conclusion Efforts to bridge the gaps between preclinical and clinical assessments should yield large rewards in drug development and individualized treatment strategies. Functional neuroimaging may play a major role in these developments.
The 15-Year Outcome of Chinese Patients with Schizophrenia in Hong Kong
Authors: Lee Peter WH , Lieh-Mak F , Wong MC , Fung Amy SM , Mak KY , Lam Julia 
Published: January 2017

Objective: To explore the differential outcome of schizophrenia in developed and developing countries. The 15–year outcome of patients with schizophrenia in Hong Kong is reported. Method: In a 15-year retrospective outcome study, 100 patients with first-onset schizophrenia in 1977–1978 were randomly selected for outcome assessment from a pool of 797 patient files. The patterns of outcome were assessed by the same set of instruments and methodology as in other centres, since Hong Kong is 1 of the World Health Organization (WHO) centres for the International Study of Schizophrenia (ISoS). Results: Nineteen subjects were untraceable, and 10 subjects committed suicide. More than one-half of the subjects had a good symptomatic outcome, while about 20% of the subjects were rated as having a good psychosocial adjustment. Over the entire 15-year period, 96% of the subjects were maintained on medications, and 79% were living with family members. Conclusion: Despite Hong Kong's developed economy, its schizophrenia outcome is similar to that in developing countries. The existence of good family support and active follow-up treatment may be important contributory factors to better outcome.
Physician Satisfaction with Review Boards: The Provincial Psychiatric Hospital Perspective
Authors: Persad E , Kazarian SS 
Published: January 2017

Objectives: To assess the level of satisfaction of physicians in provincial psychiatric hospitals with Review Boards (RBs) regarding Civil Commitment Certificates (CCCs), Certificates of Incompetence (COIs), and Treatment Orders (TOs). Method: A total of 200 survey questionnaires were distributed to physicians in provincial psychiatric hospitals. Ninety surveys (completed by 25 females, 45 males, and 20 unknown gender) were returned, representing a 45% return rate. Because of their assignments (for example, outpatient department), not all physicians were involved with RBs, and the return rate is likely to have been influenced by this factor. Results: Physician satisfaction rates of 58.2% for CCCs, 66.7% for COIs, and 70.0% for TOs were obtained. Stepwise multiple regression analysis showed that the level of physician satisfaction with RBs for CCCs was predicted best (44.7% of variance) by physician level of comfort with certification and years of institutional affiliation. Qualitative physician responses revealed 3 major themes: patient-related issues, physician-related issues, and RB structure- and process-related issues. Conclusions: Strategies that increase physician comfort level with RBs and changes in the medicolegal structure and process are discussed. A similar survey of patients and RB members is recommended.
Treatment of the Psychiatric Manifestations of Huntington's Disease: A Review of the Literature
Authors: Leroi Iracema , Michaion Max 
Published: January 2017

Objective: To review the clinical management of the psychiatric aspects of Huntington's disease (HD), namely the mood disorders, psychotic disorders, anxiety symptoms, sleep disorders, disorders of sexuality, and the behavioural changes of apathy, irritability, and aggression. Emphasis is on pharmacologic and psychotherapeutic intervention strategies. In addition, the role of psychiatric intervention in presymptomatic testing is explored. Method: English language literature on the pharmacologic and psychotherapeutic management of the psychiatric manifestations of HD between 1976 and 1996 was critically reviewed. Results: Few sound studies address the clinical management of the psychiatric aspects of HD; thus, only the broadest conclusions can be drawn. Pharmacologic strategies for the treatment of psychiatric aspects of HD were organized according to the therapeutic agent and class, and psychotherapeutic strategies were discussed. Conclusion: The clinical management of the psychiatric manifestations of HD requires much more complete and systematic study before any definite conclusions as to efficacy of various approaches can be drawn.
Mental Health Service Use: A Comparison of Treated and Untreated Individuals with Substance Use Disorders in Ontario
Authors: Ross Helen E , Lin Elizabeth , Cunningham John 
Published: January 2017

Objective: To determine the prevalence of and factors associated with mental health service use in the past year among respondents with an alcohol or other drug use disorder in a general population survey of Ontario adults. Method: Data were obtained from the 1990/1991 Mental Health Supplement to the Ontario Health Survey, which used the University of Michigan Composite International Diagnostic Interview (UM-CIDI). The current study examined 436 respondents aged 15–64 years who met Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for a substance use disorder in the past year. The 82 respondents who used services for a mental health or substance abuse problem during the past year were compared with the 354 nonusers. Illness severity, disability, health beliefs and attitudes, and predisposing or enabling factors were examined in bivariate and logistic regression analyses. Results: Twenty-two percent of respondents used services in the past year. Having concurrent disorders (comorbidity), troubled relationships with others, and dysfunction in main activity, feeling comfortable talking to a professional about mental health problems, being older and an urban resident, not working or being in school, and having a biological parent with an alcohol or drug problem were all associated with service use. Conclusions: The results suggest that individual determinants, such as severity of illness, disability, attitudes, and predisposing or enabling variables, all have a role in predicting service use among individuals in the general population who suffer from alcohol and other drug disorders.
Curriculum Renewal in Child Psychiatry
Authors: Hanson Mark , Tiberius Richard , Charach Alice , Ulzen Thaddeus , Sackin David , Jain Umesh , Reiter Sharon , Shomair Gary 
Published: January 2017

Objective: To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement. Method: The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students 'perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated. Results: The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI). Conclusions: Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.