bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Metaanalysis of Clinical Trials Comparing Moclobemide with Selective Serotonin Reuptake Inhibitors for the Treatment of Major Depressive Disorder
Authors: Papakostas George I , Fava Maurizio 
Published: January 2017

Objective: To compare response rates among patients with major depressive disorder (MDD) treated with either moclobemide, an antidepressant thought to simultaneously enhance both noradrenergic and serotonergic neurotransmission, or selective serotonin reuptake inhibitors (SSRIs). Methods: Using a random-effects model, we combined 12 trials involving 1207 outpatients with MDD. Results: Patients treated with moclobemide were as likely to experience clinical response as those treated with SSRIs (risk ratio 1.08; 95% confidence interval, 0.92 to 1.26; P = 0.314). Simply pooling response rates for the 2 agents resulted in a 62.1% response rate for moclobemide and a 57.5% response rate for the SSRIs. A metaregression did not reveal a statistically significant relation between the mean moclobemide dosage for each study and the risk ratio for response rates. Further, we found no difference between the 2 treatments in overall discontinuation rates, discontinuation rates due to adverse events, or discontinuation rates due to lack of efficacy. Also, rates of fatigue or somnolence and of insomnia were similar between the 2 treatment groups. However, SSRI treatment was associated with higher rates of nausea, headaches, and treatment-emergent anxiety than was treatment with moclobemide. Conclusions: These results suggest that moclobemide and the SSRIs do differ with respect to their side effect profiles but not in their overall efficacy in the treatment of MDD.
Lithium and Triiodothyronine Augmentation of Antidepressants
Authors: Joffe Russell T , Sokolov Stephen TH , Levitt Anthony J 
Published: January 2017

Objective: To evaluate the relative benefits of the combination of lithium and triiodothyronine (T3) in augmentation of antidepressants, compared with either lithium or T3 alone. Methods: We performed a 2-week, randomized, double-blind, placebo-controlled pilot study of the addition of lithium compared with T3 compared with the combination of both in subjects with major depressive disorder who had not responded to an antidepressant. Results: All groups improved significantly over the 2 weeks of treatment, but there were no significant between-group differences. Conclusion: There may be no advantage to a combination of these augmenting agents, although we failed to show separation between active treatments and placebo.
Rang de naissance, difficultés de comportement et relation mère-enfant chez des jeunes de 4 à 11 ans de fratries composées de deux enfants
Authors: Marleau Jacques D , Saucier Jean-François , Allaire Jean-François 
Published: January 2017

Objectif: Cette étude vise à préciser la relation entre certaines caractéristiques de la fratrie (rang de naissance, sexe des membres de la fratrie et intervalle intergénésique) et certaines difficultés de comportement d'enfants d'une part, et certaines dimensions de la relation mère-enfant d'autre part. Méthode: L'échantillon, tiré de l'Enquěte longitudinale nationale canadienne sur les jeunes et les enfants, est constitué de 1211 familles composées de deux enfants biologiques âgés entre 4 et 11 ans. Les difficultés de comportement et les dimensions de la relation mère-enfant ont été évaluées par les mères. Des analyses de variance multivariée à mesure répétée ont été effectuées. Résultats: Les analyses révèlent que les premiers-nés présentent plus de symptômes intériorisés que les seconds-nés. Aussi, les seconds-nés ont plus d'interactions positives avec leur mère que les premiers-nés. L'intervalle de temps entre les naissances ne modifie pas ces résultats. Conclusion: Quelques différences ressortent entre les enfants de měmes fratries. Les professionnels de la santé devraient tenir compte de ces particularités lors de leurs évaluations cliniques.
Geographical Variation in the Prevalence of Problematic Substance Use in Canada
Authors: Veldhuizen Scott , Urbanoski Karen , Cairney John 
Published: January 2017

Objective: The prevalence of substance-related problems has been shown to vary between Canadian provinces, but little else is known about the pattern of geographical differences. In this study, we modelled these differences, using methods of spatial analysis, and attempted to determine whether they are explained by known risk factors. Methods: We used data from Cycle 1.2 of the Canadian Community Health Survey. We tested interprovincial differences, before and after adjustment for covariates, and also examined differences between urban areas. We then used interpolation techniques to model variation in prevalence without reference to administrative boundaries. Finally, we performed a spatial cluster scan for areas of heightened prevalence. Results: The prevalence of problematic substance use is lower in Ontario and Quebec than in the rest of the country. This pattern is due principally to low prevalence in Toronto, Montreal, and surrounding areas. Prevalence is higher in mid-sized cities than in larger ones or in rural areas. Problematic substance use shows a fairly high degree of spatial clustering, especially within major cities. Interprovincial differences and clustering are generally not explained by known risk factors. Conclusions: The pattern of large-scale differences is consistent with existing research and is probably part of a larger disparity among regions of Canada. The persistence of variation after adjustment for covariates suggests the influence of unmeasured, geographically varying factors, of which there are several candidates, including latitude and immigrant settlement patterns.
Benefits of Enriched Intervention Compared with Standard Care for Patients with Recent-Onset Psychosis: A Metaanalytic Approach
Authors: Harvey Philippe-Olivier , Lepage Martin , Malla Ashok 
Published: January 2017

Objective: To assess the effectiveness of enriched intervention (EI) on symptomatic and functional outcomes, compared with standard care (SC). Method: Studies were retrieved from search engines and, using a metaanalytic approach, we compared EI trials with SC trials. Eleven EI sample trials (1053 patients) and 6 SC sample trials (500 patients), totalling data from 1553 patients (69% male), were examined. We calculated the effect sizes (ESs) of both symptomatic and functional improvement over a follow-up period of about 1 year. Results: Significant differences between EI and SC were observed at follow-up for the improvement of both positive and negative symptoms, respectively: positive, EI = −1.54 (95%CI, −1.63 to −1.45) and SC = −1.07 (95%CI, −1.19 to −0.94) ( Qbetween = 40.3, df 1, P < 0.001); negative, EI = −0.44 (95%CI, −0.53 to −0.35) and SC = −0.18 (95%CI, −0.31 to −0.05) ( Qbetween = 10.6, df 1, P < 0.01). We also observed a significant difference between the EI and the SC groups for functional improvement over the follow-up period with mean EI = 1.11 (95%CI, 0.99 to 1.23) and SC = 0.63 (95%CI, 0.49 to 0.77) ( Qbetween = 24.5, df 1, P < 0.001). Conclusions: There is now quantitative evidence across multiple studies and sites to indicate that EIs for patients with recent-onset psychosis are significantly more effective than SC for symptomatic and functional improvement over a period of about 1 year.
Preexisting Neuroticism, Subjective Stressor Severity, and Posttraumatic Stress in Soldiers Deployed to Iraq
Authors: Engelhard Iris M , van den Hout Marcel A 
Published: January 2017

Objective: To investigate the extent to which preexisting neuroticism confounds the relation between appraisals of the severity of major and minor stressors and posttraumatic stress disorder (PTSD) symptoms. Method: A sample of 383 Dutch army soldiers completed a neuroticism scale before their 4-month tour of duty in Iraq. About 5 months after deployment, most of them rated the severity of stressors on deployment. PTSD symptoms were also assessed. Results: Appraisal of major stressors in Iraq was significantly related to PTSD symptoms and was, for the most part, independent of neuroticism. However, the strength of the association between minor stressors and PTSD symptoms dropped by 31% after statistical control for neuroticism. Conclusion: Neuroticism may partly compromise the relation between perceived minor stressors and PTSD symptoms.
Posttraumatic Stress Disorder and Associated Risk Factors in Canadian Peacekeeping Veterans with Health-Related Disabilities
Authors: Richardson J Don , Naifeh James A , Elhai Jon D 
Published: January 2017

Objectives: This study investigates posttraumatic stress disorder (PTSD) and its associated risk factors in a random, national, Canadian sample of United Nations peacekeeping veterans with service-related disabilities. Methods: Participants included 1016 male veterans (age < 65 years) who served in the Canadian Forces from 1990 to 1999 and were selected from a larger random sample of 1968 veterans who voluntarily and anonymously completed a general health survey conducted by Veterans Affairs Canada in 1999. Survey instruments included the PTSD Checklist-Military Version (PCL-M), Center for Epidemiological Studies-Depression Scale (CES-D), and questionnaires regarding life events during the past year, current stressors, sociodemographic characteristics, and military history. Results: We found that rates of probable PTSD (PCL-M score > 50) among veterans were 10.92% for veterans deployed once and 14.84% for those deployed more than once. The rates of probable clinical depression (CES-D score > 16) were 30.35% for veterans deployed once and 32.62% for those deployed more than once. We found that, in multivariate analyses, probable PTSD rates and PTSD severity were associated with younger age, single marital status, and deployment frequency. Conclusions: PTSD is an important health concern in the veteran population. Understanding such risk factors as younger age and unmarried status can help predict morbidity among trauma-exposed veterans.
Reduction of Length of Stay in an Acute Care Psychiatric Unit
Authors: Edward-Chandran Therese , De Malcolm  , Bowen RC 
Published: January 2017

Objective: To study the association between reduced length of stay in an acute care psychiatric unit and readmission rates. Method: Data on average length of stay, total discharges and readmission rates from April 1988 to March 1994 for 2 hospitals with high average lengths of stay was obtained from the Canadian Institute for Health Information database. Results: The average length of stay decreased from 25 days to 16 days, reaching the national level at one hospital. An initial increase in the readmission rate subsequently declined to pre-study levels. There was no change in length of stay at the other hospital. Conclusion: Reducing the length of stay in an acute care facility by 9 days to an average of 16 days did not lead to a sustained increase in the readmission rate.
Antisocial Personality Disorder: A Biopsychosocial Model
Authors: Paris Joel 
Published: January 2017

Objective: To propose an etiological model of antisocial personality disorder that is grounded in empirical data. Method: Recent research findings are reviewed that clarify our understanding of the etiology and course of antisocial pathology. Results: Neither biological nor psychological factors fully account for the development of this disorder. Epidemiological studies show that there are strong cross-cultural differences in its prevalence, pointing to the importance of social factors in its etiology. Outcome research shows that antisocial personality only partially remits with time, and that most patients continue to be dysfunctional in later life. No treatment modality has been shown to be effective. Conclusions: All these empirical findings can be accounted for by a biopsychosocial model of antisocial personality disorder.
Clozapine: Current Status and Role in the Pharmacotherapy of Schizophrenia
Authors: Remington Gary J , Addington Donald , Collins Evan J , Jones Barry D , Lalonde Pierre , MacCrimmon Duncan J , MaCewan G William 
Published: January 2017

Objective: This study evaluates clozapine and its present role in the pharmacotherapy of schizophrenia. Method: Clozapine's current clinical status is reviewed, as is its position with respect to other treatment options. Results: Clozapine represents the prototype of “atypical” neuroleptics, with evidence of clinical efficacy in both positive and negative symptoms, as well as a diminished risk of extrapyramidal side effects. It is the only neuroleptic to date that has established itself as having little, if any, risk of tardive dyskinesia. More recent research has focused on its potential for overall savings in health care costs, as well as possible benefits in the area of neuropsychological functioning. Conclusion: Evidence suggesting that the course of schizophrenia can be altered by effective treatment favours a systematic approach that optimizes treatment options. While clozapine does not represent a 1st-line agent because of its risk of agranulocytosis, it has an integral role to play in treatment-resistant schizophrenia or in individuals experiencing intolerable side effects with conventional neuroleptics. Objectif: La présente étude vise à évaluer la clozapine et son rôle actuel dans la pharmacothérapie de la schizophrénie. Méthode: On évalue l'emploi clinique actuel de la clozapine ainsi que sa position par rapport à d'autres options de traitement. Résultats: La clozapine constitue le prototype des neuroleptiques «atypiques,» révélant une efficacité clinique autant sur les symptômes positifs que négatifs ainsi qu'un risque réduit d'effets secondaires extrapyramidaux. Elle constitue le seul neuroleptique à ce jour associé à peu, voire pas du tout, de risque de dyskinésie tardive. De récentes recherches se sont penchées sur son potentiel d'économies globales en soins de santé ainsi que sur ses avantages en matière de fonctionnement neuropsychologique. Conclusion: L'information qui suggère que l'évolution de la schizophrénie peut être modifiée par un traitement efficace encourage une approche systématique optimisant les options de traitement. Bien que la clozapine ne soit pas un médicament d'élection étant donné le risque d'agranulocytose, elle joue un rôle important dans le traitement de la schizophrénie résistante au traitement ou chez les personnes pour qui les effets secondaires des neuroleptiques conventionnels sont intolérables.
A Critical Review of Recovered Memories in Psychotherapy: Part II—Trauma and Therapy
Authors: Paris Joel 
Published: January 2017

Objective: The clinical implications of the use of recovered memories in psychotherapy will be examined. Method: The paper will review the relationship of trauma to psychopathology and discuss how traumatic histories might be dealt with in therapy. Results: Trauma is a risk factor for psychopathology, but is only one of many etiological factors in mental disorders. The search for recovered memories in psychotherapy could present dangers for patients. Conclusions: The most reliable memories of trauma are those that have been present throughout the patient's life.
The Characteristics and Intervention Histories of Incarcerated and Conduct-Disordered Youth
Authors: Shamsie Jalal , Hamilton Hayley , Sykes Cynthia 
Published: January 2017

Objectives: 1) To determine if incarcerated youth and conduct-disordered youth in treatment display similar risk factors associated with chronicity of antisocial behaviour; 2) to determine if incarcerated youth had experienced high numbers of interventions by many different agencies as has been reported for conduct-disordered youth in treatment. Method: The files of 25 conduct-disordered youth in treatment and 25 incarcerated youth were examined to extract all relevant data. Results: Incarcerated youth were similar to conduct-disordered youth with regard to the number of symptoms of disruptive behaviour disorders, age of onset of behavioural problems, and family backgrounds. Both groups had high numbers of interventions and agencies in their histories. Interventions began earlier for the conduct-disordered youth. Conclusion: The distinction between conduct-disordered youth who are treated and youth who are incarcerated may be arbitrary and accidental. Given the similarity in the clinical characteristics, incarcerated youth should be offered help that is similar to that offered to conduct-disordered youth. Such help may lower the rate of recidivism.
A Review of the Psychobiology and Pharmacotherapy of Posttraumatic Stress Disorder
Authors: Katz Laurence , Fleisher William , Kjernisted Kevin , Milanese Paul 
Published: January 2017

Objective: To review the literature on certain psychobiologic elements of posttraumatic stress disorder (PTSD) as they pertain to possible pharmacotherapeutic interventions. Method: The literature pertaining to the neuroanatomical, neurochemical, and cellular elements was reviewed. As well, both controlled and uncontrolled studies of pharmacotherapy in PTSD were analyzed. Results: The literature suggests that the stress response triggers certain neuromodulators with subsequent psychoneurological restructuring; that various antidepressants have been demonstrated to be effective for treatment of criterion B symptoms; that, to date, a single antidepressant has been demonstrated to be effective in a controlled trial for criterion C symptoms; and that, to date, in controlled trials, antidepressants and a benzodiazepine have proved effective for criterion D symptoms. Conclusion: Currently, a comprehensive approach requires multimodel understanding and multimodal treatment.
A Double-Blind, Multicentre Study of Paroxetine and Maprotiline in Major Depression
Authors: Schnyder Ulrich , Koller-Leiser Annemarie 
Published: January 2017

Objective: This study was performed to compare the clinical efficacy, side effects, and safety of paroxetine and maprotiline, the latter being the most frequently prescribed antidepressant in Switzerland. Method: Seventy-one patients (in and outpatients) with major depression were randomly allocated to treatment with paroxetine (20 to 40 mg daily) or with maprotiline (50 to 150 mg daily). Efficacy was measured by means of the Hamilton Psychiatric Rating Scale for Depression, the Montgomery-Asberg Depression Rating Scale, the Clinical Global Impression, and the Hopkins Symptom Checklist. Results: The 2 components showed a similar efficacy. The adverse effect profile was comparable in the 2 treatment groups, although the findings showed a nonsignificant trend pointing in the direction of lower side effects with paroxetine. Conclusion: In the moderate dose regimens tested, the 2 components seemed to be of similar efficacy, with comparable profiles of side effects and safety.
Neuroleptic Dosing in Chronic Schizophrenia: A 10-Year Follow-up
Authors: Remington Gary J , Prendergast Peter , Bezchlibnyk-Butler Kalyna Z 
Published: January 2017

Objective: To evaluate neuroleptic dosing patterns in individuals with schizophrenia over a 10-year interval. Method: Changes in neuroleptic dosing between 1980 and 1990 were followed in 65 patients with a diagnosis of chronic schizophrenia. Results: According to more recent dosing guidelines, doses were already high at the time of initial evaluation, yet overall they continued to increase during the next decade of treatment for both males and females. Patients were almost equally divided, however, by those who underwent an increase (n = 33) and those whose dose remained stable (n = 4) or was decreased (n = 28). Conclusion: A considerable number of patients with schizophrenia appear to receive progressively higher neuroleptic doses over the course of their illness, despite a lack of empirical data to support such an approach. Results are discussed in terms of current dosing recommendations and factors influencing dose changes.
Rediscovering General Psychiatry: Creation of an Academic Division
Authors: Goldbloom David S , Buckingham Robert A , Voore Peter 
Published: January 2017

Objective: To describe the rationale, origins, and goals of a newly created academic division of general psychiatry within a university setting. Method: Literature review, observation, and description. Results: Within 2 years of its inception, the General Psychiatry Division of the University of Toronto has begun to realize some of its goals and further elucidate specific objectives. Conclusions: In an era of increasing academic subspecialization, the preservation of core skills in psychiatry and the recognition of the continuing public need for psychiatric generalists must be enshrined within academic training programs.
Evaluating the Effectiveness of Interventions in Child Psychiatry
Authors: Fonagy Peter 
Published: January 2017

Objective: To review the nature of outcome measures used to evaluate psychosocial treatment in children. Method: Recent research findings that highlight the importance of outcome data and justify randomized controlled trials (RCTs) are reviewed. Results: Outcome measures of child therapy can focus on changes in the child's symptoms, adaptation to the psychosocial environment, cognitive or emotional capacities, and changes in interaction with others. They can also assess service utilization, related costs, and the suffering of those associated with the child before and after treatment. RCTs remain the optimal methodology, notwithstanding current critiques. Conclusion: Studies assessing the effectiveness of psychosocial treatment must include a definition of various outcomes and use appropriate methodologies to measure them.
Posttraumatic Stress Symptoms and Medical Procedures in Children
Authors: Wintgens Anne , Boileau Bernard , Robaey Philippe 
Published: January 2017

Objective: To focus on posttraumatic stress symptoms after childhood diseases such as cancer, organ transplantation, and severe burns. Methods: Differential diagnoses, risk factors, and treatment aspects (psychological and pharmacological) are discussed. Results: The concept of adjustment problems in chronic or severe illnesses is widely used in pediatrics. Many aspects of severe childhood diseases are traumatic, as defined by the DSM-IV: severe illnesses are life-threatening, medical procedures threaten the child's physical integrity, and disorganized behaviour periods are common. Conclusion: This concept, which remains insufficiently investigated, is a promising area of investigation for prospective and prevention studies.
The Treatment of Conduct Disorder: Perspectives from across Canada
Authors: Moretti Marlene M , Emmrys Chuck , Grizenko Natalie , Holland Roy , Moore Ken , Shamsie Jalal , Hamilton Hayley 
Published: January 2017

Objective: To provide a synopsis of treatment programs for conduct-disordered children in Canada. Method: Five groups of authors from British Columbia, Ontario, Quebec, and New Brunswick describe their approaches to the treatment of children with conduct disorder. Results: All programs emphasize the needs to use multimodal treatment schemes, including day and short-term residential care, and to base programs on identified factors associated with the development of conduct disorder. Conclusion: Specific forms of treatment of conduct disorder are promising but are often hampered by social and political agendas.