bluuebunny/crossref_metadata_2025_split huggingface dataset:
Homophobia Among Psychiatric Residents, Family Practice Residents and Psychiatric Faculty
Authors: Chaimowitz G.A. 
Published: April 2017

As the number of AIDS cases has continued to increase, psychiatric research has focused on the victims of this disease. Little has been written about the caregivers and the impact that their attitudes have on patients. There have been a few studies measuring attitudes of health care providers to homosexuals and AIDS patients, but to the best of our knowledge, none have looked at the attitudes of psychiatrists or residents in psychiatry. Psychiatric residents, family practice residents and psychiatric faculty in a medium-sized Canadian medical school completed a questionnaire measuring attitudes toward homosexuals. We report on the results of this questionnaire and comment on the impact of the attitudes of health care professionals on the quality of patient care.
Aspects Cliniques et Neurobiologiques de L'Administration à Long Terme des Psychotropes*
Authors: Bourin Michel , Bradwejn Jacques 
Published: April 2017

In neuroleptic therapy for psychotic illnesses, clinical improvement occurs much later than central dopamine blockade, and its time course varies widely among patients. A hypothesis explaining neuroleptic-responsive illness cannot be explained by dopamine blockade alone. Nevertheless, experimental data suggest that this mechanism may be a step in the therapeutic process for schizophrenia. Explanations are suggested for the time lag in therapeutic response for neuroleptics, including the hypothesis of delayed inactivation of mid-brain dopamine neurones. Chronic benzodiazepine treatment elicits adaptive responses in the CNS that are manifested as functional tolerance and physical dependence. Possible mechanisms involved in such a profound alteration of neuronal functioning are suggested. Down regulation of benzodiazepine receptors has been shown to be related to functional tolerance under certain conditions. The effect of repeated treatment with antidepressants is compatible with the hypothesis that changes in central monoamine transmission are involved in the activity of these drugs. Beta-adrenergic receptors are desensitized and their density is decreased; alpha-2 adrenoreceptors sensitivity is reduced, and post-synaptic serotoninergic receptors sensitivity is increased. It remains to be clarified whether some of the changes have larger role than others or whether they all contribute to the psychotropic drug activity in the therapeutic process.
Changes in Appetite and Weight during the Pharmacological Treatment of Patients with Panic Disorder
Authors: Balon Richard , Yeragani Vikram K. , Pohl Robert , Merlos Barbara , Sherwood Paul 
Published: April 2017

Antidepressants reportedly increase appetite, carbohydrate craving and weight in some patients with depression and panic disorder. This paper presents the results of changes in appetite and weight inpatients with panic disorder treated with imipramine, diazepam or placebo in a double-blind prospective study. Forty-four patients with panic disorder were randomly assigned imipramine, diazepam and placebo. The investigators monitored weight and the patients rated their appetite and cravings during the eight week study. No significant increases in weight or appetite were found in the patients with panic disorder patients.
The Geographical Distribution of Psychiatrists in Canada: Unmet Needs and Remedial Strategies
Authors: El-Guebaly N. , Kingstone E. , Rae-Grant Q. , Fyfe I. 
Published: April 2017

Many efforts are underway to rationalize the process of manpower planning in psychiatry. A wide variation in the geographic distribution of psychiatrists remains. A multidimensional assessment of the needs of a population is recommended, based on the epidemiology of mental disorders, professional and institutional needs, consumer estimates, and the requirements of subgroups. Counting the number of vacant positions for psychiatrists can be misleading. Professional norms for the optimal access of a population to psychiatric services and standards for the quantity and/or quality of services provided need to be developed. Potential outcome measures are suggested, along with a three-tiered system of estimating geographic needs. Deterrent factors to an optimal geographic distribution of most professionals are reviewed, along with factors specific to our residency training programs. In the short term, the benefits and limitations of recruiting foreign-trained psychiatrists are compared with those of recruiting Canadian specialists. Complementary long term strategies include the provision of financial incentives, optimal working conditions, relevant training and maintenance of competence issues, and community support.
Attachment Organization and Adaptation in Sexually-Abused Women
Authors: Carol A. Stalker , Davies Felicity 
Published: April 2017

Objective To explore the possible associations among attachment organization, current functioning and Axis II personality disorder. Method Attachment organization was assessed using the Adult Attachment Interview in a clinical sample of 40 women with a history of childhood sexual abuse. The Global Assessment Scale yielded measures of current psychosocial functioning and the Structured Clinical Interview for Diagnosis on DSM-III-R was used to assess presence of personality disorder. Results Preoccupation with attachment issues was evident in 68% of the subjects; 60% of the subjects were unresolved in respect to loss and/or trauma: and 88% of the subjects met criteria for one or more Axis II disorders. A relationship between Borderline Personality Disorder and the Unresolved attachment classification is suggested. Conclusions Women who have experienced childhood sexual abuse require intervention that focuses on resolution of trauma and loss and responds to individual differences in attitudes toward attachment issues.
Child Psychiatric Epidemiology: Current Status and Future Prospects
Authors: David R. Offord 
Published: April 2017

Objective The purpose of this paper is to present selected findings from child psychiatric epidemiology in areas of prevalence and correlates, and discuss issues in interpreting these data and their relevance. Method Selected references were used. Results Prevalence rates of 1 or more child psychiatric disorders in nonclinical community samples of children and adolescents vary between 17.6% and 22%. Issues in interpreting these data include: the boundary between normal and abnormal, boundary between disorders, disagreement among informants, and problems with instrumentation. Knowledge about the correlates of child psychiatric disorders is quite extensive, but information on causal factors is relatively sparse. Conclusions Findings in child psychiatric epidemiology are relevant to clinicians, and future emphasis in the field will be on prospective studies with multiple waves of data from different domains including the child, the family, the school, and the wider community.
Mendacious Moms or Devious Dads? Some Perplexing Issues in Child Custody/Sexual Abuse Allegation Disputes
Authors: Susan Penfold P 
Published: April 2017

Objective To explore relevant literature about sexual abuse allegations arising in child custody disputes. Method A literature review of false allegations is given and the contribution of gender bias to this issue is discussed. The role a child psychiatrist may play in such cases is outlined. Results Contrary to much popular and professional opinion, sexual abuse allegations are found in only 2% of child custody disputes, and, of these, 8% to 16.5% are false. While false allegations arise for a variety of reasons, the word “false” can imply both erroneous and deceitful activities. This ambiguity, along with gender bias, may lead to disbelief of, and blame towards, parents who report sexual abuse in the context of a dispute about custody or access. Conclusion The child psychiatrist who testifies in such custody disputes should have caution, humility, and an open mind both in the courtroom and in dealing with other professionals working in this area.
A Case-Control Study of Corticosteroid Exposure as a Risk Factor for Clinically-Diagnosed Depressive Disorders in a Hospitalized Population
Authors: Scott B Patten , Jeanne Va Williams , Edgar J Love 
Published: April 2017

Objective Depressive symptoms may be a side effect of exogenous corticosteroids. However, the literature does not confirm that corticosteroid exposure is associated with the occurrence of depressive disorders. The objective of this study was to determine whether or not corticosteroid exposures are associated with clinical diagnoses of depressive disorders in hospitalized patients. Method The study used a case-control design. Cases and 2 control groups were selected from a health records case summary database maintained at the Calgary General Hospital. Additional data were collected by chart review. Results The analysis reproduced associations between depressive diagnoses and several psychosocial and biological risk factors. However, the data did not suggest that corticosteroids were associated with an elevated risk of depressive diagnoses. In fact, odds ratios for corticosteroid exposure were less than 1, consistent with a protective effect. Conclusions Although corticosteroids may produce depressive symptoms as a side effect, corticosteroid exposures are not associated with an elevated risk of clinically diagnosed depressive disorders in hospitalized patients. There are several possible explanations for this. Depressive syndromes associated with corticosteroid exposure may not clinically resemble depressive disorders, and may not warrant a diagnosis of a depressive disorder. Alternatively, clinicians may not identify and formally diagnose depressive disorders caused by corticosteroids.
Interpersonal Disorder in Schizoid and Avoidant Personality Disorders: An Attachment Perspective
Authors: West Malcolm , Sarah Rose M , Sheldon-Keller Adrienne 
Published: April 2017

Objective To investigate the characteristics related to avoidant attachment of 13 schizoid/avoidant psychiatric outpatients and 20 nonschizoid/avoidant psychiatric outpatients. Method Three scales (“maintains distance in relationships”, “high priority on self-sufficiency” and “attachment relationship is a threat to security”) differentiated schizoid and avoidant personality disordered patients from other personality disordered patients. Results The results are discussed in terms of the attachment and DSM diagnostic models of avoidant styles in relationships. Conclusion The 2 groups of schizoid and avoidant personality disordered patients were not significantly different on the desire for close affectional bonds scale.
Brief Psychiatric Hospitalization: Preliminary Experience with an Urban Short-Stay Unit
Authors: Mok Hiram , Watler Crosbie 
Published: April 2017

Objective To present data from the recently implemented psychiatric short-stay units (SSUs) in metro Halifax. There are few data describing SSUs and factors associated with successful outcome. Method A 4-month retrospective chart review of 124 patients. Results Patients tended to be single, unemployed young adults, with a past history of psychiatric admission. Most patients were admitted voluntarily. There was an equal sex ratio. Mean length of stay for all patients was 2.5 days. Adjustment disorder was the diagnosis most responisble for admission. Conclusion Many psychiatric inpatients may benefit from brief hospitalization. Brief hospitalization results in reduced health care costs.
Dangerosité Et Obligations Du Thérapeute: Perspective Canadienne
Authors: Melançon Geoffroy , Aubut Et Jocelyn 
Published: April 2017

Objective To clarify the position Canadian therapists must adopt regarding their obligation to protect others against patients' potentially violent actions. This obligation is based on jurisprudence which has been well established in the United States since the Tarasoff case, but which does not apply in Canada. Method A review of jurisprudence in Canada and recent clinical recommendations. The latter are then discussed in the Canadian context and followed by a range of suggested avenues to explore. Conclusion Professional standards could be established but they should be reviewed on a regular basis and allow flexibility for clinicians.
Small Area Variation in the Utilization of Mental Health Services: Implications for Health Planning and Allocation of Resources
Authors: Kelly Ann , Jones Wayne 
Published: April 2017

ObjectiveTo determine the variables associated with utilization of mental health services and to develop a planning model to predict service utilization that incorporates these factors.MethodA regression analysis of service utilization and demographic characteristics was used to assess the relative importance of alternative service, supply of psychiatrists and demographics in explaining variations of services use. A model using socioeconomic factors was applied to the population to predict need.ResultsThe percentage of divorced males was the only factor significantly and positively correlated with the utilization of hospital inpatient and provincial psychiatric beds. Predicted need exceeds utilization in 7 out of 10 areas for all services.ConclusionsSmall area variations in inpatient psychiatric utilization is correlated with community characteristics, not supply of psychiatrists or utilization of alternative services. A model has been developed using census data to allocate resources according to need.
Neuroleptic Dosing and Neuroleptic Plasma Levels in Schizophrenia: Determining the Optimal Regimen
Authors: Shriqui Christian L 
Published: April 2017

Objective: To recommend dose range and therapeutic plasma concentration for several neuroleptics, and to discuss conditions under which neuroleptic plasma levels are clinically useful. Method: Neuroleptic drug therapy is a major component of the acute and maintenance treatment of schizophrenia. However, there is no consensus on what constitutes an appropriate or optimal dose of antipsychotic drug in individual patients. Low-dose medication has the potential to improve psychosocial function and reduces the frequency of side effects but can lead to an increase in positive symptoms and schizophrenic relapse. High doses may be associated with behavioural toxicity, symptom exacerbation, a worsening of secondary deficit symptoms, impaired social functioning and increased adverse effects such as acute extrapyramidal symptoms and tardive dyskinesia. Numerous clinical studies have attempted to determine the degree of correlation between dose, neuroleptic blood levels, and clinical response. Results: To date, this approach has met with only limited success: neuroleptic dose overall appears to be a poor predictor of clinical outcome, and the suggested therapeutic plasma level concentrations of some antipsychotic drugs cannot be regarded as established by any means. Furthermore, the ability to conduct neuroleptic plasma levels is not readily accessible in the usual clinical setting. In the acute treatment phase, titrating the dose until the onset of minimal cogwheel rigidity or hypokinesia (neuroleptic threshold dose) has met with some success and is preferable to standard dosing as a means of individualizing pharmacotherapy. During the maintenance phase, a slow and gradual dosage reduction with adjunctive psychosocial and psychotherapeutic intervention is the preferred strategy. Conclusion: Reinforcing patient and physician compliance is a key element in achieving an optimal treatment regimen.
Utilization of Thoracic Ultrasound for Confirmation of Central Venous Catheter Placement and Exclusion of Pneumothorax: A Novel Technique in Real-Time Application
Authors: Raman Dileep , Sharma Manish , Moghekar Ajit , Wang Xiaofeng , Hatipoğlu Umur 
Published: April 2017

Aim: To evaluate the safety and utility of ultrasonography as a tool to confirm central venous catheter (CVC) position and to exclude insertion-related pneumothorax in place of chest radiography (CXR) in a tertiary medical intensive care unit (ICU). Methods: We randomized 60 consecutive medical ICU patients to conventional or ultrasound groups for CVC placement. Both groups had CVCs inserted under ultrasound guidance. The intervention group underwent real-time transthoracic echocardiography to assist in catheter positioning and chest ultrasonography for exclusion of pneumothorax. Our primary end point was reduction in CXR use. The secondary end point was time elapsed from the end of procedure to the availability of CVC for use. χ2 test was used to compare the 2 groups for the primary end point. T test was used to compare the 2 groups for the secondary end point. Results: Thirty patients were randomized to the conventional group and 30 were randomized to the ultrasound group. One patient was excluded in the control group since the procedure needed to be aborted. Patient characteristics were well matched for age, body mass index, and acute physiologic assessment and chronic health evaluation (APACHE III) scores. There was a 56.7% ( P < .0001) reduction in CXR use in the ultrasound arm. Mean time to use was 53.6 minutes in the control group and 25 minutes in the ultrasound arm ( P = .0015). Mean time required to complete the procedure was 27.7 minutes in the control group and 24.1 minutes in the ultrasound group ( P = .2053). No pneumothorax was detected in either arm. Conclusion: Ultrasound-guided CVC placement and positioning with a minor modification in technique reduced the use of bedside CXR and reduced the time to use of the CVC.
Provocative encounters reflecting struggles with change: Power and coercion in a Japanese university situation
Authors: Toh Glenn 
Published: April 2017

This article examines a case of what Olssen et al. (2004) call ‘managerial oppression’ set in a faculty of international studies of a Japanese university. Japanese universities have, in recent times, been facing the financial pressures of a falling birthrate and dwindling enrolments. To remain solvent, some universities have had to reinvent their curriculum in the hope of attracting students. Institutional renewal, as will be noted, does not occur without accompanying complications relating to power and politics. In the present case, these complications are attributable to tensions created within an ideological dialectic of openness and closedness ( Peters and Roberts, 2012 ) as universities face the dilemmas of globalization alongside the endurance of conservative mercantilist philosophies traceable to policies set during Japan’s post-war occupation by Allied forces. Through a critical examination of a series of instances of bullying and coercion, I seek in this article to argue that bullying and coercion are not random or idiosyncratic but are instead embedded in larger socio-political epistemologies that impinge on education and influence the way institutional agendas and managerialist decisions can adversely affect or defile human behavior. In this way, I seek not only to make a contribution to current understandings of language policy, ideology, power and higher education in Japan, but more uniquely, to establish a connection between ideological closed mindedness, corporate managerialism and acts of institutionalized bullying and coercion.
Multidrug intolerance in the treatment of hypertension: result from an audit of a specialized hypertension service
Authors: Okeahialam Basil N. 
Published: April 2017

Background: Hypertension as a cardiovascular disease risk factor continues to take a heavy toll on the population despite efforts with containment. Poor control, even among those on treatment, is part of the challenge and results from patient, physician and health system factors. When the problem resides at patient level, adherence is largely responsible. An entity defined as multidrug intolerance (MDI) is hardly considered. A situation when a patient is willing to adhere but is compelled otherwise could frustrate both patient and physician. Encountering a few such cases prompted the author to audit his specialized hypertension service in order to evaluate the burden of MDI and its associations. Methods: Between 7 May and 30 July 2016 (to cover a 12-week cycle which ensured all attendees were captured), all patients attending follow up for blood pressure control had their records evaluated for intolerance to three or more different classes of anti-hypertensives, which defines MDI. Their ages, sex, control state and co-morbidities were extracted from the records. Results: A total of 489 patients with hypertension were seen over the period; 271 (55.4%) of whom were women and 248 (50.7%) were uncontrolled. Overall 15 (3.1%) satisfied the definition of MDI; 10 women and 5 men. All the men with MDI were uncontrolled while 7 out of the 10 women were uncontrolled; with two having premenstrual syndrome as co-morbidity. A total of four patients (three men, one woman) had history suggesting allergy and two (one man, one woman) were on treatment for anxio-depressive illness. Conclusion: MDI does occur in sub-Sahara African patients with hypertension and should be considered before describing hypertension as resistant or considering alternative treatments including device therapy. Staggering doses or trying different formulations could be of benefit.
Return to Sport in the Younger Patient With Anterior Cruciate Ligament Reconstruction
Authors: Webster Kate E. , Feller Julian A. , Whitehead Timothy S. , Myer Gregory D. , Merory Peter B. 
Published: April 2017

Background: Although anterior cruciate ligament (ACL) reconstruction is generally regarded as a successful procedure, only 65% of patients return to their preinjury sport. While return-to-sport rates are likely higher in younger patients, there is a paucity of data that focus on the younger patient and their return-to-sport experience after ACL reconstruction. Purpose: To investigate a range of return-to-sport outcomes in younger athletes who had undergone ACL reconstruction surgery. Study Design: Case series; Level of evidence, 4. Methods: A group of 140 young patients (<20 years old at surgery) who had 1 ACL reconstruction and no subsequent ACL injuries completed a survey regarding details of their sport participation at a mean follow-up of 5 years (range, 3-7 years). Results: Overall, 76% (95% CI, 69%-83%) of the young patient group returned to the same preinjury sport. Return rates were higher for males than females (81% vs 71%, respectively; P > .05). Of those who returned to their sport, 65% reported that they could perform as well as before the ACL injury and 66% were still currently participating in their respective sport. Young athletes who never returned to sport cited fear of a new injury (37%) or study/work commitments (30%) as the primary reasons for dropout. For those who had successfully returned to their preinjury sport but subsequently stopped participating, the most common reason cited for stopping was study/work commitments (53%). At a mean 5-year follow-up, 48% of female patients were still participating in level I (jumping, hard pivoting) sports, as were 54% of males. Conclusion: A high percentage of younger patients return to their preinjury sport after ACL reconstruction surgery. For patients in this cohort who had not sustained a second ACL injury, the majority continue to participate and are satisfied with their performance.