bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Distribution of Mental Health Service Costs for Depression in the Alberta Population
Authors: Slomp Mel , Jacobs Philip , Ohinmaa Arto , Bland Roger , Block Ray , Dewa Carolyn S , Wang Carina 
Published: January 2017

Objectives: In Canada, most mental health services are embedded in the public health care system. Little is known of the cost distribution within the mental health population. Our study aims to estimate the depression care costs of patients with a depression diagnosis, ranking them by the increasing total depression health care costs. Methods: For fiscal year 2007/08, we extracted administrative health care records from across the continuum, including physicians, outpatient services, and hospitals. Using a unique patient identifier, all service costs were merged for each person. Costs were summed by service categories and then divided by the served population into 10 equal-size groups. Further, we divided costs in the top decile into 10 percentile groups. Results: There were 208 167 people (5.9% of Albertans) who had at least 1 health care visit for depression. The total cost for depression treatment services was $114.5 million, an average $550 per treated person. In the first 9 deciles, most costs were for general practitioners. By the ninth decile, cost per person was about $400. Within the tenth decile, costs increased regularly, and in the top 1 percentile (1 % of patients) there was an increase of cost per patient to $25 826 from $5792 in the previous percentile. Conclusion: Per person costs were highly skewed. Until the ninth decile, the cost increased slowly, consisting of mainly physician costs. In the last decile, costs increased substantially, mainly because of hospitalizations. Thus both primary care and specialist care play key roles.
Gene—Environment Interactions in Major Depressive Disorder
Authors: Klengel Torsten , Binder Elisabeth B 
Published: January 2017

Family, twin, and epidemiologic studies have suggested that both genes and environment are important risk factors for the development of major depressive disorder (MDD). In the absence of consistent and strong main genetic effects, numerous studies have supported gene–environment interactions in this disorder. While the impact of negative environmental factors, such as early life stress, traumatic experiences, and negative life events have been established as risk factors, they are not sufficient to predict MDD. This article will review evidence suggesting that genetic variants moderate the effects of adversities on the development of MDD, with a focus on the importance of careful characterization of the stressful life events as well as systemic and molecular mechanisms that potentially mediate these gene–environment interactions. Les études sur les familles, les jumeaux et l'épidémiologie suggèrent que les gènes et l'environnement sont d'importants facteurs de risque du développement d'un trouble dépressif majeur (TDM). En l'absence de grands effets génétiques cohérents et marqués, nombre d'études soutiennent des interactions gène–environnement dans ce trouble. Bien que l'effet de facteurs environnementaux négatifs, comme le stress en début de vie, les expériences traumatiques et les événements négatifs de la vie ait été établi comme facteur de risque, il ne suffit pas à prédire le TDM. Cet article examine les données probantes qui suggèrent que les variantes génétiques modèrent les effets de l'adversité sur le développement du TDM, et met l'accent sur l'importance de la caractérisation prudente des événements stressants de la vie ainsi que des mécanismes systémiques et moléculaires qui assistent potentiellement ces interactions gène–environnement.
Clinical and Sociodemographic Characteristics Associated with Suicidal Ideation in Depressed Outpatients
Authors: Trivedi Madhukar H , Morris David W , Wisniewski Stephen R , Nierenberg Andrew A , Gaynes Bradley N , Kurian Benji T , Warden Diane , Stegman Diane , Shores-Wilson Kathy , Rush A John 
Published: January 2017

Objective: To identify clinical and sociodemographic characteristics associated with suicidal ideation (SI) among patients seeking care for depression in routine primary and psychiatric care settings. Methods: We examined data from 4041 treatment-seeking outpatients with major depressive disorder (MDD) to compare baseline sociodemographic and clinical characteristics of those with and without SI, and the presence or absence of baseline depressive symptoms and psychiatric comorbidities in those with SI. Results: SI was significantly ( P < 0.01) associated with numerous sociodemographic characteristics (that is, lower level of education, Caucasian or African American, male, unemployed, and treated in psychiatric care) and clinical features (that is, previous suicide attempt, younger age of MDD onset, greater baseline depressive symptom severity, greater number of depressive symptoms, and presence of agoraphobia and [or] generalized anxiety disorder). Elevated levels of SI at baseline were associated with decreased remission rates. Conclusions: Consistent with past findings, increased rates of SI were associated with greater depressive symptom severity as well as other features suggestive of severity of illness. Our results confirm previous findings of associations between SI and panic and (or) phobic symptoms and anxiety, but did not confirm previous findings of an association between SI and alcohol or drug use and (or) dependence. While selective serotonin reuptake inhibitor monotherapy appeared significantly helpful in reducing SI during the course of treatment, the presence of SI at baseline was found to be a associated with decreased treatment response, with patients reporting SI at the start of treatment being less likely to achieve remission. Clinical Trial Registration Number: Sequenced Treatment Alternatives to Relieve Depression, NCT00021528.
A Review and Retrospective Analysis of Mental Health Services Provided after the September 11 Attacks
Authors: Pandya Anand 
Published: January 2017

Objective: Various mental health services were provided in New York City in the response to the September 11 attacks. This article describes these services and the subsequent research in disaster psychiatry to identify recommended practices for future disasters. Method: A PubMed search identified 198 articles since the 9/11 attacks that included “New York City,” and either “9/11” or “disaster,” and either “psychiatry” or “mental health.” The abstracts of all of these articles were reviewed to identify articles that described clinical services and those articles were then reviewed in detail. Additional reports on 9/11-related services were identified through book chapters. Results: Acute services included debriefings and other single-time outreach interventions. Postacute phase interventions included community outreach with the goal of addressing normative psychological sequelae, multisession interventions based on evidence-based treatments, and hospital-based psychiatric services provided in the context of general health screenings for response workers. Conclusions: Many programs integrated medical and nonmedical services. The professional literature in the decade since this disaster has shifted recommended practices away from psychological debriefings in the acute phase to the implementation of psychological first aid (PFA). Many of the acute 9/11-related services actually closely resembled PFA. In the postacute phase, resources need to be made available for more resource-intensive psychiatric treatment for the fraction of survivors who develop psychiatric illness.
Assessing Children's Disaster Reactions and Mental Health Needs: Screening and Clinical Evaluation
Authors: Pfefferbaum Betty , North Carol S 
Published: January 2017

Objective: To present a framework for assessing children's disaster reactions and mental health needs. Methods: We reviewed the relevant literature and clinical experience to identify information on assessment approaches in children and to construct an assessment framework based on disaster exposure. Results: Child disaster mental health assessment includes 2 components—screening and clinical evaluation—but these have not been fully explicated or distinguished in the literature. Screening can be used to assess large numbers of children across exposure groups. Clinical evaluation is appropriate for children who are directly exposed to a disaster, for those whose family members and (or) close associates are directly exposed, and for those who are identified through screening as being at risk for psychiatric disturbance. Clinical evaluation includes a full diagnostic assessment (posttraumatic stress disorder and other disorders) with the goals of identifying psychopathology, determining the need for clinical care, and guiding intervention planning and referral. Children with psychiatric conditions should be referred to treatment, while those with psychological distress but without psychiatric illness may benefit from psychosocial interventions. Conclusions: Screening is appropriate to identify children at risk for psychiatric disturbance who will need further evaluation to determine diagnosis. Screening should not be used to dictate treatment decisions. Children who screen positive for psychiatric risk should receive a full clinical evaluation. Children determined to be suffering from psychiatric disorders should receive, or be referred for, formal treatment. Children without psychiatric disorders may benefit from psychosocial interventions.
Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice
Authors: Beutel Manfred E , Scheurich Vera , Knebel Achim , Michal Matthias , Wiltink Jörg , Graf-Morgenstern Mechthild , Tschan Regine , Milrod Barbara , Wellek Stefan , Subic-Wrana Claudia 
Published: January 2017

Objective: To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany. Method: German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale. Results: Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1 % and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively. Conclusions: PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. (Clinical Trial Registration Number: German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245)
High Positive Psychiatrie Screening Rates in an Urban Homeless Population
Authors: Ganesh Aravind , Campbell David J T , Hurley Janette , Patten Scott 
Published: January 2017

Objective: To carry out a preliminary assessment of the use of a psychiatric screening tool in an urban homeless population, and to estimate the potential prevalence of undiagnosed and (or) unmanaged mental illness in this population. Methods: Participants ( n = 166) were recruited from the Calgary Drop-in and Rehab Centre to complete a questionnaire containing 6 modules screening for common psychiatric disorders. Summary statistics were used in the analysis. Results: Only 12 respondents (7%) screened negative on each of the 6 modules. The screening process determined that 60.2% of the sample ( n = 100) had probable mental illness but reported no history of psychiatric diagnosis or treatment. Conclusions: A straightforward application of screening (in which screen-positive subjects are referred for assessment) would be difficult in this population as most will screen positive. The results highlight the tremendous burden of psychiatric symptoms in this population.
Les centres de jour pédopsychiatriques pour la clientèle des 0–12 ans au Québec
Authors: Smolla Nicole , Lebel Alain 
Published: January 2017

Objectif: La recension répertorie les Centres de jour pédopsychiatriques au Québec, estime leur capacité d'accueil et les décrit selon l'âge d'admission, les psychopathologies traitées et l'implication parentale demandée. Méthode: Affiliés à des hôpitaux, les 26 programmes sélectionnés évaluent et traitent des enfants de 0 à 12 ans selon une formule d'hospitalisation de jour. Une entrevue semi-structurée porte sur l'organisation, le fonctionnement clinique et la recherche. Résultats: La capacité d'accueil moyenne est de 18 enfants (de 4 à 40), et de 454 enfants au total. Le nombre de places accordées au préscolaire est comparable au scolaire. Peu de programmes se consacrent aux troubles envahissants du développement; le tiers traitent les troubles de comportement ou affectifs. Les plus nombreux reçoivent une clientèle «mixte». La majorité des programmes sont éclectiques et cherchent à promouvoir l'implication parentale sans la forcer. Conclusions: La discussion tient compte des diverses influences théoriques, de la controverse entourant les critères de regroupement et de l'implication parentale, ainsi que de la spécificité du mandat pédopsychiatrique.
The Prevalence of Mental Disorders in the Elderly in Edmonton: A Community Survey Using GMS-AGECAT
Authors: Newman Stephen C , Bland Roger C , Orn Helene T 
Published: January 2017

Objective: To estimate the current prevalence rate of Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) disorders in the elderly population in Edmonton, Alberta. To compare the prevalence rate of GMS-AGECAT depression with the prevalence rate of Diagnostic Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders (DIS-DSM-III) major depression based on an earlier survey in Edmonton. Method: A sample of 1119 community residents age 65 years and over was selected using the provincial health insurance database. Data on mental disorders were collected using the Geriatric Mental State questionnaire, and diagnoses were made with the Automated Geriatric Examination for Computer Assisted Taxonomy computer program. Prevalence rates, standard errors, and logistic regression coefficients were estimated using software designed to analyze survey data. Results: The prevalence rates of GMS-AGECAT depression and organic disorder were 11.2% and 2.9% respectively. For depression there was a statistically significant difference in the prevalence rates for males (7.3%) and females (14.1%) (P = 0.003), and for organic disorder there was a statistically significant increasing trend across age-groups for females (P < 0.0001). The prevalence rate of GMS-AGECAT depression in Edmonton is comparable to rates reported from several European studies but is much higher than the 6-month prevalence rate of DIS-DSM-III major depression of 1.2% based on an earlier Edmonton survey. Conclusions: GMS-AGECAT depression is a depressive syndrome that has a larger prevalence rate than DIS-DSM-III major depression. Community surveys that measure only the prevalence rate of DSM-III major depression may be missing clinically significant cases of geriatric depression.
Therapy for Vaginismus: In Vivo versus In Vitro Desensitization
Authors: Schnyder Ulrich , Schnyder-Lüthi Christine , Ballinari Pietro , Blaser Andreas 
Published: January 2017

Objective: To verify the effectiveness of desensitization exercises with dilators in the treatment of vaginismus, while comparing 2 therapeutic variations with differing instruction procedures (“in vivo” versus “in vitro”) during the desensitization exercises. Method: A consecutive random sample of 44 female outpatients in sexual therapy were divided into groups for either treatment on a random basis. All patients were treated until the symptoms abated on the basis of a structured therapy program. The stability of the therapeutic success was verified through follow-up interviews. Results: Forty-three (97.2%) of the patients were able to have sexual intercourse after an average of 6.3 therapeutic sessions. One-third reported an increase in their sexual desire. Thirty-four of 39 patients (87.2%) would be prepared to repeat the therapy. There were no significant differences in the success and the required number of consultations for the cure between the 2 groups investigated. Conclusions: Desensitization through exercises with dilators is an effective method for treating vaginismus. The choice of instruction procedure can be left to the patient.
Hospital Days in Clozapine-Treated Patients
Authors: Dickson Ruth A , Dalby J Thomas , Williams Richard , Warden Sarah J 
Published: January 2017

Objective: To examine inpatient hospital days used by a group of patients with treatment-resistant schizophrenia for 3 years before and 3 years after clozapine initiation. Method: A retrospective chart review of 26 consecutive admissions to an outpatient clozapine clinic was conducted for a 6-year period. The total number of hospital days was recorded. Results: Patients separated into 3 groups: those who used clozapine for 3 uninterrupted years (N = 11, 42.3%), those who interrupted but resumed clozapine and continued on to 3 years (N = 4, 15.4%), and those who abandoned clozapine treatment (N = 11, 42.3%). Only the group that was continuously on clozapine showed a decline in percentage of inpatient days during the 3-year follow-up period. Three of the 11 patients who discontinued clozapine died during the posttreatment period: 2 suicides and 1 “death by misadventure.” Conclusions: Continuous clozapine treatment significantly reduces days in hospital; this reduction was sustained throughout 3 years ‘follow-up. While the sample size is small, all patients were tracked over a 6-year period, and both drug continuers and dropouts were followed. The reduction in inpatient days may be lost if patients stop and then restart clozapine. For patients who do not respond to or abandon trials of clozapine, there is an urgent need to develop more effective treatment strategies.
Prevalence of DSM-IV Disorders in Children and Adolescents with Asthma versus Diabetes
Authors: Vila G , Nollet-Clemençon C , Vera M , Robert JJ , de Blic J , Jouvent R , Mouren-Simeoni MC , Scheinmann P 
Published: January 2017

Objective: To evaluate the relationships between asthma and type and incidence of psychiatric problems in a pediatric population. Methods: A series of 93 children and adolescents with asthma presenting during a 1-year period to a pediatric pneumology and allergy service was studied. Their psychopathological problems were compared with those of 93 children with insulin-dependent diabetes mellitus (IDDM). Various questionnaires were completed by the patients: the Child Depression Inventory (CDI), the State-Trait Anxiety Inventory for Children (STAIC), and the Coopersmith Self-Esteem Inventory (SEI). Their parents were administered the Child Behavior Checklist (CBCL). The patients were examined using the revised Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-R). Results: There were more symptoms in the asthma group than in the IDDM group, as indicated by total CBCL scores, internalization and externalization CBCL subscores, and the STAIC scores. Asthma was often associated with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders. We found 30 anxiety disorders, 5 affective disorders, and 6 disruptive behaviour disorders. Asthmatic children did not seem to be more depressed than the IDDM group, and their self-esteem, overall, was good. However, the asthma subgroup presenting with psychiatric disorders had poorer self-esteem and social competence. Adolescents did not seem to suffer more psychiatric disturbances than did younger patients. Girls did not suffer more psychiatric disturbances than did boys. Conclusion: Asthma appears to be associated both with higher overall incidence of psychiatric problems than in IDDM and with particular categories of psychiatric problems. In particular, the problems include anxiety disorders, internalizing symptoms, and disruptive behaviours.
Hierarchical Decline of the Initiative and Performance of Complex Activities of Daily Living in Dementia
Authors: Giebel Clarissa M. , Sutcliffe Caroline , Challis David 
Published: January 2017

Objectives: While basic activities of daily living hierarchically decline in dementia, little is known about the decline of individual instrumental activities of daily living (IADLs). The objective of this study was to assess initiative and performance deficits in IADLs in dementia. Methods: A total of 581 carers completed the revised Interview for Deterioration in Daily Living Activities in Dementia 2 to rate their relative’s everyday functioning. Results: Initiating and performing IADLs deteriorated hierarchically, while people with dementia were consistently most impaired in initiating using the computer and managing finances. Initiating preparing a cold or hot meal and managing finances were more impaired than their performance, whereas performing maintaining an active social life for example were more impaired than their initiative. Conclusion: Findings can help identify the severity of dementia by understanding deficits in initiative and performance. This study has implications for the development of targeted interventions depending on the stage of dementia.
Genital Papillomavirus Infection in Women Treated for Chlamydial Infection
Authors: Andersson-Ellström A , Forssman L 
Published: January 2017

Samples for chlamydia testing were taken from 298 and PAP smear from 284 non-pregnant sexually active young women in a midwife-run family planning service. Chlamydia was found in 36 (12.1%). Three women (1.1%) had cytological atypia corresponding to CIN I or II. Koilocytosis was seen in 9 smears (2.8%). Thirty-two of the chlamydia-positive women were followed for a mean of 15 months by a gynaecologist with chlamydia tests, colposcopy, PAP-smears and in some cases biopsies. There were 7 reinfections with chlamydia (22%). Signs of genital papillomavirus infection (GPVI) were found in 24 of the 32 chlamydia cases during follow-up. Twenty chlamydia-positive patients had abnormal colposcopy, 15 of them had other changes suggestive of GPVI, seven of these had CIN I or II. At follow-up 6 patients had cytologic atypia (18.8%) compared with the average 1.5% in this department during this period. Among 12 patients with normal colposcopy there were no cytological changes. Chlamydial infection calls for increased alertness regarding abnormal vaginal cytology even among young patients not commonly included in PAP smear screening programmes.